Difference between revisions of "Castleman disease"

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'''Use of this site is subject to you reading and agreeing with the terms set forth in the [[HemOnc.org_-_A_Hematology_Oncology_Wiki:General_disclaimer|disclaimer]].'''
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Is there a regimen missing from this list?  Would you like to share a different dosage/schedule or an additional reference for a regimen?  Have you noticed an error?  Do you have an idea that will help the site grow to better meet your needs and the needs of many others?  You are [[How_to_contribute|invited to contribute to the site]].
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[[#top|Back to Top]]
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{{#lst:Editorial board transclusions|anhl}}
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''Are you looking for a regimen but can't find it here? For placebo or observational studies in this condition, please visit [[Castleman disease - null regimens|this page]]. If you still can't find it, please let us know so we can add it!''.<br>
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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 [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5364342/ here].
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*''We have moved [[How I Treat]] articles to a dedicated page.''
 
{| class="wikitable" style="float:right; margin-right: 5px;"
 
{| class="wikitable" style="float:right; margin-right: 5px;"
 
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|<div style="background-color: #66FF66; border: 1px solid #808000; padding: 5px; {{border-radius|16px}}" align="right"><font size="4"><b>{{#ask: [[-Has subobject::{{FULLPAGENAME}}]] |?Regimen |limit=10000|format=sum}} regimens on this page</b></font></div>
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|<div style="background-color: #fee0d1; border: 1px solid #808000; padding: 5px; {{border-radius|16px}}" align="right"><font size="4"><b>{{#ask: [[-Has subobject::{{FULLPAGENAME}}]] |?Regimen |limit=10000|format=sum}} [[Tutorial#Regimens|regimens]] on this page</b></font></div>
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<div style="background-color: #66CCFF; border: 1px solid #808000; padding: 5px; {{border-radius|16px}}"><font size="4"><b>{{#ask: [[-Has subobject::{{FULLPAGENAME}}]] |?Variant |limit=10000|format=sum}} variants on this page</b></font></div>
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<div style="background-color: #deebf6; border: 1px solid #808000; padding: 5px; {{border-radius|16px}}"><font size="4"><b>{{#ask: [[-Has subobject::{{FULLPAGENAME}}]] |?Variant |limit=10000|format=sum}} [[Tutorial#Variants|variants]] on this page</b></font></div>
 
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=Guidelines=
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'''Given the rapid change in evidence in many areas of hematology/oncology, readers are encouraged to consider any guideline published 5+ years ago to be for historical purposes, only.'''
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==CDCN==
 +
*For a list of chemotherapy regimens used plus their references, please visit http://www.cdcn.org/about-castleman-disease/treatments/nonspecific-cytotoxic-immuno-depletion
  
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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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==International Consensus guidelines==
 +
*'''2017:''' Fajgenbaum et al. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5364342/ International, evidence-based consensus diagnostic criteria for HHV-8–negative/idiopathic multicentric Castleman disease] [https://www.ncbi.nlm.nih.gov/pubmed/28087540 PubMed]
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*'''2018:''' van Rhee et al. [http://www.bloodjournal.org/content/132/20/2115.long International, evidence-based consensus treatment guidelines for idiopathic multicentric Castleman disease] [https://www.ncbi.nlm.nih.gov/pubmed/30181172 PubMed]
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==NCCN==
 +
*[https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1518 NCCN Guidelines - Castleman Disease]
  
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=HIV-associated multicentric Castleman's disease=
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=HIV-associated multicentric Castleman disease, all lines of therapy=
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==Rituximab monotherapy {{#subobject:5bcc73|Regimen=1}}==
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==Rituximab (Rituxan) {{#subobject:5bcc73|Regimen=1}}==
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<div class="toccolours" style="background-color:#eeeeee">
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{| class="wikitable" style="float:right; margin-left: 5px;"
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===Regimen {{#subobject:0a3d2a|Variant=1}}===
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{| class="wikitable sortable" style="width: 60%; text-align:center;"  
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!style="width: 33%"|Study
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!style="width: 33%"|Dates of enrollment
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!style="width: 33%"|[[Levels_of_Evidence#Evidence|Evidence]]
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|-
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|[https://doi.org/10.1200/jco.2007.10.6732 Gérard et al. 2007 (ANRS 117 CastlemaB)]
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|2003-03 to 2004-12
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| style="background-color:#91cf61" |Phase 2
 +
|-
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|[https://doi.org/10.7326/0003-4819-147-12-200712180-00003 Bower et al. 2007]
 +
|2003-2006
 +
| style="background-color:#91cf61" |Phase 2
 
