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Re: Reactions to Rituxan

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My husband had a reaction that caused him to shake

uncontrollably it almost looked like he was having a seizure

but it wasn't. I think they referred to it as planking? He

has to have it infused slowly to avoid that happening again.

It happened on his first treatment.

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My husband also had shaking from his first infusion, but not

as extreme. It only lasted a few minutes after they slowed

the rate. They called it rigor, pronounced with a long i.

He gets light-headed and tired from the benadryl they give

him before the infusion, usually sleeping through a lot of

it, and is a little woozy afterwards.

Judy C.

Beth wrote:

> My husband had a reaction that caused him to shake

> uncontrollably it almost looked like he was having a seizure

> but it wasn't. I think they referred to it as planking? He

> has to have it infused slowly to avoid that happening again.

> It happened on his first treatment.

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Hi Mel

There are many conditions related to having a suppressed

immune system. Most are related to what rituxan does rather

than rituxan itself.

However all reactions must be watched very closely by your

doctor. Shingles is common as are new or reactivated viral

infections included cytomegalovirus, herpes simplex virus,

parvovirus, varicella zoster virus, West Nile virus, and

hepatitis B and C

Also in general night sweats, rash, pruritus, urticaria

The FDA lists them all here..

http://www.accessdata.fda.gov/drugsatfda_docs/label/2010/103705s5311lbl.pdf

More info for the patient..

http://www.drugs.com/rituxan.html

~chris

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I believe infusion reactions to Rituxan are

euphemistically called 'Shake and Bake'...

~chris

Mel wrote:

> Has anyone had or have knowledge of dermatological

> or other adverse reactions to Rituxan?

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My husband, , experienced remarkable chills, sudden

increase in BP & temperature, and bright red rash from the

top of his bald head to the upper part of his chest. Most

frightening was his difficulty breathing, a feeling that his

throat closing, resulting in a decrease in his O2 level. All

this occurred within the first 40 minutes of the infusion,

still at 50ml/hr. Mel, please remember that this severe a

reaction is not usual by any means. Still, Rituxan should be

respected.

Warm wishes,

Jan

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I too had a reaction to Rituxan. When I was given Rituxan

in 2003/04 I did not have reaction. However, in 2007/08, my

second round of treatment, I had very bad allergic like

itching. Sometimes to the point of wanting to go outside

into the snow and lie in it hoping it would relieve the

itching. They pretreated with Benadryl, steroids and

something like a Tagamet drug, cannot recall name. They had

to give me Benadryl every 2 hours, to help with the itch.

Sometimes I could go that long and sometimes I was already

itching by that time. They also slowed the drip to very slow

and long time to deliver. My oncologist wanted me to keep

doing the Rituxan anyway, as long as I could stand the

discomfort. Happy to say that it worked and still in

remission. I did FCR the second time. First time, FR.

Hope this helps.

Helen

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It's my understanding that Rituxan, being mouse-based rather

than human-based, brings on an allergic infusion reaction,

at least initially, quite commonly. I had an initial

reaction, too, including the closing throat, but the nurses

were on point. They had warned me on the very first day of

treatment about the possibility, so I let them know

immediately when it started and was given medication,

infusion was slowed, and I had no more problems on any

following infusions.

Karni

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Tom never had the " shake and bake " with Rituximab but he did

develop an allergy that consisted of a dry cough that

started upon infusion and lasted for the following week.

After that, Rituximab quit working on him. Every infusion

his cough would last longer and cause more problems. Really

interesting because it always started within 30 minutes of

the start of infusion. He also always had benedryll

infused.

JLOU

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I have failed both RF concurrent and HD-R (High Dose Rituxan

monotherapy) due to life threatening reactions. My HD-R

therapy in March of this year put me in a wheelchair for

only a day but sent me into a reaction that was

characterized by hypotension (very low blood pressure) rapid

platelet drop severe pain in my feet and jaw. The bad

reactions to both treatment protocols that included renal

failure due to ATN (Acute Tubular Necrosis) are not

completely understood by my doctors, making me an outlier in

the very heterogeneous world of CLL. My Immunologist has

told me " Wayne you don't want to be this interesting " , My NY

oncologist has said " You are a mystery " My Nephrologist is

" Puzzled " and Dr. Byrd continues to ponder but has offered a

possible nod toward sub-clinical vasculitis and Complement

dysregulation to explain the kidney issue and R-reaction.

In my ongoing search for cause, with the hope of leading to

an optimal TX for my CLL that won't further the damage to my

kidneys, I came across a discussion on " Renal Fellows

Network " (a teaching blog for kidney docs) that is a great

source of credible information that may help the unfortunate

few of us that have a difficult kidney problems as a result

of the CLL and or connected to the drugs in our treatment.

In a discussion of systemic vasculitis the blogger states

" Another potential complication arises from the fact that

rituximab is an IgG1kappa chimeric antibody as it appears to

bind to the IgM paraprotein in some cases leading to the

deposition of more immune complexes and worsening of the

vasculitis. This complication is seen particularly in those

treated with high dose rituximab (1g) and suggests that

lower dose therapy (375mg/m2) may be more appropriate. " For

those wanting more depth on a variety of kidney issues and

the full text of the Vasculitis blog -

click on the following link:

http://renalfellow.blogspot.com/search/label/vasculitis

From a renal TX perspective, Rituximab is used to treat many

conditions such as ANCA-associated vasculitis, transplant

glomerulopathy, lupus nephritis and membranous nephropathy.

The rock and a hard place arises for us CLLers when it is

suspected that Rituximab TX can be implicated in Complement

dysregulation which could cause renal problems. It should be

noted here that I had a slowly progressing kidney impairment

from CLL prior to any TX but the treatments amplified the

existing impairment to near fatal proportions. Uric acid was

slightly elevated after cycle 2 of RF but was brought down

by increased Allopurinol so as to eliminate TLS (Tumor Lysis

Syndrome) as the usual culprit in kidney failure during CLL

TX.

A side consideration: Patients may be hyper-reactive to the

mouse protein component of Rituximab that can trigger a more

serious reaction than the common Shake-n-Bake with is

usually transient and controllable through meds and by

slowing the drip. The logic might be - Why not then, use

Ofatumumab since it is a fully humanized mAb (monoclonal

antibody) and does not contain any mouse protein? I explored

this option on the suggestion of my NY Onc. but when I ran

it by Dr. Byrd he explained that the reaction to mouse

protein, if found, would not rule out a similar hyper-

reaction from Ofatumumab due to the similarity of the use of

Complement as a cell killing mechanism by both mAbs

(Rituximab & Ofatumumab). Complement is a complex of 25

molecular protein and protein fragments that comprise an arm

of our innate immune system. The Complement proteins can be

damaging to our normal healthy tissue and must be regulated

by inhibitor proteins. There is evidence that when

Complement becomes dysregulated either by cancer or

treatment, auto immune disease or reactions, such as what I

experienced, will be the result. Two helpful links to gain

more insight on the role of Complement.

http://en.wikipedia.org/wiki/Complement_system

http://tinyurl.com/4xycjr4

WWW

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A while back, I came across a medical paper that said to infuse

complement before rituxan, as complement is depleted from rituxan.

Can't remember the source, but may be from the onc in Virginia who has

papers on very low-dose fcr. Could be worth exploring. Sorry to read

about your complications, hope you improve soon.

Ellen

Wayne Wells wrote:

/message/15861

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I had a severe reaction to rituxan. Within 2 mins of getting

a very small amount, my heart stopped. I found out that I

was allergic to something for the first time in my life!

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