Difference between revisions of "Castleman disease"
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===Regimen {{#subobject:0a3d2a|Variant=1}}=== | ===Regimen {{#subobject:0a3d2a|Variant=1}}=== | ||
− | {| class="wikitable" style="width: | + | {| class="wikitable" style="width: 50%; text-align:center;" |
− | !style="width: | + | !style="width: 25%"|Study |
− | !style="width: | + | !style="width: 25%"|[[Levels_of_Evidence#Evidence|Evidence]] |
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|[http://jco.ascopubs.org/content/25/22/3350.long Gérard et al. 2007 (ANRS 117 CastlemaB)] | |[http://jco.ascopubs.org/content/25/22/3350.long Gérard et al. 2007 (ANRS 117 CastlemaB)] | ||
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===Regimen {{#subobject:a0de40|Variant=1}}=== | ===Regimen {{#subobject:a0de40|Variant=1}}=== | ||
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− | !style="width: | + | !style="width: 25%"|[[Levels_of_Evidence#Evidence|Evidence]] |
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|[http://journals.lww.com/jpho-online/Abstract/2008/12000/IL_1RA_Agonist__Anakinra__in_the_Treatment_of.13.aspx Galeotti et al. 2008] | |[http://journals.lww.com/jpho-online/Abstract/2008/12000/IL_1RA_Agonist__Anakinra__in_the_Treatment_of.13.aspx Galeotti et al. 2008] | ||
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===Regimen {{#subobject:9b3fef|Variant=1}}=== | ===Regimen {{#subobject:9b3fef|Variant=1}}=== | ||
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− | !style="width: | + | !style="width: 25%"|[[Levels_of_Evidence#Evidence|Evidence]] |
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|[https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2141.2006.06212.x Hess et al. 2006] | |[https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2141.2006.06212.x Hess et al. 2006] | ||
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===Regimen {{#subobject:5dd5b9|Variant=1}}=== | ===Regimen {{#subobject:5dd5b9|Variant=1}}=== | ||
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− | !style="width: | + | !style="width: 25%"|[[Levels_of_Evidence#Evidence|Evidence]] |
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|[https://www.jstage.jst.go.jp/article/jslrt/53/1/53_95/_article Inoue et al. 2013] | |[https://www.jstage.jst.go.jp/article/jslrt/53/1/53_95/_article Inoue et al. 2013] | ||
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===Regimen {{#subobject:251273|Variant=1}}=== | ===Regimen {{#subobject:251273|Variant=1}}=== | ||
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− | !style="width: | + | !style="width: 25%"|Study |
− | !style="width: | + | !style="width: 25%"|[[Levels_of_Evidence#Evidence|Evidence]] |
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|[https://onlinelibrary.wiley.com/doi/10.1111/j.1600-0609.2005.00570.x/full Ide et al. 2006] | |[https://onlinelibrary.wiley.com/doi/10.1111/j.1600-0609.2005.00570.x/full Ide et al. 2006] | ||
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===Regimen {{#subobject:c4a164|Variant=1}}=== | ===Regimen {{#subobject:c4a164|Variant=1}}=== | ||
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− | !style="width: | + | !style="width: 25%"|[[Levels_of_Evidence#Evidence|Evidence]] |
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|[https://onlinelibrary.wiley.com/doi/10.1002/ajh.24242/full Iwaki et al. 2016] | |[https://onlinelibrary.wiley.com/doi/10.1002/ajh.24242/full Iwaki et al. 2016] | ||
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TCP: '''<u>T</u>'''halidomide, '''<u>C</u>'''yclophosphamide, '''<u>P</u>'''rednisone | TCP: '''<u>T</u>'''halidomide, '''<u>C</u>'''yclophosphamide, '''<u>P</u>'''rednisone | ||
===Regimen {{#subobject:0a11f4|Variant=1}}=== | ===Regimen {{#subobject:0a11f4|Variant=1}}=== | ||
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|[http://www.bloodjournal.org/content/133/16/1720.long Zhang et al. 2019 (ZS-1159)] | |[http://www.bloodjournal.org/content/133/16/1720.long Zhang et al. 2019 (ZS-1159)] | ||
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===Regimen {{#subobject:c5ac9b|Variant=1}}=== | ===Regimen {{#subobject:c5ac9b|Variant=1}}=== | ||
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|[http://www.bloodjournal.org/content/106/8/2627.long Nishimoto et al. 2005] | |[http://www.bloodjournal.org/content/106/8/2627.long Nishimoto et al. 2005] |
Revision as of 00:50, 10 May 2019
9 regimens on this page
9 variants on this page
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There are (at least) three distinct entities under this topic: unicentric Castleman's disease (UCD); HHV-8-positive multicentric Castleman's disease (MCD), which is usually (but not always) associated with HIV, and HHV-8-negative a.k.a. idiopathic MCD. UCD is usually treated with surgery or embolization. There are very few prospective trials for these diseases. The first-ever diagnostic criteria for HHV-8-negative "idiopathic" Multicentric Castleman disease can ensure diagnosis is correct and subsequent treatment is appropriate for the diagnosed subtype. You can read the full Diagnostic Criteria article here.