|-
 
|-
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|[[#top|back to top]]
 
 
|}
 
|}
 +
<div class="toccolours" style="background-color:#b3e2cd">
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====Targeted therapy====
 +
*[[Rituximab (Rituxan)]] 375 mg/m<sup>2</sup> IV once on day 1
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'''7-day cycle for 4 cycles (4-week course)'''
 +
</div></div>
 +
===References===
 +
# '''ANRS 117 CastlemaB:''' 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. [https://doi.org/10.1200/jco.2007.10.6732 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/17664482/ 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. [https://doi.org/10.7326/0003-4819-147-12-200712180-00003 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/18087054/ PubMed]
  
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===Regimen {{#subobject:0a3d2a|Variant=1}}===
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=HHV-8-negative/"Idiopathic" multicentric Castleman disease, all lines of therapy=
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{| border="1" style="text-align:center;" !align="left"  
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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 [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5364342/ here].
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|'''Study'''
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==Anakinra monotherapy {{#subobject:7f4267|Regimen=1}}==
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|[[Levels_of_Evidence#Evidence|'''Evidence''']]
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<div class="toccolours" style="background-color:#eeeeee">
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===Regimen {{#subobject:a0de40|Variant=1}}===
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{| class="wikitable" style="width: 40%; text-align:center;"  
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!style="width: 25%"|Study
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!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]
 +
|style="background-color:#ffffbe"|Case report
 
|-
 
|-
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|[http://jco.ascopubs.org/content/25/22/3350.long Gérard et al. 2007 (ANRS 117 CastlemaB)]
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|}
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| style="background-color:#EEEE00" |Phase II
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<div class="toccolours" style="background-color:#b3e2cd">
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====Immunosuppressive therapy====
 +
*[[Anakinra (Kineret)]] 1 mg/kg SC once per day
 +
'''Continued indefinitely'''
 +
</div></div>
 +
===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. [http://journals.lww.com/jpho-online/Abstract/2008/12000/IL_1RA_Agonist__Anakinra__in_the_Treatment_of.13.aspx link to original article] [https://pubmed.ncbi.nlm.nih.gov/19131781/ PubMed]
 +
==Bortezomib monotherapy {{#subobject:45ea3a|Regimen=1}}==
 +
<div class="toccolours" style="background-color:#eeeeee">
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===Regimen {{#subobject:9b3fef|Variant=1}}===
 +
{| class="wikitable" style="width: 40%; text-align:center;"
 +
!style="width: 25%"|Study
 +
!style="width: 25%"|[[Levels_of_Evidence#Evidence|Evidence]]
 
|-
 
|-
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|[http://annals.org/article.aspx?articleid=738069 Bower et al. 2007]
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|[https://doi.org/10.1111/j.1365-2141.2006.06212.x Hess et al. 2006]
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| style="background-color:#EEEE00" |Phase II
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|style="background-color:#ffffbe"|Case report
 
|-
 
|-
 
|}
 
|}
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====Chemotherapy====
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<div class="toccolours" style="background-color:#b3e2cd">
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*[[Rituximab (Rituxan)]] 375 mg/m<sup>2</sup> IV once per week
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====Targeted therapy====
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*[[Bortezomib (Velcade)]] 1.3 mg/m<sup>2</sup> IV once per day on days 1, 4, 8, 11
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'''4-week course'''
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'''21-day cycle for 6 cycles'''
 +
</div></div>
 
