Rituximab - reasonable waiting period for results?

Hi there,

I finished my 4 doses of Rituximab recently and we're all waiting to see if my counts stabilize. So far still on the rollercoaster of tanking and pulse-dose steroids but I haven't given up hope! What do folks think is a reasonable about of time to allow Rituximab a chance to work? I read this article ( onlinelibrary.wiley.com/doi/full/10.1111/j.1365-2141.2004.04889.x?sid=nlm%3Apubmed ) that's a little old at this point that seems to point to two things:

- Most people who see results from Rituximab see them within 8 weeks of the 1st dose (for me that means end of September 2019)
- The farthest out results were seen within 31 weeks of the 1st dose (for me that means end of February 2020)

I already plan to discuss this with my hematologist at my next appointment. To me, it seems perfectly reasonable to at least wait until September 2019 is over. But going all the way until the end of February 2020 seems a very long time to be stuck to steroids. What do folks think?

All input is appreciated!

cedrap

cedrap, I don't recall if you have overt symptoms. I suspect not, because if you did your doctor would probably already be seeking Promacta/Nplate approval. Without expediting the paperwork, it often takes a couple of weeks for approval. It's been a awhile but I think some/many insurance company's need to see two counts below 30 before they will allow you to move on.

I'll tell you what I did. Note that I don't have overt ITP symptoms. Nor do I respond to steroids. Looking over an old calendar, it was 16 weeks between my last Rituxan treatment and starting Promacta. During that time I had a bone marrow biopsy - which is good practice before starting Promacta/Nplate. Insures MDS or bone cancer is not the problem.

So I waited a long time. But, one doesn't have to. If you're moving on, no reason why not to move on right away. Get away from steroids.

Hope this helps.

Up to 180 days before Rituximab can kick in: see page 4193:- table 4 "Definitions of time to and duration of response, and the time to initial and peak response for different ITP treatments"
www.bloodjournal.org/content/bloodjournal/117/16/4190.full.pdf?sso-checked=true