[CIS-PAGID] CVID + LIP

[Cunningham-Rundles, Charlotte]

Hi,

 it is true that we need a new idea for these patients.    However,   I am thinking that we need to be sure that we are treating more X ray findings. So many have nodules and lymphoid infiltrates, but not the decompensation that Terri's patient had. So I think I would rather follow these folks on a macrolide and busesonide perhaps and not do more unless diffusion becomes abnormal or deteriorates . 

Then, I,d like to know if the infiltrates are a lot of  B cells or not.   Rituxan makes a lot of sense here.  as for azathioprine, not sure over the longer haul on that.     We had two lymphomas on pts on methotrexate for autoimmunity.   Short run, anything works. Long run, well, that does need a trial, but also similar patients with biopsy data on the infiltrates, hopefully with cell staining.  


Charlotte

Charlotte Cunningham-Rundles MD PhD



-----Original Message-----
From: pagid-bounces at list.clinimmsoc.org on behalf of Terri Tarrant
Sent: Fri 7/22/2011 2:32 PM
To: pagid at list.clinimmsoc.org
Subject: Re: [CIS-PAGID] CVID + LIP
 
Moving forward prospectively or historical case compilation? We're game either way.
Terri Tarrant

Sent from my iPhone


On Jul 22, 2011, at 2:15 PM, "Nelson, Robert P Jr" <ronelson at iupui.edu> wrote:


> What about considering a mutlicenter clinical trial so we could contibute our patients to an organized effort?  Bob

> ________________________________________

> From: pagid-bounces at list.clinimmsoc.org [pagid-bounces at list.clinimmsoc.org] on behalf of Fleisher, Thomas (NIH/CC/DLM) [E] [TFleishe at cc.nih.gov]

> Sent: Friday, July 22, 2011 10:32 AM

> To: Routes, John; pagid at list.clinimmsoc.org

> Subject: Re: [CIS-PAGID] CVID + LIP

> 

> Sorry for copying all on a simple question to Jack.

> 

> Thomas A. Fleisher, M.D.

> Chief, Department of Laboratory Medicine

> NIH Clinical Center

> 301 496-5668 (T)

> 301 402-1612 (F)

> 

> -----Original Message-----

> From: Routes, John [mailto:jroutes at mcw.edu]

> Sent: Friday, July 22, 2011 8:32 AM

> To: pagid at list.clinimmsoc.org

> Subject: Re: [CIS-PAGID] CVID + LIP

> 

> We have treated over ten patients with combination chemotherapy consisting of rituxin and azathioprine with outstanding results no infections and in many cased complete or near complete clearing.

> 

> Sent from my Verizon Wireless BlackBerry

> 

> ________________________________

> From: Terri Tarrant <tarra002 at gmail.com>

> Sender: "pagid-bounces at list.clinimmsoc.org" <pagid-bounces at list.clinimmsoc.org>

> Date: Fri, 22 Jul 2011 06:16:47 -0500

> To: pagid at list.clinimmsoc.org<pagid at list.clinimmsoc.org>

> ReplyTo: "pagid at list.clinimmsoc.org" <pagid at list.clinimmsoc.org>

> Subject: Re: [CIS-PAGID] CVID + LIP

> 

> Yes, we have 3 cases that responded well (2 with CVID and 1 idiopathic LIP).  We used the Eisenberg protocol of 1 g IV day 0 and day 14 with 100 mg IV solumedrol pre-med.  We did not use in combination with other drugs.  We did not see an increase in infections.  All patients needed redosing at 9-12 month intervals.

> 

> Terri Tarrant

> 

> On Thu, Jul 21, 2011 at 10:07 PM, Church, Joseph <JChurch at chla.usc.edu<mailto:JChurch at chla.usc.edu>> wrote:

> Colleagues:

> 

> A 60yo female with long term CVID has had lymphoid interstitial pneumonitis that was biopsy documented in 2005.

> 

> She had developed worsening of symptoms over the past 6 months.

> 

> She is trying to avoid increasing her prednisone, currently at 10mg/d, because of coronary artery disease and hypertension; she could not tolerate CellCept.

> 

> Has anyone tried Rituximab in this setting?

> 

> Joe Church, MD

> Children's Hospital Los Angeles

> 

> 

> 

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> --

> Terri Tarrant, MD

> Assistant Professor of Medicine

> Thurston Arthritis Research Center

> Lineberger Cancer Center Member

> CB # 7280, 3300 Manning Dr.

> Chapel Hill, NC 27599

> (919) 843-4727

> http://tarc.med.unc.edu/tarrant_welcome.php

> 


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