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Damania B, Dittmer DP. Today's Kaposi sarcoma is not the same as it was 40 years ago, or is it? J Med Virol 2023; 95:e28773. [PMID: 37212317 PMCID: PMC10266714 DOI: 10.1002/jmv.28773] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/20/2023] [Accepted: 04/22/2023] [Indexed: 05/23/2023]
Abstract
This review will provide an overview of the notion that Kaposi sarcoma (KS) is a disease that manifests under diverse and divergent circumstances. We begin with a historical introduction of KS and KS-associated herpesvirus (KSHV), highlight the diversity of clinical presentations of KS, summarize what we know about the cell of origin for this tumor, explore KSHV viral load as a potential biomarker for acute KSHV infections and KS-associated complications, and discuss immune modulators that impact KSHV infection, KSHV persistence, and KS disease.
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Affiliation(s)
- Blossom Damania
- Lineberger Comprehensive Cancer Center, Department of Microbiology and Immunology, School of Medicine, University of North Carolina at Chapel Hill, 450 West Drive CB#7295, Rm 12-048, Chapel Hill, NC 27599
| | - Dirk P. Dittmer
- Lineberger Comprehensive Cancer Center, Department of Microbiology and Immunology, School of Medicine, University of North Carolina at Chapel Hill, 450 West Drive CB#7295, Rm 12-048, Chapel Hill, NC 27599
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2
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Aydin Goker ET, Cagdas D, Bajin IY, Kukul MG, Aytekin ES, Orhan D, Alp A, Uzar S, Sarac F, Kara A, Kutluk MT. Multicentric Castleman disease in a DOCK8-deficient patient with Orf virus infection. Pediatr Allergy Immunol 2022; 33:e13666. [PMID: 34792227 DOI: 10.1111/pai.13666] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 09/05/2021] [Accepted: 09/09/2021] [Indexed: 12/01/2022]
Affiliation(s)
| | - Deniz Cagdas
- Department of Pediatric Immunology, Hacettepe University, Ankara, Turkey
| | - Inci Yaman Bajin
- Division of Pediatric Oncology, Department of Pediatrics, Hacettepe University, Ankara, Turkey
| | - Musa Gurel Kukul
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Hacettepe University, Ankara, Turkey
| | - Elif Soyak Aytekin
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Hacettepe University, Ankara, Turkey
| | - Diclehan Orhan
- Department of Pathology, Hacettepe University, Ankara, Turkey
| | - Alpaslan Alp
- Department of Medical Microbiology, Hacettepe University, Ankara, Turkey
| | - Serdar Uzar
- Pendik Veterinary Control and Research Institute, Istanbul, Turkey
| | - Fahriye Sarac
- Pendik Veterinary Control and Research Institute, Istanbul, Turkey
| | - Ates Kara
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Hacettepe University, Ankara, Turkey
| | - M Tezer Kutluk
- Division of Pediatric Oncology, Department of Pediatrics, Hacettepe University, Ankara, Turkey
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3
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Carbone A, Borok M, Damania B, Gloghini A, Polizzotto MN, Jayanthan RK, Fajgenbaum DC, Bower M. Castleman disease. Nat Rev Dis Primers 2021; 7:84. [PMID: 34824298 PMCID: PMC9584164 DOI: 10.1038/s41572-021-00317-7] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/06/2021] [Indexed: 01/02/2023]
Abstract
Castleman disease (CD), a heterogeneous group of disorders that share morphological features, is divided into unicentric CD and multicentric CD (MCD) according to the clinical presentation and disease course. Unicentric CD involves a solitary enlarged lymph node and mild symptoms and excision surgery is often curative. MCD includes a form associated with Kaposi sarcoma herpesvirus (KSHV) (also known as human herpesvirus 8) and a KSHV-negative idiopathic form (iMCD). iMCD can present in association with severe syndromes such as TAFRO (thrombocytopenia, ascites, fever, reticulin fibrosis and organomegaly) or POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal plasma cell disorder and skin changes). KSHV-MCD often occurs in the setting of HIV infection or another cause of immune deficiency. The interplay between KSHV and HIV elevates the risk for the development of KSHV-induced disorders, including KSHV-MCD, KSHV-lymphoproliferation, KSHV inflammatory cytokine syndrome, primary effusion lymphoma and Kaposi sarcoma. A CD diagnosis requires a multidimensional approach, including clinical presentation and imaging, pathological features, and molecular virology. B cell-directed monoclonal antibody therapy is the standard of care in KSHV-MCD, and anti-IL-6 therapy is the recommended first-line therapy and only treatment of iMCD approved by the US FDA and EMA.
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Affiliation(s)
- Antonino Carbone
- Centro di Riferimento Oncologico (CRO), IRCCS, National Cancer Institute, Aviano, Italy.
