NPlate & Rituxin?

So I get a phone call from the nurse this morning asking me if I'm ok with starting Rituxin on Friday morning. I'm a little confused. The NPlate is obviously working so why the Rituxin? She said the NPlate is only a short term thing, just to get the platelets up and the Rituxin is a longer term thing, like 6 to 9 months. Ok, I guess that makes sense. Right? But why both at the same time. I don't get it. Any thoughts or experiences like this?

I've tried both. The initial Rituxan regimen gave me the 6-9 months relief from the Preds. Then the count started to fall. Tried the N-Plate for 16 weeks. Results were unpredictable and sporatic. Had to occasionally use Preds to stay in the safe range.

In Jan 11,2010 I started a Rituxan re-treatment. As of 4/5/10, it is still not working. Pharma mfgr data sorta shows only about 1/3 of those re-treated will be successful. Rituxan is used 'off lable' in ITP treatments. Its initial application is for the treatment of Lynphnode (NHL) cancer. There is no Phara data on Rituxan for ITP.

My next move is Promacta, which I will start in May. Not much short or long term data on this one either. But it is an ITP drug.

The N-Plate and Promacta promote exessisve platelet production to sorta flood the system with platelets. The function of the Rituxan is to kill-off or destroy the bad guys that are consuming the platelets. Basically its 'production versus consumption'.

Our longterm options to the various medications are limited by the way our body reacts to each medication. A splenectomy may work for a lot of patients but it did not work for me. Sometimes its 'trial and evaluation'...................

thanks for the info. I didn't know that about the Rituxin, it destroying the "bad guys". Interesting. So, I'm still wondering about the 2 of them at the same time. Doesn't make sense.

Thought I'd throw in more confusion.....
While trying to increase and stabilize the platelets, on Feb. 16 I developed DVT (Deep view Thrombosis) in my right leg. So now my family doc has me on a semi-permanet Coumadan (anticoag) medication while my Hemo Doc has me on 20mg Pred to keep the platelets up. So now we're trying prevent blood clots while maintaining the blood clotting ingredients in a safe range.........musta been something I drank in college.

Server:

Rituxan destroys B and T cells, they are one type of white cell (lymphocytes). It only targets the adult cells and leaves the baby ones alone.

Well, I go this morning to start the Rituxin and......nope, not going to do it now! Yeah! on one hand...the doc decided not to do it because my count was 377! (Hallelujah!) but I'm starting to get dizzy too! First we're doing it..then no we're not. Then, we're doing it...then no we're not! Let's make up our minds! The final decision is I'm glad he decided not to do it.

Gretchen, congrats on the great counts!

My experience with Nplate leads me to believe that nothing should be mixed with it, not rituxan or anything else. Counts tend to be quite erratic and it's impossible to tell what's happening if the waters are muddied with another medication.

My observations here and elsewhere also lead me to believe that the drug isn't treated with the respect it deserves by some doctors. Considering that little is known about it and the manufacturers are wary of high counts with it, I'd urge everyone to do their own research and ensure that they aren't allowed to have overly high counts for any length of time.

I'm getting the drug on a trial and am therefore supposed to follow protocol strictly but as time goes on protocol appears to have been nudged aside which pleases me greatly as I now feel that I have regained control over my own treatment. Last week I was at a silly high of 335 and we dropped the dose immediately instead of waiting another week as protocol dictates. The aim for me now is for a count between 30 and 50 and I am happy with that.

Thank you Lorie

Ann, you think 335 is to high? Maybe I'm not understanding something. I'm under the impression that 140 - 420 is a normal range. Is there something I'm missing? Isn't it a good thing that the NPlate brings it up that high?
You said "the manufacturers are wary of high counts with it" They are? How did you find that out?
and "ensure that they aren't allowed to have overly high counts for any length of time" I understand that high counts, anything over 420 for a long time isn't good, but I thought that could be adjusted with the dose.
Sorry if I sound stupid! I just need to know!

Server:

N-Plate comes with a risk of blood clots, so you really don't want counts too high. The goal with N-Plate is, as Ann said, 50k.

I didn't think of it before, but I do agree with Ann that mixing treatments in this case could be a bad idea. Some people with ITP are prone to clots anyway (if they have APS) and splenectomy can also enhance clotting. It's a fine line to walk sometimes.

The protocol for Nplate is here www.nplate.com/ hit the link for 'Prescribing Information & Medication Guide'.

Basically the rules are that if the count is below 50 you increase the dose. Above 200 for 2 weeks you lower the dose and if it's above 400 you stop and wait until the count goes below 200 and then start again at a lower dose.

The reasoning is that as it is forcing you to make new platelets, all the platelets are large and new, and lots and lots of large platelets are prone to clotting. So yes, my 335 was way too high and I was glad to reduce the dose.

thank you for that link. I will be questioning the doc when I see him this Wednesday.

Just as you said Ann. I had 2 weeks at 300+ so we'll see what it is this Friday. Oh and......apparently we are going to start the Rituxin! May I just say..........UGH!!!!!! If for some reason they say no again, I think I'll flip my lid!