Steroids with Rituxan

[Guest guest]

Dear Fred,

First I like to say Thanks to all and for some reason I felt much better

this morning, do not know why but I was amazed to feel well on waking up,

then a friend phoned to say she will come for 3 hours to do some work for me

so I do not have to stress myself over the funeral visitors etc. for Friday.

Here is what the CLL expert told me last month. He said I had to have

steroids to get my blood counts better before any chemo could be administer,

here is what the letter said

" The best thing for stage C disease is to give six weeks of treatment with

Prednisolone, about 1 mg./kg. for 4 weeks, which will in her case, be about

50 mg./day, and then tailing off for two weeks. This would be covered with

allopurinol (as the lymphocyte count will rise temporarily during steroid

treatment), lansoprazole and folic acid supplements as her indices are

macrocytic. This is likely to result in an improvement in the Hb and

platelets and a reduction in the organomegaly. Perhaps two weeks after

completing the steroids, she could start chemotherapy " .......then he goes on

about the rest related to the chemo saying we have not agreed yet on that

and also mentioned the Rituximab we have spoken in the past.

What I understood from our conversation was that my haemoglobin and

platelets needed sorted before I could have the chemo.

The letter is very long.

As far as I know I have never been allergic top any thing, but again I have

not had any medication for over 25 years in my life and before that only

antibiotic occasionally, so you never know what the body has created over

that time.

Chonette

Message: 2

Date: Tue, 24 Aug 2004 19:49:13 -0700

From: " Fred Hummel " <fch1@...>

Subject: Steroids with Rituxan

(I've posted this to the ACOR list as well.)

It has become somewhat common to administer steroids

(Decadron/dexamethasone; Solumedrol/ methyl prednisolone)

with Rituxan. I've been unable to learn exactly what role the

steroid plays in the infusion.

The best reasons given for using them, that I've heard, are

1) to lessen the severity of reactions to the R, especially during

the first infusion, and 2) to work synergistically with the R to

destroy the leukemic cells. Sounds great but who knows for

sure, some doctors use steroids, some don't.

Is anyone aware of any trials, studies or papers that address

this issue? Or are there any medical professionals on the

listserv willing to offer an explanation in lay terms.

I should add that I have had allergic reactions to both steroids

I mentioned above. I'd like to know if the misery they give me is

worth the benefit they provide.

Fred Hummel, 77, Arcata, CA;

CLL/SLL dx 1.98; Fludara 2000;

Rituxan, Fludara, Novantrone,

& Decadron, April-August 2002.

Started R+Solumedrol 8.19.04.

[Guest guest]

A Google search on " Rituxan Steroids " yields several hits.... I had already

gone this route.... Found one abstract at

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_uids=1\

2176898 & dopt=Abstract I'm currently taking Rituxan with steroids

(dexamethasone the first time out and hydrocortisone after that)... Message I

got from the onc was to make the cells more receptive to the Rituxan, which is

consistent with what you say and everything else I've read on this combo....

Regards,

Walter V.

Date: Tue, 24 Aug 2004 19:49:13 -0700

From: " Fred Hummel " <fch1@...>

Subject: Steroids with Rituxan

(I've posted this to the ACOR list as well.)

It has become somewhat common to administer steroids

(Decadron/dexamethasone; Solumedrol/ methyl prednisolone)

with Rituxan. I've been unable to learn exactly what role the

steroid plays in the infusion.

[Guest guest]

Glucocorticoids and rituximab have a synergistic effect.

This study explains it:

http://bloodjournal.hematologylibrary.org/content/100/5/1765.long

~chris

CLL CANADA

[Guest guest]

Hi,

The purpose may depend on the dose. High dose steroids are

sometimes used to treat CLL.

My impression is that steroids are commonly used to prevent

infusion-related adverse reactions to Rituxan - a way to

speed up the administration of Rituxan as well.

All the best,

Karl

>

> What is the purpose of taking steroids during Rituxan?

[Guest guest]

Steroids were used to suppress the extreme shivering that

occurred during my first treatment with Rituximab.

I believe that steroids, in general, suppress the immune

system.

>

> What is the purpose of taking steroids during Rituxan?