Difference between revisions of "Castleman disease"
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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. | ||
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+ | =HIV-associated multicentric Castleman's disease= | ||
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+ | ===References=== | ||
+ | # Bower M. How I treat HIV-associated multicentric Castleman disease. Blood. 2010 Nov 25;116(22):4415-21. Epub 2010 Aug 5. [http://www.bloodjournal.org/content/116/22/4415.long link to original article] [http://www.ncbi.nlm.nih.gov/pubmed/20688959 PubMed] | ||
=Multicentric Castleman’s disease= | =Multicentric Castleman’s disease= |
Revision as of 15:35, 11 March 2015
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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.
HIV-associated multicentric Castleman's disease
References
- 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
Multicentric Castleman’s disease
Placebo
Regimen
Study | Evidence | Comparator | Efficacy |
van Rhee et al. 2014 | Phase III | 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
Siltuximab (Sylvant)
back to top |
Regimen #1
Study | Evidence | Comparator | Efficacy |
van Rhee et al. 2014 | Phase III | Placebo | Superior durable tumor and symptomatic response for at least 18 weeks |
Patients had symptomatic, measurable, HIV-negative, and HHV-8-negative multicentric Castleman’s disease (MCD).
- Siltuximab (Sylvant) 11 mg/kg IV over 1 hour once on day 1
Supportive medications:
- All patients received "best supportive care"
21-day cycles, given until treatment failure
Regimen #2
Study | Evidence |
Kurzrock et al. 2013 | Phase I |
This dose was the recommended dose after the dose-finding study Kurzrock et al. 2013. Note that this is different from the FDA-approved dose, which is 11 mg/kg.
- Siltuximab (Sylvant) 12 mg/kg IV over 1 hour once on day 1
21-day cycles, given until progression of disease or unacceptable toxicity
References
- 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
- 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
Tocilizumab (Actemra)
Regimen
Study | Evidence |
Nishimoto et al. 2005 | Phase II |
- Tocilizumab (Actemra) 8 mg/kg IV 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