ONCAlert | 2018 ASCO Annual Meeting
Multicentric Castleman Disease Case Studies

Episode 4: Dr. Fajgenbaum’s Commentary

Published Online:Apr 06, 2016
Dr. David Fajgenbaum, Perelman School of Medicine, University of Pennsylvania, says that this is a very complicated case, with a patient who is very, very ill. Within just a few weeks, this patient went from being a healthy young adult to being hospitalized in the intensive care unit.

Differential Diagnosis

  • Patient did very well for full year after cytotoxic chemotherapy, while on anti-interleukin-6 therapy
  • After ~12 months of remission, patient experiences repeat symptoms
    • Enlarged lymph nodes, fatigue, nausea, and eruption of cherry hemangiomas
    • Potential relapse suspected
  • Again, treated with rituximab
    • Proves ineffective
  • Patient given repeat combination of cytotoxic chemotherapy and has positive response
  • Patient had idiopathic Multicentric Castleman Disease, but did not do well long term on siltuximab
    • HAMA performed to see if any antibodies to mouse antibodies of siltuximab
    • None found; another cytokine suspected as involved in driving patient’s illness, other than interleukin-6
  • Once patient improved, following cytotoxic chemotherapy, he is kept on more intense maintenance regimen of weekly bortezomib, dexamethasone, and daily thalidomide, while continuing anti-interleukin-6 therapy
    • Doctors hoped combination would help to keep patient in remission
  • Patient in remission for just over year and a half

Read through the episodes of one patient’s journey toward an accurate diagnosis and listen to an expert’s analysis on each episode.

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