Guidelines
Chemotherapy
- For a list of chemotherapy regimens used plus their references, please visit http://www.cdcn.org/about-castleman-disease/treatments/nonspecific-cytotoxic-immuno-depletion
"How I treat"
- 2010: Bower M. How I treat HIV-associated multicentric Castleman disease. Blood. 2010 Nov 25;116(22):4415-21. Epub 2010 Aug 5. link to original article PubMed
International Consensus guidelines
- 2017: Fajgenbaum et al. International, evidence-based consensus diagnostic criteria for HHV-8–negative/idiopathic multicentric Castleman disease
- 2018: van Rhee et al. International, evidence-based consensus treatment guidelines for idiopathic multicentric Castleman disease
HIV-associated multicentric Castleman disease, all lines of therapy
Rituximab monotherapy
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Regimen
Study | Evidence |
---|---|
Gérard et al. 2007 (ANRS 117 CastlemaB) | Phase II |
Bower et al. 2007 | Phase II |
Chemotherapy
- Rituximab (Rituxan) 375 mg/m2 IV once per week
4-week course
References
- Gérard L, Bérezné A, Galicier L, Meignin V, Obadia M, De Castro N, Jacomet C, Verdon R, Madelaine-Chambrin I, Boulanger E, Chevret S, Agbalika F, Oksenhendler E. Prospective study of rituximab in chemotherapy-dependent human immunodeficiency virus associated multicentric Castleman's disease: ANRS 117 CastlemaB Trial. J Clin Oncol. 2007 Aug 1;25(22):3350-6. link to original article contains verified protocol PubMed
- 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 Dec 18;147(12):836-9. link to original article contains verified protocol PubMed
HHV-8-negative/"Idiopathic" multicentric Castleman disease, all lines of therapy
The first-ever diagnostic criteria for HHV-8-negative "idiopathic" multicentric Castleman disease was published in Blood in 2017. You can read the full PMC article here.
