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Omar A, Marques N, Crawford N. Cancer and HIV: The Molecular Mechanisms of the Deadly Duo. Cancers (Basel) 2024; 16:546. [PMID: 38339297 PMCID: PMC10854577 DOI: 10.3390/cancers16030546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/19/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
The immune deficiency associated with human immunodeficiency virus (HIV) infection causes a distinct increased risk of developing certain cancer types. Kaposi sarcoma (KS), invasive cervical cancer and non-Hodgkin's lymphoma (NHL) are the prominent malignancies that manifest as a result of opportunistic viral infections in patients with advanced HIV infection. Despite the implementation of antiretroviral therapy (ART), the prevalence of these acquired immunodeficiency syndrome (AIDS)-defining malignancies (ADMs) remains high in developing countries. In contrast, developed countries have experienced a steady decline in the occurrence of these cancer types. However, there has been an increased mortality rate attributed to non-ADMs. Here, we provide a review of the molecular mechanisms that are responsible for the development of ADMs and non-ADMs which occur in HIV-infected individuals. It is evident that ART alone is not sufficient to fully mitigate the potential for ADMs and non-ADMs in HIV-infected individuals. To enhance the diagnosis and treatment of both HIV and malignancies, a thorough comprehension of the mechanisms driving the development of such cancers is imperative.
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Affiliation(s)
- Aadilah Omar
- Division of Oncology, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa
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2
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Atamna A, Yahav D, Hirzel C. Prevention of Oncogenic Gammaherpesvirinae (EBV and HHV8) Associated Disease in Solid Organ Transplant Recipients. Transpl Int 2023; 36:11856. [PMID: 38046068 PMCID: PMC10689273 DOI: 10.3389/ti.2023.11856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 11/07/2023] [Indexed: 12/05/2023]
Abstract
Long-term risk for malignancy is higher among solid organ transplant (SOT) recipients compared to the general population. Four non-hepatitis viruses have been recognized as oncogenic in SOT recipients-EBV, cause of EBV-associated lymphoproliferative diseases; human herpes virus 8 (HHV8), cause of Kaposi sarcoma, primary effusion lymphoma and multicentric Castleman disease; human papilloma virus, cause of squamous cell skin cancers, and Merkel cell polyomavirus, cause of Merkel cell carcinoma. Two of these viruses (EBV and HHV8) belong to the human herpes virus family. In this review, we will discuss key aspects regarding the clinical presentation, diagnosis, treatment, and prevention of diseases in SOT recipients associated with the two herpesviruses.
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Affiliation(s)
- Alaa Atamna
- Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Dafna Yahav
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Infectious Diseases Unit, Sheba Medical Center, Ramat-Gan, Israel
| | - Cédric Hirzel
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
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3
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Khanmammadov N, Paksoy N, Doğan İ, Ferhatoğlu F, Saip P, Aydiner A. Efficacy and outcomes of systemic chemotherapy in posttransplant and immunosuppression associated Kaposi sarcoma: Twenty years experience of a tertiary cancer center. Medicine (Baltimore) 2023; 102:e35383. [PMID: 37773844 PMCID: PMC10545387 DOI: 10.1097/md.0000000000035383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 09/04/2023] [Indexed: 10/01/2023] Open
Abstract
Kaposi sarcoma is a malignant angioproliferative disease, and human herpesvirus-8 plays a major role in its etiology. Iatrogenic Kaposi sarcoma (IKS) can occur in patients undergoing immunosuppressive therapy. The treatment strategy for patients with IKS is immunosuppressive therapy modification. However, it is unclear which chemotherapy drug is the most effective and safe in the treatment of IKS. Therefore, we investigated the efficacy and safety of systemic treatment in patients with IKS at our tertiary cancer center. This cross-sectional retrospective study analyzed the clinical data of 22 patients diagnosed with IKS between January 2000 and January 2020. The patients were divided into the following 2 groups according to the transplantation status: organ transplant recipient (OTR) group and non-organ transplant recipient (non-OTR) group. Of the 22 patients, 12 were included in the OTR group and 10 were included in the non-OTR group. The median patient age at diagnosis was 52.1 years in the OTR group and 68.1 years in the non-OTR group. The median overall survival (OS) was 65.4 months in the OTR group, while the median OS was not reached in the non-OTR group. There was no statistically significant difference in OS between the 2 groups (P = .45). The 5-year OS rate among all patients was 54%. In the OTR group, the objective response rate and disease control rate were 50% and 83%, respectively, and in the non-OTR group, the objective response rate and disease control rate were 60% and 90%, respectively. Chemotherapy was well tolerated in both groups. Hematological toxicities were the main dose-limiting adverse events. Grade III/IV leucopenia and neutropenia were observed in 5 and 4 patients, respectively; however, no patient experienced febrile neutropenia. No chemotherapy-related death occurred. Systemic chemotherapy is an effective treatment and can be considered for disease control in patients with an aggressive disease course, who do not experience regression with immunosuppressive therapy modification.
