By Shane Reeves, Chief Executive Officer, TwelveStone Health Partners
The packing list for a first infusion is strangely domestic. TwelveStone tells people to bring whatever calms them. Suggestions range from a crossword to a playlist to a Bible. The bigger questions, though, still need answers. What is this drug going to do? Why does the paperwork list a medication name the oncologist never told me about? How long is this going to take? September is Leukemia and Lymphoma Awareness Month, which makes it a fair time to answer them.
What the Drug Does
Rituximab hunts a marker. Certain B cells carry a protein called CD20 on their surface; rituximab locks onto it, and the immune system takes it from there. Oncologists reach for rituximab in certain B-cell non-Hodgkin lymphomas, including diffuse large B-cell lymphoma, and in chronic lymphocytic leukemia. It runs on its own in certain regimens and alongside chemotherapy in others. What a patient gets depends on the type of cancer, how far along it is, what has been tried, and how the patient is responding. Two people with the same diagnosis can leave with different schedules.
Why the Bag Says a Different Name
Rituximab is sold under three brand names: Rituxan, Truxima, and Ruxience. Rituxan came first. Truxima and Ruxience are biosimilars, which is the FDA’s way of saying it checked them against Rituxan and found no clinically meaningful differences in safety or effectiveness. Which one is used depends on what the oncologist ordered and what the insurance will cover.
Why the First One Takes All Day
Rituximab carries a boxed warning: infusion reactions, severe skin and mouth reactions, hepatitis B coming back, and a rare brain infection called PML. Roughly 80 percent of the fatal infusion reactions happened on somebody’s first infusion. So, the first visit gets built around that. Blood work checks for hepatitis B, using HBsAg and anti-HBc, plus a CBC with platelets, before anything goes in. Premedications go first, then the drip starts slow, with the nurse stepping it up only as the body tolerates it. Genentech puts later cycles at three to four hours, and the first runs longer.
Line up a ride for the first appointment. Weakness or dizziness makes driving unsafe, and the first dose is when patients learn how their bodies respond. Many insurance plans cover transportation, so check your benefits.
Who Decides What, and Where
The oncologist prescribes the drug and designs the schedule. Choosing an infusion location needs to involve the patient. A 2025 analysis found comparable outcomes at lower cost in outpatient settings. The same review cited a survey in which more than two-thirds of infusion patients had no say in where they were treated. Where treatment will take place is a fair question, and it allows patients to work with their teams to find the best location.
Once the oncologist signs off on outpatient treatment, TwelveStone administers the prescribed product in a private suite and sends notes back to the referring practice. Patients who want additional support can connect with a TwelveStone peer advocate with the same condition to share firsthand experience.
The packing list still looks strangely domestic. Knowing what the medication does and what to expect makes the first appointment easier.
Prescribed rituximab? Learn more about receiving your infusion at a TwelveStone Infusion Center, or ask your care team whether TwelveStone is an option.
This article offers general education and does not replace guidance from a treating oncologist. Treatment decisions depend on individual diagnosis and clinical circumstances.
