Tocilizumab in patients with symptomatic Kaposi sarcoma herpesvirus–associated multicentric Castleman disease
Ramya Ramaswami, Kathryn Lurain, Cody J. Peer, Anna Serquiña, Victoria Wang, Anaida Widell, Priscila Gonçalves, Seth M. Steinberg, Vickie Marshall, Jomy George, William D. Figg, Denise Whitby, Joseph M. Ziegelbauer, Thomas S. Uldrick, Robert Yarchoan
Abstract
Kaposi sarcoma (KS) herpesvirus (KSHV), also known as human herpesvirus-8, is the causative agent for KS and a plasmablastic form of multicentric Castleman disease (MCD; KSHV-MCD). 1 KSHV-MCD is a relapsing and remitting B-cell lymphoproliferative disorder that occurs primarily in people living with HIV. 2,3Patients present with anemia, thrombocytopenia, and inflammatory symptoms associated with elevated cytokines including interleukin-6 (IL-6) and IL-10, elevated levels of C-reactive protein (CRP), and elevated KSHV viral loads (KSHV-VLs).5][6] Treatment options include rituximab (a humanized monoclonal antibody against CD20), rituximab with liposomal doxorubicin or etoposide, or virus-activated cytotoxic therapy with high-dose zidovudine (AZT) and valganciclovir (VGC). 7-13However, some patients do not respond to rituximab, and, when used alone, it is associated with worsening or development of KS in 35% to 67%. 8,9