===References===
 
===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. [http://jco.ascopubs.org/content/25/22/3350.long link to original article] '''contains verified protocol''' [https://www.ncbi.nlm.nih.gov/pubmed/17664482 PubMed]
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# '''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. [https://doi.org/10.1111/j.1365-2141.2006.06212.x link to original article] [https://pubmed.ncbi.nlm.nih.gov/16856889/ PubMed]
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# 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. [http://annals.org/article.aspx?articleid=738069 link to original article] '''contains verified protocol''' [https://www.ncbi.nlm.nih.gov/pubmed/18087054 PubMed]
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# '''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. [http://www.bloodjournal.org/content/123/19/2924.long link to original article] [https://pubmed.ncbi.nlm.nih.gov/24622327/ PubMed]
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# 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] [https://www.ncbi.nlm.nih.gov/pubmed/20688959 PubMed]
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==Cyclosporine monotherapy {{#subobject:0a5e9b|Regimen=1}}==
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* Doxorubicin (Adriamycin)
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<div class="toccolours" style="background-color:#eeeeee">
−
 
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===Regimen {{#subobject:5dd5b9|Variant=1}}===
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=HHV-8-negative/"Idiopathic" Multicentric Castleman’s disease=
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{| class="wikitable" style="width: 40%; text-align:center;"  
−
 
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!style="width: 25%"|Study
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==Placebo==
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!style="width: 25%"|[[Levels_of_Evidence#Evidence|Evidence]]
−
 
 
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===Regimen===
 
−
{| border="1" style="text-align:center;" !align="left"  
 
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|'''Study'''
 
−
|[[Levels_of_Evidence#Evidence|'''Evidence''']]
 
−
|'''Comparator'''
 
−
|[[Levels_of_Evidence#Efficacy|'''Efficacy''']]
 
 
|-
 
|-
−
|[http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(14)70319-5/fulltext van Rhee et al. 2014]
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|[https://www.jstage.jst.go.jp/article/jslrt/53/1/53_95/_article Inoue et al. 2013]
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| style="background-color:#00CD00" |Phase III
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|style="background-color:#ffffbe"|Case report
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|[[Castleman’s_disease#Siltuximab_.28Sylvant.29|Siltuximab]]
 
−
| style="background-color:#ff0000" |Inferior durable tumor and symptomatic response for at least 18 weeks
 
 
|-
 
|-
 
|}
 
|}
−
 
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<div class="toccolours" style="background-color:#b3e2cd">
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''No active treatment; all patients did receive "best supportive care."''
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====Immunosuppressive therapy====
−
 
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*[[Cyclosporine|Cyclosporine A]]
 +
</div></div>
 
===References===
 
===References===
−
<!-- # '''Abstract:''' Raymond S Wong, Corey Casper, Nikhil Munshi, Xiaoyan Ke, Alexander Fosså, David Simpson, Marcelo Capra, Ting Liu, Ruey Kuen Hsieh, Yeow Tee Goh, Jun Zhu, Seok-Goo Cho, Hanyun Ren, James Cavet, Rajesh Bandekar, Margaret Rothman, Thomas A Puchalski, Shalini Chaturvedi, Helgi van de Velde, Jessica Vermeulen, and Frits van Rhee. A Multicenter, Randomized, Double-Blind, Placebo-Controlled Study Of The Efficacy and Safety Of Siltuximab, An Anti-Interleukin-6 Monoclonal Antibody, In Patients With Multicentric Castleman’s Disease. 2013 ASH Annual Meeting abstract 505. [http://bloodjournal.hematologylibrary.org/content/122/21/505 link to abstract] -->
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# '''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. [https://www.jstage.jst.go.jp/article/jslrt/53/1/53_95/_article link to original article] [https://pubmed.ncbi.nlm.nih.gov/23801140/ PubMed]
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# 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. [http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(14)70319-5/fulltext link to original article] [https://www.ncbi.nlm.nih.gov/pubmed/25042199 PubMed]
 
