Improved outcome with rituximab in patients with HIV-associated multicentric Castleman disease

Author:

Hoffmann Christian12,Schmid Holger3,Müller Markus4,Teutsch Christian5,van Lunzen Jan6,Esser Stefan7,Wolf Timo8,Wyen Christoph9,Sabranski Michael10,Horst Heinz-August2,Reuter Stefan11,Vogel Martin12,Jäger Hans13,Bogner Johannes3,Arasteh Keikawus14

Affiliation:

1. Infektionsmedizinisches Centrum Hamburg, Hamburg, Germany;

2. University of Schleswig-Holstein, Campus Kiel, Kiel, Germany;

3. Department of Infectious Diseases, University Hospital of Munich, Downtown Campus, Munich, Germany;

4. Vivantes Krankenhaus Neukölln, Berlin, Germany;

5. Helios Klinikum Berlin-Buch, Berlin, Germany;

6. University Hospital of Eppendorf, Hamburg, Germany;

7. University Hospital of Essen, Essen, Germany;

8. Hospital of the Johann Wolfgang Goethe University, Frankfurt, Germany;

9. University of Cologne, Cologne, Germany;

10. Ifi institute, Hamburg, Germany;

11. University Hospital Düsseldorf, Düsseldorf, Germany;

12. Department of Internal Medicine III, Bonn University, Bonn, Germany;

13. MVZ Karlsplatz-HIV Research and Clinical Care Centre, Munich, Germany; and

14. Epimed, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany

Abstract

Abstract Although HIV-associated multicentric Castleman disease (HIV-MCD) is not classified as an AIDS-defining illness, mortality is high and progression to lymphoma occurs frequently. At present, there is no widely accepted recommendation for the treatment of HIV-MCD. In this retrospective (1998-2010), multicentric analysis of 52 histologically proven cases, outcome was analyzed with respect to the use of different MCD therapies and potential prognostic factors. After a mean follow-up of 2.26 years, 19 of 52 patients died. Median estimated overall survival (OS) was 6.2 years. Potential risk factors, such as older age, previous AIDS, or lower CD4 T cells had no impact on OS. Treatment was heterogeneous, consisting of cytostatic and/or antiviral agents, rituximab, or combinations of these modalities. There were marked differences in the outcome when patients were grouped according to MCD treatment. Patients receiving rituximab-based regimens had higher complete remission rates than patients receiving chemotherapy only. The mean estimated OS in patients receiving rituximab alone or in combination with cytostatic agents was not reached, compared with 5.1 years (P = .03). Clinical outcome and overall survival of HIV-MCD have markedly improved with rituximab-based therapies, considering rituximab-based therapies (with or without cytostatic agents) to be among the preferred first-line options in patients with HIV-MCD.

Publisher

American Society of Hematology

Subject

Cell Biology,Hematology,Immunology,Biochemistry

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