Use of rituximab as a salvage therapy for HIV-associated multicentric Castleman disease

Abstract

Several approved therapies for multicentric Castleman disease (MCD) cannot be uniformly applied due to intolerable side effects. There is also a high percentage of recurrence of this disease despite treatment. Rituximab may be effective in controlling MCD in a subset of patients. This paper includes a brief case report and an extensive review of previously published cases. We observed an aggravation of concomitant cutaneous Kaposi sarcoma, and hypothesize that rituximab could have exacerbated it.

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

“…Although HHV-8-infected plasmablasts frequently do not express high levels of CD20, it has been speculated that rituximab is effective in HIV-MCD by eliminating or reducing the pool of HHV-8-infected B cells, which are localized mainly in the mantle zone of lymph nodes. After initial case reports, [15][16][17][18] two recent pilot studies have evaluated rituximab in patients with HIV-MCD. In a French study, 19 16 of 24 patients reached a complete remission of clinical symptoms after 4 cycles.…”

How I treat HIV-associated multicentric Castleman disease

“…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.…”

Cytokine changes during rituximab therapy in HIV-associated multicentric Castleman disease

“…2,3 Manifestations of the disease are thought to be related in part to cytokine disarray, in particular increased levels of interleukin-6 (IL-6), a homologue of which is produced by the HHV-8 genome. 4,5 Treatment of HIV-MCD had been largely ineffective until a number of case reports [6][7][8][9][10][11] and 2 recent single-arm clinical trials showed that rituximab induces clinical remission in both persons at first presentation 12,13 and with pretreated and relapsed HIV-MCD. 14 Rituximabinduced B-cell depletion, a likely reservoir of HHV-8, has been postulated to occur via antibody-dependent cell-mediated cytotoxicity (ADCC), complement-dependent cytotoxicity, and apoptosis.…”