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Tedesco S, Postacchini L, Manfredi L, et al. Successful treatment of a Caucasian case of multifocal Castleman's disease with TAFRO syndrome with a pathophysiology targeted therapy - a case report. Exp Hematol Oncol. 2015;4(1):3doi: 10.1186/2162-3619-4-3.
Tedesco, S., Postacchini, L., Manfredi, L., Goteri, G., Luchetti, M. M., Festa, A., Gabrielli, A., & Pomponio, G. (2015). Successful treatment of a Caucasian case of multifocal Castleman's disease with TAFRO syndrome with a pathophysiology targeted therapy - a case report. Experimental hematology & oncology, 4(1), 3. https://doi.org/10.1186/2162-3619-4-3
Tedesco, Silvia, et al. "Successful treatment of a Caucasian case of multifocal Castleman's disease with TAFRO syndrome with a pathophysiology targeted therapy - a case report." Experimental hematology & oncology vol. 4,1 (2015): 3. doi: https://doi.org/10.1186/2162-3619-4-3
Tedesco S, Postacchini L, Manfredi L, Goteri G, Luchetti MM, Festa A, Gabrielli A, Pomponio G. Successful treatment of a Caucasian case of multifocal Castleman's disease with TAFRO syndrome with a pathophysiology targeted therapy - a case report. Exp Hematol Oncol. 2015 Jan 14;4(1):3. doi: 10.1186/2162-3619-4-3. eCollection 2015. PMID: 25671135; PMCID: PMC4322808.
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Exp Hematol Oncol. 2015 Jan 14;4(1):3. doi: 10.1186/2162-3619-4-3. eCollection 2015.

Successful treatment of a Caucasian case of multifocal Castleman's disease with TAFRO syndrome with a pathophysiology targeted therapy - a case report.

Experimental hematology & oncology

Silvia Tedesco, Laura Postacchini, Lucia Manfredi, Gaia Goteri, Michele M Luchetti, Antonella Festa, Armando Gabrielli, Giovanni Pomponio

Affiliations

  1. Clinica Medica - Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Via Conca 71, 60126 Ancona, Italy.
  2. Anatomia Patologica - Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Via Conca 71, 60126 Ancona, Italy.
  3. Clinica Medica - Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Via Conca 71, 60126 Ancona, Italy ; Clinica Medica - Ospedali Riuniti di Ancona, Via Conca 71, 60126 Ancona, Italy.
  4. Clinica Medica - Ospedali Riuniti di Ancona, Via Conca 71, 60126 Ancona, Italy.

PMID: 25671135 PMCID: PMC4322808 DOI: 10.1186/2162-3619-4-3

Abstract

BACKGROUND: Castleman-Kojima disease (TAFRO Syndrome) is characterized by Thrombocytopenia, Anasarca, myeloFibrosis, Renal dysfunction, Organomegaly, multiple lymphadenopathy and histopathology pattern of atypical Castleman's disease (CD). Only few cases of this recently identified unique variant of Multicentric CD (MCD) are described in literature, all Japanese. It therefore poses serious diagnostic and therapeutic challenges.

CASE DESCRIPTION: We describe a 21 year old woman with fever, asthenia, bilateral pleural effusion, ascites, hypoalbuminemia, severe thrombocytopenia, anemia, renal failure and proteinuria, whereas microbiological tests, immune serology (except ANA) and bone marrow biopsy were all negative. A CT-scan showed multiple lymphadenopathy and tissue samplings of mediastinal lymph nodes was compatible with a mixed-type CD. The diagnosis of MCD with TAFRO syndrome was made, but after an initial improvement with high dose corticosteroid therapy, clinical and laboratory features worsened. Based upon the high serum IL-6 levels and the high number of CD20-lymphocytes in lymph nodes tissue, we started tocilizumab (partial benefit), followed by rituximab combined with CVP (cyclophosphamide, vincristine and prednisone) chemotherapy, achieving a complete response. A total of six cycles of R-CVP were administered monthly, followed by maintenance with monthly rituximab. A complete remission persists at the 12th month of follow-up.

CONCLUSIONS: In patients with massive immune system activation and lymphadenopathy it is mandatory to rule out Castleman-Kojima disease. In our patient a therapy aimed at the prominent pathophysiological abnormalities has been successful so far. However, since the rarity of TAFRO Syndrome, a multicenter registry is strongly desirable for a better understanding of the disease mechanisms, hopefully leading to evidence-based therapeutic choices.

Keywords: Castleman’s disease; Chemotherapy; Multicentric; PRES; Rituximab; TAFRO syndrome; Tocilizumab

References

  1. J Clin Exp Hematop. 2013;53(1):87-93 - PubMed
  2. BMJ Case Rep. 2009;2009:null - PubMed
  3. Mayo Clin Proc. 2010 May;85(5):427-32 - PubMed
  4. Rinsho Ketsueki. 2014 Mar;55(3):350-5 - PubMed
  5. Pediatr Blood Cancer. 2014 Apr;61(4):737-9 - PubMed
  6. Leuk Lymphoma. 2008 Nov;49(11):2224-6 - PubMed
  7. J Pediatr Hematol Oncol. 2010 Nov;32(8):622 - PubMed
  8. BMC Pediatr. 2014 Jun 02;14 :139 - PubMed
  9. Intern Med. 2013;52(13):1503-7 - PubMed
  10. J Clin Exp Hematop. 2013;53(1):95-9 - PubMed
  11. Med Oncol. 2013 Mar;30(1):492 - PubMed
  12. Clin Adv Hematol Oncol. 2010 Jul;8(7):486-98 - PubMed
  13. Haematologica. 2005 Aug;90(8):1128-32 - PubMed
  14. Lupus. 2007;16(6):436-43 - PubMed
  15. Eur J Haematol. 2006 Feb;76(2):119-23 - PubMed
  16. Mol Cancer Ther. 2012 Aug;11(8):1623-6 - PubMed
  17. Intern Med. 2007;46(11):771-4 - PubMed
  18. J Clin Exp Hematop. 2013;53(1):79-85 - PubMed
  19. Cancer. 2001 Aug 1;92(3):670-6 - PubMed
  20. J Pediatr Hematol Oncol. 2005 Dec;27(12):666-9 - PubMed
  21. J Clin Exp Hematop. 2013;53(1):69-77 - PubMed
  22. J Clin Exp Hematop. 2013;53(1):57-61 - PubMed
  23. Med Oncol. 2010 Dec;27(4):1171-8 - PubMed
  24. Blood. 2000 Jan 1;95(1):56-61 - PubMed

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