title: Long-term remission in idiopathic Castleman's disease with tocilizumab followed by consolidation with high-dose melphalan--two case studies.
abstract: Multicentric Castleman's disease (MCD) is an uncommon lymphoproliferative disorder, often associated with a clinically aggressive behavior. No standard treatment has been established, but patients are usually treated with lymphoma-type regimens such as rituximab or combination chemotherapy. Recently, immunotherapies targeting IL-6 have proven effective and have been approved for this indication. However, these agents require long-term administration. Here, we describe the clinical course of two patients, refractory to rituximab and chemotherapy, showing long-term remission (18 and 24 months), following an induction phase with tocilizumab (an anti-IL-6 receptor antibody) and a consolidative phase with high-dose melphalan accompanied by autologous stem cell support. This may prove to be an effective option for this group of patients with an orphan disorder.
authors.affiliation: Department of Oncology, Skane University Hospital, Lund, Sweden.
authors.forename: Mats
authors.initials: M
authors.lastname: Jerkeman
authors.affiliation: Department of Oncology, Skane University Hospital, Lund, Sweden.
authors.forename: Ola
authors.initials: O
authors.lastname: Lindén
mesh_terms: D000328:Adult; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D000970:Antineoplastic Agents; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D015415:Biomarkers; D001706:Biopsy; D005871:Castleman Disease / Q000175:diagnosis / Q000188:drug therapy*; D060830:Consolidation Chemotherapy; D005260:Female; D006801:Humans; D060828:Induction Chemotherapy; D008297:Male; D008558:Melphalan / Q000008:administration & dosage*; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D015415:Biomarkers; C502936:tocilizumab; D008558:Melphalan
keywords: Castleman′s disease; autologous stem cell transplantation; tocilizumab