Episode 3: Dr. Fajgenbaum’s Commentary

• Patient treated with rituximab
• Discharged from hospital
• Received weekly rituximab for 3 weeks
• After 3-week period, patient began to have recurrence of symptoms
  • Elevated CRP, low albumin, and low platelets
• Patient hospitalized and given very high doses of methylprednisolone, expected to help improve symptoms, but with no response
• Patient treated with double-dose rituximab; still no response
• CRP climbed over 300 and patient had no response to steroids or rituximab
• Then treated with very intense combination of cytotoxic chemotherapy:
  • Bortezomib, dexamethasone, thalidomide, adriamycin, Cytoxan, etoposide, rituximab, siltuximab.
• Combination resulted in immediate improvement in symptoms
• Patient was on dialysis 3 times/week and was able to go from dialysis frequently, then no longer needed dialysis
• Albumin began to improve
• Previous pancytopenia began to improve following chemotherapy
• CRP began to drop very quickly
• Patient demonstrated positive response to cytotoxic chemotherapy
• Based on now-approved drug siltuximab, anti-interleukin-6 therapy, patient was put on maintenance anti-IL-6 therapy following intense hospitalization and discharge
• Patient was on maintenance anti-interleukin-6 therapy for full year

Read through the episodes of one patient’s journey toward an accurate diagnosis and listen to an expert’s analysis on each episode.