Bendamustine and Rituximab and liver toxicity

[profrich]

My first round of BR went fine with no change in liver numbers. My ALT and AST are usually under 20. Three days after my second round they were slightly over 20, 5 days after the second round they were close to 40, and 10 days after the second round (today) they are over 100, which concerns me.

Has anyone else had an experience like this?

[Justasheet1]

Rich,

Mine did that too. It’ll normalize before you get to do it again.

Jeff

[profrich in reply to Justasheet1]

Did it happen the second time but not the first?

[Justasheet1 in reply to profrich]

I just checked and mine took off after round 3. Round 1 and 2 were normal.

[profrich in reply to Justasheet1]

Thanks. Same kind of pattern. We seem to becoming friends. I know a lot about ibrutinib and acalbrutinib, if you have any questions.

Rich

[Justasheet1 in reply to profrich]

Rich,

My liver enzymes went up but at the time, I was in a blind clinical trial. The thinking was that the idelalisib was causing it but it turned out I was on a placebo and BR. My LDH was always high/normal too. Everything was entirely resolved about a month after treatment ended.

I’ll pick your brain on the 2 BTK’s pretty soon. I’ll be on one or the other fairly soon.

Jeff

[profrich in reply to Justasheet1]

Like I said, I strongly recommend acalabrutinib.

[profrich in reply to profrich]

By the way did yours go up slowly like mine? I did not hit a really high value until today.

[Justasheet1 in reply to profrich]

Got it. Problem is, it’s not approved for CLL right now and the only way you can get it is either through a clinical trial or having major issues with ibrutinib and then asking your doctor to fight your insurance company to cover it.

[profrich in reply to Justasheet1]

One member of this group got it for first treatment by having his doctor make a case to his insurance company. You should at least try that. I got it as second line (I plan to only do BR twice and then acalabrutinib) when imbruvica landed me in the hospital.

Did you see me question above about your time progression?

[Justasheet1 in reply to profrich]

They noticed it right away on my third round of treatment. They held the placebo/idelalisib thinking that would normalize it but it did it on its own.

[profrich in reply to Justasheet1]

So it did not go up gradually over a week or so like mine? How high did it go?

[Justasheet1 in reply to profrich]

The ALT went to 99 and then 236 at round two. Then returned to normal. I was told that the liver was filtering everything out and the anti nausea meds plus the prophylactic meds were elevating them.

[profrich in reply to Justasheet1]

Wow, How long after treatment did it take to get to 236? Did you possibly have hepatitis?

[Justasheet1 in reply to profrich]

It went there in one month and was almost normal the next. It was during treatment.

[profrich in reply to Justasheet1]

Thanks. By the way I think you meant round 3 above, not round 2.

[profrich in reply to profrich]

Oh. I get it now. They noticed the value 236 at the start of your 3rd round. So, it was a month after your 2nd round.