Tocilizumab in patients with symptomatic Kaposi sarcoma herpesvirus–associated multicentric Castleman disease

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