Is tocilizumab a potential therapeutic option for refractory unicentric Castleman disease?

Castleman disease is a rare lymphoproliferative disorder with 2 distinctly defined clinical forms. While multicentric Castleman disease (UCD) poses a potential therapeutic challenge, unicentric variant has historically been considered curable with surgical resection. Hence, little is known to guide management of patients with UCD, refractory to surgical resection and combination chemotherapy. We present a case of a patient, negative for HIV and HHV-8, who had an unsuccessful surgical intervention and no response to radiotherapy and chemotherapy. He had severe paraneoplastic pemphigus and was treated with tocilizumab, an anti-interleukin-6 receptor monoclonal antibody that has demonstrated good response rates in multicentric Castleman disease but demonstrated no clinical response despite 2 months of treatment. Our report is the first to describe a lack of response to tocilizumab in the rare setting of refractory UCD and discuss potential for distinct disease biology.

Recurrence of extramedullary plasmacytoma of the breast.

We present a rare case of a multiple recurrent extramedullary plasmacytoma of the breast and spine that showed aggressive behaviour without bone marrow involvement. A 29-year-old woman initially presented with extramedullary plasmacytoma of the left breast that was treated with radiotherapy. Shortly after, a recurrence appeared in the right breast, spine, and in both breasts, despite treatment with local and systemic therapy.