Brief Communication: Rituximab in HIV-Associated Multicentric Castleman Disease
- Mark Bower, PhD;
- Tom Powles, MD;
- Sarah Williams, MB;
- Tom Newsom Davis, PhD;
- Mark Atkins, PhD;
- Silvia Montoto, MD;
- Chloe Orkin, MD;
- Andy Webb, PhD;
- Martin Fisher, BSc;
- Mark Nelson, MA;
- Brian Gazzard, MD;
- Justin Stebbing, PhD; and
- Peter Kelleher, PhD
- From Imperial College, The Chelsea and Westminster Hospital, Barts and the London NHS Trust, and Queen Mary's University, London, and Royal Sussex Country Hospital, Brighton, United Kingdom.
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.
Design: Single-group, open-label, phase II trial.
Setting: 3 teaching hospitals in England.
Patients: Previously untreated patients with histologically proven HIV-associated multicentric Castleman disease.
Intervention: 4 infusions of rituximab, 375 mg per m2 of body surface area, at weekly intervals.
Measurements: 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.
Limitation: The study had no comparison group.
Conclusion: Rituximab may be clinically valuable as initial therapy for HIV-associated multicentric Castleman disease.
Article and Author Information
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Financial Support: Support for the cytokine assays was provided by St. Stephen's AIDS Trust, a national charity supporting clinical research in HIV/AIDS.
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Potential Financial Conflicts of Interest: None disclosed.
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Requests for Single Reprints: Mark Bower, PhD, Department of Oncology, The Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, United Kingdom; e-mail, m.bower{at}imperial.ac.uk.
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Current Author Addresses: Drs. Bower, Newsom Davis, Atkins, and Gazzard; Ms. Williams; and Mr. Nelson: The Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, United Kingdom.
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Drs. Powles, Montoto, and Orkin: St. Bartholomew's Hospital, Little Brittain, London EC1 7BE, United Kingdom.
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Dr. Webb and Mr. Fisher: Royal Sussex County Hospital, Eastern Road, Brighton BN1 3RP, United Kingdom.
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Drs. Stebbing and Kelleher: Imperial College School of Medicine, 369 Fulham Road, London SW10 9NH, United Kingdom.
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Author Contributions: Conception and design: M. Bower, T. Powles, T. Newsom Davis, C. Orkin, M. Nelson, B. Gazzard, J. Stebbing, P. Kelleher.
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Analysis and interpretation of the data: M. Bower, T. Powles, S. Williams, T. Newsom Davis, S. Montoto, J. Stebbing, P. Kelleher.
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Drafting of the article: M. Bower, T. Powles, S. Montoto, J. Stebbing, P. Kelleher.
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Critical revision of the article for important intellectual content: M. Bower, T. Powles, M. Atkins, S. Montoto, A. Webb, M. Fisher, M. Nelson, J. Stebbing, P. Kelleher.
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Final approval of the article: M. Bower, T. Powles, S. Williams, T. Newsom Davis, S. Montoto, C. Orkin, A. Webb, M. Fisher, M. Nelson, B. Gazzard, J. Stebbing.
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Provision of study materials or patients: M. Bower, M. Atkins, S. Montoto, C. Orkin, A. Webb, M. Fisher, M. Nelson, P. Kelleher.
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Statistical expertise: M. Bower, J. Stebbing.
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Obtaining of funding: M. Nelson, B. Gazzard, P. Kelleher.
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Administrative, technical, or logistic support: M. Bower, B. Gazzard, P. Kelleher.
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Collection and assembly of data: M. Bower, M. Atkins, A. Webb, M. Fisher, J. Stebbing, P. Kelleher.
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