Long-term remission of Kaposi sarcoma-associated herpesvirus-related multicentric Castleman disease with anti-CD20 monoclonal antibody therapy.
Kaposi sarcoma-associated herpesvirus (KSHV)-related multicentric Castleman disease (MCD) is potentially lethal. Growing evidence indicates that, as in Epstein-Barr virus-driven lymphoproliferative disorders after transplantation, KSHV DNA burden in peripheral blood mononuclear cells (PBMCs) may represent the most accurate marker of disease activity. This report describes a patient with human immunodeficiency virus who was followed up clinically and by quantitative polymerase chain reaction for KSHV DNA sequences in PBMCs for more than 3 years following the diagnosis of KSHV-related MCD. Therapy with the antiherpesvirus agent cidofovir, antihuman interleukin-6 antibody BE-8, antiblastic chemotherapy, and combination antiretroviral agents did not achieve durable clinical or virologic remission of the disease. By contrast, administration of the anti-CD20 monoclonal antibody rituximab was well tolerated and allowed a 14-month remission of clinical symptoms and KSHV viremia. Rituximab should be added to the therapeutic armamentarium for KSHV-related MCD.
Corbellino
M
M
Institute of Infectious Diseases and Tropical Medicine, University of Milan, Italy. mcorbell@mailserver.unimi.it
Bestetti
G
G
Scalamogna
C
C
Calattini
S
S
Galazzi
M
M
Meroni
L
L
Manganaro
D
D
Fasan
M
M
Moroni
M
M
Galli
M
M
Parravicini
C
C
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20 / Q000276:immunology*; D005871:Castleman Disease / Q000821:virology*; D004279:DNA, Viral / Q000097:blood; D005260:Female; D019288:Herpesvirus 8, Human / Q000235:genetics; D006801:Humans; D007167:Immunotherapy; D015850:Interleukin-6 / Q000032:analysis / Q000276:immunology; D007963:Leukocytes, Mononuclear / Q000821:virology; D008198:Lymph Nodes / Q000737:chemistry / Q000821:virology; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D012074:Remission Induction; D000069283:Rituximab; D012514:Sarcoma, Kaposi / Q000821:virology*
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20; D004279:DNA, Viral; D015850:Interleukin-6; D000069283:Rituximab