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 Blood, 7 May 2009, Vol. 113, No. 19, pp. 4521-4524.
Prepublished online as a Blood First Edition Paper on February 17, 2009; DOI 10.1182/blood-2008-12-197053.

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CLINICAL TRIALS AND OBSERVATIONS

Brief report

Cytokine changes during rituximab therapy in HIV-associated multicentric Castleman disease

Mark Bower1, Ophelia Veraitch2, Richard Szydlo3, Peter Charles4, Peter Kelleher1, Brian Gazzard1, Mark Nelson1, and Justin Stebbing1,2

1 Department of Oncology, HIV Medicine and Immunology, Imperial College School of Medicine, Chelsea and Westminster Hospital, London; and Departments of2 Oncology, 3 Statistics, and 4 Biochemistry, Imperial College School of Medicine, Imperial College Healthcare National Health Service (NHS) Trust, London, United Kingdom

Recent data highlight the importance of inflammatory markers during human immunodeficiency virus type 1 (HIV) infection. HIV-associated multicentric Castleman disease (HIV-MCD) presents with systemic symptoms attributed to cytokine disarray, and we have previously shown that the use of the anti-CD20 monoclonal antibody rituximab induces clinical remissions. Before and during successful rituximab therapy, 15 plasma cytokines were measured as were adaptive (CD4, CD8, CD19) and innate (CD16/56) immune cell populations and HIV-1 viral loads. A significant reduction from baseline of the CD19 B-cell count, consistent with rituximab's mechanism of action, was observed. Markedly elevated cytokine levels were observed before rituximab therapy, and a reduction from baseline values with rituximab therapy was observed for interleukin (IL)-5, IL-6, and IL-10. Therapies that reduce the inflammatory cytokine response are likely to be successful in a range of diseases, including HIV-MCD, and in the future may be used to guide therapeutic strategies.


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