Brief communication: rituximab in HIV-associated multicentric Castleman disease.
BACKGROUND
HIV-associated multicentric Castleman disease is a rare lymphoproliferative disorder with marked systemic symptoms attributed to cytokine disarray. Many therapeutic approaches in small series of patients have proved largely unsuccessful to date.


OBJECTIVE
To investigate the efficacy and clinicopathologic variables associated with first-line treatment for HIV-associated multicentric Castleman disease with the anti-CD20 monoclonal antibody rituximab.


METHODS
Single-group, open-label, phase II trial.


METHODS
3 teaching hospitals in England.


METHODS
Previously untreated patients with histologically proven HIV-associated multicentric Castleman disease.


METHODS
4 infusions of rituximab, 375 mg per m2 of body surface area, at weekly intervals.


METHODS
Response was evaluated clinically and radiologically and by measuring plasma Kaposi sarcoma-associated herpesvirus viral load.


RESULTS
21 consecutive patients (18 men) with plasmablastic multicentric Castleman disease were recruited. The median follow-up was 12 months (range, 1 to 49 months). One patient died before completing therapy, 20 achieved remission of symptoms, and 14 (67%) achieved a radiologic response. The overall and disease-free survival rates at 2 years were 95% (95% CI, 86% to 100%) and 79% (CI, 49% to 100%), respectively. Plasma acute-phase proteins, immunoglobulins, and Kaposi sarcoma-associated herpesvirus viral load decreased after rituximab therapy. The main adverse effect was reactivation of Kaposi sarcoma.


CONCLUSIONS
The study had no comparison group.


CONCLUSIONS
Rituximab may be clinically valuable as initial therapy for HIV-associated multicentric Castleman disease.
Bower
Mark
M
Department of Oncology, Imperial College, The Chelsea and Westminster Hospital, Barts and the London NHS Trust, and Queen Mary's University, London, United Kingdom.
Powles
Tom
T
Williams
Sarah
S
Davis
Tom Newsom
TN
Atkins
Mark
M
Montoto
Silvia
S
Orkin
Chloe
C
Webb
Andy
A
Fisher
Martin
M
Nelson
Mark
M
Gazzard
Brian
B
Stebbing
Justin
J
Kelleher
Peter
P
D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D005871:Castleman Disease / Q000097:blood / Q000150:complications* / Q000188:drug therapy* / Q000821:virology; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000150:complications* / Q000821:virology; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D000069283:Rituximab; D019562:Viral Load
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D007155:Immunologic Factors; D000069283:Rituximab