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Lang E, van Rhee F. Idiopathic multicentric Castleman disease: An update in diagnosis and treatment advances. Blood Rev 2024; 64:101161. [PMID: 38087716 DOI: 10.1016/j.blre.2023.101161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/27/2023] [Accepted: 11/29/2023] [Indexed: 03/12/2024]
Abstract
Idiopathic multicentric Castleman disease (iMCD) is a rare disease, and it is likely underdiagnosed because of the heterogeneity of clinical manifestations and laboratory findings. While the disease leads to significant morbidity and mortality, its causes are not yet fully elucidated. There have been significant advances in diagnosis and treatment of iMCD in the past decade, including the approval of the anti-IL-6 antibody siltuximab. In this review, we provide an update of the many new developments and publications surrounding iMCD.
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Affiliation(s)
- Evan Lang
- Oncology Hematology Care, 5053 Wooster Road, Cincinnati, OH 45226, USA.
| | - Frits van Rhee
- Myeloma Center, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
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2
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Li H, He Y, Wang Y, Xu M. Successful treatment with bortezomib in combination with dexamethasone in a middle-aged male with idiopathic multicentric Castleman's disease: A case report. Open Med (Wars) 2024; 19:20230763. [PMID: 38250020 PMCID: PMC10799255 DOI: 10.1515/med-2023-0763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 07/04/2023] [Accepted: 07/04/2023] [Indexed: 01/23/2024] Open
Abstract
Multicentric Castleman disease (MCD) is a heterogeneous, life-threatening disease. A subgroup of HIV-negative and HHV-8-negative MCD is defined as idiopathic MCD (iMCD) with a poor prognosis. Here we report an unusual case of a 47-year-old male patient with iMCD who experienced multiple treatment regimens such as chemotherapy, immunomodulatory therapy, and targeted therapy, all of which were considered ineffective. Subsequently, he was started on bortezomib in combination with dexamethasone for six cycles and he was in complete remission. The patient has survived nearly 13 years to date - the longest survival of any iMCD patient treated with bortezomib in combination with dexamethasone. Bortezomib combined with dexamethasone may be an effective salvage strategy for severe and refractory iMCD.
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Affiliation(s)
- Hongling Li
- Department of Oncology, Gansu Provincial Hospital, 204 West Donggang Road, 730000, Gansu, Lanzhou, China
| | - Yang He
- College of Clinical Medicine, Ningxia Medical University, Yinchuan, China
- Department of Oncology, Gansu Provincial Hospital, Gansu, Lanzhou, China
| | - Yongying Wang
- First College of Clinical Medicine, Gansu University of Chinese Medicine, Lanzhou, China
- Department of Oncology, Gansu Provincial Hospital, Gansu, Lanzhou, China
| | - Mengwei Xu
- Department of Pathology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
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3
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Zhu Q, Wang S. Castleman disease of plasma cell type accompanied with bronchiolitis obliterans: a case report and review of the literature. J Med Case Rep 2023; 17:539. [PMID: 38082371 PMCID: PMC10714532 DOI: 10.1186/s13256-023-04285-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/25/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Castleman disease, also known as giant lymph node hyperplasia or angiofollicular lymph node hyperplasia, is a highly heterogeneous clinicopathological entity that belongs to the family lymphoproliferative disorders. Castleman disease accompanied by bronchiolitis obliterans is uncommon and often poses a great diagnostic challenge, which is easily confused with respiratory diseases and impeding the correct diagnosis and treatment. The main aim in presenting such rare case studies is to raise awareness and expand the diagnostic horizon of clinicians for appropriate management. CASE PRESENTATION Here, we present a 69-year-old Chinese male who was admitted to our hospital due to right chest pain for 6 months, accompanied by cough, expectoration, and fever. Laboratory examinations revealed elevated immunoglobulin G and C-reactive protein, and normal serum levels of tumor markers and interleukin-6. Computed tomography scan detected diffuse bronchial wall thickening and patchy area of air trapping consistent with small airway disease. Pulmonary function test showed mild small airway obstructive ventilation dysfunction and moderate decrease in diffusion capacity. The pathological result of the right axillary lymph node was consistent with the plasma cell type Castleman disease. According to the above examinations, the patient was finally diagnosed with the plasma cell type Castleman disease accompanied with bronchiolitis obliterans. He received immunosuppressive medication after surgery and has been followed up for 11 months. Now the patient is currently in stable condition without recurrence. CONCLUSION Castleman disease is a rare lymphoproliferative disorder with a variety of symptoms. At present, the treatment of Castleman disease accompanied with bronchiolitis obliterans is mostly based on experiences or previous case reports, and there is no standard treatment. Here, we report an uncommon case of Castleman disease accompanied with bronchiolitis obliterans in which the patient received immunosuppressive medication after surgery and has been followed up for 11 months without experiencing a recurrence, which may deepen and extend our understanding of this disease.
