Natural History of KSHV-Associated Multicentric Castleman s Disease

Natural History Study of KSHV-Associated Multicentric Castleman's Disease

Background:

Kaposi s sarcoma herpes virus (KSHV) causes several kinds of cancer, Kaposi sarcoma (KS), a form of Multicentric Castleman s Disease (MCD) and a type of lymphoma known as Primary Effusion Lymphoma (PEL). These cancers can occur alone or at the same time in the same patient. MCD can cause a lot of symptoms and problems with various organs in the body, making patients feel quite unwell. If unrecognized, the disease can be fatal. Medications such as rituximab alone or in combination with chemotherapy may help treat MCD but there is little known about the long term effects and the natural course of MCD.

Objective:

To better understand the biology of KSHV-MCD to help identify how this disease causes illness and how cancer treatments known to be effective in MCD may help patients with this condition. This study also aims to help identify ways to treat the disease by providing other standard cancer treatments that would be useful to use to treat MCD based on what we know about this condition.

Eligibility:

People 18 years of age and older with KSHV-MCD.

Design:

Participants will be screened with:

Medical history

Physical exam

CT scan

Blood and heart tests

Participants will have an initial evaluation. This will include:

Review of participants symptoms and ability to perform their normal activities

Blood and urine tests

Imaging studies such as CT and PET scans. Participants may have a contrast agent injected into their arm.

Photographs to document skin lesions

Optional skin biopsy. For this, a small piece of the skin will be removed.

Optional lymph node needle biopsy

Optional samples of the fluid in the space around the lungs, intestines, or heart

Optional sample of the liquid that surrounds the brain and spinal cord

Saliva samples

DEXA scan to examine the bones

Questionnaires

Optional limb measurements or cognitive tests

Physicians will give participants recommendations about treatment.

After their initial evaluation and any treatment, participants will have additional visits. These will occur every 3 months for the first year, then every 6 months for the second year, and then once a year for up to 1 year.

Study Overview

• Status: Recruiting
• Conditions: Multicentric Castleman s Disease

Detailed Description

Background:

• Multicentric Castleman s disease (MCD) is a rare but lethal Kaposi s sarcoma-associated herpesvirus (KSHV) associated lymphoproliferative disorder with a historical 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 little or no survival advantage over the HIV-positive cohort. The disease has no defined standard treatment and there is much to be learned about its pathogenesis and natural history with current treatments.
• Patients with KSHV-MCD may present with other KSHV-associated conditions such as Kaposi sarcoma (KS) and may develop primary effusion lymphoma (PEL) following their diagnosis, which may affect morbidity and mortality. It is not clear how these concurrent conditions develop simultaneously and over time.
• Since 2004, the HIV and AIDS Malignancy Branch has studied the natural history and assessed novel therapies for KSHV-MCD which has contributed to the development of at least two therapies that are now considered as first-line therapies: (1) rituximab plus liposomal doxorubicin and (2) high dose zidovudine plus valganciclovir.
• These therapies plus either rituximab alone or other rituximab-based therapies that have been developed over the last 15 years have resulted in durable responses in patients with KSHV-MCD and have substantially improved the prognosis of these patients.
• The longitudinal evaluations along with tissue sample collection, imaging studies, and participant reported outcomes will allow for the development of a better understanding of the natural history of this disease, and the development of the basis for more effective treatments.

Objective:

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

Eligibility:

• Age >= 18 years
• Biopsy proven KSHV-associated MCD

Design:

• This will be a long-term study to comprehensively study participants with KSHV-MCD
• Medical history will be collected, and participants followed throughout the course of their illness, with particular attention to patterns of disease presentation, recurrence and progression, response to therapies, and duration of responses
• Tissue samples and blood will be obtained from participants during this study.
• We anticipate accruing 135 participants on this protocol

• Study Type: Observational
• Enrollment (Estimated): 135

Contacts and Locations

• Study Contact: Name: Ramya M Ramaswami, M.D.; Phone Number: (240) 506-1088; Email: ramya.ramaswami@nih.gov
• Study Contact Backup: Name: Irene Ekwede, R.N.; Phone Number: (240) 760-6126; Email: irene.ekwede@nih.gov

Study Locations

• United States
  • Maryland
    • Bethesda, Maryland, United States, 20892
      • Recruiting
      • National Institutes of Health Clinical Center
      • Contact: For more information at the NIH Clinical Center contact National Cancer Institute Referral Office; Phone Number: 888-624-1937

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

• Sampling Method: Probability Sample

Study Population

primary clinical

Description

• INCLUSION CRITERIA:
• Biopsy proven KSHV-associated MCD, confirmed in the Laboratory of Pathology, CCR
• Age >=18 years.
• ECOG performance status <=4 (Karnofsky >=20%).
• Ability of subject to understand and the willingness to sign a written informed consent document.
• Participants may be co-enrolled in other protocols, including investigational studies to treat KSHV-associated malignancies.

EXCLUSION CRITERIA:

• Any condition or set of circumstances that in the opinion of the investigators would make participation in this study unsafe or otherwise inappropriate for a given individual.
• Pregnancy

Study Plan

How is the study designed?

Design Details

• Observational Models: Cohort
• Time Perspectives: Prospective

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort
Cohort 1; Subjects with KSHV-associated MCD

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
natural history of MCD	clinical presentation, patterns of disease progression, therapeutic response, disease recurrence and participant overall survival	ongoing

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
concurrent KS or PEL evaluation	Percentage of subjects with concurrent PEL or KS	every 3 months for year 1, every 6 month for year 2, yearly from year 3
relapse-free survival	time from any treatment until first recurrence	every 3 months for year 1, every 6 month for year 2, yearly from year 3
overall survival	time from any treatment to death	every 3 months for year 1, every 6 month for year 2, yearly from year 3

Collaborators and Investigators

• Sponsor: National Cancer Institute (NCI)
• Investigators: Principal Investigator: Ramya M Ramaswami, M.D., National Cancer Institute (NCI)

Publications and helpful links

Helpful Links

• NIH Clinical Center Detailed Web Page

Study record dates

Study Major Dates

• Study Start (Actual): November 17, 2021
• Primary Completion (Estimated): January 1, 2034
• Study Completion (Estimated): January 1, 2035

Study Registration Dates

• First Submitted: July 17, 2021
• First Submitted That Met QC Criteria: July 17, 2021
• First Posted (Actual): July 20, 2021

Study Record Updates

• Last Update Posted (Actual): June 26, 2024
• Last Update Submitted That Met QC Criteria: June 25, 2024
• Last Verified: June 24, 2024

More Information

Terms related to this study

• Keywords: HIV; Natural History; Kaposi s sarcoma; primary effusion lymphoma; interlerleukin-6
• Other Study ID Numbers: 10000337; 000337-C

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No