Castleman Disease

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Treating Castleman Disease TOPICS

Chemotherapy for Castleman disease

Chemotherapy (chemo) is the use of anti-cancer drugs that are injected into a vein or a muscle or are taken by mouth. These drugs enter the bloodstream and reach all areas of the body, making this treatment very useful for multicentric Castleman disease (CD). Chemo may be used alone, in combination with corticosteroids, or in combination with radiation therapy (called chemoradiation).

Many chemo drugs have been used to treat patients with multicentric CD. The drugs used most often include carmustine, cladribine, chlorambucil, cyclophosphamide, doxorubicin, etoposide, melphalan, vinblastine, and vincristine. Often several drugs are combined. Chemotherapy combinations like those used for lymphoma have been used. But because CD is so rare, there is not a lot of information on which chemo treatment is best or even how well it works.

Doctors give chemo in cycles, in which a period of treatment is followed by a rest period to allow the body time to recover. Each chemo cycle generally lasts for several weeks. Most chemo treatments are given on an outpatient basis (in the doctor's office or clinic or hospital outpatient department) but some may require a hospital stay. Sometimes a patient takes one drug combination for several cycles and then later is switched to a different one.

Chemo drugs attack cells that are dividing quickly, which is why they work against cancer and diseases like CD. But other cells in the body, such as those in the bone marrow, the lining of the mouth and intestines, and the hair follicles, also divide quickly. These cells are also likely to be affected by chemotherapy, which can lead to certain side effects.

The side effects of chemo depend on the type and dose of drugs given and the length of time they are taken. These side effects can include:

  • Hair loss
  • Mouth sores
  • Loss of appetite
  • Nausea and vomiting
  • Diarrhea
  • Increased risk of infection (due to low white blood cell counts)
  • Easy bruising and bleeding (due to low platelet counts)
  • Fatigue and weakness (due to anemia - low red blood cells)

Your doctor will try to avoid or lessen these side effects as much as possible. For example, drugs can be given before or along with chemotherapy to help prevent or reduce nausea and vomiting. Most side effects are temporary and go away after treatment is finished.

Infections can be very serious in people getting chemo. A low white blood cell count is an important risk factor for serious infections, so some patients find it helpful to keep track of their counts. If you are interested in this information, ask your doctor or nurse about your blood cell counts and what these numbers mean. You may want to keep a diary of your treatment and blood counts to help you follow the effects of your treatment.

If your white blood cell counts are very low during treatment, you can help reduce your risk of infection by carefully limiting your exposure to germs. During this time, your doctor may advise you to:

  • Wash your hands often.
  • Avoid fresh, uncooked fruits and vegetables and other foods that might carry germs.
  • Avoid fresh flowers and plants because they may carry mold.
  • Make sure other people wash their hands before they touch you.
  • Avoid large crowds and people who are sick (wearing a surgical mask offers some protection in these situations).

Certain chemo drugs can have other, more specific side effects. Organs that could be damaged by certain chemo drugs include the kidneys, liver, testicles, ovaries, brain, heart, and lungs. Many of the drugs used to treat CD can cause nerve damage, leading to problems such as numbness and tingling in the hands and feet.

If serious side effects occur, the chemotherapy may have to be reduced or stopped, at least for a short time. Your doctor will carefully monitor and adjust drug doses because some side effects can be permanent.

Last Medical Review: 06/11/2012
Last Revised: 06/11/2012