  
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==Siltuximab (Sylvant) {{#subobject:9fe1e6|Regimen=1}}==
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==Rituximab monotherapy {{#subobject:ccff7a|Regimen=1}}==
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{| class="wikitable" style="float:right; margin-left: 5px;"
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<div class="toccolours" style="background-color:#eeeeee">
 +
===Regimen {{#subobject:251273|Variant=1}}===
 +
{| class="wikitable" style="width: 40%; text-align:center;"  
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!style="width: 25%"|Study
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!style="width: 25%"|[[Levels_of_Evidence#Evidence|Evidence]]
 +
|-
 +
|[https://doi.org/10.1111/j.1600-0609.2005.00570.x Ide et al. 2006]
 +
|style="background-color:#ffffbe"|Retrospective
 
|-
 
|-
−
|[[#top|back to top]]
 
 
|}
 
|}
−
 
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<div class="toccolours" style="background-color:#b3e2cd">
 +
====Targeted therapy====
 +
*[[Rituximab (Rituxan)]] 375 mg/m<sup>2</sup> IV once on day 1
 +
'''7-day cycle for 4 to 8 cycles'''
 +
</div>
 +
<div class="toccolours" style="background-color:#cbd5e7">
 +
====Subsequent treatment====
 +
*After the rituximab administration, oral prednisolone (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
 +
</div></div>
 +
===References===
 +
# '''Retrospective:''' 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. [https://doi.org/10.1111/j.1600-0609.2005.00570.x link to original article] [https://pubmed.ncbi.nlm.nih.gov/16405432/ 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. [http://www.bloodjournal.org/content/123/19/2924.long link to original article] [https://pubmed.ncbi.nlm.nih.gov/24622327/ PubMed]
 +
==Siltuximab monotherapy {{#subobject:9fe1e6|Regimen=1}}==
 +
<div class="toccolours" style="background-color:#eeeeee">
 
===Regimen {{#subobject:c9d934|Variant=1}}===
 
===Regimen {{#subobject:c9d934|Variant=1}}===
−
{| border="1" style="text-align:center;" !align="left"  
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{| class="wikitable sortable" style="width: 100%; text-align:center;"  
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|'''Study'''
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!style="width: 20%"|Study
−
|[[Levels_of_Evidence#Evidence|'''Evidence''']]
+
!style="width: 20%"|Dates of enrollment
−
|'''Comparator'''
+
!style="width: 20%"|[[Levels_of_Evidence#Evidence|Evidence]]
−
|[[Levels_of_Evidence#Efficacy|'''Efficacy''']]
+
!style="width: 20%"|Comparator
 +
!style="width: 20%"|[[Levels_of_Evidence#Comparative_efficacy|Comparative Efficacy]]
 +
|-
 +
|[https://doi.org/10.1158/1078-0432.CCR-12-3349 Kurzrock et al. 2013 (CR008566)]
 +
|2005-06 to 2009-09
 +
| style="background-color:#91cf61" |Phase 1, >20 pts
 +
| style="background-color:#d3d3d3" |
 +
| style="background-color:#d3d3d3" |
 
|-
 
|-
−
|[http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(14)70319-5/fulltext van Rhee et al. 2014]
+
|[https://doi.org/10.1016/S1470-2045(14)70319-5 van Rhee et al. 2014 (CR016705)]
−
| style="background-color:#00CD00" |Phase III
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|2010-02-09 to 2012-02-03
−
|[[Castleman’s_disease#Placebo|Placebo]]
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| style="background-color:#1a9851" |Randomized Phase 2 (E-RT-esc)
−
| style="background-color:#00CD00" |Superior durable tumor and symptomatic response for at least 18 weeks
+
|[[Castleman_disease_-_null_regimens#Placebo|Placebo]]
 +
| style="background-color:#1a9851" |Superior durable tumor and symptomatic response for at least 18 weeks (primary endpoint)
 
|-
 
|-
 
|}
 
|}
−
''Patients had symptomatic, measurable, HIV-negative, and HHV-8-negative multicentric Castleman’s disease (MCD). Note that in the phase I study by Kurzrock et al. the MTD was 12 mg/kg, but the update reports using the 11 mg/kg dosing.''
+
''Note: 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.''
−
====Chemotherapy====
+
<div class="toccolours" style="background-color:#b3e2cd">
−
*[[Siltuximab (Sylvant)]] 11 mg/kg IV over 1 hour once on day 1
+
====Immunosuppressive therapy====
−
 
