What are the best treatments for Castleman disease?

Castleman disease is a rare disorder characterized by the abnormal growth of cells in the lymph nodes. It can affect multiple organs and lead to various symptoms, including enlarged lymph nodes, fever, fatigue, night sweats, and weight loss. The treatment approach for Castleman disease depends on the subtype and severity of the condition.

1. Surgical resection: In some cases, surgical removal of the affected lymph nodes may be an option, especially for localized unicentric Castleman disease. This procedure aims to eliminate the abnormal cells and alleviate symptoms. However, it may not be suitable for multicentric Castleman disease, which involves multiple lymph nodes or affects vital organs.

2. Medications: Medications play a crucial role in managing Castleman disease. The choice of medication depends on the subtype and symptoms experienced by the patient. Some commonly used drugs include:

• Corticosteroids: These anti-inflammatory medications can help reduce the abnormal immune response and control symptoms such as fever and fatigue.


• Interleukin-6 (IL-6) inhibitors: IL-6 is a protein involved in the growth of abnormal cells in Castleman disease. Inhibitors like tocilizumab can block the action of IL-6 and help manage the disease.


• Chemotherapy: In more aggressive or advanced cases, chemotherapy drugs may be prescribed to target and destroy the abnormal cells. This treatment option is typically used for multicentric Castleman disease.


• Monoclonal antibodies: Monoclonal antibodies, such as rituximab, can be used to target specific cells or proteins involved in Castleman disease. These antibodies can help suppress the abnormal cell growth and reduce symptoms.

3. Immunotherapy: Immunotherapy is an emerging treatment option for Castleman disease. It involves using drugs that enhance the body's immune response to fight against the abnormal cells. Immune checkpoint inhibitors, such as pembrolizumab, have shown promise in treating certain subtypes of Castleman disease.

4. Clinical trials: As Castleman disease is a rare condition, participation in clinical trials can provide access to novel treatments and contribute to advancing medical knowledge. Clinical trials may involve testing new drugs, combination therapies, or experimental approaches to manage the disease.

5. Supportive care: Alongside specific treatments, supportive care is essential to manage symptoms and improve the overall well-being of individuals with Castleman disease. This may include pain management, nutritional support, physical therapy, and psychological support.

It is important for individuals with Castleman disease to work closely with a multidisciplinary medical team, including hematologists, oncologists, and supportive care specialists. The treatment plan should be tailored to the individual's unique circumstances, considering factors such as disease subtype, symptoms, overall health, and personal preferences.