My mother (78) was diagnosed with Marginal Zone B-cell non-Hodjkin Lymphoma of the thyroid gland. It is a type of blood cancer that falls under the specialty of Hematopathologists like Dr. Devinda Jayathilake, mum's doctor. A PET CT scan showed few lymph nodes with minimal FDG in the neck's front and back. The doctor determined to treat her with Rituximab 500, an Immune Therapy drug. She will receive four infusions (weekly) followed by another PET CT scan to assess the progress of the treatment.

The first infusion is concerning because we do not know how the body will react to the drug. As a precaution, the first infusion will be performed as an inpatient.

How the drug works

Rituximab treats cancers that contain a high level of CD20 proteins. It is cytotoxic, or, in other words, it kills cells. The drug attaches itself to the CD20 protein and paints a target, but the immune system destroys it. Once attached, the drug may also kill the cancer cell on its own.

The treatment can cause a variety of complications and, in some rare instances, be serious and life-threatening. I recommend you do further reading in this regard.

In my understanding, this is because of toxicities resulting from rapid cell death (CD20-positive cancer and immune cells) due to the effects of the drug.

Hospital Admission & Preparation

We reserved a room at Asiri Surgical (at Kirimandala Mawatha) at about 4:30 PM on Wednesday. The admission process took roughly 45 minutes, and we were in our room for about 1 hour. The pharmacy delivered the drugs to the ward in a cool pack. Once the paperwork was signed, the nurse stored the dose in the fridge.

A 2D echo of the heart was performed. The heart and its valves were healthy enough to proceed with the treatment. The doctor reviewed the many blood tests we had already done at Hemas Thalawathugoda.

At night, she was given 6 tablets of Prednisolone. The same continued early morning.

The process

The infusion process started around 9:00 AM. The nurses administered some medicines intravenously as a first step. Thirty minutes later, a 500ml saline drip with Rituximab 500mg (50ml) was initialized. The rates of flow was as follows:

Hour	Rate
1st Hour	25ml/hr
2nd Hour	50ml/hr
3rd Hour	75ml/hr
4th Hour	100ml/hr
5th Hour	100ml/hr
6th Hour	100ml/hr
7th Hour	100ml/hr

The nurses checked the pressure, temperature, and blood sugar levels during the infusion. They were also taking note of the side effects of the medication.

Observed Side Effects

The first 2 hours of the infusion were incidentless. The first symptoms were noticed once the flow rate was increased to 75ml/hr. She presented with a headache followed by a pain in the jaw, which then moved to the foot. After a while, the pain/discomfort seemed to have gone away.

Throughout the process, she experienced some pain and discomfort. Her jaw pain seemed to be the most prevalent. The doctor visited her in the evening. As she experienced some side effects, to be on the safe side, the doctor decided to keep her in the hospital for observation.

By sunrise, all side effects had gone away.

Discharge

The nurses monitored her throughout Friday (the day following the infusion). The doctor revisited her before starting his evening consulting session and discharged her.

Just as the bill was preparing, we were served dinner.

Hospital Experience

I was the patient's "bystander" and was present throughout the stay. The hospital staff we met were kind and helpful. The nurses that were in charge of Mum were caring and lovely.

I ordered additional meals and tea for myself. The food was surprisingly good, saving me the hassle of sourcing food. The tea, in particular, was terrific.

It is a tad more expensive than Hemas Thalawathugoda Hospital and Sri Jayawardanapura Hospital. Neither hospital can compete with the car parking facilities available at Asiri Surgical. I love how the car park extends vertically and connects many hospital floors.

Conclusion

I arrived at the hospital uncertain about the process and concerned about side effects. However, except for some minor side effects, the infusion proceeded smoothly. The nursing staff was caring and helpful, and I felt confident she was in good hands.

While we need to be aware of the side effects of Rituximab 500, we should not worry about it. We need to ensure that the patient is in a decent hospital capable of responding to an emergency.