Rituximab used successfully in Lyme patient

[Jonathan Edwards]

This looks to me pretty unsurprising. People who get multiple cytotoxic agents for lymphoma often develop severe and unusual infections. (This is partly because of the cancer and partly the powerful combination of non-specific drugs like cyclo and is quite different from the situation in autoimmunity.) For someone harbouring borrelia to develop neurological involvement in this context would seem unremarkable. What seems worth a publication is that rituximab might well prevent a major rise in antibody to the borrelia at the time of the spreading infection - making diagnosis of borreliosis by serology particularly inconclusive in this scenario. I think this is the message they want to put across.

There is certainly no suggestion that rituximab is making Lyme better. Unfortunately it may be easy to get the wrong end of the stick - and I think daffodil has had that problem. Treating Lyme with rituximab would be plain crazy, I think.

 

[msf]

Prof. Edwards, does it make sense that it would take over a year after the first Rituximab infusion for the symptoms to manifest themselves? The last dose of Ritux was given about 10 months before the neurological symptoms developed - would this fit in with the plasma cells being depleted at around 6 months after each treatment?

 

[msf]

Ah, I see you said multiple cytotoxic agents - do you think this would be likely to happen if only Ritux was given?

 

[Jonathan Edwards]

Prof. Edwards, does it make sense that it would take over a year after the first Rituximab infusion for the symptoms to manifest themselves? The last dose of Ritux was given about 10 months before the neurological symptoms developed - would this fit in with the plasma cells being depleted at around 6 months after each treatment?

I guess we do not know when the Lyme infection occurred for sure. So we do not know what scope there was for making antibodies before rituximab. Once given rituximab can block new antibody formation for anything from 5 months to about 4 years. Most times B cells are back by 9 months but by no means always. With no new B cells no new plasma cells can be generated.

It is difficult to dissociate the effect of the lymphoma from the other cytotoxics since other cytotoxics are routinely given for lymphoma. This sort of reactivation of infection is rare in autoimmunity treated with rituximab alone. That is all we can really say, I think.

 

[msf]

When it is seen in Ritux-only patients, does it happen quicker than this, or does it vary?

 

[Jonathan Edwards]

When it is seen in Ritux-only patients, does it happen quicker than this, or does it vary?

Not sure what you are referring to. The only reactivations of infection I have seen after rituximab monotherapy are shingles - which can occur after anyway and I don't recall the precise time frames in the two or three I have seen after rituximab.

 

[msf]

I was referring to this:

This sort of reactivation of infection is rare in autoimmunity treated with rituximab alone

 

[Daffodil]

This looks to me pretty unsurprising. People who get multiple cytotoxic agents for lymphoma often develop severe and unusual infections. (This is partly because of the cancer and partly the powerful combination of non-specific drugs like cyclo and is quite different from the situation in autoimmunity.) For someone harbouring borrelia to develop neurological involvement in this context would seem unremarkable. What seems worth a publication is that rituximab might well prevent a major rise in antibody to the borrelia at the time of the spreading infection - making diagnosis of borreliosis by serology particularly inconclusive in this scenario. I think this is the message they want to put across.

There is certainly no suggestion that rituximab is making Lyme better. Unfortunately it may be easy to get the wrong end of the stick - and I think daffodil has had that problem. Treating Lyme with rituximab would be plain crazy, I think.

i am not suggesting treating lyme with rituxan - of course not ! i just want people to know that my CFS is GOING AWAY with lyme treatment....that has to mean something!

 

[Charles555nc]

i am not suggesting treating lyme with rituxan - of course not ! i just want people to know that my CFS is GOING AWAY with lyme treatment....that has to mean something!

Im seeing a new doctor myself and learning new things. What things helped you the most (list drug/supplement names plz lol).