Brief communication: rituximab in HIV-associated multicentric Castleman disease.

BACKGROUND

HIV-associated multicentric Castleman disease is a rare lymphoproliferative disorder with marked systemic symptoms attributed to cytokine disarray. Many therapeutic approaches in small series of patients have proved largely unsuccessful to date.

OBJECTIVE

To investigate the efficacy and clinicopathologic variables associated with first-line treatment for HIV-associated multicentric Castleman disease with the anti-CD20 monoclonal antibody rituximab.

DESIGN

Single-group, open-label, phase II trial.

SETTING

3 teaching hospitals in England.

PATIENTS

Previously untreated patients with histologically proven HIV-associated multicentric Castleman disease.

INTERVENTION

4 infusions of rituximab, 375 mg per m2 of body surface area, at weekly intervals.

MEASUREMENTS

Response was evaluated clinically and radiologically and by measuring plasma Kaposi sarcoma-associated herpesvirus viral load.

RESULTS

21 consecutive patients (18 men) with plasmablastic multicentric Castleman disease were recruited. The median follow-up was 12 months (range, 1 to 49 months). One patient died before completing therapy, 20 achieved remission of symptoms, and 14 (67%) achieved a radiologic response. The overall and disease-free survival rates at 2 years were 95% (95% CI, 86% to 100%) and 79% (CI, 49% to 100%), respectively. Plasma acute-phase proteins, immunoglobulins, and Kaposi sarcoma-associated herpesvirus viral load decreased after rituximab therapy. The main adverse effect was reactivation of Kaposi sarcoma.

LIMITATION

The study had no comparison group.

CONCLUSION

Rituximab may be clinically valuable as initial therapy for HIV-associated multicentric Castleman disease.