+
*[[Siltuximab (Sylvant)]] 11 mg/kg IV over 60 minutes once on day 1
−
====Supportive medications====
+
====Supportive therapy====
 
*All patients received "best supportive care"
 
*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.''
 +
</div></div>
 +
===References===
 +
# '''CR008566:''' 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. Epub 2013 May 9. [https://doi.org/10.1158/1078-0432.CCR-12-3349 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/23659971/ PubMed] content property of [https://hemonc.org HemOnc.org] [https://clinicaltrials.gov/study/NCT00412321 NCT00412321]
 +
## '''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. [https://doi.org/10.18632/oncotarget.4655 link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4745809/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/26327301/ PubMed]
 +
<!-- # '''Abstract:''' Raymond S Wong, Corey Casper, Nikhil Munshi, Xiaoyan Ke, Alexander Fosså, David Simpson, Marcelo Capra, Ting Liu, Ruey Kuen Hsieh, Yeow Tee Goh, Jun Zhu, Seok-Goo Cho, Hanyun Ren, James Cavet, Rajesh Bandekar, Margaret Rothman, Thomas A Puchalski, Shalini Chaturvedi, Helgi van de Velde, Jessica Vermeulen, and Frits van Rhee. A Multicenter, Randomized, Double-Blind, Placebo-Controlled Study Of The Efficacy and Safety Of Siltuximab, An Anti-Interleukin-6 Monoclonal Antibody, In Patients With Multicentric Castleman’s Disease. 2013 ASH Annual Meeting abstract 505. [http://www.bloodjournal.org/content/122/21/505 link to abstract] -->
 +
# '''CR016705:''' 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. [https://doi.org/10.1016/S1470-2045(14)70319-5 link to original article] [https://pubmed.ncbi.nlm.nih.gov/25042199/ PubMed] [https://clinicaltrials.gov/study/NCT01024036 NCT01024036]
  
−
'''21-day cycles, given until treatment failure'''
+
==Sirolimus monotherapy {{#subobject:26101f|Regimen=1}}==
−
 
+
<div class="toccolours" style="background-color:#eeeeee">
−
''Patients in the extension of the phase I study could have their treatment interval lengthened to every 6 weeks if they had a documented PR/CR at 6 months.''
+
===Regimen {{#subobject:c4a164|Variant=1}}===
−
 
+
{| class="wikitable" style="width: 40%; text-align:center;"
 +
!style="width: 25%"|Study
 +
!style="width: 25%"|[[Levels_of_Evidence#Evidence|Evidence]]
 +
|-
 +
|[https://doi.org/10.1002/ajh.24242 Iwaki et al. 2016]
 +
|style="background-color:#ffffbe"|Case report
 +
|-
 +
|}
 +
<div class="toccolours" style="background-color:#b3e2cd">
 +
====Immunosuppressive therapy====
 +
*[[Sirolimus (Rapamune)]]
 +
</div></div>
 +
===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. [https://doi.org/10.1002/ajh.24242 link to original article] [https://pubmed.ncbi.nlm.nih.gov/26805758/ PubMed]
 +
==TCP {{#subobject:969973|Regimen=1}}==
 +
TCP: '''<u>T</u>'''halidomide, '''<u>C</u>'''yclophosphamide, '''<u>P</u>'''rednisone
 +
<div class="toccolours" style="background-color:#eeeeee">
 +
===Regimen {{#subobject:0a11f4|Variant=1}}===
 +
{| class="wikitable sortable" style="width: 60%; text-align:center;"
 +
!style="width: 33%"|Study
 +
!style="width: 33%"|Dates of enrollment
 +
!style="width: 33%"|[[Levels_of_Evidence#Evidence|Evidence]]
 +
|-
 +
|[https://doi.org/10.1182/blood-2018-11-884577 Zhang et al. 2019 (ZS-1159)]
 +
|2015-06 to 2018-06
 +
|style="background-color:#91cf61"|Phase 2
 +
|-
 +
|}
 +
<div class="toccolours" style="background-color:#b3e2cd">
 +
====Targeted therapy====
 +
*[[Thalidomide (Thalomid)]] 100 mg PO once per day
 +
====Chemotherapy====
 +
*[[Cyclophosphamide (Cytoxan)]] as follows:
 +
**Cycles 1 to 52: 300 mg/m<sup>2</sup> PO once on day 1
 +
====Glucocorticoid therapy====
 +
*[[Prednisone (Sterapred)]] as follows:
 +
**Cycles 1 to 52: 1 mg/kg PO once per day on days 1 & 4
 +
'''7-day cycle for 104 cycles (2 years)'''
 +
</div></div>
 
