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Thread: Rituximab Round Four

  1. #21
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    I got some info from the JHU infusion clinic nurses today about the dosing and administration of rtx. The clinic is very conservative about how they administer rtx so they have a low rate of allergic reactions.

    The 2-infusion protocol: 1,000mg of rtx each infusion for every patient (ie, not based on height/ weight).
    The 4-infusion protocol: Dose is 375mg/m2 per infusion, so the actual dose you receive is calculated based on your height and weight.

    I'm pretty fat, so on the 4-infusion protocol I get 900mg of rtx each infusion (total 3,600mg). That's a lot more rtx than I got on the 2-infusion protocol (2,000mg) and is probably why it didn't work for me. It makes me wonder if "larger" people need the 4-infusions but smaller people do okay with 2. A smaller person would receive similar doses using either protocol. I'll definitely ask Dr Seo if he's seen that trend.

    The nurses also told me:
    --The rtx (at any dose) should be given in a 500 ml bag of saline. Some infusion centers are using 250ml to speed up the infusion, but this is too fast and makes it more likely to have a reaction to the rtx. The nurses said the studies used 500 ml of saline.

    -- Appropriate "pre-meds" need to be given to all patients--solumedrol and Benadryl. I get 100mg solumedrol. Some of their patients even get 150mg. They now give the solumedrol and Benadryl and wait 30 min before starting the rtx. This has decreased allergic reactions.

    Rtx is a genetically-engineered antibody. The pre-meds work by sort of hiding the rtx from your immune system so it can go in unnoticed. You don't want to form antibodies to those antibodies or you'll be unable to take more rtx.
    Last edited by Sangye; 05-18-2011 at 10:48 AM.

  2. #22
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    Hang in there Sangye. I sure hope the 4 infusions is the answer for you. I can only imagine how hard it is to go in for a treatment that you know is going to make you miserable.

  3. #23
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    Sangye, I've been thinking about you all day today. I hope that the grosseness goes away faster this time and you don't have to go through this exercise for a long long time. Take care of yourself, pamper your sick little body and keep that wonderful spirit alive and kicking as it always does. Be healthy! Lots of love and healing vibes coming your way across the continent.

  4. #24
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    Wishing you a speedy recovery Sangye... I just heard of someone who took rtx and is now doing very well indeed... you will do too... you'll be in my prayers tonight...

  5. #25
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    Ah hah, I knew you'd be back ... the "needed" comment earlier was to keep that fire lit (the chiro/professional side)

    Now get some "needed" R&R ... hope you can get a good night sleep!

  6. #26
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    Thanks again for the good info Sangye. How on earth are you going to be able to do 10 days with the Dali Lama?
    Phil Berggren, dx 2003

  7. #27
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    Thanks for the info Sangye and I hope you get to feeling better soon.
    My doc at Mayo had me do the solumedrol the first infusion this time but the other 3, I didn't receive it. Just the tylenol and benedryl.....

  8. #28
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    Thanks you guys.

    Marta, I've got to do rtx every 6 months indefinitely. Oy, I don't even wanna think about it!

    Raj, yup this is my 4th round of rtx. The first two worked well. Both were needed to fully put out a severe flare. I'm hoping this one gets things under control.

    Daggar, ha! You know me too well. Even when I was laying down I was reviewing and organizing the info from the nurses in my head so I could share it.

    Phil, I dunno. I'll do my best. There is tremendous blessing in making the attempt, and it often clears the obstacles. I've had that happen twice with the Dalai Lama and many times with my own lama and other lamas. It's very rare to be able to receive teachings and blessings like this--worth any added exhaustion or whatever.

    Brooke, yikes. I think that's taking a very big and unnecessary risk. Even though I've never had even the slightest allergic reaction to rtx, Dr Seo and the infusion clinic would never treat me without solumedrol on board. Each time you receive it (even with pre-meds) you are more likely to become allergic to it. Unless you're already on very high dose pred, having solumedrol seems to be necessary.

  9. #29
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    Each time you receive Rituxan, you are more likely to become allergic to it?
    I will have to ask my Mayo doc, I am not sure why I just received for the first one.
    Does the pred or solumedrol have something to do with someone having a reaction? - Or is it like you stated above, it hides the Rituxan from your immune system?
    I havent been on pred since last year, I wonder if that has something to do with it.

  10. #30
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    Yes, each time your body is exposed to rtx it's more likely to figure it out and become allergic to it. This is true of any of the biological drugs. The body has to be fooled into accepting them. However, it isn't a given that someone will eventually develop an allergy to rtx. It's just that you want to do everything to lower the chances.

    Since you're not on any pred (yay!) that would make it more necessary to have solumedrol with the rtx. The solumedrol is what hides the rtx from your immune system, along with Benadryl. Dr Seo told me he'd never go lower than 80mg solumedrol.

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