- S. Maria degli Angeli Hospital, Pordenone, Italy.
| | - Margaret Borok
- Unit of Internal Medicine, University of Zimbabwe Faculty of Medicine and Health Sciences, Harare, Zimbabwe
| | - Blossom Damania
- Department of Microbiology and Immunology and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Annunziata Gloghini
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Mark N Polizzotto
- Clinical Hub for Interventional Research, John Curtin School of Medical Research, The Australian National University, Canberra, NSW, Australia
| | - Raj K Jayanthan
- Castleman Disease Collaborative Network, Philadelphia, PA, USA
| | - David C Fajgenbaum
- Center for Cytokine Storm Treatment & Laboratory, University of Pennsylvania, Philadelphia, PA, USA
| | - Mark Bower
- National Centre for HIV Malignancy, Chelsea & Westminster Hospital, London, UK
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4
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Blumenthal MJ, Cornejo Castro EM, Whitby D, Katz AA, Schäfer G. Evidence for altered host genetic factors in KSHV infection and KSHV-related disease development. Rev Med Virol 2021; 31:e2160. [PMID: 33043529 PMCID: PMC8047912 DOI: 10.1002/rmv.2160] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/06/2020] [Accepted: 08/08/2020] [Indexed: 01/09/2023]
Abstract
Kaposi's sarcoma-associated herpesvirus (KSHV) is the etiological agent of Kaposi's sarcoma (KS), the most common AIDS-related malignancy. It also causes other rare, but certainly underreported, KSHV-associated pathologies, namely primary effusion lymphoma, multicentric Castleman disease and KSHV inflammatory cytokine syndrome. Epidemiology and pathogenicity studies point to the potential for host genetic predisposition to KSHV infection and/or the subsequent development of KSHV-associated pathologies partly explaining the peculiar geographic and population-specific incidence of KSHV and associated pathologies and discrepancies in KSHV exposure and infection and KSHV infection and disease development. This review consolidates the current knowledge of host genetic factors involved in the KSHV-driven pathogenesis. Studies reviewed here indicate a plausible connection between KSHV susceptibility and host genetic factors that affect either viral access to host cells via entry mechanisms or host innate immunity to viral infection. Subsequent to infection, KSHV-associated pathogenesis, reviewed here primarily in the context of KS, is likely influenced by an orchestrated concert of innate immune system interactions, downstream inflammatory pathways and oncogenic mechanisms. The association studies reviewed here point to interesting candidate genes that may prove important in achieving a more nuanced understanding of the pathogenesis and therapeutic targeting of KSHV and associated diseases. Recent studies on host genetic factors suggest numerous candidate genes strongly associated with KSHV infection or subsequent disease development, particularly innate immune system mediators. Taken together, these contribute toward our understanding of the geographic prevalence and population susceptibility to KSHV and KSHV-associated diseases.
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Affiliation(s)
- Melissa J. Blumenthal
- International Centre for Genetic Engineering and BiotechnologyCape TownSouth Africa
- Division of Medical Biochemistry and Structural Biology, Department of Integrative Biomedical SciencesUniversity of Cape TownCape TownSouth Africa
- Institute of Infectious Disease and Molecular MedicineUniversity of Cape TownCape TownSouth Africa
| | - Elena Maria Cornejo Castro
- Viral Oncology Section, AIDS and Cancer Virus Program, Leidos Biomedical ResearchFrederick National Laboratory for Cancer ResearchFrederickMarylandUSA
| | - Denise Whitby
- Viral Oncology Section, AIDS and Cancer Virus Program, Leidos Biomedical ResearchFrederick National Laboratory for Cancer ResearchFrederickMarylandUSA
| | - Arieh A. Katz
- Division of Medical Biochemistry and Structural Biology, Department of Integrative Biomedical SciencesUniversity of Cape TownCape TownSouth Africa
- Institute of Infectious Disease and Molecular MedicineUniversity of Cape TownCape TownSouth Africa
| | - Georgia Schäfer
- International Centre for Genetic Engineering and BiotechnologyCape TownSouth Africa
- Division of Medical Biochemistry and Structural Biology, Department of Integrative Biomedical SciencesUniversity of Cape TownCape TownSouth Africa
- Institute of Infectious Disease and Molecular MedicineUniversity of Cape TownCape TownSouth Africa
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5
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Caba L, Gug C, Gorduza EV. Heterogeneity in combined immunodeficiencies with associated or syndromic features (Review). Exp Ther Med 2020; 21:84. [PMID: 33363595 PMCID: PMC7725017 DOI: 10.3892/etm.2020.9517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 10/14/2020] [Indexed: 11/06/2022] Open
Abstract
Primary immunodeficiencies are genetic diseases, mainly monogenic, that affect various components of the immune system and stages of the immune response. The category of combined immunodeficiencies with associated or syndromic features comprises over 70 clinical entities, characterized by heterogeneity of clinical presentation, mode of transmission, molecular, biological, mutational and immunological aspects. The mutational spectrum is wide, ranging from structural chromosomal abnormalities to gene mutations. The impact on the function of the proteins encoded by the genes involved is different; loss of function is most common, but situations with gain of function are also described. Most proteins have multiple functions and are components of several protein interaction networks. The pathophysiological mechanisms mainly involve: Missing enzymes, absent or non-functional proteins, abnormal DNA repair pathways, altered signal transduction, developmental arrest in immune differentiation, impairment of cell-to-cell and intracellular communications. Allelic heterogeneity, reduced penetrance and variable expressivity are genetic phenomena that cause diagnostic difficulties, especially since most are rare/very rare diseases, which is equivalent to delaying proper case management. Most primary immunodeficiencies are Mendelian diseases with X-linked or recessive inheritance, and molecular diagnosis allows the identification of family members at risk and the application of appropriate primary and secondary prevention measures in addition to the specific curative ones. In conclusion, recognizing heterogeneity and its sources is extremely important for current medical practice, but also for the theoretical value of improving biological and biomedical applications.
