Rituxan for Castleman’s – pro

Castleman’s disease, also called angiofollicular lymph node has two forms, localized and a multicentric. The clinical and biological signs are varied and heterogeneous, and the diagnostic is made on the histologic examination. There are no expert assessment, guidelines or consensus statements, policy statements or formal technology assessments for this disease.

Not much has been published about RItuxan in Castleman’s Disease, aside from case reports. Rituximab may be clinically valuable as initial therapy for HIV-associated multicentric Castleman disease. However, in two human immunodeficiency virus-infected patients who needed etoposide therapy to control exacerbations of Castleman disease and received four infusions of rituximab, clinical and virologic relapses with increased blood human herpesvirus-8 DNA levels occurred in both patients 4 and 24 weeks later and were associated with a worsening of Kaposi sarcoma. On the other hand, Rituximab was both effective and safe in a small prosepctive study of HIV-infected patients with chemotherapy-dependent Multicentri Casteleman’s Disease. Since the literature is conflicting and only a small phase II study supports it, Rituxan should be considered experimental at this time.

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.

Neuville S, Agbalika F, Rabian C, Brière J, Molina JM. Failure of rituximab in human immunodeficiency virus-associated multicentric Castleman disease.Am J Hematol. 2005 Aug;79(4):337-9.

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.Clin Oncol. 2007 Aug 1;25(22):3350-6.

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