How long after Rituxan to See results?

I am 3 weeks post and results still not great as I taper prednisone. I want to give this the maximum wait before exploring other treatment options

Pre Rituxan 15 mg kept me around 65K. We tried to go down to 10 mg for a week and I dropped to 17K the day before my first Rituxan infusion

Rituxan Week 1: 46K on 15 mg pred
Rituxan Week 2: 41K on 15 mg pred
Rituxan Week 3: 24K on 15 mg pred
Rituxan Week 4: 31K on 15 mg pred (blood btest was done 2 weeks after my last infusion)

Doctor told me to taper to 10 mg since I can't take the pred side effects any longer. My count this week dropped to 15K :dry: on 10mg.

Should I give the Rituxan much longer to work? (Dr is already wanting to schedule Winhro or Splenectomy. I want to wait a little longer. I have no bleeding problems except the bruises that pop up at random on my legs)

I haven't done Rituxan, but the posts seem to indicate it can take several weeks for it to kick in. You might consider the boost that Winrho could give you for the short term before going for the spleenectomy.

Winrho bumps me into the high 100's or low 200's, and lasts for 6-10 weeks before I drop back to into the 30's. In the beginning, they did 2 steriods and benadryl with the infusion and it took about 2 hours in the office, and then a 3 hour nap when I got home (the benadryl in the iv is potent). The steriods did a number on my blood sugars for a day and half, so I wasn't real perky until they were out of my system. When I didn't have any reactions to the first treatment, we cut the steroids in half the next infusion and then phased out all pre-treats as I continued not to have reactions. I'm in the office 20 minutes now, but do need to take it easy the rest of the day or I have a low grade fever and chills. I just schedule for the last appt on a Friday.

Did the winrho make you anaemic? The drug diverts the spleen's attention to the red blood cells and it starts destroying them short term and stops attacking the platelets.

I had five weekly Win-Rho treatments years ago and didn't have any red cell problems, even with having them so close together. I was new then, and should not have had so many since the first one didn't work at all. I sure know better now. I think it's worth a shot - it seems to do the trick for some people.

Rituxan took 12 weeks the first time to see any type of improvement for me the first time, 2 time a little longer, 3rd time I didnt have a response to it. Winrho didnt work for and it didnt make me anemic either. Id actually go back up to 15mg and try tapering down 1 mg ever 2 weeks. I noticed that my counts would do a quick drop but rebound after a week if i didnt taper again. I assume its my body adjusting. Its worth a shot IMO

tigereyes, did that pred taper put you in remission? Or are you still tapering?

Okay, I am 5 weeks post the last Rituxan infusion and platelets today are at 16K on 10 mg prednisone. So my Hematologist is anxious to try the next thing. He wants me to decide if I want Imuran :ohmy: (I hear this stuff is toxic) or Splenectomy :dry: . Those 2 don't sound great but oh well. He said I could take Winhro to buy time while I think or up the prednisone but the prednisone is dealing with my joints so badly I can't go up anymore.

Right now, I am looking out my window and just hoping and praying for a solution. Don't know which option to pick right now :huh: .

If WinRho works for you, it's no more 'buying time' than the other drugs, a lot of people, some right here, have used WinRho for years with much success. You might need it every 6 weeks or every few months, but if you don't get anemic you can probably use it for years.

At conference Dr. Liebman said (I know I use that phrase a lot but he said a lot of good stuff) that success with Rituxan tends to predict success with Imuran. He didn't say anything about the reverse, whether failure with Rituxan predicts anything regarding Imuran.

There are a few people here who reported that Rituxan may have kicked in after a couple of months but you're right, it's not looking good.
And what about nPlate and Promacta?
Erica

Thanks Erica. I just may try the Winhro. Just concerned about any wierd side effects.

Nplate and Promacta stimulate the bone marrow to make more platelets. My hematologist said that's not going to help me any since my body is destroying the good platelets anyway.

I could go up on the steriods for a better count but the side effects are not worth it. Maybe I should try black bean soup like someone had suggested . I really don't know what to do but have to tell my Hem tomorrow how I want to proceed

For sure try black bean soup, that is pretty squarely in the 'can't hurt' category. There has been a lot of buzz in recent years about strawberry unfrosted poptarts as well.

Sandi, I think you have good info on the nplate/Promacta thing? Even though we are destroying good platelets, it's been found that boosting platelet production has helped many ITP patients. So you might want another opinon on that one, it sounds a little like your doctor isn't up to date on it. We pretty much all here have bodies destroying our good platelets. But some are responding well to the platelet production boosters.
Erica

Yeah, that sounds a bit strange to me too. Many people with ITP successfully use Promacta or N-Plate and they all have destruction problems too. It i considered a valid ITP treatment.

Of the four, I'd consider Win-Rho the lesser of the evils.

I don't have any info on it. I don't do as much research as I used to.

I just viewed the CD's from the 2009 PDSA Conf. There are no 'black-and-white' answers. BUT there is a lot of info on the CD's, particularly CD#3 with Drs. Bussel and Liebman as they discuss the pros and cons of various treatment regimens. The CD set is $50 but well worth the cost. I wish this type of data had been available 6 years ago when I was first diagnosed.

ITP has come a very long way in the past 6 years. I've seen more discoveries in the last four years than I have since my diagnosis in 1998.