===References===
 
===References===
−
# '''Phase I:''' 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. [http://clincancerres.aacrjournals.org/content/19/13/3659.long link to original article] '''contains verified protocol''' [https://www.ncbi.nlm.nih.gov/pubmed/23659971 PubMed] content property of [http://hemonc.org HemOnc.org]
+
# '''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. [https://doi.org/10.1182/blood-2018-11-884577 link to original article] '''contains dosing details in abstract''' [https://pubmed.ncbi.nlm.nih.gov/30760451/ PubMed] [https://clinicaltrials.gov/study/NCT03043105 NCT03043105]
−
## '''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. [http://www.impactjournals.com/oncotarget/misc/linkedout.php?pii=4655 link to original article] [https://www.ncbi.nlm.nih.gov/pubmed/26327301 PubMed]
 
−
<!-- # '''Abstract:''' Raymond S Wong, Corey Casper, Nikhil Munshi, Xiaoyan Ke, Alexander Fosså, David Simpson, Marcelo Capra, Ting Liu, Ruey Kuen Hsieh, Yeow Tee Goh, Jun Zhu, Seok-Goo Cho, Hanyun Ren, James Cavet, Rajesh Bandekar, Margaret Rothman, Thomas A Puchalski, Shalini Chaturvedi, Helgi van de Velde, Jessica Vermeulen, and Frits van Rhee. A Multicenter, Randomized, Double-Blind, Placebo-Controlled Study Of The Efficacy and Safety Of Siltuximab, An Anti-Interleukin-6 Monoclonal Antibody, In Patients With Multicentric Castleman’s Disease. 2013 ASH Annual Meeting abstract 505. [http://bloodjournal.hematologylibrary.org/content/122/21/505 link to abstract] -->
 
−
# 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. [http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(14)70319-5/fulltext link to original article] [https://www.ncbi.nlm.nih.gov/pubmed/25042199 PubMed]
 
−
 
 
−
==Tocilizumab (Actemra) {{#subobject:dd12c2|Regimen=1}}==
 
  
 +
==Tocilizumab monotherapy {{#subobject:dd12c2|Regimen=1}}==
 +
<div class="toccolours" style="background-color:#eeeeee">
 
===Regimen {{#subobject:c5ac9b|Variant=1}}===
 
===Regimen {{#subobject:c5ac9b|Variant=1}}===
−
{| border="1" style="text-align:center;" !align="left"  
+
{| class="wikitable sortable" style="width: 60%; text-align:center;"  
−
|'''Study'''
+
!style="width: 33%"|Study
−
|[[Levels_of_Evidence#Evidence|'''Evidence''']]
+
!style="width: 33%"|Dates of enrollment
 +
!style="width: 33%"|[[Levels_of_Evidence#Evidence|Evidence]]
 
|-
 
|-
−
|[http://www.bloodjournal.org/content/106/8/2627.long Nishimoto et al. 2005]
+
|[https://doi.org/10.1182/blood-2004-12-4602 Nishimoto et al. 2005]
−
| style="background-color:#EEEE00" |Phase II
+
|2001-07-19 to 2001-10-11
 +
| style="background-color:#91cf61" |Phase 2
 
|-
 
|-
 
|}
 
|}
−
====Chemotherapy====
+
<div class="toccolours" style="background-color:#b3e2cd">
−
*[[Tocilizumab (Actemra)]] 8 mg/kg IV once every 2 weeks
+
====Immunosuppressive therapy====
−
 
+
*[[Tocilizumab (Actemra)]] 8 mg/kg IV once on day 1
−
'''16-week course; could be extended at physician discretion'''
+
'''14-day cycle for 8 cycles; could be extended at physician discretion'''
−
 