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Affiliation(s)
- Qingyuan Zhu
- Department of Respiratory Diseases, Quzhou TCM Hospital at the Junction of Four Provinces Affiliated to Zhejiang Chinese Medical University, Quzhou, 324002, Zhejiang Province, China
| | - Shuiyou Wang
- Department of Respiratory Diseases, Quzhou TCM Hospital at the Junction of Four Provinces Affiliated to Zhejiang Chinese Medical University, Quzhou, 324002, Zhejiang Province, China.
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Strach M, Kuszmiersz P, Chmura Ł, Korkosz M. A challenging diagnosis of idiopathic multicentric Castleman disease with complex systemic presentation: A case report. Clin Case Rep 2023; 11:e7981. [PMID: 37854256 PMCID: PMC10580699 DOI: 10.1002/ccr3.7981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/12/2023] [Accepted: 09/19/2023] [Indexed: 10/20/2023] Open
Abstract
Key Clinical Message Idiopathic multicentric Castleman disease (iMCD) is challenging to diagnose due to clinical similarities with other conditions, such as Still's disease. Once diagnosed, iMCD may be effectively managed with the anti-interleukin-6 antibody siltuximab. Abstract Here, we present the case of a 19-year-old Polish woman with persistent fever and enlarged lymph nodes and whose diagnosis remained inconclusive following initial clinical assessments and extensive laboratory analyses. The patient had subsequent complaints of joint pain and erythema which were suspicious of Still's disease and resolved with treatment with tocilizumab. Later, the progression of symptoms, such as lymphadenopathy, and elevated interleukin-6 levels were consistent with Castleman disease, leading to the diagnosis of idiopathic multicentric Castleman disease seven years after the patient first reported symptoms. Treatment with the anti-interleukin-6 antibody siltuximab resulted in complete symptom resolution and normalization of inflammatory parameters. No adverse events were reported due to treatment with siltuximab.
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Affiliation(s)
- Magdalena Strach
- Department of Rheumatology and Immunology, Faculty of MedicineJagiellonian University Medical CollegeKrakówPoland
| | - Piotr Kuszmiersz
- Department of Rheumatology and Immunology, Faculty of MedicineJagiellonian University Medical CollegeKrakówPoland
| | - Łukasz Chmura
- Department of Pathomorphology, Faculty of MedicineJagiellonian University Medical CollegeKrakówPoland
| | - Mariusz Korkosz
- Department of Rheumatology and Immunology, Faculty of MedicineJagiellonian University Medical CollegeKrakówPoland
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Yu T, Cai QQ, Zhai QL, Li L, Fang X, Li J, Sun R, Yang H, Wang Z, Qian W, Xu-Monette ZY, Young KH, Yu L. Analysis of albumin as a prognostic factor in HHV-8/HIV-negative Castleman disease from a multicenter study. Leuk Lymphoma 2022; 63:3082-3091. [PMID: 36074798 DOI: 10.1080/10428194.2022.2118528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
As a rare lymphoproliferative disorder, many patients with HHV-8/HIV-negative Castleman disease (CD) have hypoalbuminemia. However, data is limited on whether hypoalbuminemia is an independent predictor of CD. We retrospectively collected data from 230 patients diagnosed at 12 medical centers in China and the U.S. Different classifications included 147 patients with unicentric CD (UCD) and 83 with idiopathic multicentric CD (iMCD). Adjusted smooth curve fitting showed that the relationship between albumin and all-cause death of patients with CD and iMCD was linear. Cox proportional hazards regression modeling showed a negative association between the risk of death and albumin level (hazard ratio [HR]: 0.84; 95% CI, 0.76, 0.93). Using the Kaplan-Meier method, we determined that hypoproteinemia was a risk factor for poorer prognosis in patients with CD, UCD, and iMCD. Albumin was independently and negatively associated with the risk of death in CD patients, especially those with iMCD.
