- Surgery for Castleman disease
- Radiation therapy for Castleman disease
- Corticosteroids for Castleman disease
- Chemotherapy for Castleman disease
- Immunotherapy for Castleman disease
- Antiviral drugs for Castleman disease
- Clinical trials for Castleman disease
- Complementary and alternative therapies for Castleman disease
- Treatment of localized (unicentric) Castleman disease
- Treatment of multicentric Castleman disease
Immunotherapy for Castleman disease
Immunotherapy is treatment that either boosts the patient's own immune system or uses man-made versions of the normal parts of the immune system.
Monoclonal antibodies are special immune proteins made in the lab. They are directed toward specific molecules on the surface of cells or in the blood.
Siltuximab (Sylvant™) is a monoclonal antibody that was recently approved to treat multicentric Castleman disease. Patients with multicentric Castleman disease have high levels of a protein called IL-6. Siltuximab binds to IL-6, which keeps the protein from acting. It doesn’t seem to bind to IL-6 that is made from viruses, so this drug isn’t meant for patients with Castleman disease who are infected with either HIV or HHV-8. (IL-6, HIV, HHV-8 and Castleman disease were discussed in the section “Do we know what causes Castleman disease?”).
This drug is given as an infusion into a vein (IV), usually every 3 weeks.
Side effects tended to be mild and included rash, itching, swelling, and weight gain. Some patients also had side effects during the infusion, such as flushing (skin redness with a feeling of warmth), chest pain, back pain, nausea, and rapid heartbeat.
Rituximab (Rituxan®) is a monoclonal antibody that is widely used for lymphoma. It can also be helpful in treating Castleman disease (CD). Rituximab attaches to a protein called CD20 that is found on the surface of some lymphocytes. This attachment tells the cell to die.
Patients get rituximab through infusion into a vein (IV) at the doctor's office or clinic. As when it is used to treat lymphoma, it is often given along with chemotherapy.
Side effects of rituximab are most common during the infusion, and can include chills, fever, nausea, rashes, fatigue, and headaches. Rarely, more severe side effects occur during the infusion, such as trouble breathing and low blood pressure. This drug may also increase a person's risk of certain infections. Unlike regular chemotherapy, rituximab does not cause low blood counts or hair loss.
In people who have ever been infected with the hepatitis B virus, this drug can sometimes cause the infection to become active again. Your doctor may check your blood for signs of a prior hepatitis infection before starting this drug to see if it is safe.
Newer antibodies that attack other targets are also being studied for use against CD. These are discussed in the section, “What’s new in research and treatment of Castleman disease?”
The drug thalidomide (Thalomid®) is a type of drug called an immunomodulating agent. It is thought to work by affecting parts of a person's immune system, although it’s not exactly clear how it does this. It is used to treat certain cancers of immune cells such as multiple myeloma and some types of lymphoma, but it has also helped some patients with CD.
Thalidomide is taken once a day as a capsule. Side effects can include drowsiness, fatigue, severe constipation, low white blood cell counts (with an increased risk of infection), and neuropathy (nerve damage causing pain). It also increases the risk of serious blood clots that start in the leg and can travel to the lungs. Because thalidomide causes severe birth defects if taken during pregnancy, this drug should not be used by women who are or may become pregnant.
Interferon is a hormone-like protein naturally made by white blood cells in the body to help the immune system fight infections. Some patients with CD have improved with man-made interferon treatment.
Interferon is given by an injection, either daily or several times a week. This may be into a vein (IV), under the skin (SubQ), or into a muscle (IM). It may be given in a doctor's office, or you or a family member can be taught how to give the medicine under the skin.
Side effects of this treatment can include fatigue, fever, chills, headaches, muscle and joint aches, and mood changes. Because of these side effects, interferon is not used very often. It may be given to some patients in addition to chemotherapy.
Last Medical Review: 06/11/2012
Last Revised: 04/24/2014