Dham Anu, Peterson Bruce A
Division of Hematology-Oncology, University of Minnesota, Minneapolis, Minneapolis, USA.
Curr Opin Hematol. 2007 Jul;14(4):354-9. doi: 10.1097/MOH.0b013e328186ffab.
Castleman disease was initially described over 50 years ago as a benign localized mass of lymph nodes found primarily in the mediastinum of asymptomatic patients. Subsequently, additional types were recognized that extend the spectrum of this heterogeneous group of diseases. Optimal standard therapies have not been established. Currently, most patients receive treatments derived from past experience with non-Hodgkin lymphoma that are not altogether satisfactory.
Advances in understanding the biological basis of Castleman disease have provided new targets for therapeutic exploitation. Recognition of the role of interleukin-6 in disease perpetuation has led to the use of an antihuman interleukin-6 receptor monoclonal antibody, tocilizumab. Rituximab, an anti-CD20 monoclonal antibody, targets CD20-positive B lymphocytes, a prominent component of this disorder. Human herpes virus-8 and angiogenesis, both involved in the pathogenesis of Castleman disease, may provide additional unique therapeutic opportunities.
Rational approaches to the treatment of Castleman disease have begun to have an impact on disease management; however, the role of these new agents remains to be established. As the complexity of Castleman disease is more fully understood, additional targets for new innovative therapies undoubtedly will be identified.
Castleman病于50多年前首次被描述为主要在无症状患者纵隔中发现的良性局限性淋巴结肿块。随后，人们认识到了其他类型，从而扩展了这一异质性疾病组的范围。尚未确立最佳标准疗法。目前，大多数患者接受的是源自过去非霍奇金淋巴瘤治疗经验的疗法，但这些疗法并不完全令人满意。
对Castleman病生物学基础认识的进展为治疗开发提供了新靶点。认识到白细胞介素-6在疾病持续存在中的作用，促使人们使用抗人白细胞介素-6受体单克隆抗体托珠单抗。抗CD20单克隆抗体利妥昔单抗靶向CD20阳性B淋巴细胞，这是该疾病的一个主要成分。人类疱疹病毒8和血管生成均参与Castleman病的发病机制，可能提供更多独特的治疗机会。
Castleman病的合理治疗方法已开始对疾病管理产生影响；然而，这些新药物的作用仍有待确立。随着对Castleman病复杂性的更全面理解，无疑将确定新的创新疗法的更多靶点。
