What is the Therapy for Castleman Disease and its Cost?

 Managing Castleman Disease: Understanding Therapies and Their Costs Based on Disease Type

Treatment for Castleman's disease varies depending on the type of disease and the presence of specific infections like HHV-8 or HIV. Surgical removal is the primary treatment for Unicentric Castleman Disease, which can cost somewhere between Rs. 20,000 and Rs. 50,000, depending on the doctor’s experience and the patient’s condition. For Multicentric Castleman Disease, systemic therapies like monoclonal antibodies and antivirals are preferred

What is the Cost of Different Therapies for Castleman’s Disease?

Castleman’s disease is a rare non-clonal lymphoproliferative disorder characterized by abnormal lymph node growth and systemic inflammation. It can be classified into two main forms: unicentric and multicentric. Unicentric means affecting a single lymph node region, whereas multicentric means affecting multiple lymph node regions.

Treatment and prognosis vary significantly between these two forms. In this section, we will discuss different therapies to treat this condition:

1. Unicentric Castleman’s Disease

Complete surgical excision of the affected lymph node is the most preferred and often curative treatment. If surgery is not possible or if the disease recurs, doctors recommend radiation therapy, which can cost somewhere between Rs. 60,000 and Rs. 3,00,000.

2. Multicentric Castleman’s Disease  

These are some of the treatment approaches for MCD:

• Rituximab: A monoclonal antibody that targets B cells, it is a common treatment for HHV-8-associated MCD. The average cost of rituximab generally ranges from Rs. 10,000 to Rs. 77,000, depending on various brands.
• Siltuximab: It is an IL-6 inhibitor used for idiopathic MCD, may cost around ₹85,000 per vial, though availability in India is limited and may require special procurement.
• Corticosteroids: Medications like corticosteroids can help reduce inflammation and provide symptom relief. Generally, tablets like Hydrocortisone or Prednisolone can range from R 30 to Rs. 1265 per strip.
• Chemotherapy: Anticancer drugs that doctors use in treating Castleman’s disease in severe cases are cyclophosphamide and doxorubicin (also known as hydroxydaunorubicin). The cost of these drugs ranges from Rs. 30 to Rs. 420 per vial, depending on the brands.
• Antiviral Therapy: Antiviral medicines like acyclovir can be helpful to treat HHV-8-associated MCD. In India, acyclovir may cost somewhere between 100 and Rs. 1,000,depending on the composition and brands.
• Antiretroviral Therapy: For patients with HIV-associated MCD, antiretroviral therapy is crucial. Common antiretroviral drugs are Abacavir, Tenofovir, and Zidovudine, which can cost between 100 and Rs. 2,000,depending on the salt and brands.   

What are the Complications of Castleman’s Disease?

Uricentric Castleman disease typically resolves with the surgical removal of the affected lymph node, but can rarely lead to paraneoplastic pemphigus (PNP) or bronchiolitis obliterans (BO). On the other hand, multicentric Castleman disease (MCD) can cause serious complications, such as life-threatening infections, organ failure, and increased risk of lymphoma and Kaposi’s sarcoma.

Castleman's disease can be challenging to diagnose due to its similarity to other illnesses like non-Hodgkin lymphoma and angioimmunoblastic T-cell lymphoma. It is important to consult with haematologists or oncologists who are experienced in treating Castleman’s disease to get proper consultation regarding treatment plans.