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Prepublished online as a Blood First Edition Paper on July 3, 2003; DOI 10.1182/blood-2003-03-0951.
Submitted March 27, 2003
Accepted June 13, 2003
Rituximab therapy for HIV-associated Castleman's disease
Anne-Genevieve Marcelin, Laurent Aaron, Christina Mateus, Emmanuel Gyan, Isabelle Gorin, Jean-Paul Viard, Vincent Calvez, and Nicolas Dupin*
Department of Virology, Hopital Pitie-Salpetriere, Paris, France
Department of Immunology, Hopital Necker, Paris, France
Department of Dermatology, Hopital Cochin, Paris, France
Department of Hematology, Hopital Cochin, Paris, France
* Corresponding author; email: nicolas;dupin{at}cch.ap-hop-paris.fr.
To assess the clinical benefit of rituximab for HIV-associated Castleman's disease, five HIV-infected patients with histological proven Castleman's disease were prospectively enrolled to receive 4 infusions of rituximab (Mabthera®). Clinical and biological parameters (C-reactive protein, CD19 cell count, KSHV viral load in peripheral blood mononuclear cells) were assessed before and at different time points following rituximab infusions. Two patients died very quickly after the beginning of rituximab with no effect on both KSHV viral load and CD19 cell count. Three out of 5 patients were considered in complete remission with no more clinical symptoms related to Castleman's disease with a follow-up of 4 to 14 months. In two cases, clinical remission correlated with a dramatic decrease of KSHV viral load and C-reactive protein levels and a transitory but sharp decrease of CD19 cell count. In two responders, we observed an aggravation of Kaposi's sarcoma. Our preliminary results suggest that rituximab may be effective in controlling Castleman disease in a subset of patients while it may exacerbate concomitant Kaposi's sarcoma.
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