Treatment of Multicentric Castleman Disease
Treatment of this form of Castleman disease is much more difficult. Surgery does not usually cure the disease because it is too widespread. Occasionally people are helped by surgical removal of some of the diseased tissue. No single treatment has proven effective for most patients. Several types of treatment, however, have been successful in some patients. Doctors will try 1 or a combination of them to put the disease in remission. The most favored treatments are corticosteroid drugs, chemotherapy, and radiation therapy. Sometimes 2 or more of these treatments are combined. In about half of patients the disease completely disappears. This is less likely to happen in patients with AIDS or HIV infection. Even if the HIV infection is successfully treated with drugs, the Castleman disease likely will not go away.
Corticosteroids and chemotherapy have produced long remissions for some patients. In other cases, the benefit does not last long and the symptoms worsen after the course of therapy is done. Some patients do not respond to these drugs at all.
Another drug that might be used is the monoclonal antibody rituximab. This can be successful, but some patients have gotten worse after receiving the drug. Antiviral drugs in addition to anti-HIV treatment may also help.