Pretreatment sample: On requisition, Ask our lab to save for future comparison with post-treatment samples
Immunocompetency panel: Send at least for CD3, CD19
Quantitative immunoglobulins (IgM; IgG; IgA)
More likely response to treatment of IgM antibody-related neuropathy: If IgM levels fall
More likely infectious complications: If IgG levels are low before treatment
Start IV heparin lock
Start normal saline at 100 cc/hr
Run saline at keep vein open (kvo) rate during infusion
Frequency of IV treatments
Weekly x 2 doses
Then 1 dose every 10 to 12 weeks for 2 years
Premedication: Thirty minutes prior to infusion of Rituximab with
Benadryl 25 mg p.o.
Tylenol 650 mg p.o.
Rituximab dose: 375 mg/M2 for each treatment. Calculate absolute dose to be administered.
Begin at 25 mg/hr
Follow-up rates: Increase if systolic blood pressure remains between 170 and 100.
First infusion: Double every hour to a maximum of 100 mg/hr
Subsequent infusions: Double every hour to a maximum of 200 mg/hr
Patients may take all regular medicines.
Continue saline infusion for 1 to 2 hours after Rituximab is completed.
Problems: Contact the Neuromuscular fellow immediately.
A fellow is available 24 hours a day
Phone #: 747-3000
Notify MD for
Temp > 38.0
Respiratory symptoms: Shortness of breath must be reported immediately.
Activity while in treatment center: Patient may be up ad lib
After infusion is finished
Treatment 1 : Patient should be observed overnight.
Follow-up treatments: Patient may be discharged 1 to 2 hours after the infusion is completed.
Patient should be sent home on their regular medicines
Follow-up in the Neuromuscular clinic: Exam & Lab testing every 3 months; 2 months after final infusion.
Questions or problems: Patient should call Neuromuscular office at 314-362-6981.
Follow-up testing: Blood is drawn every 2 to 3 months for
CBC and electrolytes, glucose, and creatinine (BMP)
Antibody titers: IgM vs GM1 & GalNAc-GD1a ganglioside, MAG, GD1b or TS-HDS
2 red top tubes to Neuromuscular Clinical Laboratory
Box 8111 - Neurology; Room 404 IWJ
660 South Euclid Avenue
St. Louis, MO 63110
Save serum specimen for comparison with post treatment samples
Immunocompetency panel: Send for CD3, CD19
Quantitative immunoglobulins: IgM, IgG, IgA
Levine, TD, Pestronk, A. IgM antibody-related polyneuropathies:
Treatment with B-cell depletion chemotherapy using rituximab.
Pestronk A, Florence J, Miller T, Choksi R, Al-Lozi MT, Levine TD.
Treatment of IgM antibody-associated polyneuropathies using Rituximab.
J Neurol Neurosurg Psychiat 2003;74:485-489.
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