+
</div></div>
 
===References===
 
===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. [http://www.bloodjournal.org/content/106/8/2627.long link to original article] '''contains verified protocol''' [https://www.ncbi.nlm.nih.gov/pubmed/15998837 PubMed]
+
# 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. [https://doi.org/10.1182/blood-2004-12-4602 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/15998837/ PubMed]
−
 
+
[[Category:Castleman disease regimens]]
−
== Rituximab ==
+
[[Category:Disease-specific pages]]
−
'''Regimen'''
+
[[Category:Lymphoproliferative disorders]]
−
* Rituximab administered intravenously at the standard dose of 375 mg/m^2 weekly for four or eight cycles without chemotherapy. After the rituximab administration, oral predonisolone (15 mg/d, tapered to 5 mg/d) and/or alkylating agent (cyclophosphamide 100 mg/d or melphalan 2 mg/d) were started for maintenance therapy. [http://onlinelibrary.wiley.com/doi/10.1111/j.1600-0609.2005.00570.x/full Link to original article]
 
−
'''References'''
 
−
# Ide, Makoto, et al. "Long‐term remission in HIV‐negative patients with multicentric Castleman's disease using rituximab." ''European journal of haematology'' 76.2 (2006): 119-123. [http://onlinelibrary.wiley.com/doi/10.1111/j.1600-0609.2005.00570.x/full Link to original article]
 
−
# Fajgenbaum, David C., Frits van Rhee, and Christopher S. Nabel. "HHV-8-negative, idiopathic multicentric Castleman disease: novel insights into biology, pathogenesis, and therapy." ''Blood'' 123.19 (2014): 2924-2933. [http://files.www.cdcn.org/Treatments/blood_2014.pdf Link to original article]
 
−
 
 
−
== Anakinra (Kineret) ==
 
−
'''Regimen'''
 
−
* Anakinra (Kineret) daily subcutaneous dose of 1 mg/kg
 
−
'''References'''
 
−
# Galeotti, Caroline, et al. "IL-1RA agonist (anakinra) in the treatment of multifocal castleman disease: case report." ''Journal of pediatric hematology/oncology'' 30.12 (2008): 920-924. [https://www.ncbi.nlm.nih.gov/pubmed/?term=2008+Galeotti+C%2C+Kone-Paut+I.+IL-1RA+agonist+(anakinra)+in+the+treatment+of+multifocal+castleman+disease%3A+case+report.+J+Pediatr+Hematol+Oncol+2008+30%3A920%E2%80%934 PubMed]
 
−
 
 
−
== Bortezomib ==
 
−
'''Regimen'''
 
−
* Bortezomib initiated at the standard dose of 1.3 mg/m^2 onday 1, 4, 8, 11, repeated at day 22 for a total of six cycles
 
−
'''References'''
 
−
# Hess, Georg, et al. "Effects of bortezomib on pro‐inflammatory cytokine levels and transfusion dependency in a patient with multicentric Castleman Disease." ''British journal of haematology'' 134.5 (2006): 544-545.
 
−
# Fajgenbaum, David C., Frits van Rhee, and Christopher S. Nabel. "HHV-8-negative, idiopathic multicentric Castleman disease: novel insights into biology, pathogenesis, and therapy." ''Blood'' 123.19 (2014): 2924-2933. [http://files.www.cdcn.org/Treatments/blood_2014.pdf Link to original article]
 
−
 
 
−
== Sirolimus (Rapamycin) ==
 
−
'''Regimen'''
 
−
* Sirolimus (Rapamycin) daily
 
−
'''References'''
 
−
# Iwaki, Noriko, et al. "Clinicopathologic analysis of TAFRO syndrome demonstrates a distinct subtype of HHV‐8‐negative multicentric Castleman disease." ''American journal of hematology'' 91.2 (2016): 220-226. [http://files.www.cdcn.org/Treatments/Iwaki_Fajgenbaum_et_al-American_Journal_of_Hematology.pdf Link to original article]
 
