rituxan cycles

Hi,
Need a little feedback on rituxan. I've just completed my fourth dose of rituxan yesterday. From what I've read, the protocol is once a week for four weeks. I've also read it could take up to 12 weeks to see a result. BTW, my platelets seem to be crashing much faster since I started the rituxan cycle. Last week they dropped to 5, so I got a dose of IVIG, my usual treatment, and the next day received my third dose of rituxan. This week my count was 35 (definitely a good count for me but I wouldn't call it an improvement as a result of the rituxan since I did have IVIG last week. Actually they would normally jump to andwhere from 70 to 100 and then dropped over a period of two weeks to four weeks to 10 or lower.)
So, my question is for those of you out there who completed a four-week cycle. How long did you wait before doing another cycle, given you saw no improvement? Do I wait 12 weeks? My doc wants me to come back next week for a cbc and, depending on my count, get IVIG if count is below 10, or get another dose of rituxan. I'm not sure why he'd want to do another dose of rituxan (he was with a patient when I was leaving) since I thought protocol was a four-week cycle, but then again he was ready to abandon rituxan after my counts dropped to 5 last week. I told him I wanted to do the full cycle, but he may have misunderstood and thought I wanted to just keep taking it weekly for an unspecified period of time until we get a positive result. I'm not worried about him suggesting doing rituxan again. My plan will be to check the count next week and if they've dropped to 10 or lower do IVIG. I won't do another rituxan just yet since I want to give it some time to work. I just want to know how long should I wait between cycles?

Thanks for any feedback,
Lisa

Lisa:

Studies have shown that having more Rituxan generally does not help. The latest studies show that just one dose or a few lower doses work just as well as the four full doses quoted in protocol. It's usually the amout of time after the first dose that makes the difference, not the number of doses. Yes, I'd give it the 12 weeks and supplement with other treatments if necessary.

Sandi,

Thanks for the info.

Lisa

Last July I had the 4 doses (not the max)of rituximab, it didnt do anything. Saw a specialist haematologist this year, who has written loads of papers on ITP and she surgested I have the maximum dose of Rituximab, I am waiting for a phone call from the day ward with my appointments for the infusions.

My Dr wants me to wait at least 6 months between cycles, but then again I usually get a partial response about 5 weeks after finishing rituxan.