How to tell if Rituximab is working?

[Redkatt]

Are you able to tell if Rituximab is working from changes that show in your blood tests? What specifically would improve or should everything improve?

[Skyshark]

There should be a nearly immediate reduction in ALC. It may rise again as the concentration of Rituximab reduces between doses.

Everything else takes time as the marrow has to recover from infiltration to start making platelets etc.

[Redkatt in reply to Skyshark]

Thanks for that information. Lymphocytes have decreased from 2.1 to 1.3 after 2 rounds of Rituximab and platelets have increased from 135 to 214 after 2 treatments so fingers crossed it’s working.

[lankisterguy Volunteer]

Hi Redkatt,

As  Skyshark says, your Lymph# (ALC) should drop quickly and may level out below normal around 1.0 to 2.0, wherever that lands is OK.

It is best if your Neut# / ANC stays steady above 1.5 and certainly not below 1.0, if that drops- get medical attention right away.

Ignore the WBC and any % numbers on white cells, only watch the Lymphs and Neuts separately.

See: cllsociety.org/cll-sll-pati...

or cllsociety.org/lab-values/

All your Red blood components (RBC, Hct, Hgb) may climb back up slowly as your marrow recovers. RDW & everything else focused on red cell shape, size and maturity should settle down over time. See: cllsociety.org/cll-sll-pati...

Len

[Redkatt in reply to lankisterguy]

Thanks for that information. Lymphocytes are 1.3 after 2 treatments of Rituximab. Neutrophils are at 1.0 so hopefully they don’t drop further. What would they do if it does drop lower?

Those links are really helpful too.

[AussieNeil Partner Administrator in reply to Redkatt]

If necessary, it's usual to delay a rituximab infusion to provide a bit more time for bone marrow recovery to lift the neutrophil count above 1.5. If that doesn't work then G-CSF injections (neulasta, filgrasim, etc. ), are used to boost neutrophil production.

Neil

[Redkatt in reply to AussieNeil]

Thanks Neil. I’m guessing it’s alright while it’s at 1.0 but will see what this weeks level is at

[Big_Dee]

Hello Redkatt

My WBC dropped from 200K+ to 10K in 28 days on B+R treatment. Everyone however is different. Blessings.

[Redkatt in reply to Big_Dee]

That’s a huge drop! I think B&R was an option for me too. How did you find this treatment for you?

[Big_Dee in reply to Redkatt]

Hello Redkatt

I had some allergic reaction the first two treatments. First round was rash on upper body, 5-day hiccups and some wooziness for couple days. The next 4 treatments had much milder side effects. It gave me about 3.5-4 years of remission. This was back in 2018 and ibrutinib was newly approved with lifetime of use. I elected to go time limited treatment of Bentamustine and Rituxan for 6 months, personal choice. My reasoning was that there were a lot of new drugs in the pipeline, I just finished V&O last November. Blessings.

[Redkatt in reply to Big_Dee]

seems like B&R worked well for you without too many awful side effects. 3.5-4 years remission is a good time frame. I hope the V&O brings you a long remission too