title: Tocilizumab for AA Amyloidosis after Treatment of Multicentric Castleman Disease with Steroids, Chemotherapy and Rituximab for Over 20 Years.
abstract: We herein report the long-term outcome (30 years) of a human immunodeticiency virus- and human herpesvirus 8-negative Japanese man who was diagnosed to have multicentric Castleman disease (MCD) of the plasmacytic type after investigation of generalized lymphadenopathy at 34 of age in 1983. He received chemotherapy based on lymphoma regimens (combinations of prednisolone, vincristine, vindesine, cyclophosphamide, etoposide, melphalan, and ranimustine, etc.) for over 20 years. Although the systemic lymphadenopathy resolved, AA amyloidosis-related nephropathy occurred, with a serum creatinine (Cre) level of 0.9 mg/dL and urinary protein excretion (UP) of 7.5 g daily. Rituximab was started, but Cre increased to 2.6 mg/dL in 2010 and UP was unchanged. Therefore, treatment with tocilizmab was started. As a result, his hypergammaglobulinemia was well controlled, C-reactive protein became normal, UP decreased to 3.5 g daily, and Cre remained at 2.5 mg/dL in 2013. When AA amyloid nephropathy occurred after long-term chemotherapy, lituximab could not control it, but tocilizmab stopped the progression of nephropathy. This case suggests that MCD and AA amyloidosis may both have a close relationship to the overproduction of interleukin-6.
authors.affiliation: Nephrology Center, Toranomon Hospital Kajigaya, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Iijima
authors.forename: Junichi
authors.initials: J
authors.lastname: Hoshino
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Suwabe
authors.forename: Keiichi
authors.initials: K
authors.lastname: Sumida
authors.forename: Koki
authors.initials: K
authors.lastname: Mise
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kawada
authors.forename: Toshiharu
authors.initials: T
authors.lastname: Ueno
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hamanoue
authors.forename: Noriko
authors.initials: N
authors.lastname: Hayami
authors.forename: Rikako
authors.initials: R
authors.lastname: Hiramatsu
authors.forename: Naoki
authors.initials: N
authors.lastname: Sawa
authors.forename: Kenmei
authors.initials: K
authors.lastname: Takaichi
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Ubara
mesh_terms: D000686:Amyloidosis / Q000139:chemically induced* / Q000188:drug therapy; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D002097:C-Reactive Protein / Q000096:biosynthesis; D005871:Castleman Disease / Q000188:drug therapy*; D018450:Disease Progression; D006801:Humans; D007674:Kidney Diseases / Q000139:chemically induced / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D000069283:Rituximab / Q000009:adverse effects; D013256:Steroids / Q000009:adverse effects
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D013256:Steroids; D000069283:Rituximab; D002097:C-Reactive Protein; C502936:tocilizumab