Long-term remission of Kaposi sarcoma-associated herpesvirus-related multicentric Castleman disease with anti-CD20 monoclonal antibody therapy

Blood. 2001 Dec 1;98(12):3473-5. doi: 10.1182/blood.v98.12.3473.

Abstract

Kaposi sarcoma-associated herpesvirus (KSHV)-related multicentric Castleman disease (MCD) is potentially lethal. Growing evidence indicates that, as in Epstein-Barr virus-driven lymphoproliferative disorders after transplantation, KSHV DNA burden in peripheral blood mononuclear cells (PBMCs) may represent the most accurate marker of disease activity. This report describes a patient with human immunodeficiency virus who was followed up clinically and by quantitative polymerase chain reaction for KSHV DNA sequences in PBMCs for more than 3 years following the diagnosis of KSHV-related MCD. Therapy with the antiherpesvirus agent cidofovir, antihuman interleukin-6 antibody BE-8, antiblastic chemotherapy, and combination antiretroviral agents did not achieve durable clinical or virologic remission of the disease. By contrast, administration of the anti-CD20 monoclonal antibody rituximab was well tolerated and allowed a 14-month remission of clinical symptoms and KSHV viremia. Rituximab should be added to the therapeutic armamentarium for KSHV-related MCD.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acquired Immunodeficiency Syndrome / complications
  • Antibodies, Monoclonal / therapeutic use*
  • Antibodies, Monoclonal, Murine-Derived
  • Antigens, CD20 / immunology*
  • Castleman Disease / virology*
  • DNA, Viral / blood
  • Female
  • Herpesvirus 8, Human* / genetics
  • Humans
  • Immunotherapy
  • Interleukin-6 / analysis
  • Interleukin-6 / immunology
  • Leukocytes, Mononuclear / virology
  • Lymph Nodes / chemistry
  • Lymph Nodes / virology
  • Middle Aged
  • Polymerase Chain Reaction
  • Remission Induction*
  • Rituximab
  • Sarcoma, Kaposi / virology*

Substances

  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Murine-Derived
  • Antigens, CD20
  • DNA, Viral
  • Interleukin-6
  • Rituximab