title: Brief communication: rituximab in HIV-associated multicentric Castleman disease.
abstract: 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.
authors: Department of Oncology, Imperial College, The Chelsea and Westminster Hospital, Barts and the London NHS Trust, and Queen Mary's University, London, United Kingdom.
authors: Mark
authors: M
authors: Bower
authors: Tom
authors: T
authors: Powles
authors: Sarah
authors: S
authors: Williams
authors: Tom Newsom
authors: TN
authors: Davis
authors: Mark
authors: M
authors: Atkins
authors: Silvia
authors: S
authors: Montoto
authors: Chloe
authors: C
authors: Orkin
authors: Andy
authors: A
authors: Webb
authors: Martin
authors: M
authors: Fisher
authors: Mark
authors: M
authors: Nelson
authors: Brian
authors: B
authors: Gazzard
authors: Justin
authors: J
authors: Stebbing
authors: Peter
authors: P
authors: Kelleher
mesh_terms: 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
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D007155:Immunologic Factors; D000069283:Rituximab