Treatment Approach for Castleman's Disease and IgG4 Disease with Renal Failure

Treatment Protocol

• For severe inflammation or inadequate response to combined corticosteroid and tocilizumab therapy, consider triple therapy with corticosteroids, rituximab, and cyclophosphamide, as recommended by the American Journal of Kidney Diseases 1

Management of Renal Complications

• Bortezomib-based regimens may be considered for patients with monoclonal immunoglobulin deposition disease (MIDD) components, as they can lead to deep and rapid responses, according to Leukemia 2
• For patients with severe renal impairment, evaluate for kidney transplantation if appropriate, but defer until disease is in complete remission, as suggested by the American Journal of Kidney Diseases 1

Prognosis and Special Considerations

• The therapeutic goal is to achieve disease remission and stabilize or improve renal function, as stated in Leukemia 2