Anakinra monotherapy
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Regimen
Study | Evidence |
---|---|
Galeotti et al. 2008 | Case report |
Immunosuppressive therapy
- Anakinra (Kineret) 1 mg/kg SC once per day
Continued indefinitely
References
- Case report: Galeotti C, Tran TA, Franchi-Abella S, Fabre M, Pariente D, Koné-Paut I. IL-1RA agonist (anakinra) in the treatment of multifocal castleman disease: case report. J Pediatr Hematol Oncol. 2008 Dec;30(12):920-4. link to original article PubMed
Bortezomib monotherapy
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Regimen
Study | Evidence |
---|---|
Hess et al. 2006 | Case report |
Chemotherapy
- Bortezomib (Velcade) 1.3 mg/m2 IV once per day on days 1, 4, 8, 11
21-day cycle for six cycles
References
- Case report: Hess G, Wagner V, Kreft A, Heussel CP, Huber C. Effects of bortezomib on pro-inflammatory cytokine levels and transfusion dependency in a patient with multicentric Castleman disease. Br J Haematol. 2006 Sep;134(5):544-5. link to original article PubMed
- Review: Fajgenbaum DC, van Rhee F, Nabel CS. HHV-8-negative, idiopathic multicentric Castleman disease: novel insights into biology, pathogenesis, and therapy. Blood. 2014 May 8;123(19):2924-33. Epub 2014 Mar 12. link to original article PubMed
Cyclosporine monotherapy
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Regimen
Study | Evidence |
---|---|
Inoue et al. 2013 | Case report |
To be completed
Immunosuppressive therapy
References
- Case report: Inoue M, Ankou M, Hua J, Iwaki Y, Hagihara M, Ota Y. Complete resolution of TAFRO syndrome (thrombocytopenia, anasarca, fever, reticulin fibrosis and organomegaly) after immunosuppressive therapies using corticosteroids and cyclosporin A : a case report. J Clin Exp Hematop. 2013;53(1):95-9. link to original article PubMed
Placebo
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Regimen
Study | Evidence | Comparator | Efficacy |
---|---|---|---|
van Rhee et al. 2014 | Phase III (C) | Siltuximab | Inferior durable tumor and symptomatic response for at least 18 weeks |
No active treatment; all patients did receive "best supportive care."
References
- van Rhee F, Wong RS, Munshi N, Rossi JF, Ke XY, Fosså A, Simpson D, Capra M, Liu T, Hsieh RK, Goh YT, Zhu J, Cho SG, Ren H, Cavet J, Bandekar R, Rothman M, Puchalski TA, Reddy M, van de Velde H, Vermeulen J, Casper C. Siltuximab for multicentric Castleman's disease: a randomised, double-blind, placebo-controlled trial. Lancet Oncol. 2014 Aug;15(9):966-74. Epub 2014 Jul 17. Erratum in: Lancet Oncol. 2014 Sep;15(10):417. link to original article PubMed
Rituximab monotherapy
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Regimen
Study | Evidence |
---|---|
Ide et al. 2006 | Pilot |
Chemotherapy
- Rituximab (Rituxan) 375 mg/m2 IV once per week
4 to 8 doses
After the rituximab administration, oral predonisolone (15 mg/d, tapered to 5 mg/d) and/or alkylating agent (cyclophosphamide 100 mg/day or melphalan 2 mg/d) were started for maintenance therapy.
References
- Ide M, Kawachi Y, Izumi Y, Kasagi K, Ogino T. Long-term remission in HIV-negative patients with multicentric Castleman's disease using rituximab. Eur J Haematol. 2006 Feb;76(2):119-23. link to original article PubMed
- Review: Fajgenbaum DC, van Rhee F, Nabel CS. HHV-8-negative, idiopathic multicentric Castleman disease: novel insights into biology, pathogenesis, and therapy. Blood. 2014 May 8;123(19):2924-33. Epub 2014 Mar 12. link to original article PubMed
Siltuximab monotherapy
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Regimen
Study | Evidence | Comparator | Efficacy |
---|---|---|---|
Kurzrock et al. 2013 | Phase 1, >20 pts | ||
van Rhee et al. 2014 | Phase III (E) | Placebo | Superior durable tumor and symptomatic response for at least 18 weeks |
Patients had symptomatic, measurable, HIV-negative, and HHV-8-negative multicentric Castleman disease (MCD). Note that in the phase 1 study by Kurzrock et al. the MTD was 12 mg/kg, but the update reports using the 11 mg/kg dosing.
Immunosuppressive therapy
- Siltuximab (Sylvant) 11 mg/kg IV over 60 minutes once on day 1
Supportive medications
- All patients received "best supportive care"
21-day cycles
Patients in the extension of the phase 1 study could have their treatment interval lengthened to every 6 weeks if they had a documented PR/CR at 6 months.