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Affiliation(s)
- Lavinia Caba
- Department of Medical Genetics, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Cristina Gug
- Department of Microscopic Morphology, 'Victor Babeş' University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Eusebiu Vlad Gorduza
- Department of Medical Genetics, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iași, Romania.,Prenatal Diagnosis Department, 'Cuza Voda' Obstetrics-Gynecology Clinical Hospital, 700038 Iași, Romania
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6
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Borocco C, Ballot-Schmit C, Ackermann O, Aladjidi N, Delaleu J, Giacobbi-Milet V, Jannier S, Jeziorski E, Maurier F, Perel Y, Piguet C, Oksenhendler E, Koné-Paut I, Galeotti C. The French paediatric cohort of Castleman disease: a retrospective report of 23 patients. Orphanet J Rare Dis 2020; 15:95. [PMID: 32303241 PMCID: PMC7164260 DOI: 10.1186/s13023-020-1345-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 03/02/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Castleman disease (CD) is a rare non-malignant lymphoproliferation of undetermined origin. Two major disease phenotypes can be distinguished: unicentric CD (UCD) and multicentric CD (MCD). Diagnosis confirmation is based on histopathological findings in a lymph node. We attempted to survey all cases of paediatric CD identified to date in France to set up a national registry aiming to improve CD early recognition, treatment and follow-up, within the context of a new national reference center (http://www.castleman.fr). METHODS In 2016, we e-mailed a questionnaire to members of the French paediatric immunohaematology society, the paediatric rheumatology society and the Reference Centre for Castleman Disease to retrospectively collect cases of paediatric CD (first symptoms before age 18 years). Anatomopathological confirmation was mandatory. RESULTS We identified 23 patients (12 girls) with a diagnosis of UCD (n = 17) and MCD (n = 6) between 1994 and 2018. The mean age at first symptoms was 11.47 ± 4.23 years for UCD and 8.3 ± 3.4 years for MCD. The mean diagnosis delay was 8.16 ± 10.32 months for UCD and 5.16 ± 5.81 years for MCD. In UCD, the initial symptoms were isolated lymph nodes (n = 10) or lymph node associated with other symptoms (n = 7); fever was present in 3 patients. Five patients with MCD presented fever. No patients had HIV or human herpesvirus 8 infection. Autoinflammatory gene mutations were investigated in five patients. One patient with MCD carried a K695R heterozygous mutation in MEFV, another patient with MCD and Duchenne myopathy carried two variants in TNFRSF1A and one patient with UCD and fever episodes carried two heterozygous mutations, in IL10RA and IL36RN, respectively. Treatment of UCD was mainly surgical resection, steroids, and radiotherapy. Treatment of MCD included tocilizumab, rituximab, anakinra, steroids, chemotherapy, and splenectomy. Overall survival after a mean of 6.1 ± 6.4 years of follow-up, was 100% for both forms. CONCLUSION Paediatric CD still seems underdiagnosed, with a significant diagnosis delay, especially for MCD, but new international criteria will help in the future. Unlike adult CD, which is strongly associated with HIV and human herpesvirus 8 infection, paediatric CD could be favored by primary activation of innate immunity and may affect life expectancy less.
