Characterizing the heterogeneity of Castleman disease and oligocentric subtype: Findings from the ACCELERATE registry

• Oligocentric Castleman disease (CD) is an intermediate phenotype distinctly characterized from unicentric and idiopathic multicentric CD

• Oligocentric Castleman disease cases demonstrate a pattern of oligocentric or regional lymphadenopathy and few inflammatory symptoms

Castleman disease (CD) describes a group of rare lymphoproliferative disorders that exhibit a wide range of symptomatology and degree of lymphadenopathy, particularly across the two forms of CD with unknown etiology, unicentric CD (UCD) and HHV-8-negative/idiopathic multicentric CD (iMCD). Whereas UCD cases typically present with localized lymphadenopathy and mild symptoms, iMCD involves multicentric lymphadenopathy and cytokine-storm driven symptoms with three recognized clinical phenotypes. Increasingly, there are anecdotal reports of cases that do not fit into this framework, but these cases have not been systematically described. Herein, we utilize the ACCELERATE natural history registry to characterize the spectrum of CD based on disease features, symptomatology, and severity. Our results characterize a cohort of 179 CD cases, which were reviewed and confirmed by an expert panel of clinicians and hematopathologists. We show that CD patients present on a continuous spectrum of clinical phenotypes, and we describe oligocentric CD (OligoCD), an intermediate phenotype that does not fit the criteria for UCD or iMCD. These cases tend to have "oligocentric" lymphadenopathy (median [interquartile range] regions of lymphadenopathy: 3.0 [2.0,4.0]) in a regional pattern and exhibit a mild clinical phenotype that is more similar to UCD than iMCD. We also show that OligoCD patients are inconsistently categorized as UCD versus iMCD, highlighting the need for this characterization. Future data collected through ACCELERATE may further elucidate the natural history and risk profile of these patients.