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Rituximab Maintenance Treatment
Diagnosed with WM in Feb 2026; currently asymptomatic.
· Initial Hb about 8–9 g/dL (reported 8.9); current Hb 13.5 g/dL.
· Initial M-spike 4.26 g/dL; current M-spike 0.8 g/dL (~81% reduction).
· Initial quantitative IgM was 3,089.5 mg/dL (3.09 g/dL). Current quantitative IgM not available
Treatment given was a multi-agent regimen including dexamethasone, bortezomib, rituximab, cyclophosphamide and zoledronic acid, followed by a treatment-free interval. Prescribed maintenance treatment of rituximab on 3 monthly basis for 24 to 36 months. Confused whether to go ahead, in light the excellent clinical progress achieved and keeping in mind the risk of infection
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The disease has to many variables for you to evaluate for specific treatment plan. Apparently the oncologist recommended the right treatment initially and I would go with the latest recommendation. What is your age? Glad you are doing well but a second opinion is an option, but best to discuss directly with your oncologist.
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1 Reaction@bloodguy Yes, the treatment was successful, no doubt. But at 71, when the clinical progress has been excellent, even after all cancer treatment was stopped for two months, I personally would prefer monitoring to commencing maintenance treatment. Will discuss with the treating oncologist and ascertain the trade off between the incremental benefits of treatment versus the risk of infection caused by depletion of B Cells. Yes, second opinion is also on the table.
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2 ReactionsMy diagnosis is a LPL non-WM. A high kappa light chain count caused a peripheral neuropathy with profound lower leg weakness and that was my presenting symptom. Treatment was 4 months of bendamustine-rituximab followed by two additional months of rituximab. The bendamustine was stopped 2 months early since my kappa light chains had plateaued at a 90% decrease and I was starting to have some bothersome side effects.
Both of my oncologists at different facilities agreed that I should be on maintenance rituximab every 2 months for 2 years. The reasons were one - that the kappa light chain level had not reached what is considered a normal level (though it is debatable what is a normal level for a 77 year old), and two, the severity of the presenting neuropathy. (The neuropathy greatly improved within 2 months of treatment.)
Of course I did some searching through the web for the pros and cons of maintenance therapy and could find convincing arguments on both sides. I decided that I was happy with the treatment plan so far and would stay with what both docs were recommending.
I hope my experience might be helpful to you.
@jerry48 While the treatment protocol in my case was not a conventional one, it was effective and all credit to the oncologist.
However, the decision to start Rituximab maintenance seems probably motivated by the fact that the M Band isn't zero, which is the target set by the oncologist, based on conversations with him. Surprisingly he isn't too concerned about the following:
1. What are my **IgG, IgA and IgM levels** now?
2. What is my current **B-cell count/CD19 or CD20 level, if it has been measured?
I need more clarity before I agree to any further treatment because of risk of infection and will schedule a consultation for next week.