Saturday, July 5, 2014

Rituxan and Infections

Good news on a potential side effect of Rituxan: according to a small German study of patients in a single treatment center, Rituxan doesn't seem to increase the likelihood of a patient developing infections.

Rituxan works by targeting the protein CD20 on B cells, the type of white blood cell that (when being normal) works to keep out invaders, or (when being pains the rear) get all cancery and give you Follicular Lymphoma. Rituxan just goes for the CD20 -- it doesn't care if it's on a normal cell or a lymphoma cell.

The problem, of course, is that if Rituxan is wiping out normal cells, then those cells can't do their job of fighting off invaders. Thus, Rituxan can do a good job (warding off cancer) while doing a bad job (keeping the immune system from doing one of its jobs, and thus inviting infections).

This study looked at 125 patients with various types of lymphoma (80 of them had Follicular Lymphoma), who were given Rituxan as a first treatment -- either Rituxan by itself, or as part of a chemotherapy combination (lots of R-CHOP, some R-Bendamustine, and a few others, incluidng some funky German chemotherapies).

The article breaks down the number of patients with the different types of lymphomas, the numbers of patients who received which treatments, and the number and types of infections they developed. All very interesting.

The bottom line, though is this: there was no statistical significance to the number and type of infections. In other words, there is no evidence that receiving Rituxan increases the likelihood of developing an infection.

This is good news. While this has always been a concern, the authors note that very few actual studies have looked to see if the concern should really be a concern.

A couple of important things to consider, though: first, the study looked back at patients who received Rituxan between 2000 and 2005, before Rituxan Maintenance was used widely. It's possible that receiving Rituxan for a prolonged amount of time (after that initial 4 or 6 or 8 weeks) could have a stronger impact on the immune system. Makes sense -- while those first few doses last for a few months, a common course of R-Maintenance could see the effects go for more than 2 years. That might have a greater impact on the immune system, and encourage more infections.

The other important issue: it seems like infections are more likely for people who take Prednisone as part of their chemo (that's the P in CHOP). So that's something to keep an eye on, too.

Overall, though, it seems like good news. From my personal experience, I didn't really have any significant infection issues after my Rituxan. But I was a study of 1, not 125. Good to see it all played out in a broader, more serious study.


Anonymous said...

I too was diagnosed with Follicular Lymphoma in 2011. I had RChop and maintenance of Rituxin every 3 months for 2 years. I had no serious infections just a fever blister and rash which they quickly put me on Acyclovir (which I had to take during my 6 rounds of chemo but not during Rituxin maintenance.) So far so good--blood work has been good. Last scan was in November 2013--It was good--No more scans unless I have any symptoms or my blood work suggest I need one. Exercise, yoga and raindrop therapy are helping during this stage of my journey--Kelly

Lymphomaniac said...

Glad to hear things are going well, and you've found things that keep you healthy and feeling happy. Good luck with the journey.

Anonymous said...

I was initially treated with 8 rounds of Rituxan for NHL..then 2 years of is now 3 years after my last dose and my Oncologist has discovered that my b-cells and b-cell subsets have still not recovered. I receive IVIG every 3 weeks to keep me from getting sick...not so sure that the maintenance was a good idea for me after all...

Lymphomaniac said...

I'm sorry you're still having some troubles. But my small bit of advice to you: don't ever regret the decisions you make about treatment. We all make decisions with the best information we have at the time. It sounds like Rituxan and Maintenance kept your NHL under control, which was the goal. And now you have this new challenge, and a plan to combat it. I don't mean to be a pollyanna, but I do believe in looking forward as much as possible. We cancer patients have enough things to stress us out. There's no sense in adding to it by regretting something we can't change.
I hope things keep getting better for you.