Joseph A. Sparano, MD


August 02, 2001


A 34-year-old man presented with a 6-month history of abdominal pain. CT scan showed a 9-cm mesenteric abdominal mass. On laparotomy, an unresectable mesenteric tumor was found, consistent with Castleman's disease, plasma cell variant, localized. The patient had an elevated erythrocyte sedimentation rate and hypergammaglobulinemia. He is asymptomatic after 6 cycles of chemotherapy with cyclophosphamide, vincristine, and prednisone, but CT scan shows only a partial response (4 cm).

What is the best treatment protocol moving forward?

Response from Joseph A. Sparano, MD

Localized Castleman's disease is potentially curable with surgical resection.[1,2] Although this patient had unresectable disease at presentation, there has clearly been some evidence of a significant response. Another attempt at potentially curative resection should be considered.

Other treatments that have been reported to have efficacy in multicentric disease have included a humanized anti-interleukin-6 antibody,[3] retinoic acid,[4] cyclosporine plus cyclophosphamide,[5] and highly active antiretroviral therapy (HAART) in patients with HIV infection.[6]


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