2-Chloro-deoxyadenosine Induces Durable Complete Remission in Castleman's Disease but may Accelerate its Transformation to Non-Hodgkin's Lymphoma

Colleoni, Gisele W. B.; Duarte, Luiz Cláudio C; Kerbauy, Fábio R.; Lobão, Marcos; Yunis, Melissa Palis; Alves, Antônio Corrêa; Souza, Vanda Akiko Ueda Fick de; Bordin, José Orlando; Oliveira, José Salvador Rodrigues de

doi:10.1080/02841860310003527

Cited by 10 publications

(13 citation statements)

References 13 publications

(15 reference statements)

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“…Reports of the use of 2-chlorodeoxyadenosine (2-CDA) in patients with CD are limited [56,57]. In a series of three patients with CD (two patients with multicentric and one patient with unresectable HV), two patients responded with relapse-free survivals of 24 and 20 months.…”

Section: -Chlorodeoxyadenosinementioning

confidence: 99%

“…In a series of three patients with CD (two patients with multicentric and one patient with unresectable HV), two patients responded with relapse-free survivals of 24 and 20 months. However, both patients later evolved to non-Hodgkin's lymphoma (diffuse large B-cell lymphoma and peripheral T-cell NHL, respectively) [56]. This brings into question it accelerates the transformation of CD to lymphoma [56], reminiscent of the high risk observed in HIVpositive patients [21•].…”

Section: -Chlorodeoxyadenosinementioning

confidence: 99%

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Treatment of castleman’s disease

Dispenzieri

Gertz

2005

Curr. Treat. Options in Oncol.

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Castleman's disease (CD) was first described in 1954 and further defined in 1956 by Castleman. Since then much has been learned about the heterogeneity of this condition. Subsequently, three pathologic classifications have been developed (hyaline vascular variant, plasma cell variant, and mixed variant) and two clinical classifications (unicentric [unifocal or localized] and multicentric [multifocal or generalized]). The pathology found with the unicentric presentation is most commonly that of the HV variant. It responds well to surgical resection and is associated with a benign course. The multicentric presentation is rarely composed of lymph nodes with HV pathology, but rather with the plasma cell or mixed pathology. This presentation requires systemic therapy and prognosis is guarded. Associated systemic symptoms are common. There is an increased incidence of CD in patients with HIV. The human herpes virus-8 is associated with nearly all of the HIV-associated CD cases and nearly 50% of non-HIV cases. Interleukin (IL)-6 has also been shown to play a significant role in the pathogenesis of the disease. Paraneoplastic and autoimmune entities are not uncommon in the disorder. Variable benefit has been achieved with single agent chemotherapy, combination chemotherapy, interferon (IFN)-alpha, rituximab, anti-IL-6 receptor antibodies, and thalidomide. Patients with CD are at increased risk for developing frank malignant lymphoma.

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Section: -Chlorodeoxyadenosinementioning

confidence: 99%

Section: -Chlorodeoxyadenosinementioning

confidence: 99%

Treatment of castleman’s disease

Dispenzieri

Gertz

2005

Curr. Treat. Options in Oncol.

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“…Seven of these 12 patients were treated with cladribine and a combination of other agents, including prednisone, cyclophosphamide, fludarabine, chlorambucil, thalidomide, and rituximab. Other reported malignancies associated with Waldenstro¨m's macroglobulinemia include acute leukaemia [5] and immunoblastic sarcoma [6,7]. These cases usually occur after treatment with alkylating agents.…”

Section: Discussionmentioning

confidence: 99%

“…It has also been reported that 2-CDA may accelerate the transformation of Castleman's disease to non-Hodgkin's lymphoma [6]. In 2003, Lenz et al described a case of EBV-associated non-Hodgkin's lymphoma shortly after cladribine treatment of hairy-cell leukemia [7]. Although the increased risk of secondary malignancies was found to be statistically significant in a study of 2,014 patients with chronic lymphocytic leukaemia and hairy-cell leukaemia treated with nucleoside analogues (NA), fludarabine and cladribine, whether the risk is a consequence of NA or is simply attributed to the underlying disease is not clear.…”

Section: Discussionmentioning

confidence: 99%

Transformation and progression of Waldenström's macroglobulinemia following cladribine therapy in two cases: natural evolution or iatrogenic causation?

et al. 2006

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We report two cases of Waldenströ m's macroglobulinemia with an unusual aggressive transformation following treatment with cladribine (2-chlorodeoxyadenosine, 2-CdA), a purine analogue. The first patient developed transformation to a diffuse large-cell nonHodgkin lymphoma, while the second developed extensive extramedullary involvement. Both patients displayed rapid progression following transformation and were refractory to chemotherapy. Both patients were pretreated with multiple courses of prednisone and chlorambucil, and transformation occurred shortly after therapy with cladribine. We propose that immune suppression from alkylating agents and purine analogues may have contributed to the unusual progression, resulting in a dismal outcome. Am.

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“…Single chemotherapy agents including etoposide [15], cladribine [16], thalidomide [17] have been successful in inducing remissions but symptoms often recurred after discontinuation of therapy. Combination chemotherapy (CHOP and CVAD [18,19]) has had more success in achieving prolonged complete remissions.…”

Section: Introductionmentioning

confidence: 99%

Multicentric Castleman's disease treated with combination chemotherapy and rituximab in four HIV‐positive men: A case series

et al. 2007

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Multicentric Castleman's disease (MDC) is a rare herpesvirus-8-related prelymphomatous condition that may develop in patients infected with human immunodeficiency virus (HIV). Therapy for MCD is not well established and most often includes: corticosteroids, single or combined chemotherapy, anti-CD20 monoclonal antibody and antiretroviral therapy. In order to obtain a rapid and long-lasting clinical response, we are reporting on a short course of anthracycline-based chemotherapy associated with rituximab in HIV-positive patients with MCD. Our study suggests that the combined immuno-chemotherapy approach may represent a valid strategy with acceptable toxicity in patients with severe and extensive MDC. Further studies will be needed to assess the efficacy and safety of such an approach, and to identify risk factors predictive of long-term tolerance in HIV patients with different degrees of immunosuppression. Am. J. Hematol. 83:508-511, 2008. V

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2-Chloro-deoxyadenosine Induces Durable Complete Remission in Castleman's Disease but may Accelerate its Transformation to Non-Hodgkin's Lymphoma

Cited by 10 publications

References 13 publications

Treatment of castleman’s disease

Treatment of castleman’s disease

Transformation and progression of Waldenström's macroglobulinemia following cladribine therapy in two cases: natural evolution or iatrogenic causation?

Multicentric Castleman's disease treated with combination chemotherapy and rituximab in four HIV‐positive men: A case series

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