References
- Phase 1: Kurzrock R, Voorhees PM, Casper C, Furman RR, Fayad L, Lonial S, Borghaei H, Jagannath S, Sokol L, Usmani SZ, van de Velde H, Qin X, Puchalski TA, Hall B, Reddy M, Qi M, van Rhee F. A phase I, open-label study of siltuximab, an anti-IL-6 monoclonal antibody, in patients with B-cell non-Hodgkin lymphoma, multiple myeloma, or Castleman disease. Clin Cancer Res. 2013 Jul 1;19(13):3659-70. link to original article contains verified protocol PubMed content property of HemOnc.org
- Update: van Rhee F, Casper C, Voorhees PM, Fayad LE, van de Velde H, Vermeulen J, Qin X, Qi M, Tromp B, Kurzrock R. A phase 2, open-label, multicenter study of the long-term safety of siltuximab (an anti-interleukin-6 monoclonal antibody) in patients with multicentric Castleman disease. Oncotarget. 2015 Oct 6;6(30):30408-19. link to original article link to PMC article PubMed
- van Rhee F, Wong RS, Munshi N, Rossi JF, Ke XY, Fosså A, Simpson D, Capra M, Liu T, Hsieh RK, Goh YT, Zhu J, Cho SG, Ren H, Cavet J, Bandekar R, Rothman M, Puchalski TA, Reddy M, van de Velde H, Vermeulen J, Casper C. Siltuximab for multicentric Castleman's disease: a randomised, double-blind, placebo-controlled trial. Lancet Oncol. 2014 Aug;15(9):966-74. Epub 2014 Jul 17. Erratum in: Lancet Oncol. 2014 Sep;15(10):417. link to original article PubMed
Sirolimus monotherapy
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Regimen
Study | Evidence |
---|---|
Iwaki et al. 2016 | Case report |
To be completed
Immunosuppressive therapy
References
- Case report: Iwaki N, Fajgenbaum DC, Nabel CS, Gion Y, Kondo E, Kawano M, Masunari T, Yoshida I, Moro H, Nikkuni K, Takai K, Matsue K, Kurosawa M, Hagihara M, Saito A, Okamoto M, Yokota K, Hiraiwa S, Nakamura N, Nakao S, Yoshino T, Sato Y. Clinicopathologic analysis of TAFRO syndrome demonstrates a distinct subtype of HHV-8-negative multicentric Castleman disease. Am J Hematol. 2016 Feb;91(2):220-6. link to original article PubMed
TCP
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TCP: Thalidomide, Cyclophosphamide, Prednisone
Regimen
Study | Evidence |
---|---|
Zhang et al. 2019 (ZS-1159) | Phase II |
Note: cyclophosphamide & prednisone are discontinued after the first year of treatment.
Chemotherapy
- Thalidomide (Thalomid) 100 mg PO once per day
- Cyclophosphamide (Cytoxan) 300 mg/m2 PO once per week
- Prednisone (Sterapred) 1 mg/kg PO twice per week
2-year course (see note)
References
- ZS-1159: Zhang L, Zhao AL, Duan MH, Li ZY, Cao XX, Feng J, Zhou DB, Zhong DR, Fajgenbaum DC, Li J. Phase 2 study using oral thalidomide-cyclophosphamide-prednisone for idiopathic multicentric Castleman disease. Blood. 2019 Apr 18;133(16):1720-1728. Epub 2019 Feb 13. link to original article contains protocol PubMed
Tocilizumab monotherapy
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Regimen
Study | Evidence |
---|---|
Nishimoto et al. 2005 | Phase II |
Immunosuppressive therapy
- Tocilizumab (Actemra) 8 mg/kg IV once every 2 weeks
16-week course; could be extended at physician discretion
References
- Nishimoto N, Kanakura Y, Aozasa K, Johkoh T, Nakamura M, Nakano S, Nakano N, Ikeda Y, Sasaki T, Nishioka K, Hara M, Taguchi H, Kimura Y, Kato Y, Asaoku H, Kumagai S, Kodama F, Nakahara H, Hagihara K, Yoshizaki K, Kishimoto T. Humanized anti-interleukin-6 receptor antibody treatment of multicentric Castleman disease. Blood. 2005 Oct 15;106(8):2627-32. Epub 2005 Jul 5. link to original article contains verified protocol PubMed