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Affiliation(s)
- Tiantian Yu
- Department of Hematology and Oncology, The Second Affiliated Hospital of NanChang University, Nanchang, China
| | - Qing-Qing Cai
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Qiong-Li Zhai
- Department of Pathology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Ling Li
- Department of Medical Oncology, Zhenzhou University Cancer Center, Zhenzhou, China
| | - Xiaosheng Fang
- Department of Hematology and Oncology, Shandong Cancer Hospital, Shandong, China
| | - Jianyong Li
- Department of Hematology and Oncology, Jiangsu Province Hospital, Nanjing University, Nanjing, China
| | - Ruifang Sun
- Department of Pathology, Shanxi Cancer Hospital, Shanxi, China
| | - Hanjin Yang
- Department of Pathology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhaoming Wang
- Department of Pathology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wenbian Qian
- Department of Hematology and Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zijun Y Xu-Monette
- Division of Hematopathology and Department of Pathology, Duke University Medical Center, Durham, NC, USA
| | - Ken H Young
- Division of Hematopathology and Department of Pathology, Duke University Medical Center, Durham, NC, USA.,Duke University Cancer Center, Durham, NC, USA
| | - Li Yu
- Department of Hematology and Oncology, The Second Affiliated Hospital of NanChang University, Nanchang, China
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Liu W, Cai Q, Yu T, Strati P, Hagemeister FB, Zhai Q, Zhang M, Li L, Fang X, Li J, Sun R, Zhang S, Yang H, Wang Z, Qian W, Iwaki N, Sato Y, Oksenhendler E, Xu-Monette ZY, Young KH, Yu L. Clinical characteristics and outcomes of Castleman disease: a multicenter Consortium study of 428 patients with 15-year follow-up. Am J Cancer Res 2022; 12:4227-4240. [PMID: 36225639 PMCID: PMC9548017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 06/30/2022] [Indexed: 06/16/2023] Open
Abstract
Castleman disease (CD) has been reported as a group of poorly understood lymphoproliferative disorders, including unicentric CD (UCD) and idiopathic multicentric CD (iMCD) which are human immunodeficiency virus (HIV) negative and human herpes virus 8 (HHV-8) negative. The clinical and independent prognostic factors of CD remain poorly elucidated. We retrospectively collected the clinical information of 428 patients with HIV and HHV-8 negative CD from 12 large medical centers with 15-year follow-up. We analyzed the clinicopathologic features of 428 patients (248 with UCD and 180 with iMCD) with a median age of 41 years. The histology subtypes were hyaline-vascular (HV) histopathology for 215 patients (56.58%) and plasmacytic (PC) histopathology for 165 patients (43.42%). Most patients with UCD underwent surgical excision, whereas the treatment strategies of patients with iMCD were heterogeneous. The outcome for patients with UCD was better than that for patients with iMCD, 5-year overall survival (OS) rates were 95% and 74%, respectively. In further analysis, a multivariate analysis using a Cox regression model revealed that PC subtype, hepatomegaly and/or splenomegaly, hemoglobin ≤ 80 g/L, and albumin ≤ 30 g/L were independent prognostic factors of CD for OS. The model of iMCD revealed that age > 60 years, hepatomegaly and/or splenomegaly, and hemoglobin ≤ 80 g/L were independent risk factors. In UCD, single-factor analysis identified two significant risk factors: hemoglobin ≤ 100 g/L and albumin ≤ 30 g/L. Our study emphasizes the distinction of clinical characteristics between UCD and iMCD. The importance of poor risk factors of different clinical classifications may direct more precise and appropriate treatment strategies.
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Affiliation(s)
- Wanying Liu
- Department of Hematology and Oncology, The Second Affiliated Hospital of NanChang UniversityNanChang, China
| | - Qingqing Cai
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer CenterGuangzhou, China
| | - Tiantian Yu
- Department of Hematology and Oncology, The Second Affiliated Hospital of NanChang UniversityNanChang, China
| | - Paolo Strati
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer CenterHouston, TX, USA
| | - Frederick B Hagemeister
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer CenterHouston, TX, USA
| | - Qiongli Zhai
- Department of Pathology, Tianjin Medical University Cancer Institute and HospitalTianjin, China
| | - Mingzhi Zhang
- Department of Medical Oncology, Zhengzhou University Cancer CenterZhengzhou, China
| | - Ling Li
- Department of Medical Oncology, Zhengzhou University Cancer CenterZhengzhou, China
| | - Xiaosheng Fang
- Department of Hematology and Oncology, Shandong Cancer HospitalShandong, China
| | - Jianyong Li
- Department of Hematology and Oncology, Jiangsu Province Hospital, Nanjing UniversityNanjing, China
| | - Ruifang Sun
- Department of Pathology, Shanxi Cancer HospitalShanxi, China
| | - Shanxiang Zhang
- Department of Pathology, Indiana University School of MedicineIndianapolis, IN, USA
| | - Hanjin Yang
