Successful treatment of multicentric Castleman's disease with combined immunochemotherapy in an AIDS patient with multiorgan failure

How I treat HIV-associated multicentric Castleman disease

“…23,39 However, the oncogenicity of etoposide, in particular the risk of secondary acute myeloid leukemia, 56 limits this approach. The encouraging results observed with rituximab monotherapy in patients with less aggressive HIV MCD have led to a combined immunochemotherapy approach in aggressive HIV MCD using rituximab with combination chemotherapy 27,57 or rituximab with single-agent etoposide. 38 The optimal chemotherapy has not been established; and although several case reports described successful treatment of HIV MCD with the cyclophosphamide, doxorubicin, vincristin, prednisone (CHOP) regimen without rituximab, 48,50,52,55 there is greater experience with rituximab and etoposide.…”

“…Similarly, the combination of peripheral neuropathy and monoclonal paraprotein with or without other features of POEMS is well recognized in plasma cell MCD but is only rarely seen in patients with HIV. 27 Nevertheless, the combination of pyrexia, lymphadenopathy, and splenomegaly with a raised C-reactive protein should alert clinicians to the possibility of this diagnosis and prompt investigations.…”

Rituximab plus liposomal doxorubicin in HIV-infected patients with KSHV-associated multicentric Castleman disease

“…[36][37][38][39][40] Also, rituximab alone may sometimes be inadequate in severe KSHV-MCD. [41][42][43] We combined rituximab with liposomal doxorubicin (R-Dox) with the rationale that liposomal doxorubicin would directly target CD20 -KSHV-infected MCD plasmablasts and KS spindle cells, including those in lymph nodes that may provide paracrine stimulation for KSHV-MCD plasmablasts. 44 We describe a pilot study of R-Dox in HIV-infected KSHV-MCD patients with concurrent KS and/or inflammatory symptoms of at least moderate severity.…”

Selective killing of Kaposi's sarcoma-associated herpesvirus lytically infected cells with a recombinant immunotoxin targeting the viral gpK8.1A envelope glycoprotein

“…16,24,25 Antineoplastic chemotherapy with single or combination agents has yielded clinical remissions, though the responses are typically transient and drug toxicities limit extended use. Successes have been reported with immunotherapy using monoclonal antibodies (mAbs) tocilizumab (Actemra ® ), 26 and siltuximab 27 against interlekin-6 or rituximab against the B-cell antigen CD20, 18,[28][29][30][31] though the latter agent has been complicated by aggravation of KS lesions. 28,29,32 A recent report described MCD remission in a multiple myeloma patient undergoing treatment with the proteosome inhibitor bortezomib.…”