First in 45 Years: Scientists Discover New Subtype of Castleman Disease

The discovery broadens the known spectrum of this rare disorder, emphasizing the critical role of collaboration with patient advocates.

A newly discovered subtype of Castleman disease promises to improve diagnosis and treatment for thousands of patients who have not fit neatly into existing classifications. Named Oligocentric Castleman Disease (OligoCD), this distinct clinical entity differs significantly from the two previously recognized forms of Castleman disease.

This breakthrough, the first major classification advancement in over 45 years, offers new clarity in the understanding of this rare and complex immune disorder, which affects an estimated 4,300 to 5,200 people in the United States. The findings, led by researchers at the Perelman School of Medicine at the University of Pennsylvania, were published in the journal Blood Advances.

“This discovery is a game-changer for Castleman disease patients,” said David Fajgenbaum, MD, an associate professor of Translational Medicine and Human Genetics at Penn and co-founder of the Castleman Disease Collaborative Network (CDCN). “For decades, patients with OligoCD have been falling through the cracks, classified as having a different type of Castleman Disease and being subjected to potentially over-aggressive treatments such as chemotherapy that come with very uncomfortable side effects. Now we can match these patients—about 15 percent of all Castleman cases—with the right treatments for their specific condition.”

Castleman disease (CD), first described in 1956 by Dr. Benjamin Castleman, encompasses a spectrum of conditions characterized by abnormal lymph node growth and a range of symptoms from mild to life-threatening. Historically, CD has been divided into UCD, involving a single lymph node region with milder symptoms, and iMCD, marked by widespread lymphadenopathy and severe, cytokine-driven inflammation. However, some patients’ experiences with CD don’t fit these two types, complicating diagnosis and care.

A new subtype identified

Using the ACCELERATE registry—which combines medical data from hundreds of patients with CD so that researchers and physicians can better understand and treat CD—the research team of clinicians and hematopathologists analyzed 179 patients.

The study found that OligoCD patients exhibit fewer and less severe symptoms than those with iMCD, suggesting that surgical removal of affected lymph nodes—effective for the milder UCD—may be more appropriate than the intense treatments used for iMCD. Therapies for iMCD include IL-6 inhibitors used for serious rheumatoid arthritis, immunosuppressants used for autoimmune disease and transplants, and chemotherapies. However, the team emphasizes the need for further research to refine treatment guidelines and a further understanding of how OligoCD develops, with ACCELERATE poised to provide ongoing insights.

“ACCELERATE has consistently proven to be an invaluable tool in unlocking the mysteries of Castleman disease,” said Josh Brandstadter, MD, PhD, director of clinical research at Penn’s Center for Cytokine Storm Treatment & Laboratory. “Without the robust data from patients around the world, we would not have been able to redefine the CD spectrum with such clarity.”

The Penn Clinical and Research teams also worked with several patients from the Castleman Disease Collaborative Network (CDCN) who shared their experiences, which helped identify the gaps in existing classifications and inspired the push to define OligoCD as a new subtype.

Penny Deremer is a member of the CDCN and a Penn Medicine patient with OligoCD. “I am so thankful to finally have a name for what I and so many other patients have been going through,” she said.

Reference: “Characterizing the heterogeneity of Castleman disease and oligocentric subtype: findings from the ACCELERATE registry” by Sheila K. Pierson, Joshua D. Brandstadter, Drew A. Torigian, Adam Bagg, Mary Jo Lechowicz, Daisy Alapat, Corey Casper, Amy Chadburn, Shanmuganathan Chandrakasan, Angela Dispenzieri, Alexander Fosså, Christian Hoffmann, Makoto Ide, Razelle Kurzrock, Sudipto Mukherjee, Sunita Nasta, José-Tomás Navarro, Ariela Noy, Eric Oksenhendler, Mateo Sarmiento Bustamante, Saishravan Shyamsundar, Matthew Streetly, Raymond S. M. Wong, Lu Zhang, Megan S. Lim, Gordan Srkalovic, Frits van Rhee and David C. Fajgenbaum, 14 April 2025, Blood Advances.
DOI: 10.1182/bloodadvances.2024014391

The ACCELERATE natural history registry has received funding from Janssen Pharmaceuticals (2016 — 2018), EUSA Pharma, LLC (US), which has merged with Recordati Rare Diseases Inc. (2018 — 2022), and the U.S. Food & Drug Administration (R01FD007632).

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