Re: Allergic to Rituxan

[Guest guest]

Judith, my husband has had probably 8 or 9 rounds of Rituxan

over the years (over 45 individual infusions) and he has

always had the same reaction to the first infusion of each

round, requiring lots of premeds, a reaction, and a very

long infusion day. But the next infusions of that round he

has absolutely no reaction at all and they can be done in a

couple of hours. So I understand that a strong reaction to

the first infusion is pretty normal.

[Guest guest]

That's why many infusion centers give the first infusion

over a two day period. My infusions still took 4-6 hours. I

suppose the protocol for rates of infusion varies. I know

that the premeds are different in different centers.

Pat

On 3/30/11, chsngrnbos@... <chsngrnbos@...> wrote:

> Judith, my husband has had probably 8 or 9 rounds of Rituxan

> over the years (over 45 individual infusions) and he has

> always had the same reaction to the first infusion of each

> round, requiring lots of premeds, a reaction, and a very

> long infusion day. But the next infusions of that round he

> has absolutely no reaction at all and they can be done in a

> couple of hours. So I understand that a strong reaction to

> the first infusion is pretty normal.

>

[Guest guest]

Allergy to rituxan is incredibly rare. What is very common

is the 'shake and bake' reaction that is probably caused by

the release of complement components as the antibody bites

on to its target. This is especially bad if the white count

is high or the infusion is given too fast. The sensible way

of giving rituxan for the first time is to give 20% of the

dose on the first day and the remaining 80% on the second

day.

Terry Hamblin MD

[Guest guest]

Dr Hamblin,

Why is it sensible to have Rituxan over 2 days? I've had 2

separate treatments and 4 cocktails of FCR. I was always

given Rituxan in 1 day without any reaction. Please explain.

On Thu, Mar 31, 2011 at 4:01 AM, <TERJOHA@...> wrote:

> Allergy to rituxan is incredibly rare. What is very common

> is the 'shake and bake' reaction that is probably caused by

> the release of complement components as the antibody bites

> on to its target. This is especially bad if the white count

> is high or the infusion is given too fast. The sensible way

> of giving rituxan for the first time is to give 20% of the

> dose on the first day and the remaining 80% on the second

> day.

>

> Terry Hamblin MD

[Guest guest]

It depends on the white count. When the anti-CD20 hits the

CD20, complement is activated releasing C3a and C5a which

are vaso-active compounds and which lead to shake and bake.

It doesn't happen to everybody but it can be prevented by

making the original first contact smaller.

In a message dated 01/04/2011 02:55:13 GMT Daylight Time,

abg446@... writes:

Dr Hamblin,

Why is it sensible to have Rituxan over 2 days? I've had 2

separate treatments and 4 cocktails of FCR. I was always

given Rituxan in 1 day without any reaction. Please explain.

On Thu, Mar 31, 2011 at 4:01 AM, TERJOHA@... wrote:

> Allergy to rituxan is incredibly rare. What is very common

> is the 'shake and bake' reaction that is probably caused by

> the release of complement components as the antibody bites

> on to its target. This is especially bad if the white count

> is high or the infusion is given too fast. The sensible way

> of giving rituxan for the first time is to give 20% of the

> dose on the first day and the remaining 80% on the second

> day.

>

> Terry Hamblin MD

[Guest guest]

Generally those with a WBC >50 are susceptible.

_______________

Dr. Hamblin,

<snipped>

'depends on white count'.... can one assume from this that

patients whose white counts are on the higher side at

treatment or who have high cd20 presentation are possible

candidates for shake and bake and should consider a slower

infusion of Rituxan? and or that those with more moderate

wbc may not experience this effect?

thanks, beth fillman

[Guest guest]

Dr. Hamblin,

since not everyone who is targeted for Rituxan has extreme

wbc, but may have other triggers for treatment, and you

say......

'depends on white count'.... can one assume from this that

patients whose white counts are on the higher side at

treatment or who have high cd20 presentation are possible

candidates for shake and bake and should consider a slower

infusion of Rituxan? and or that those with more moderate

wbc may not experience this effect?

thanks, beth fillman

[Guest guest]

My WBC was in the normal range. I was given Rituxan for my

kidneys. They still did the two day first round all three

times that I had it (weekly x4 each time).

Pat

[Guest guest]

I'm in a trial of Cal-101 and Rituxan right now. When I

started my WBC was 235,000. I had to have my first two

infusions in the hospital because Dr. Coutre expected

problems. I did have problems but I was given tylenol,

benadryl and anti-nausea drugs which helped greatly.I'm

now in my 5th week and have no problems with the infusion in

the infusion area. My white count is now 118,000 and all my

lymph nodes are normal size. I hope this info helps. Arlene

[Guest guest]

Thanks for the information. Actually, I have had multiple

infusions now and the reactions get worse with each one. I

was actually tested for an allergy and found to be allergic

so they are working to desensitize me with slow rates of

infusion and different meds.

[Guest guest]

Dr. Hamblin was good enough to answer that perhaps those

with lower white counts going in may have less of an initial

reaction, since that's what I had asked. I was wondering

if that's the case, in patients who have lower counts, but

more nodal involvement might get 'delayed' reactions as the

Rituxan takes effect on the CLL that is in the nodes, or

marrow, spleen etc ? With apologies for my amateurish

question. It would make sense, but may have absolutely no

basis in science.

beth fillman