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1. Rituximab in HIV-Associated Multicentric Castleman Disease

   • Raphael Stricker, MD

   California Pacific Medical Center

   The excellent clinical report by Bower and colleagues (1) demonstrates the efficacy of rituximab in HIV-associated multicentric Castleman disease. The main adverse reaction to this therapy was progression of Kaposi’s sarcoma (KS) in 36% of patients. As noted by the authors, activation of human herpesvirus 8 (HHV-8), the viral agent associated with both KS and Castleman disease, appears to be mediated by two cytokines, IL-6 and IL-10 (2).

   The authors measured cytokine levels in their patients before and after treatment with rituximab. The method of cytokine measurement was not described in the article. Only two cytokines showed a rebound pattern after initial suppression by rituximab: IL-6 and IL-10. It would be of interest to know whether this rebound was associated with progression of KS in individual patients. Cytokine levels might also be useful to predict response to rituximab in HIV-associated Castleman disease.

   Raphael B. Stricker, MD California Pacific Medical Center San Francisco, CA 94108

   References

   1. Bower M, Powles T, Williams S, Davis TN, Atkins M, Montoto S, Orkin C, Webb A, Fisher M, Nelson M, Gazzard B, Stebbing J, Kelleher P. Brief communication: rituximab in HIV-associated multicentric Castleman disease. Ann Intern Med 2007;147:836-9.

   2. Oksenhendler E, Carcelain G, Aoki Y, Boulanger E, Maillard A, Clauvel JP, Agbalika F. High levels of human herpesvirus 8 viral load, human interleukin-6, interleukin-10, and C reactive protein correlate with exacerbation of multicentric Castleman disease in HIV-infected patients. Blood 2000;96:2069-73.

   Conflict of Interest:

   None declared

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   Published March 12, 2008