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Rituximab combined with liposomal doxorubicin (R-Dox) in HIV-infected patients with severe Kaposi sarcoma-associated herpes virus (KSHV) associated multicentric Castleman disease (MCD)

  • Thomas Uldrick1Email author,
  • Mark Polizzotto1,
  • Deirdre O’Mahony1,
  • Karen Aleman1,
  • Kathy Wyvill1,
  • Seth M Steinberg2,
  • Stefania Pittaluga3,
  • Vickie Marshall5,
  • Denise Whitby5,
  • Giovanna Tosato4,
  • Richard F Little1 and
  • Robert Yarchoan1
Infectious Agents and Cancer20105(Suppl 1):A72

Published: 11 October 2010


ZidovudineLiposomal DoxorubicinAdditional TherapyValganciclovirRadiographic Response


MCD is characterized by inflammatory symptoms, splenomegaly, adenopathy, hypoalbuminemia, hyponatremia, and cytopenias. MCD in HIV-infected patients is generally KSHV-associated. No standard therapy exists. Rituximab has activity, but monotherapy may be insufficient in severe disease and can be associated with worsening of Kaposi’s sarcoma (KS).


Patients with symptomatic MCD received rituximab 375 mg/m2 plus liposomal doxorubicin 20 mg/m2 every 21 days until substantial clinical improvement or disease progression. This regimen is being evaluated prospectively within an MCD natural history protocol. Additional therapy, employing agents with antiviral activity (discussed below), was generally employed to consolidate or maintain responses. Clinical, biochemical, and radiographic responses were evaluated using protocol-defined criteria. Overall complete response (CR) required normalization of all MCD-related abnormalities.


Patient characteristics: 12 (1 woman, 11 men) patients completed R-dox. Median age, 43 (34-55); median number of prior therapies 2 (0-8). Diffuse adenopathy (12); median spleen (cm), 18.5 (12.5-28). Concurrent KS (5). All were receiving concurrent combination antiretroviral therapy. Baseline laboratory values, median (range): CD4 cells/μL, 291 (21-1598); C-reactive protein (mg/dL), 9.9 (0.4-21); albumin (mg/dL), 2.7 (1.5-3.3); sodium (mEq/L), 133 (126-136); platelets (K/μL), 70 (10-377); hemoglobin (gm/dL), 9.4 (6.8-12.2). Median cycles received 4.5 (3-9) (Table 1)
Table 1

Best response with R-Dox.

Response Category

Complete Response

Partial Response

Stable Disease


12 (100%)




10 (83%)

1 (8%)

1 (8%)


6 (50%)

6 (50%)



3 (25%)

6 (50%)


With 9 patients receiving additional therapy after R-dox; IFNα (6), high-dose zidovudine + valganciclovir (2), additional liposomal doxorubicin (1); 6 additional patients achieved overall CR (total 75%). KS responded in 4/5 (80%). With 31.4 months median potential followup (actual 5.5+ to 47+), estimated 2-year progression-free survival and overall survival are 61.1% and 78.6%, respectively. 8/12 (67%) remain symptom free, while 3 had recurrent MCD flares (months 7, 10, 17) responding to additional R-Dox. One had progressive MCD and worsening KS during cycle 6 and died at month 6. At autopsy, primary effusion lymphoma was discovered. One patient died at month 17 of sepsis unrelated to therapy. Select toxicities: 9 infusion reactions (Gr. 1 = 3, Gr. 2 = 4, Gr. 3 = 2) with the first dose of rituximab; 6/60 cycles complicated by neutropenia (Gr. 2 = 5, Gr. 3 = 1), no infectious complications.


R-Dox is effective in treating severe KSHV-MCD or MCD with concurrent severe KS. Evaluation of R-Dox in KSHV-MCD is ongoing.



This article has been published as part of Infectious Agents and Cancer Volume 5 Supplement 1, 2010: Proceedings of the 12th International Conference on Malignancies in AIDS and Other Acquired Immunodeficiencies (ICMAOI).The full contents of the supplement are available online at

Authors’ Affiliations

HIV and AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute, Bethesda, USA
Biostatistics and Data Management Section, Center for Cancer Research, National Cancer Institute, Bethesda, USA
Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, USA
Laboratory of Cellular Oncology, Center for Cancer Research, National Cancer Institute, Bethesda, USA
Viral Oncology Section, AIDS and Cancer Virus Program, National Cancer Institute, Bethesda, USA


© Uldrick et al; licensee BioMed Central Ltd. 2010

This article is published under license to BioMed Central Ltd.