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Affiliation(s)
- Charlotte Borocco
- Department of Paediatric Rheumatology, CeReMAIA, CHU Bicêtre, Assistance Publique - Hôpitaux de Paris, Université Paris-Sud-Saclay, 94270, Le Kremlin Bicêtre, France
| | | | - Oanez Ackermann
- Department of Paediatric Hepatology, CHU Bicêtre, Assistance Publique -Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Nathalie Aladjidi
- Paediatric Oncology Haematology Unit, Hôpital Pellegrin, Bordeaux, France
| | - Jeremie Delaleu
- Department of Internal Medicine, CeReMAIA, CHU Tenon, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Vannina Giacobbi-Milet
- Department of Paediatric Haematology and Oncology, Centre Hospitalier du Mans, Le Mans, France
| | - Sarah Jannier
- Department of Paediatric Haematology and Oncology, CHU Hautepierre, Strasbourg, France
| | - Eric Jeziorski
- Department of Paediatrics, CeReMAIA, CHU Arnaud de Villeneuve, Montpellier, France
| | - François Maurier
- Department of Internal Medicine, Hôpitaux privés de Metz, Metz, France
| | - Yves Perel
- Paediatric Oncology Haematology Unit, Hôpital Pellegrin, Bordeaux, France
| | - Christophe Piguet
- Paediatric Oncology Haematology Unit, CHU de Limoges, Limoges, France
| | - Eric Oksenhendler
- Department of Clinical Immunology, CHU Saint-Louis, Paris, France.,National Reference Center for Castleman Disease, Paris, France
| | - Isabelle Koné-Paut
- Department of Paediatric Rheumatology, CeReMAIA, CHU Bicêtre, Assistance Publique - Hôpitaux de Paris, Université Paris-Sud-Saclay, 94270, Le Kremlin Bicêtre, France
| | - Caroline Galeotti
- Department of Paediatric Rheumatology, CeReMAIA, CHU Bicêtre, Assistance Publique - Hôpitaux de Paris, Université Paris-Sud-Saclay, 94270, Le Kremlin Bicêtre, France. .,National Reference Center for Castleman Disease, Paris, France.
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7
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Barlingay G, Findakly D, Hartmann C, Amar S. The Potential Clinical Benefit of Tocilizumab Therapy for Patients with HHV-8-infected AIDS-related Multicentric Castleman Disease: A Case Report and Literature Review. Cureus 2020; 12:e7589. [PMID: 32399323 PMCID: PMC7212740 DOI: 10.7759/cureus.7589] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 04/08/2020] [Indexed: 12/27/2022] Open
Abstract
Castleman disease (CD), also known as angiofollicular hyperplasia, is a rare disorder characterized by nonmalignant mediastinal lymph node enlargement provoked by excess interleukin-6 (IL-6) secretion. It could be unicentric or multicentric (MCD). Here, we describe a 27-year-old man with a prior history of AIDS, Kaposi sarcoma (KS), and latent syphilis who presented to the ED for persistent fatigue, fever, chills, night sweats, and productive cough. Infectious workup was negative, and the patient continued to have a high fever despite empiric antibiotic therapy. Bone marrow biopsy was performed and was negative for malignancy. The patient eventually underwent a left clavicular lymph node biopsy, which showed a plasma cell variant CD with positive immunostaining for human herpesvirus 8 (HHV-8), and high HHV-8 viral load. We started the patient on rituximab and liposomal doxorubicin, but unfortunately, the patient had a severe anaphylactic reaction to the rituximab, so we could not proceed with this treatment. We, therefore, started tocilizumab treatment, which improved the patient's general condition, and he was eventually discharged from our hospital. Upon follow-up 11-months later, a repeat CT scan of the chest and abdomen showed a near-complete treatment response with decreased lymphadenopathy throughout and hepatosplenomegaly. IL-6 overproduction in patients with CD is linked to the production of inflammatory cytokines and has a role in tumor angiogenesis, which makes it potential for IL-6 targeted therapy. The diagnosis of CD, especially MCD, requires a high index of suspicion, and a lymph node biopsy is essential in the diagnosis. Tocilizumab, an IL-6 receptor antibody, could potentially be considered as a practical therapeutic approach in managing HHV-8 positive MCD patients who do not tolerate or respond to initial rituximab therapy.
