Castleman's disease medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [2]
Overview
Medical Therapy
Unicentric
- Surgical resection is often curative,[1] [2] and the prognosis is excellent.
- If surgery fails or is not possible then the following forms of treatment can be used
Multicentric
There is no standard therapy for MCD at the moment.
It is important to distinguish AIDS-related Multicentric Castleman’s disease from other forms of Multicentric Castleman’s disease. Treatment for the former can be focused upon the same protocols used for treating the underlying AIDS.[3]
Recent work with HIV-positive patients with KSHV-related MCD suggests that treatment with the antiherpesvirus drug ganciclovir or the antiCD20 B cell monoclonal antibody, rituximab, may markedly improve outcome. These drugs target and kill B cells via the B cell specific CD20 marker. Since B cells are required for the production of antibodies, the body's immune response is weakened whilst on treatment and the risk of further viral or bacterial infection is increased. Due to the uncommon nature of the condition there are not many large scale research studies from which standardized approaches to therapy may be drawn, and the extant case studies of individuals or small cohorts should be read with caution. As with many diseases, the patient's age, physical state and previous medical history with respect to infections may impact on the disease progression and outcome.
Use of tocilizumab has been proposed.[4]
Siltuximab, a monoclonal antibody that binds interleukin-6, is currently being investigated in a Phase II clinical trial.[5]
Other treatments for multicentric castleman disease include the following:
References
- ↑ name=pmid21934347
- ↑ Talarico F, Negri L, Iusco D, Corazza GG (2008). "Unicentric Castleman's disease in peripancreatic tissue: case report and review of the literature". G Chir. 29 (4): 141–4. PMID 18419976. Unknown parameter
|month=ignored (help) - ↑ Sprinz E, Jeffman M, Liedke P, Putten A, Schwartsmann G (2004). "Successful treatment of AIDS-related Castleman's disease following the administration of highly active antiretroviral therapy (HAART)". Ann. Oncol. 15 (2): 356–8. doi:10.1093/annonc/mdh066. PMID 14760135. Unknown parameter
|month=ignored (help) - ↑ Matsuyama M, Suzuki T, Tsuboi H; et al. (2007). "Anti-interleukin-6 receptor antibody (tocilizumab) treatment of multicentric Castleman's disease" (– Scholar search). Intern. Med. 46 (11): 771–4. doi:10.2169/internalmedicine.46.6262. PMID 17541233.[dead link]
- ↑ A Study to Evaluate the Safety of Long-term Treatment With Siltuximab in Patients With Multicentric Castleman's Disease ClinalTrails.gov.
- ↑ http://www.mayoclinic.com/health/castleman-disease/DS01000/DSECTION=treatments-and-drugs