Is there a place for interferon alpha in treatment strategy of multicentric Castleman's disease?

Introduction, - Castleman's disease is an unusual condition of unknown caus e, consisting of massive proliferation of lymphoid tissue. Two forms (local ized and multicentric) have been described. Interleukin-6 (IL-6) is at the core of the disease, being responsible for most of the clinical and biologi cal signs that may be observed. Despite the benignancy of this pre-lymphoma condition, ifs course is usually aggressive and of poor prognosis in regar d to the multicentric form. No consensus regarding treatment has been defin ed. Available data on the multicentric form of the disease are to scarce to allow any conclusion about the treatment timing and type of chemotherapy b est suited to this condition. We report the case of a patient in whom inter feron alpha (IFN-alpha) was used as first line treatment. Exegesis. - The case of a 52-year-old man with multicentric Castleman's dis ease combined with high IL-6, in whom, however, testing for human herpes vi rus-8 proved to be negative, is described. Interferon alpha (4.5 MU/m(2) th ree times per week during 18 months) administered as first line treatment i nduced dramatic improvement in the patient's general condition and normaliz ation of the tumoral syndrome. Moreover, biological parameters and IL-6 ret urned to normal. Two years after interferon disruption, complete remission is still present. Conclusion. - On the basis of the present data and those of two previous ob servations, anti-IL-6 and anti-infective properties of INF-alpha are discus sed. Treatment of multicentric Castleman's disease is based on corticostero ids and drugs derived from those pertaining to treatment of malignant lymph omas. Our results indicate that INF-alpha is truly directed against Castlem an's disease and has less toxicity than drugs usually prescribed. This argu es for early use of INF-alpha in Castleman's disease, in association or not with corticosteroids. (C) 2000 Editions scientifiques et medicales Elsevie r SAS.