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Affiliation(s)
- Gauri Barlingay
- Internal Medicine, Creighton University Arizona Health Education Alliance/Valleywise Health, Phoenix, USA
| | - Dawood Findakly
- Internal Medicine, Creighton University Arizona Health Education Alliance/Valleywise Health Medical Center, Phoenix, USA
| | | | - Surabhi Amar
- Hematology/Oncology, Creighton University Arizona Health Education Alliance/Valleywise Health, Phoenix, USA
- Oncology, University of Arizona College of Medicine - Phoenix Campus, Phoenix, USA
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Sopfe J, Endres A, Campbell K, Hayes K, Trout AT, Liang X, Lorsbach R, O’Brien MM, Cost CR. Castleman disease in pediatrics: Insights on presentation, treatment, and outcomes from a two-site retrospective cohort study. Pediatr Blood Cancer 2019; 66:e27613. [PMID: 30680887 PMCID: PMC6428598 DOI: 10.1002/pbc.27613] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 12/03/2018] [Accepted: 12/20/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Castleman disease (CD) is an uncommon lymphoproliferative disorder that is rare in pediatric populations; the literature describing this population is sparse. We sought to describe pediatric CD, including unicentric CD (UCD) and human herpes virus-8 (HHV8)-negative multicentric CD (MCD), in a multi-institutional cohort. METHODS We retrospectively reviewed 24 patients, aged 0 to 26 years at diagnosis, who were diagnosed with CD between January 1, 2005, and May 16, 2017, at two tertiary children's hospitals. Demographic and clinical data were collected. RESULTS Most patients (75%, 18/24) presented with UCD. All patients with MCD were HHV8-negative. The most common histopathologic variant was hyaline vascular (75%, 18/24). Plasma cell variant occurred in 33% (2/6 [95% confidence intervals (CI), 4-78%]) of patients with HHV8-negative MCD and 17% (3/18 [95% CI, 4-41%]) of patients with UCD. Systemic symptoms were present in 4 of 6 of patients with HHV8-negative MCD and 8 of 18 of patients with UCD. Anemia and laboratory inflammation occurred in both UCD and MCD patients, with nonsignificantly higher rates of anemia and elevated C-reactive protein in MCD patients. All but two UCD patients underwent gross total resection as definitive therapy. Among HHV8-negative MCD patients, a combination of resection, chemotherapy, and immunotherapy was used. No UCD patients and three of six HHV8-negative MCD patients experienced disease progression/relapse prior to lasting remission. There were no deaths. CONCLUSION Pediatric patients with CD most commonly have unicentric, hyaline vascular variant disease. Pediatric patients with both UCD and MCD commonly have systemic inflammation and, despite risk of progression/relapse in MCD patients, ultimately have excellent survival.
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Affiliation(s)
- Jenna Sopfe
- Center for Cancer and Blood Disorders, Department of Pediatrics, University of Colorado School of Medicine, 13123 E. 16 Ave, B115, Aurora, Colorado, 80045, USA, Phone: 720-777-1002, Fax: 720-777-7279
| | - Ashley Endres
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, 45229, USA, Phone: 513-736-3243, Fax: 866-466-9505
| | - Kristen Campbell
- Department of Pediatrics, University of Colorado School of Medicine, 13001 E 17th Pl, Building 500, N2228A, Aurora, Colorado, 80045, USA, Phone: 303-724-3400, Fax: None
| | - Kari Hayes
- Department of Radiology, University of Colorado School of Medicine, 13123 E. 16 AveB125, Aurora, Colorado, 80045, USA, Phone: 720-777-4525, Fax: 720-777-7264
| | - Andrew T. Trout
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, 45229, USA, Phone: 513-803-3004, Fax: 513-636-8145
| | - Xiayuan Liang
- Department of Pathology, University of Colorado School of Medicine, 13123 E. 16 Ave, B120, Aurora, Colorado, 80045, USA, Phone: 720-777-6266, Fax: 720-777-7119
| | - Robert Lorsbach
- Department of Pathology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati, OH, 45229, USA, Phone: 513-636-4261, Fax: 513-636-3924
| | - Maureen M. O’Brien
- Cancer and Blood Diseases Institute, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati, OH, 45229, USA, Phone: 513-803-1678, Fax: 513-636-3549
| | - Carrye R. Cost
- Center for Cancer and Blood Disorders, Department of Pediatrics, University of Colorado School of Medicine, 13123 E. 16 Ave, B115, Aurora, Colorado, 80045, USA, Phone: 720-777-6775, Fax: 720-777-7227
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Damania B, Münz C. Immunodeficiencies that predispose to pathologies by human oncogenic γ-herpesviruses. FEMS Microbiol Rev 2019; 43:181-192. [PMID: 30649299 PMCID: PMC6435449 DOI: 10.1093/femsre/fuy044] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 11/30/2018] [Indexed: 12/13/2022] Open
Abstract
Human γ-herpesviruses include the closely related tumor viruses Epstein Barr virus (EBV) and Kaposi sarcoma-associated herpesvirus (KSHV). EBV is the most growth-transforming pathogen known and is linked to at least seven human malignancies. KSHV is also associated with three human cancers. Most EBV- and KSHV-infected individuals fortunately remain disease-free despite persistent infection and this is likely due to the robustness of the immune control that they mount against these tumor viruses. However, upon immune suppression EBV- and KSHV-associated malignancies emerge at increased frequencies. Moreover, primary immunodeficiencies with individual mutations that predispose to EBV or KSHV disease allow us to gain insights into a catalog of molecules that are required for the immune control of these tumor viruses. Curiously, there is little overlap between the mutation targets that predispose individuals to EBV versus KSHV disease, even so both viruses can infect the same host cell, human B cells. These differences will be discussed in this review. A better understanding of the crucial components in the near-perfect life-long immune control of EBV and KSHV should allow us to target malignancies that are associated with these viruses, but also induce similar immune responses against other tumors.
