Idiopathic multicentric Castleman disease with TAFRO clinical subtype responsive to IL‐6/JAK inhibition: A pediatric case series

Abstract

TAFRO (thrombocytopenia, anasarca, fever/elevated C‐reactive protein, reticulin myelofibrosis, renal dysfunction, and organomegaly) clinical subtype of idiopathic multicentric Castleman disease (iMCD‐TAFRO) is a rare lymphoproliferative disease characterized by systemic inflammation. First‐line treatment for iMCD‐TAFRO includes steroids and interleukin (IL)‐6 blockade. Many patients have refractory disease, which is associated with significant morbidity and mortality, and treatment remains challenging. We present two pediatric cases of iMCD‐TAFRO. One patient responded to IL‐6 blockade; the other was refractory to siltuximab and chemotherapy, ultimately responding to JAK inhibition with ruxolitinib. This is the first reported pediatric case of refractory iMCD‐TAFRO responding to JAK inhibition.

Idiopathic Multicentric Castleman Disease in Children: A Single-Center Retrospective Analysis

“…In this article, Patient 5 was ultimately diagnosed with TAFRO syndrome. So far, there have only been ve reports of pediatric TAFRO syndrome overseas [12,[23][24][25][26] . In this article, Patient 5, who had concurrent TAFRO syndrome, initially presented with fever and edema in the limbs, progressive thrombocytopenia, and small amounts of effusion in multiple serous cavities.…”

“…The main treatment methods are IL-6 receptor monoclonal antibody (tocilizumab) and IL-6 antibody (siltuximab). For some children whose treatment with tocilizumab was not effective, previous studies have shown that combination chemotherapy can achieve certain effects, such as the CHOP regimen, LD (lenalidomide, dexamethasone) regimen, etc [11,12] . In addition, thalidomide, cyclosporine, oral corticosteroids, and sirolimus have also been reported to be used in the treatment of iMCD [11,13] .…”

Treatment-resistant idiopathic multicentric Castleman disease with thrombocytopenia, anasarca, fever, reticulin fibrosis, renal dysfunction, and organomegaly managed with Janus kinase inhibitors: A case report

“…Two reports of ruxolitinib use in pediatric and adult cases of iMCD-TAFRO syndrome have been reported. [19,20] Therefore, we report 2 rare cases of ruxolitinib use in adults with the iMCD-TAFRO syndrome. However, further prospective studies should confirm the efficacy of JAK inhibitors for the treatment-resistant and refractory iMCD-TAFRO syndromes.…”

Idiopathic multicentric Castleman disease in an adolescent diagnosed following COVID‐19 infection

“…4 iMCD disproportionately affects adults, with a median age of diagnosis of 50 years, and there are very few published pediatric cases. 5,6 We report the case of an adolescent diagnosed with iMCD-TAFRO 6 weeks after hospitalization with an acute SARS-CoV-2 infection.…”