Initial management of HHV-8-positive multicentric Castleman disease

HHV-8: human herpesvirus 8; MCD: multicentric Castleman disease; HIV: human immunodeficiency virus; IL: interleukin; VEGF: vascular endothelial growth factor; FDG PET/CT: fluorodeoxyglucose positron emission tomography/computed tomography.
* Antiretroviral therapy is started or continued for all patients with HIV infection. In addition, antiviral therapy directed at HHV-8 with ganciclovir is offered to patients with concurrent KS and/or uncontrolled concomitant HIV infection (eg, CD4 count <200 cells/mm³, high HIV viral load) since such patients are at risk for the development of or exacerbation of KS lesions when treated with rituximab.
¶ Surveillance includes clinical evaluation, serum biomarkers, and imaging. Serum biomarkers include complete blood count, blood chemistries, IL-6, VEGF, C-reactive protein, serum free light chain assay, and quantitative immunoglobulins. Imaging with whole body FDG PET/CT is preferred.
Δ Examples of life-threatening organ failure that may be related to MCD include respiratory failure, renal failure, liver failure, and pancytopenia.