- Department of Pathology, The First Affiliated Hospital, Zhejiang University School of MedicineHangzhou, China
| | - Zhaoming Wang
- Department of Pathology, The First Affiliated Hospital, Zhejiang University School of MedicineHangzhou, China
| | - Wenbian Qian
- Department of Hematology and Oncology, The Second Affiliated Hospital, Zhejiang University School of MedicineHangzhou, China
| | - Noriko Iwaki
- Department of Hematology, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa UniversityKanazawa, Japan
| | - Yasuharu Sato
- Division of Pathophysiology, Okayama University Graduate School of Health SciencesOkayama, Japan
| | - Eric Oksenhendler
- Département d’Immunologie Clinique, Hôpital Saint-LouisParis, France
| | - Zijun Y Xu-Monette
- Division of Hematopathology and Department of Pathology, Duke University Medical CenterDurham, NC, USA
| | - Ken H Young
- Division of Hematopathology and Department of Pathology, Duke University Medical CenterDurham, NC, USA
- Duke University Cancer CenterDurham, NC, USA
| | - Li Yu
- Department of Hematology and Oncology, The Second Affiliated Hospital of NanChang UniversityNanChang, China
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Lomas OC, Streetly M, Pratt G, Cavet J, Royston D, Schey S, Ramasamy K. The management of Castleman disease. Br J Haematol 2021; 195:328-337. [PMID: 34340261 DOI: 10.1111/bjh.17688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/13/2021] [Accepted: 06/15/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Oliver C Lomas
- Department of Clinical Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Matthew Streetly
- Guys and St, Thomas' NHS Foundation Trust, London, UK
- Kings College Hospital NHS Foundation Trust, London, UK
| | - Guy Pratt
- Department of Haematology, University Hospitals Birmingham NHS Foundation, Birmingham, UK
| | - Jim Cavet
- The Christie NHS Foundation Trust, Manchester, UK
| | - Daniel Royston
- Department of Cellular Pathology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Stephen Schey
- King's College, University of London, London, UK
- Department of Haematology, King's College Hospital, London, UK
| | - Karthik Ramasamy
- Department of Clinical Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford University NHS Foundation Trust, Oxford, UK
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[The consensus of the diagnosis and treatment of Castleman disease in China (2021)]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2021; 42:529-534. [PMID: 34455738 PMCID: PMC8408489 DOI: 10.3760/cma.j.issn.0253-2727.2021.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Ulas ST, Dasdelen S. [Multicentric Castleman's disease combined with polyserositis and POEMS syndrome: case report and review article]. Internist (Berl) 2021; 62:777-785. [PMID: 34137908 DOI: 10.1007/s00108-021-01063-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2021] [Indexed: 10/21/2022]
Abstract
Castleman disease (CD) is a very rare disorder characterised by hyperplasia of the lymphoid tissue. The aetiology varies considerably and includes autoimmunological, infectious, autoinflammatory and paraneoplastic diseases (e.g. MGUS with POEMS syndrome). What they all have in common is usually a dysregulation/overproduction of certain cytokines and growth factors (including interleukin 6 and VEGF). The sum of these changes sometimes causes very heterogeneous symptoms and thus often makes early diagnosis difficult. The prognosis of unrecognised and untreated disease is very serious and has an average 5‑year survival rate of 55-77%. The present paper describes the case of a 79-year-old patient with refractory polyserositis who was correctly diagnosed after > 8 years.
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Affiliation(s)
- Sevtap Tugce Ulas
- Klinik für Radiologie, Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Süha Dasdelen
- Klinik für Nephrologie, Vivantes Humboldt-Klinikum, Am Nordgraben 2, 13509, Berlin, Deutschland. .,Private Universitätsklinik Witten/Herdecke, Witten/Herdecke, Deutschland.
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Fang X, Sun Z, Xu-Monette ZY, Young KH. Predictive Model for Idiopathic Multicentric Castleman Disease Supporting Treatment Decisions. Oncologist 2020; 26:4-6. [PMID: 33215784 DOI: 10.1002/onco.13605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 10/28/2020] [Indexed: 01/04/2023] Open
Affiliation(s)
- Xiaosheng Fang
- Department of Pathology, Hematopathology Division, Duke University Medical Center, Durham, North Carolina, USA.,Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China
| | - Zhongling Sun
- Department of Neurology, The People's Hospital of Zhaoyuan City, Shandong, People's Republic of China
| | - Zijun Y Xu-Monette
- Department of Pathology, Hematopathology Division, Duke University Medical Center, Durham, North Carolina, USA.,Duke Cancer Institute, Durham, North Carolina, USA
| | - Ken H Young
- Department of Pathology, Hematopathology Division, Duke University Medical Center, Durham, North Carolina, USA.,Duke Cancer Institute, Durham, North Carolina, USA
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