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CLL Support Association
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New to Site Imbruvica & Rituxan how are they tolerated together.

I’m new to the site but not new to CLL. I was diagnosed in 2003 and was watch and wait. Had treatment with fludarabine.. Was in remission for 10 years. Then back to watch and wait. Started imbruvica Jan 2019..first two weeks WBC came down...last two weeks the number went higher than when I started the medication. Now am going to start rituxim in conjunction with imbruvia. How these two drugs are tolerated?

This site is so helpful I have learned quite a bit and it has answered many of my questions.

Thank you

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This a super site and welcome to our community! So happy you found your way here. I am wishing you well as you continue on this journey. I started Imbruvica 420 in January as well. So far no side effects and labs showing things ar beginning to settle out...have a ways to go yet but is a great beginning. I really don’t know anything about what you are asking but I trust you will be hearing from those who do. I have had CLL for 30+ years with 27 years on Leukeran off and on as needed and this time when treatment was indicated they put me on the Imbruvica. I also receive IVIG every 4 weeks and that keeps me in a good place.

I hope they find the right combo for you so you may get on with your life. All the very best to you and please keep us posted. ☘️🙏😍💕


Hi Panz thanks so much....thought I knew a lot about the disease but learning a lot more.


Hi I have had them together and was fine.

Good luck


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Thanks so much Ann helps to know


No problem good luck.


I just started I/R combo last December after 18 years of watch and wait. So far so good with interaction. WBC count rose as expected but now down 60%. Ibrutinib has affected my sleep a bit and lower energy .. but not too bad. Taking R via injection once a month for 6 months - low energy the day of injection but also not so bad.



Hi Ohiaforest...that is what is planned waiting for approval to come through...did you have a reaction to R the first time given? Thanks so much


Not too bad - IV the first time but now injection


You are getting Rituxan Hycela? Interesting... it is very new...

~chris 🇨🇦


Why are you receiving Rituxan with Ibrutinib. All the stuff I’ve read said you need not bother with the Rituxan.



Hi because the wbc has gone up it was down to 206 after the first two weeks...then higher to 288 two weeks in a row which is higher than what it was when I started the meds. In my research it is common to add or use both as a treatment. Thanks


Check out recent ASH conference last December on results with I/R combo for “younger” naive patients ...in simple terms a one/two punch. Irubrutinib prevents the reproduction of the cancer cells and Rituximab flags them for priority desctruction


Hi my Dr mentioned that when we were talking about different treatments in December being I was on the cusp of being 70...


Hello Bobbietf,

I also find this site a wonderful resource of support. Welcome. I know that you have had other treatments, but since the data on toleration of combination therapies is still evolving, Woyak and colleagues (2018) study may shed a tiny bit of light on this issue. The aim of the research was to evaluate the efficacy of ibrutinib alone or in combination with Rituximab (rituxan; IR) in comparison to chemoimmunotherapy (Bendamustine with Rituximab; BR) with previously untreated patients over 65 years. Their findings are reported in the New England Journal of Medicine (a reliable source). I think it is an important study, because it directly compares the efficacy of targeted therapies with chemoimmunotherapy. However, it is only one study, and there will be more to come in future on this topic that will either affirm the findings, or provide new information.

As the article is likely to behind a paywall, I'm summarizing the findings that may inform your question below; however, I'm no expert in this field and It's much better to read the full article if you can get it.

After 2 years, the main findings showed no differences in progression free survival between treatment with

Ibrutinib in combination with Rituximab (IR) compared to Ibrutinib (I) alone. However, both IR and I were superior to treatment with bendamustine plus rituximab (BR) with regard to progression-free survival. No differences in overall survival were found among the groups, but this was a short interval (38 months)....the study is ongoing.

With respect to adverse effects :

*The rate of more severe (i.e., (grade 3, 4, or 5) hematologic adverse events was higher with bendamustine plus rituximab (61%) compared to ibrutinib or ibrutinib plus rituximab (41% and 39%, respectively)

*the rate of more severe (i.e. grade 3, 4, or 5) nonhematologic

adverse events was lower with bendamustine plus rituximab (63%) than with the ibrutinib-containing regimens (74% with each regimen).

(For a description of the different grades of adverse events, see the CTCAE table on page 4 at the bottom:


* Respiratory tract infections, urinary tract infections, sepsis, and abdominal

infections were the most common infections found among all 3 groups, and there was no difference in the frequency of infections among the groups.

*Atrial fibrillation of any grade was reported in 14% in the ibrutinib-plus-rituximab group, compared to 17% in the ibrutinib group and 3% of the patients in the bendamustine-plus-rituximab group.

*Grade 3 or higher

hypertension occurred in 34%, 29% and 14% of patients treated with IR, I and BR respectively.

*The rate of secondary cancers (13 -16%) was the statistically, the same across all 3 groups.

These findings are only the first analysis reported by the researchers - the study is ongoing. However, the findings suggest that for these groups of patients, after 2 years, the adverse effects associated with treatment with IR closely align those associated with Ibrutinib alone. More research is necessary, but it gives you a hint of what you might expect going forward. Many people on this forum have reported on their experiences with Ibrutinib therapy, so it will be interesting to learn more about how this combination therapy compares!



Woyach, J.A., Ruppert, A.S., Heerema, N.A., Zhao, W., Booth, A.M., Ding,


Bartlett, N.L., Brander, D.M., Barr, P.M., Rogers, K., Parikh, S.A., Coutre,


Hurria,A., Brown, J.R., Lozanski, G., Blachly, J.S., Ozer, H.G., Major‑Elechi, B., Fruth, B., Nattam, S., Larson, R.A., Erba, H., Litzow, M., Owen, C. Kuzma, C., Abramson, S., Little, R.F, Smith, S.E., Stone, R. M., Mandrekar, S.J., and Byrd, J.C. (2018) Ibrutinib Regimens versus Chemoimmunotherapy in Older Patients with Untreated CLL; N Engl J Med 2018;379:2517-28. DOI: 10.1056/NEJMoa1812836

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