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Affiliation(s)
- Blossom Damania
- Lineberger Cancer Research Center and Department of Microbiology and Immunology, University of North Carolina, Chapel Hill, NC 27514, USA
| | - Christian Münz
- Viral Immunobiology, Institute of Experimental Immunology, University of Zürich, 8057 Zürich, Switzerland
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10
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Nordin AB, Nordin AD, Ranalli MA, Kenney BD. Castleman's disease requiring repeat surgical excision. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2018. [DOI: 10.1016/j.epsc.2018.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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11
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Wala SJ, Fallon EM, Forlenza CJ, Shukla N, LaQuaglia MP. Unicentric Castleman disease in the mediastinum. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2018. [DOI: 10.1016/j.epsc.2018.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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Abstract
Multicentric Castleman’s disease (MCD), a distinct subtype of Castleman’s disease, is a rare, nonneoplastic, lymphoproliferative disorder. Patients with MCD present with systemic symptoms and multiple lymphadenopathy. Lymph node biopsy is necessary for the diagnosis of various histological MCD patterns including hyaline vascular, plasma cell, and mixed types. Human herpesvirus 8 (HHV8) infection was identified as an important etiology of MCD among immunocompromised patients such as those positive for human immunodeficiency virus. Although HHV8-negative MCD was reported in immunocompetent patients, the underlying etiology remains unknown. Several experts speculate that MCD in immunocompetent patients might be due to proinflammatory hypercytokinemia because of infection by a virus other than HHV8, inflammation, or neoplastic disease. In 2010, a distinct variant of HHV8-negative MCD reported in Japan was characterized by thrombocytopenia, anasarca, myelofibrosis, renal dysfunction, and organomegaly (TAFRO). Recent case reports and a systematic review suggest that TAFRO syndrome might have a unique pathogenesis among HHV8-negative MCD variants. This review introduces TAFRO syndrome as a subtype of HHV8-negative MCD and offers an overview of the current perspectives on this syndrome.
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Affiliation(s)
- Kentaro Sakashita
- Department of Internal Medicine, Tokyo Metropolitan Matsuzawa Hospital.,Department of Respiratory Medicine, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Kengo Murata
- Department of Respiratory Medicine, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Mikio Takamori
- Department of Respiratory Medicine, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
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Liu AY, Nabel CS, Finkelman BS, Ruth JR, Kurzrock R, van Rhee F, Krymskaya VP, Kelleher D, Rubenstein AH, Fajgenbaum DC. Idiopathic multicentric Castleman's disease: a systematic literature review. LANCET HAEMATOLOGY 2016; 3:e163-75. [PMID: 27063975 DOI: 10.1016/s2352-3026(16)00006-5] [Citation(s) in RCA: 195] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 01/14/2016] [Accepted: 01/14/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Multicentric Castleman's disease describes a group of poorly understood lymphoproliferative disorders driven by proinflammatory hypercytokinaemia. Patients have heterogeneous clinical features, characteristic lymph node histopathology, and often deadly multiple organ dysfunction. Human herpesvirus 8 (HHV8) causes multicentric Castleman's disease in immunosuppressed patients. The cause of HHV8-negative multicentric Castleman's disease is idiopathic; such cases are called idiopathic multicentric Castleman's disease. An absence of centralised information about idiopathic multicentric Castleman's disease represents a major challenge for clinicians and researchers. We aimed to characterise clinical features of, treatments for, and outcomes of idiopathic multicentric Castleman's disease. METHODS We did a systematic literature review and searched PubMed, the Cochrane database, and ClinicalTrials.gov from January, 1995, with keywords including "Castleman's disease" and "giant lymph node hyperplasia". Inclusion criteria were pathology-confirmed Castleman's disease in multiple nodes and minimum clinical and treatment information on individual patients. Patients with HHV8 or HIV infection or diseases known to cause Castleman-like histopathology were excluded. FINDINGS Our search identified 626 (33%) patients with HHV8-negative multicentric Castleman's disease from 1923 cases of multicentric Castleman's disease. 128 patients with idiopathic multicentric Castleman's disease met all inclusion criteria for the systematic review. Furthermore, aggregated data for 127 patients with idiopathic multicentric Castleman's disease were presented from clinical trials, which were excluded from primary analyses because patient-level data were not available. Clinical features of idiopathic multicentric Castleman's disease included multicentric lymphadenopathy (128/128), anaemia (79/91), elevated C-reactive protein (65/79), hypergammaglobulinaemia (63/82), hypoalbuminaemia (57/63), elevated interleukin 6 (57/63), hepatomegaly or splenomegaly (52/67), fever (33/64), oedema, ascites, anasarca, or a combination (29/37), elevated soluble interleukin 2 receptor (20/21), and elevated VEGF (16/20). First-line treatments for idiopathic multicentric Castleman's disease included corticosteroids (47/128 [37%]), cytotoxic chemotherapy (47/128 [37%]), and anti-interleukin 6 therapy (11/128 [9%]). 49 (42%) of 116 patients failed first-line therapy, 2-year survival was 88% (95% CI 81-95; 114 total patients, 12 events, 36 censored), and 27 (22%) of 121 patients died by the end of their observed follow-up (median 29 months [IQR 12-50]). 24 (19%) of 128 patients with idiopathic multicentric Castleman's disease had a diagnosis of a separate malignant disease, significantly higher than the frequency expected in age-matched controls (6%). INTERPRETATION Our systematic review provides comprehensive information about clinical features, treatment, and outcomes of idiopathic multicentric Castleman's disease, which accounts for at least 33% of all cases of multicentric Castleman's disease. Our findings will assist with prompt recognition, diagnostic criteria development, and effective management of the disease. FUNDING None.
