A quick question about low CD19 and Rituximab

[RWP (Rest without Peace)]

Hi All,

I think I know what the answer may be (because I've seen it here and there) but is this therapy indicated for those w/low CD 19 cells, since it is a B-cell depleter? My wife & I both have ME/CFS and hers are very low (but not atypical) @ 84. We both got ME/CFS through having mono (EBV). I have seen some here mention the possibility? of Rit. affecting the EBV infecting the B cells. Would someone in my wife's status (low CD19) be at risk of lowering her existing CD 19's or is that not likely?

 

[RWP (Rest without Peace)]

@Jonathan Edwards,

This is the question I wanted to ask you. Thank you.

 

[Jonathan Edwards]

B cell counts vary hugely - more than almost any other blood cell. This is presumably because B cells do not actually do anything in the blood, they are just passing through by chance. Unless you have no B cells at all, in which case you will have no immunoglobulins, and rituximab would just not do anything, the number is of no importance. (The idea of rituximab is to get rid of all CD19 cells - CD19 and CD20 are present on more or less the same group of cells.)

I think it is very unlikely that EBV is relevant to the action of rituximab in ME (if it has one) since improvement seems to take many months. Where rituximab is used to eradicate EBV improvement is much quicker.

 

[RWP (Rest without Peace)]

@Jonathan Edwards,

Thanks for answering those questions. I look forward to researching this further and keeping up on the latest posts.

 

[dannybex]

Hi All,
I think I know what the answer may be (because I've seen it here and there) but is this therapy indicated for those w/low CD 19 cells, since it is a B-cell depleter? My wife & I both have ME/CFS and hers are very low (but not atypical) @ 84. We both got ME/CFS through having mono (EBV). I have seen some here mention the possibility? of Rit. affecting the EBV infecting the B cells. Would someone in my wife's status (low CD19) be at risk of lowering her existing CD 19's or is that not likely?

@paulgrose, perhaps you might be interested in this other study:

http://www.ncbi.nlm.nih.gov/pubmed/16889122

Here's a (rather poor) copy of the full text:

http://www.ncf-net.org/pdf/UckunCFSCD19.pdf

Quoting:

"Notably, 94% of CFS patients had B-cell immunodeficiency with a marked depletion of their CD19+IgM+ mature B-lymphocyte population. A remarkable 81% of CFS patients experienced subjective improvement of their symptoms after treatment with folinic acid."

 

[RWP (Rest without Peace)]

@dannybex,

Thanks for this info. I had already found it when I was searching this website last year. I gave the article (paid for it) to our (my wife and my) doctor. She put my wife on Leucovorin.

Yes, I was well aware of the low B-cell counts in ME/CFS. That's why I was puzzled about Rituximab since it's a depelter. Now, I'm informed but still early in my understanding.

Do you take Leucovorin or a Methylation program? It seems like I've seen your posts on the subject?

 

[dannybex]

@paulgrose

I'm taking Folacal, which is a lower dose version of Leuvovorin, and trying to work out methylation issues, but I also have high histamine levels (histaminosis/histamine intolerance) which is complicating things. So still trying to sort things out.

The Rituximab study is puzzling to me as well. I would think we would need more B-cells for immune function, and this folinic study seems to suggest that, but I know others disagree.

If you don't mind me asking, did your wife improve while on the high-dose folinic? Or, what types of reactions did she experience?