KSHV-associated multicentric Castleman disease: A tangle of different entities requiring multitarget treatment strategies

Antonino Carbone, Paolo De Paoli, Annunziata Gloghini, Emanuela Vaccher

Research output: Contribution to journalArticle

Abstract

Multicentric Castleman Disease (MCD) is a lymphoproliferative disorder presenting with heterogeneous pathological and clinical features. It comprises disease entities with a complex aetiology and overlapping pathogenesis. MCD can be found in association with HIV infection, plasma-cell dyscrasias, Kaposi sarcoma (KS), B-cell lymphomas including primary effusion lymphoma (PEL) and its solid variant, and Hodgkin lymphoma. In KSHV-associated MCD cases, a common association is KS and a specific variant of lymphoma referred to as "plasmablastic lymphoma," also called "large B-cell lymphoma arising in KSHV-associated MCD" lacking EBV infection. MCD is often referred to as human interleukin-6 (hIL-6) syndrome, since an overproduction of IL-6 occurs in MCD-associated diseases as well as in MCD itself. hIL-6 and a viral IL-6 (vIL-6) homolog encoded by KSHV can independently or together lead to flares of KSHV-associated MCD. Recently, a new clinical entity was proposed to describe a severe systemic infection/reactivation of KSHV: KSHV inflammatory syndrome (KICS). KICS may contribute in inducing the inflammatory symptoms seen in some patients with severe KS or PEL. The precise relationship of KICS to KSHV-associated MCD is unclear and it is possible that KICS may be prodromal symptoms to frank KSHV-associated MCD. Options for treatment of KSHV-associated MCD and related diseases include monoclonal antibodies, chemotherapy, immune modulators, virus-activated cytotoxic therapy and antiviral therapies. A comprehensive understanding of the intricacies of the HIV-KSHV coinfection will probably lead to additional advances in therapy and managements for these disorders.

Original languageEnglish
Pages (from-to)251-261
Number of pages11
JournalInternational Journal of Cancer
Volume137
Issue number2
DOIs
Publication statusPublished - Jul 15 2015

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Keywords

  • Castleman disease
  • KSHV-associated MCD
  • multicentric Castleman disease
  • multitarget treatment
  • viral IL-6

ASJC Scopus subject areas

  • Cancer Research
  • Oncology
  • Medicine(all)

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