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Affiliation(s)
- Amy Y Liu
- Orphan Disease Center, Perelman School of Medicine, University of Pennsylvania, Translational Research Laboratory, Philadelphia, PA, USA
| | | | - Brian S Finkelman
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jason R Ruth
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Razelle Kurzrock
- Centre for Personalized Therapy and Clinical Trials Office, UC San Diego Moores Cancer Center, La Jolla, CA, USA
| | - Frits van Rhee
- Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Vera P Krymskaya
- Pulmonary, Allergy and Critical Care Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Translational Research Laboratory, Philadelphia, PA, USA
| | - Dermot Kelleher
- Faculty of Medicine, University of British Columbia, Woodward Instructional Resource Centre, Vancouver, BC, Canada
| | - Arthur H Rubenstein
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Smilow Center for Translational Research, Philadelphia, PA, USA
| | - David C Fajgenbaum
- Orphan Disease Center, Perelman School of Medicine, University of Pennsylvania, Translational Research Laboratory, Philadelphia, PA, USA; Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Pozzato G, Mazzaro C, Dal Maso L, Mauro E, Zorat F, Moratelli G, Bulian P, Serraino D, Gattei V. Hepatitis C virus and non-Hodgkin’s lymphomas: Meta-analysis of epidemiology data and therapy options. World J Hepatol 2016; 8:107-116. [PMID: 26807206 PMCID: PMC4716526 DOI: 10.4254/wjh.v8.i2.107] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 07/24/2015] [Accepted: 12/08/2015] [Indexed: 02/06/2023] Open
Abstract
Hepatitis C virus (HCV) is a global health problem affecting a large fraction of the world’s population: This virus is able to determine both hepatic and extrahepatic diseases. Mixed cryoglobulinemia, a B-cell “benign” lymphoproliferative disorders, represents the most closely related as well as the most investigated HCV-related extrahepatic disorder. Since this virus is able to determine extrahepatic [non-Hodgkin’s lymphoma (NHL)] as well as hepatic malignancies (hepatocellular carcinoma), HCV has been included among human cancer viruses. The most common histological types of HCV-associated NHL are the marginal zone, the lymphoplasmacytic and diffuse large cell lymphomas. The role of the HCV in the pathogenesis of the B-cell lymphoproliferative disorders is confirmed also by the responsiveness of the NHL to antiviral therapy. The purpose of this review is to provide an overview of the recent literature and a meta analysis of the epidemiology data, to explain the role of HCV in the development of NHL’s lymphoma. Furthermore, the possibility to treat these HCV-related NHL with the antiviral therapy or with other therapeutic options, like chemotherapy, is also discussed.
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Zhang J, Li C, Lv L, Yang C, Kong XR, Zhu J, Zhang Y, Wang S. Clinical and experimental study of Castleman disease in children. Pediatr Blood Cancer 2015; 62:109-14. [PMID: 25213773 DOI: 10.1002/pbc.25220] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 07/21/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND Castleman disease (CD) is a rare lymphoproliferative disease that is often underdiagnosed or misdiagnosed, especially in children. For this reason, we describe the clinical manifestations, diagnosis and treatment of CD in 11 children. PROCEDURE A retrospective study was performed to analyze the clinical features of 11 children with CD in a single institution from January 2001 to December 2012. All had computed tomography (CT) and lymph node resection for pathology diagnosis. RESULTS The average age of patients was 9.67 ± 4.26 years (range 1.3-15.5 years) including eight males (72.73%) and three females (27.27%). All but two (18.18%) had multicentric Castleman disease (MCD). Human immunodeficiency virus (HIV) or human herpes virus 8 (HHV8) infected cells were not detected in all patients. All patients were misdiagnosed in outside hospitals without tissue examination. Only in one case, the preoperative CT scan suggested CD. After treatment, 10 out of 11 children with CD in our study were disease free in the follow-up period ranging from 12 to 136 months (average 65.1 ± 10.21 months). CONCLUSION CD in children is rare, and is frequently misdiagnosed clinically. Our study shows that surgical resection is very effective in the treatment of unicentric Castleman disease (UCD). The rare UCD patient and all MCD patients treated with the modified NHLBFM-90 protocol had good prognosis.
