Rituximab

Treatments with less data behind them that are still used clinically include oral steroid-sparing immunosuppressants such as azathioprine and mycophenolate, though evidence isn't strong enough to favor one over the other.

Rituximab has also been used for refractory CIDP, and it's the treatment of choice for the autoimmune paranoidopathies.

Throughout treatment, objective outcome measures such as grip strength and disability scales help show whether a therapy is really working.

And don't forget physical and occupational therapy, bracing for foot drop, and fault prevention.

So now our patients are many, many more of our mantle cell patients are receiving BTK inhibitors in the frontline setting one way or another with chemo and the echo or yeah, and just in general or chemo free as we're seeing the data, although those are not approved yet, hopefully we'll have more approval and NCCN endorsement behind the chemo free regimens.

But tell me now if you have a BTK exposed patients in the relapse setting, what's your go to? What if they've been on Rituxan maintenance and they're progressing while on maintenance or recently after being on like years of a anti-CD20 agent?

Yeah, it's a tough scenario.

I would say here, I'm fortunate to be in a center where we can deliver CAR T-cell therapies.

I would also add

that in some countries still patients are treated with Rituximab monotherapy, which is a situation that we do not exclude.

And also in some countries there is a possibility to use the R2 combination that proves as effective as Rituximab chemotherapy.

But that will happen in a superiority trial, so it has never led to a true level.

But we should admit that in some cases this also can be an option.

We're going to go into this.

Now, I want to share one little story about Rituxan, RA, and lymphoma.

Okay? Because I think that that's super important.

We think, in general, that we find medication kind of out of the blue, right? But the Rituxan story is a beautiful story.

So in the...

I think it's in the early 2000s or late 90s.

And there was a lot of people with lymphoma at that time.

And they create this B-cell and then it becomes art shop.

They had optic neuritis.

Their bladder wasn't working, except they were given the ABC drugs, Avonex, beta-serum, Copaxone, Rebif, God forbid, Rituximab.

Their B cells are gone.

They weren't getting better.

I mean, I could just keep going.

Tocilizumab, Sarilumab, Orencio, Abatacept, Rituximab.

All of these are actually in those algorithms.

But here's the thing.

The treatment is designed to push it back and keep it suppressed for as long as possible.

Her autopsy would later document complete remission with maintenance rituxan treatment.

Rituxan is a standard immunotherapy, an infusion given at regular intervals to keep the cancer from returning.

She wasn't terminal.

She was managing a chronic disease that required ongoing medical care for the rest of her life.