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Rituximab used successfully in Lyme patient

Discussion in 'Other Health News and Research' started by msf, Jun 2, 2015.

  1. msf

    msf Senior Member

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    I know this does not mention ME, but since we have had several discussions recently about the extent to which Lyme is involved in ME, I thought I would post it here:

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3604215/

    NB, the Rituximab did not cure the patient's Lyme (if the patient had it at the time, as the article suggests), but as a 'responder' Rituximab maintenance therapy (for Lymphoma) was continued. The article also points out potential problems with diagnosing Lyme (and other diseases) when a patient's B cells have already been depleted with Rituximab.
     
    leokitten, Antares in NYC and Helen like this.
  2. Bob

    Bob

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    Actually, this patient was successfully treated intravenously with ceftriaxone (antibiotic) for B burgdorferi, and her Lyme disease was not treated with rituximab. The rituximab, along with immunochemotherapy, was used to treat "marginal zone B-cell lymphoma stage IV-B", and not Lyme disease. The patient "had a history of marginal zone B-cell lymphoma stage IV-B, for which she was successfully treated with immunochemotherapy and rituximab maintenance therapy."

    The Lyme disease was a problem after treatment with rituximab; and the bacteria was detected via PCR, after antibodies were tested for but not detected. (Perhaps the rituximab had reduced the antibodies?) So this indicates that rituximab does not treat Lyme disease or Lyme disease symptoms when there is active (detectable) bacteria present.

    Edit: The rituximab may even have made the Lyme disease active (detectable by PCR, if it had previously been undetectable), and wiped out antibodies to it. But I'm speculating - the bacteria may already have been active, and there may never have been detectable antibodies. Note that I've only read the abstract, so there may be more details about this in the full paper.

    Edit 2: I'm not sure if it's appropriate for me to talk about 'active' vs 'latent' when it's in relation to bacteria rather than viruses?
     
    Last edited: Jun 2, 2015
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  3. msf

    msf Senior Member

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    No, read it more carefully, they suggest that the patient may have had Lyme before the Rituximab treatment, since they had an erythema migrans with preceding tick bites. If you notice, I didn't title this thread 'Lyme treated successfully with Rituximab.' If you can suggest a more appropriate title, please do.

    P.S. Lyme is a bacteria, not a virus (hence the antibiotics).
     
  4. msf

    msf Senior Member

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    Perhaps 'Rituximab used successfully to treat Lymphoma in a patient who may have already contracted Lyme at that point?'
     
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  5. Daffodil

    Daffodil Senior Member

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    Lyme treatment is improving my CFS and Rituximab improves CFS, so its no surprise to me that Rituximab would temporarily improve Lyme.....

    ...maybe CFS is Lyme!
     
  6. anciendaze

    anciendaze Senior Member

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    It is appropriate in general to talk about latent bacterial infections. About 90% of those infected with such standbys as mycobacterium tuberculosis do not have active disease. Spirochetes like borrelia burghdorferi present other problems as there are several different states with low activity. In most such states you will not find free spirochetes outside cells, and those inside may not have familiar morphology. In these cases there is no guarantee that you will find antibodies to the outer coat of the spirochetes, or to proteins they produce while replicating rapidly. Exactly how you should detect the spirochetes in these states, and what this says about pathological conditions, is at the center of a number of controversies about chronic Lyme disease.
     
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  7. msf

    msf Senior Member

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    Heresy!
     
  8. Bob

    Bob

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    That seems like an accurate description of the scenario.
     
  9. msf

    msf Senior Member

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    Yes, I thought it was a bit long-winded though.
     
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  10. Bob

    Bob

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    I'm not sure if it's certain that's what's happened. The rituximab could have reactivated a latent/dormant infection that wasn't previously causing symptoms. Well, that's my understanding of it, after reading the abstract, but I might be wrong.
     
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  11. msf

    msf Senior Member

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    Yes, I thought of that possibility when I was reading it, but the authors didn't seem to make a big deal of it, except for suggesting that the B-cell depletion may have made it more difficult to diagnose Lyme, although the patient was seronegative on the Erythema Migrans test before the Rituximab treatment, and it is well established that seronegative Lyme exists in non-immunocompromised people. I think the only conclusion we can draw from it is that, if the patient already had a latent/active Lyme infection before they started the Rituximab treatment, the drug did not lead to a rapid deterioration in the patient's condition, since over a year elapsed between the Rituximab treatment and the development of acute Lyme symptoms.
     
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  12. Scarecrow

    Scarecrow Revolting Peasant

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    Either that or the timing of the infection was such that the neuroborreliosis didn't manifest until after the treatment with rituximab. Incidentally, cyclophosphamide was also used to treat the lymphoma.

    I think that there is a possibility that, given the long history of tick bites, even earlier infection could have been possible - but that could be us reading too much into it. The authors certainly don't state it explicitly. They concentrated on the effect of the rituximab stifling antibody production and hence the delay in the Lyme diagnosis.
     
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  13. msf

    msf Senior Member

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    Yes, it is not explicit, but the last paragraph but one suggest that this might have happened.
     
  14. msf

    msf Senior Member

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    suggests
     
  15. Scarecrow

    Scarecrow Revolting Peasant

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    I didn't read the penultimate paragraph like that. She had a potential erythema migrans when diagnosed with lymphoma but tested negative. The rash would be expected soon after infection.

    Elsewhere in the article they refer to a history of bites.

    Edited to add: there is no speculation on the part of the authors that the rituximab or the cyclophosphamide altered the course of the progression of the borreliosis. For all anyone knows, the neuroborreliosis may have developed when it did with or without the lymphoma treatment.
     
    Last edited: Jun 2, 2015
  16. msf

    msf Senior Member

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    It was the second-to-last paragraph:

    The sensitivity of B burgdorferi serology in erythema migrans varies from 38 to 88% depending upon the duration of the erythema, which may explain why the patient did not have detectable anti-Borrelia antibodies at that time. Rituximab is known to deplete normal B-lymphocytes and this is likely to have hampered further production of antibodies against B burgdorferi not only in serum, but also in CSF.
     
  17. Scarecrow

    Scarecrow Revolting Peasant

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    Sorry, you were typing your response as I changed 'last' to 'penultimate', so I was referring to the paragraph you'd already mentioned. I edited my previous post again to add my final two sentences.
     
  18. msf

    msf Senior Member

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    Yes, I agree that the paper does not discuss what effect, if any, Rituximab had on the progression of the borreliosis.- I guess they felt that this would have been unfounded speculation on their part.
     
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  19. msf

    msf Senior Member

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    I don't know enough about it, apart from that it is also a spirochete, to say whether this has any possible implication for Rituximab and Lyme, but there was also this in the discussion section:

    Negative tests for leishmaniasis antibodies during treatment with rituximab have also been described in a patient who had been treated for non-Hodgkin's lymphoma and was on maintenance therapy with rituximab. This patient died of undiagnosed visceral leishmaniasis.15

    I guess cancer would have contributed to the patient's death too, but it's interesting that they attribute it to the leishmaniasis. Perhaps all three factors had to be present, but the abstract only mentions the problems with diagnosing infections in B-cell depleted patients.
     
  20. msf

    msf Senior Member

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    Oops, I was confusing it with the more appropriately-named Leptospirosis.

    And it seems to be perfectly capable of killing people on its own.
     

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