title: Clinical characteristics and healthcare utilization of patients with multicentric Castleman disease.
abstract: Multicentric Castleman disease (MCD) is a rare lymphoproliferative disease. Little is known about how patient clinical features and healthcare utilization varies by human immunodeficiency virus (HIV) status and disease subtype. Data of MCD patients identified between 2000 and 2009 were collected from medical records at two United States treatment centres. Clinical, demographic, and biochemical characteristics, drug therapies and medical utilization were descriptively reported by HIV status and cell histology, and statistically compared with the Fisher's Exact and Kruskal-Wallis tests. Patients (n = 59) had a pathologically and clinically confirmed MCD diagnosis: plasmacytic (42%), hyaline vascular (29%) and mixed (15%); 10% had HIV infection. In the first year after diagnosis, MCD patients on average saw a healthcare provider more than six times, were hospitalized at least once and underwent frequent radiological and laboratory testing. Rituximab was the most commonly used drug therapy, followed by corticosteroids and conventional chemotherapy. One- and 2-year survival was excellent in HIV-negative patients (100% and 97%, respectively) but inferior for HIV-positive cases (67% and 67%, respectively). Heterogeneous treatment decisions were observed in this MCD study; HIV status was the only distinguishing clinical criteria associated with pharmacotherapies. Additional research is necessary to guide treatment of this rare lymphoproliferative disorder.
authors.affiliation: Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
authors.forename: Corey
authors.initials: C
authors.lastname: Casper
authors.forename: Dana Y
authors.initials: DY
authors.lastname: Teltsch
authors.forename: Don
authors.initials: D
authors.lastname: Robinson
authors.forename: Marie-Pierre
authors.initials: MP
authors.lastname: Desrosiers
authors.forename: Philip
authors.initials: P
authors.lastname: Rotella
authors.forename: Angela
authors.initials: A
authors.lastname: Dispenzieri
authors.forename: Ming
authors.initials: M
authors.lastname: Qi
authors.forename: Thomas
authors.initials: T
authors.lastname: Habermann
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Reynolds
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005871:Castleman Disease / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D015897:Comorbidity; D005260:Female; D015658:HIV Infections; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D010342:Patient Acceptance of Health Care; D012307:Risk Factors; D055815:Young Adult
keywords: Castleman disease; healthcare utilization; lymphoproliferative disorder; treatment