Virotherapy and Natural History Study of KHSV-Associated Multricentric Castleman s Disease With Correlates of Disease Activity

Description

Background:

* Multicentric Castleman’s disease (MCD) is a rare but lethal Kaposi’s sarcoma-associated herpesvirus (KSHV) associated lymphoproliferative disorder with a median survival of 2 years. It occurs more often in HIV-infected individuals than those without HIV infection. The poor prognosis is not fully explained by the underlying HIV, as the HIV-negative cases appear to have no survival advantage over the HIV-positive cohort. The disease has no defined standard treatment and has not been prospectively studied in a comprehensive manner.
* KSHV-MCD may provide a model for the development of targeted oncolytic virotherapy or other pathogenesis-based approaches to viral-associated malignancies. In KSHV-MCD, viral encoded tyrosine kinase genes appear to be possible targets to exploit in a virotherapy approach. Specific viral encoded genes appear to convert zidovudine and ganciclovir (or valganciclovir) into toxic phosphorylated moieties within the KSHV-infected tumor cells, to specifically target the KSHV-infected cells thus leading to specific cell death. If successful, this could have direct therapeutic benefit to participants and also provide a model for further development of this approach in other tumors.

Objectives

-To study and describe the natural history of KSHV-MCD.

Eligibility

* Age greater than or equal to 18 years
* Biopsy proven KSHV-associated MCD

Design

* Natural History study
* Inclusion of treatment as needed, with guidelines for preliminary investigation of a variety of specific treatments of interest

* High-dose zidovudine and ganciclovir
* High-dose zidovudine and ganciclovir and bortezomib
* Sirolimus
* Rituximab with liposomal doxorubicin followed by interferon-alpha
* Rituximab with EPOCH chemotherapy