Saw my doc this morning and got all of my questions answered - at least the ones I remembered to write down before I went! LOL

First, the "immediate" results a lot of people see after rtx treatment are a result of the solumedrol, not the rituximab. It takes about 8-10 weeks (from the first treatment) for the b-cells to actually die. I have to go back in a month for bloodwork (or 8-10 weeks after the first treatment) to check the b-cell levels. She said they don't do that test "just for the heck of it" because it's a very expensive test.

Second, once we see that the b-cells have been sufficiently depleted, we can reduce the mtx I'm taking. Not stop, but reduce. She said if all went well, I'd taper down to probably something like 15mg and stay there for "awhile" (she said that wryly, so I suspect that means a year or two ).

Third, she said it was an excellent idea to take extra pred if I'm going to have a particularly stressful or busy day (or have to stay up late, which for me is stressful). She said, obviously, don't do it every day, but every once in awhile is not a problem.

Fourth, when I described my prednisone "crash" that happens every day, she suggested that I split my dose and take maybe 3mg in the morning, 2mg at lunch. I don't want to do that because I already have way too much trouble sleeping, but it may work for some.

Fifth, she said we'd worry about tapering me off the pred once we got me tapered off the mtx and I was stable at that "maintenance" level.

Sixth, I'm going to try leucovorin (folinic(?) acid) once a week instead of folic acid every day to see if it helps with the hair loss.

If I think of anything else we discussed that seems relevant to anyone else, I'll post that, too!