Rituxin, part 3

So here's what I can probably expect on Friday, from what I've read and been told:

Unlike chemotherapy, Rituxan doesn't seem to have too many harsh side effects, short- and long-term. Chemo works because it targets fast-growing cells; since cancer cells typically grow faster than regular cells, they tend to take up the chemo before most healthy cells do. But other normal fast-growing cells also get hit hard -- hair cells, for example, and the lining of the mouth.

Rituxan is not a chemo treatment, so those kind of typical side effects (like hair loss) aren't an issue. Most of Rituxan's side effects come from its partially-human (and partially mouse) nature.

Much like a food allergy (which we know something about around here), the body treats Rituxan as something thast doesn't belong, and behaves accordingly, releasing histamine or other mediators that allow the body to fight off what it perceives as an invader. (Histamine causes inflammation, for example, because it dialtes blood vessels to allow white blood cells to get to the invader that much quicker.) So many patients (really, most patients) who take Rituxan have an allergic reaction. Rituxin is an invader -- it doesn't belong there naturally. Typical side effects during the infusion are things like itching, nausea, hives, fever, and chills. And they usually stop once the infusion stops. (Longer-term side effects are much less common.)

The solution, as with any allergic reaction, is to give an antihistamine (like Benadryl) during the infusion. But this will slow down the whole process, especially for the first infusion.

I'll have my treatments right at the doctor's office, where they have a treatment room. I was told to plan for a full day on Friday. I'll get there by 9:30 and have some blood taken. Then I'll go to the treatment room, pick a nice chair (I was told to try to get one in front of a TV), and settle in. I'll probablly get some Tylenol, and maybe a steroid. The amount of Rituxan I'll receive depends on body weight; this means, unfortunately, that I'm going to get a whole lot of Rituxan, which is going to add to the time I'm sitting there.

Nurses will be watching me te whole time, looking for signs of a reaction, and listening for me to tell them that I'm feeling anything abnormal. If (when?) I do start to have a reaction, they will slow down or stop the Rituxan and speed up the Benedryl.

Other than those moments of excitement, I'll pretty much just sit there. They'll have reading material and DVDs to pick from, and coffee and tea and some juice. I'm supposed to bring anything else I might want to read, or watch, and maybe my iPod, my computer (though there's no wireless access), and some snacks. The whole "snack" thing is encourgaing -- they don't expect me to be nauseous, though it is one possible allergic reaction, which is nice. They tell me there's a good deli nearby if I want to send Isabel out for something for us to eat.

All of that Benedryl will likely make me tired, so Isabel will be us driving home. That tired feeling might last into the next day, too. I'm expecting that it will -- a mere teaspoon of Benadryl makes me feel all dried out and tired, even the next day (the dreaded Benadryl Hangover), so I'm guessing that getting a pint or two of it will be that much worse.

Of course, there are some people who have almost no reaction. And then there are some who can't tolerate Rituxan at all, and have to discontinue the treatment. But most have some kind of reaction that can be dealt with.

The other three infusions usually go faster and do not pressnt the same side effects.

So I'm not terribly worried about all of this. Seems like it's all tolerable....