−
 
 
−
== Cyclosporin ==
 
−
'''Regimen'''
 
−
* Cyclosporin A 5 mg/kg daily
 
−
'''References'''
 
−
# Inoue, Morihiro, et al. "Complete resolution of TAFRO syndrome (thrombocytopenia, anasarca, fever, reticulin fibrosis and organomegaly) after immunosuppressive therapies using corticosteroids and cyclosporin A: a case report." ''Journal of clinical and experimental hematopathology'' 53.1 (2013): 95-99. [https://www.jstage.jst.go.jp/article/jslrt/53/1/53_95/_pdf PubMed]
 

Latest revision as of 19:25, 23 June 2024

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Section editor
TarsheenSethi.jpg
 Tarsheen Sethi, MD, MSCI
Yale University
New Haven, CT, USA
LinkedIn

Are you looking for a regimen but can't find it here? For placebo or observational studies in this condition, please visit this page. If you still can't find it, please let us know so we can add it!.
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.

  • We have moved How I Treat articles to a dedicated page.
9 regimens on this page
9 variants on this page


Guidelines

Given the rapid change in evidence in many areas of hematology/oncology, readers are encouraged to consider any guideline published 5+ years ago to be for historical purposes, only.

CDCN

International Consensus guidelines

NCCN

HIV-associated multicentric Castleman disease, all lines of therapy

Rituximab monotherapy

Regimen

Study Dates of enrollment Evidence
Gérard et al. 2007 (ANRS 117 CastlemaB) 2003-03 to 2004-12 Phase 2
Bower et al. 2007 2003-2006 Phase 2

Targeted therapy

7-day cycle for 4 cycles (4-week course)

References

  1. ANRS 117 CastlemaB: 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 dosing details in manuscript PubMed
  2. 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 dosing details in manuscript 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

Regimen

Study Evidence
Galeotti et al. 2008 Case report

Immunosuppressive therapy

Continued indefinitely

References

  1. 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

Regimen

Study Evidence
Hess et al. 2006 Case report

Targeted therapy

21-day cycle for 6 cycles

References

  1. 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
  2. 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

Regimen

Study Evidence
Inoue et al. 2013 Case report

Immunosuppressive therapy

References

  1. 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

Rituximab monotherapy

Regimen

Study Evidence
Ide et al. 2006 Retrospective

Targeted therapy

7-day cycle for 4 to 8 cycles

Subsequent treatment

  • After the rituximab administration, oral prednisolone (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

  1. Retrospective: 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
  2. 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

Regimen

Study Dates of enrollment Evidence Comparator Comparative Efficacy
Kurzrock et al. 2013 (CR008566) 2005-06 to 2009-09 Phase 1, >20 pts
van Rhee et al. 2014 (CR016705) 2010-02-09 to 2012-02-03 Randomized Phase 2 (E-RT-esc) Placebo Superior durable tumor and symptomatic response for at least 18 weeks (primary endpoint)

Note: 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

Supportive therapy

  • 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

  1. CR008566: 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. Epub 2013 May 9. link to original article contains dosing details in manuscript PubMed content property of HemOnc.org NCT00412321
    1. 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
  2. CR016705: 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 NCT01024036

Sirolimus monotherapy

Regimen

Study Evidence
Iwaki et al. 2016 Case report

Immunosuppressive therapy

References

  1. 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

TCP: Thalidomide, Cyclophosphamide, Prednisone

Regimen

Study Dates of enrollment Evidence
Zhang et al. 2019 (ZS-1159) 2015-06 to 2018-06 Phase 2

Targeted therapy

Chemotherapy

Glucocorticoid therapy

7-day cycle for 104 cycles (2 years)

References

  1. 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 dosing details in abstract PubMed NCT03043105

Tocilizumab monotherapy

Regimen

Study Dates of enrollment Evidence
Nishimoto et al. 2005 2001-07-19 to 2001-10-11 Phase 2

Immunosuppressive therapy

14-day cycle for 8 cycles; could be extended at physician discretion

References

  1. 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 dosing details in manuscript PubMed
Retrieved from "https://hemonc.org/w/index.php?title=Castleman_disease&oldid=86521"