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Affiliation(s)
- Jun Zhang
- Department of Surgical Oncology, Children's Hospital of Chongqing Medical University, Chongqing, China
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Smith C, Lee-Miller C, Dishop MK, Cost C, Wang M, Asturias EJ. Multicentric Castleman disease presenting with fever. J Pediatr 2014; 165:1261-5. [PMID: 25282064 DOI: 10.1016/j.jpeds.2014.08.042] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 08/08/2014] [Accepted: 08/21/2014] [Indexed: 10/24/2022]
Abstract
Multicentric Castleman disease (MCD) is a rare lymphoproliferative disorder that usually manifests with nonspecific symptoms, including fever and lymphadenopathy. Treatment of pediatric MCD varies greatly. A 21-month-old child was diagnosed with MCD after presenting with fever. He had incomplete response to initial therapy directed at interleukin-6, but improved with subsequent chemotherapy.
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Affiliation(s)
- Christiana Smith
- Division of Pediatric Infectious Diseases, University of Colorado School of Medicine, Aurora, CO.
| | - Cathy Lee-Miller
- Division of Pediatric Hematology and Oncology, University of Colorado School of Medicine, Aurora, CO
| | - Megan K Dishop
- Department of Pathology, University of Colorado School of Medicine, Aurora, CO
| | - Carrye Cost
- Division of Pediatric Hematology and Oncology, University of Colorado School of Medicine, Aurora, CO
| | - Michael Wang
- Division of Pediatric Hematology and Oncology, University of Colorado School of Medicine, Aurora, CO
| | - Edwin J Asturias
- Division of Pediatric Infectious Diseases, University of Colorado School of Medicine, Aurora, CO; Center for Global Health, Colorado School of Public Health, Aurora, CO
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Nagabushana D, Benakappa A. Multicentric Castleman's disease presenting with recurrent infections, rash, and malnutrition. Clin Pediatr (Phila) 2014; 53:906-7. [PMID: 24065736 DOI: 10.1177/0009922813504027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Asha Benakappa
- Bangalore Medical College and Research Institute, Bangalore, India
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HHV-8-negative, idiopathic multicentric Castleman disease: novel insights into biology, pathogenesis, and therapy. Blood 2014; 123:2924-33. [PMID: 24622327 DOI: 10.1182/blood-2013-12-545087] [Citation(s) in RCA: 226] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Multicentric Castleman's disease (MCD) describes a heterogeneous group of disorders involving proliferation of morphologically benign lymphocytes due to excessive proinflammatory hypercytokinemia, most notably of interleukin-6. Patients demonstrate intense episodes of systemic inflammatory symptoms, polyclonal lymphocyte and plasma cell proliferation, autoimmune manifestations, and organ system impairment. Human herpes virus-8 (HHV-8) drives the hypercytokinemia in all HIV-positive patients and some HIV-negative patients. There is also a group of HIV-negative and HHV-8-negative patients with unknown etiology and pathophysiology, which we propose referring to as idiopathic MCD (iMCD). Here, we synthesize what is known about iMCD pathogenesis, present a new subclassification system, and propose a model of iMCD pathogenesis. MCD should be subdivided into HHV-8-associated MCD and HHV-8-negative MCD or iMCD. The lymphocyte proliferation, histopathology, and systemic features in iMCD are secondary to hypercytokinemia, which can occur with several other diseases. We propose that 1 or more of the following 3 candidate processes may drive iMCD hypercytokinemia: systemic inflammatory disease mechanisms via autoantibodies or inflammatory gene mutations, paraneoplastic syndrome mechanisms via ectopic cytokine secretion, and/or a non-HHV-8 virus. Urgent priorities include elucidating the process driving iMCD hypercytokinemia, identifying the hypercytokine-secreting cell, developing consensus criteria for diagnosis, and building a patient registry to track cases.
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Slater BJ, Nordin AB, Allen CE, Elghetany MT, Heinle JS, Kim ES. Resection of mediastinal castleman's disease: a case report. Pediatr Hematol Oncol 2013; 30:554-6. [PMID: 23301538 DOI: 10.3109/08880018.2012.753494] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Bethany J. Slater
- 1Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
- 3Department of Pathology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Andrew B. Nordin
- 1Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
- 3Department of Pathology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Carl E. Allen
- 2Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
- 3Department of Pathology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - M. Tarek Elghetany
- 2Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
- 3Department of Pathology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Jeffrey S. Heinle
- 1Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
- 3Department of Pathology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Eugene S. Kim
- 1Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
- 3Department of Pathology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
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