Is there a connection between RTX and lung infections ?

[pberggren1]

Ya, the lungs even for a healthy person can be the most perfect area for infections. The entire airway system is a breeding ground for Staph. I have had a few staph infections in the lungs.

[Alysia]

Thanks everyone for your thoughts.
thanks for the good words, Anne and Deb
I think that there are 2 issues here:
1. getting infections easly because we are "immuno-supressive".
2. getting lung infection AS A RESULT of the rtx, like what happened to the woman I saw at the hospital.
for this, I also found this link:
http://erj.ersjournals.com/content/e...80209.full.pdf
I copy to here something which seems related to what Geoff wrote above:
Given the potential severity of rituximab-induced lung disease and the strong suspicion
of underlying hypersensitivity, we suggest a number of recommendations. First,
patients should be told that respiratory disease may develop, with the risk being greatest about 15 days after the last infusion and around the fourth cycle. Second, respiratory symptoms should be looked for routinely after each infusion. Third, any clinical manifestation, however mild, should prompt a chest radiograph. Finally, when the findings support a diagnosis of rituximab-induced lung disease, steroid therapy should be started immediately, as it seems to improve the outcome. Furthermore, instead of the currently recommended methylprednisolone infusion at each rituximab administration, a longer period of steroid therapy with tapering of the dose to avoid a rebound reaction may be appropriate.
Late-onset organizing pneumonia (which may occur up to several months after the last
rituximab infusion) may be related either to toxicity of the drug, whose biological half-life is poorly known but probably long, or to immune system restoration.

[Alysia]

In feb this year i finished my 2 year cycle of RTX. There were a few questions raised beford the last IV and Dr Jayne did ponder the opinion that perhaps i had had too much rtx in the time. Given my size, 6'4" and 18 stone, i was infussed every 4 months.
Be that as it may, i now find 2 months later i am struggling to shake off the worst chest infection i have ever had, and the 2nd to boot! I have finished another round of antibiotics and got the all clear from my GP on tuesday who confirmed my lungs were 'clear'.
.

I am sorry Geoff I hope that you are already feeling better ?
anyway, the woman I met at the hospital told me that the docs continue to give her rtx but only half dose. not 1000mg every 6 months but 500mg.
maybe you should get less

[Alysia]

I recently had surgery on my very bad sinuses and they were filled with Staph.

are you feeling better now ?

[Alysia]

I just had an infusion of RTX last month and came down with a lung infection shortly after.

isn't it time for some peace for you ?

[Geoff]

Hi Alysia and many thanks for this thread and your love and support. I do feel better, especially the past 2 days, (must have been all the birthday cake!)
However I will contact the crew at Adds for a referral and above all "peace of mind".
Despite the overall tone of this thread, I believe it is best to know the cause and effect that fills our Weggie lives, hence my original post on this forum, "Glad to be diagnosed".

[me2]

Wow, you found some really relevant info Alysia. Thanks. It is always better to know more. I was not aware of much of this. Honestly, I was kind of taking a break from years of always looking for answers
and keeping up on the latest. -- Now, you , and others, are doing it for me . ha Thanks again.
And yes, my sinus are doing better. Unfortunately I went into a flare right after they were starting to heal well but even in the midst of that I could tell I was better off than before.

My recent arguements with my doc will lead me to my next question. How much infection do we carry around in our sinuses as WG patients and how aggressive should we be in treating this? I dunno
Is it possible there is more going on than is being generally diagnosed and treated and leads to a fair amount of our difficulties? I dunno

Thanks again for the Rituxan info- relevant to so many of us. And the hug blah blah blah, mushy stuff, blah blah

[Alysia]

me2. lots of questions remained open....
Geoff, maybe your docs will be able to say more about it. please update us.
I hope we can find some answers....
anyway, we don't have much choice
at least we are together in this....
thanks for being here. I love you all

[MaxD]

Just adding my 2c here. First, we have to be aware of the possible side-effects of any drug we take. Yes, Rituxan does compromise our immune system - that's exactly what it is supposed to do! Before starting Rituxan treatment, my doc had me checked out for a variety of infections, including TB, Hepatitis B and HIV, among others. She also started me on Bactrim 2 weeks before treatments (to ward off pneumocystis pneumonia), and I'm already on steroids which are being tapered as per the RAVE study from 3 years back. Note that steroids are used to fight off any lung infections - so between the Bactrim and the steroids I feel well covered (fingers crossed!).

Second, I went over the references Alysia posted (thank you for that!). These are older than the RAVE study. Also, if you read carefully, the papers address a different population - patients being treated primarily for Lymphoma, with Rituxan and chemotherapy, and do not differentiate between patients with/without prior lung infections. The conclusions apply "under specific circumstances," as one of the papers states upfront in the abstract.

So, we shouldn't jump to the conclusion that Rituxan is a "very strong" drug that causes lung infections. Yes, it may result in lung infections if one is already compromised and one must always be watchful. And, no it is NOT a very strong drug, especially in comparison with Cytoxan (which provably increases the risks of bladder cancer and lymphoma several fold). It is a LESS toxic, biologic drug that targets B-cells, and not everything in its way like chemotherapy does. The risk of PML is extremely low (as my doc put it, infinitesimal).

I am grateful that my docs are treating me with Rituxan, even as I am aware of possible complications of a compromised immune system. But I agree with my docs, and the RAVE study, that it is the best available option for me.

[Alysia]

WOW, Thank you so much Max for the info and the thinking
can you tell more about the RAVE study ?