Failure of rituximab in human immunodeficiency virus-associated multicentric Castleman disease

Abstract

Two human immunodeficiency virus-infected patients who needed etoposide therapy to control exacerbations of Castleman disease received four infusions of rituximab. Clinical and virologic relapses with increased blood human herpesvirus-8 DNA levels occurred in both patients 4 and 24 weeks later and were associated with a worsening of Kaposi sarcoma. Am.

Improved outcome with rituximab in patients with HIV-associated multicentric Castleman disease

“…It can be speculated that treatment started too late in this individual case. Indeed, there are a few cases in the literature 22,23 describing fulminant courses of HIV-MCD in which rituximab failed.…”

How I treat HIV-associated multicentric Castleman disease

“…However, 2 case series have described patients with aggressive HIV MCD and organ failure who failed to respond to rituximab monotherapy. [42][43][44] For this reason, I now follow a stratified approach to the management of HIV MCD, reserving rituximab monotherapy for patients without evidence of organ failure and using chemotherapy with rituximab for those with aggressive disease based on poor performance status (Eastern Cooperative Oncology Group Performance Status Ͼ 1) and evidence of organ damage, usually lung involvement, hemophagocytic syndrome, or severe hemolytic anemia.…”

“…10,12,39,43,[45][46][47][48][49][50][51][52][53][54][55] Although rapid resolution of symptoms has been reported in patients with active disease, relapses occur frequently and the progression-free survival is often brief. A strategy using maintenance oral etoposide (100-200 mg/m 2 , weekly) has been adopted in France.…”

HIV-associated multicentric Castleman disease

“…(59) Although these studies suggest efficacy of rituximab for HIV MCD, two case series have described patients with aggressive HIV MCD and organ failure who failed to respond to rituximab monotherapy. (69, 70)…”