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TB Test

Mary from NJ's picture
Mary from NJ
Posts: 60
Joined: Apr 2016

I am curious if anyone has had a TB test during or following treatment of biologic drugs: Abatacept (Orencia), Rituximab (Rituxan) and Tocilizumab (Actemra).  I received a letter from my health insurance company today that it may be necessary to have a TB test since I have received one of these drugs. I know I had to be tested for Hepatitis B & C before treatment could begin. Neither the oncologist nor my primary care physician suggested this.  I will call to find out if necessary, but was curious if others have needed the TB test.  

yesyes2
Posts: 592
Joined: Jul 2009

I needed a TB test before starting Humara back around 2000.  I've been on Rituximab since January 2008, for both NHL and RA, and have not been tested for TB or Hep b and C.

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3518
Joined: May 2012

My oncology group never recommended a TB test for me, but they did require a pneumonia vaccine.  They also highly recommend a shingles vaccine. I have known numerous lymphoma patients who developed shingles, several have written at this site.

The letter sounds like a precautionary from the drug manufacturer.  All of the rheumatoid arthritis drugs that advertise on TV (Rituxan and others) warn about the possibility of infections, and most even warn about the possibility of developing lymphoma (Rituxan is used extensively against rheumatoid arthritis in patients without cancer, after other drugs have failed).  Be aware that drug companies are half run by medical professionals; the other half of management are insurance lawyers.  I noticed that one of my prescription meds warns against SUNLIGHT !  I mentioned this to my doc, and he said "Yea, but all durgs today warn against sunlight," and I have since verified that a lot do. 

"Our drugs are safe, as long as you don't go outside, or inhale oxugen."   George Carlin used to do a skit in which he pretended to be a news anchor.  He said in one performance: 

"This medical news just in.  Scientists have now determined that salavia causes stomach cancer, but they said don't worry -- it only happens when swallowed in small amounts, over many years."

Historical note:  My oncologist told me one day that in the 1800s, lymphoma was considered by doctors to be a form of TB, I guess because of the abnormalities in WBCs that they bopth cause.

max

Mary from NJ's picture
Mary from NJ
Posts: 60
Joined: Apr 2016

Thank you for responding.  I just had the pneumonia vaccine 2 weeks ago and was told to be sure to get the flu shot when available this fall.  Interesting enough, the oncologist told me the vaccine to NOT have is the one for shingles!  I had shingles in my early 40s and made the assumption I could never get that again....until a few years ago, I learned that it IS possible to get again.  I am assuming that you did not have a negative reaction from the shingles vaccine? Based on many lymphoma patients having developed shingles, it would only make sense to have the vaccine.  I have to ask for more details as to why the oncologist said that I should not have this.   

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3518
Joined: May 2012

Mary,

I actually have not had the shingles vaccine myself, but an getting it soon. My former next-door neighbor did six month's EPOCH for aggressive NHL, and got severe shingles within a year of his remission.  Within two years after that had to have both hips replaced; the onc said that some drug had "starved the blood supply to the bone" and killed it. He was only about 40 at the time...the doc said it was a rare but known side-effect, but I had never heard of it occuring before or since. I do not know which drug it is attributed to, but I have heard of chemos that kill tumors by eliminating the blood supply to them.  The hip replacements solved his bone issue, and he is well today, seven years since NHL.

I moved 4 miles into our little town, and my new next-door neighbor, who had been followed for the liklihood of NHL was finally diagnosed at late stage IV NHL. Six months of R-CHOP has had him disease free for a couple years now, and no side-effects, although he is a little older, about 50 now.  I guess people are not going to want me to move next door !

All of these short and  long term effects are hit-or-miss and seemingly distributed randomly, so what your neighbor had, you almost certainly will not get. Except for the neuropathy and some mental cloudiness, I seem to have avoided the worst. The neuropathy is most aggrevating when trying to keyboard, which is tedious and slow for me today, although I never really learned how to type properly.

max

lindary's picture
lindary
Posts: 695
Joined: Mar 2015

Glad you brought up the subject of these shots. When I see my local oncologist I am going to ask her about all of these shots and which ones I should get, if any. The first and only time I got the flu shot was Dec 2014, before I started chemo in Jan. Last Dec they did not want me to get any shots because the White cell count was low and I was in "prep" for SCT. Now that there is no SCT in my future there may be some shots in fall. 

Anonymous user (not verified)

i was updated on all shots before my extended R regimen. My Mom had shingles before she died and believe me you don't want it. Its painful and nasty. Please get, as a minimum, shingles, two types of pneumonia, and flu vaccinations. Also ask to be tested for TB, hep A&B and C. I got thru 26 infusions over 2 1/2 years with no issues. Now however even though I was clear my last scan my WBC is under 3 And I am catching really bad colds and hospitalised for viral pneumonia (no vaccine for that). Do all you can to avoid infections. One of the worst things is the constant greeting with hugs that is so common. Especially don't hug young kids who attend daycare. Thats how I caught the viral pneumonia.

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3518
Joined: May 2012

GK,

Yo have been taking these left/right medical punches for some time.  I hope the colds, etc clear soon and you have a healthy Fall season.

 

Anonymous user (not verified)

this cold/flu/brochitis/pneumonia sure puts a damper on activities but life is still good!

KarenSMZL
Posts: 16
Joined: May 2016

I am a lymphoma patient but I am also a nurse with years of experience.  Our lowered immunities make us more susceptible to infections.  TB is not typically easy to catch, you need to be in close proximity to an active TB patient for a period of time.  However, when taking immunotherapy like Orencia or Rituxan, TB becomes much easier for us to get.  The TB test is very easy and as a nurse I am tested every 2 years.  Hope this helps.

OO7's picture
OO7
Posts: 282
Joined: Sep 2014

I wish someone told me about the vaccine.  I'm just now getting over it :-(

not fun....

 

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