Episode 4: Dr. Fajgenbaum’s Commentary

• 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.