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Affiliation(s)
- Nij̇at Khanmammadov
- Department of Medical Oncology, Istanbul University Institute of Oncology, Istanbul, Turkey
| | - Nail Paksoy
- Department of Medical Oncology, Istanbul University Institute of Oncology, Istanbul, Turkey
| | - İzzet Doğan
- Department of Medical Oncology, Istanbul University Institute of Oncology, Istanbul, Turkey
| | - Ferhat Ferhatoğlu
- Department of Medical Oncology, Istanbul University Institute of Oncology, Istanbul, Turkey
| | - Pinar Saip
- Department of Medical Oncology, Istanbul University Institute of Oncology, Istanbul, Turkey
| | - Adnan Aydiner
- Department of Medical Oncology, Istanbul University Institute of Oncology, Istanbul, Turkey
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4
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Lee JJ, Kim JM, Ko Y, Kwon HE, Jung JH, Kwon H, Kim YH, Shin S. Transplant-associated Kaposi's sarcoma in a kidney allograft: a case report. KOREAN JOURNAL OF TRANSPLANTATION 2023; 37:135-140. [PMID: 37435144 PMCID: PMC10332279 DOI: 10.4285/kjt.23.0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 04/25/2023] [Accepted: 05/08/2023] [Indexed: 07/13/2023] Open
Abstract
Kaposi's sarcoma (KS) is a disease that is not widely known among the general public, but has a high prevalence among organ transplant recipients. Here, we present a rare case of intragraft KS after kidney transplantation. A 53-year-old woman who had been on hemodialysis due to diabetic nephropathy underwent deceased-donor kidney transplantation on December 7, 2021. Approximately 10 weeks after kidney transplantation, her creatinine level increased to 2.99 mg/dL. Upon examination, ureter kinking was confirmed between the ureter orifices and the transplanted kidney. As a result, percutaneous nephrostomy was performed, and a ureteral stent was inserted. During the procedure, bleeding occurred due to a renal artery branch injury, and embolization was performed immediately. Subsequently, kidney necrosis and uncontrolled fever developed, leading to graftectomy. Surgical findings revealed that the kidney parenchyma was necrotic as a whole, and lymphoproliferative lesions had formed diffusely around the iliac artery. These lesions were removed during graftectomy, and a histological examination was performed. The kidney graft and lymphoproliferative lesions were diagnosed as KS based on a histological examination. We report a rare case in which a recipient developed KS in the kidney allograft as well as in adjacent lymph nodes.
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Affiliation(s)
- Jae Jun Lee
- Division of Kidney and Pancreas Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin-Myung Kim
- Division of Kidney and Pancreas Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Youngmin Ko
- Division of Kidney and Pancreas Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hye Eun Kwon
- Division of Kidney and Pancreas Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joo Hee Jung
- Division of Kidney and Pancreas Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyunwook Kwon
- Division of Kidney and Pancreas Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Hoon Kim
- Division of Kidney and Pancreas Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Shin
- Division of Kidney and Pancreas Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Kaposi Sarcoma in a Child after Fanconi Anemia-Induced Haploidentical Hematopoietic Stem Cell Transplant: A Case Report. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020188. [PMID: 36832317 PMCID: PMC9954514 DOI: 10.3390/children10020188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/01/2023] [Accepted: 01/17/2023] [Indexed: 01/20/2023]
Abstract
Kaposi sarcoma is relatively common after solid organ transplantation, but very rare after hematopoietic stem cell transplant (HSCT). Here we are reporting a rare case of Kaposi sarcoma in a child after HSCT. An 11-year-old boy with Fanconi anemia was treated by haploidentical HSCT from his father. Three weeks after transplantation, the patient developed severe graft-versus-host disease (GVHD) which was treated by immunosuppressive therapy and extracorporeal photopheresis. Approximately 6.5 months after HSCT, the patient had asymptomatic nodular skin lesions over the scalp, chest, and face. Histopathological examination showed typical findings of Kaposi sarcoma. Later, additional lesions in the liver and oral cavity were confirmed. Liver biopsy was positive for HHV-8 antibodies. The patient was continued on Sirolimus which was already being used for the treatment of GVHD. Cutaneous lesions were also treated with topical timolol 0.5% ophthalmic solution. Within six months, cutaneous and mucous membrane lesions were completely resolved. Follow-up abdominal ultrasound and MRI showed the disappearance of the hepatic lesion.
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Berman H, Shimshak S, Reimer D, Brigham T, Hedges MS, Degesys C, Tolaymat L. Skin Cancer in Solid Organ Transplant Recipients: A Review for the Nondermatologist. Mayo Clin Proc 2022; 97:2355-2368. [PMID: 36334939 DOI: 10.1016/j.mayocp.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/29/2022] [Accepted: 07/07/2022] [Indexed: 11/06/2022]
Abstract
Solid organ transplant recipients (SOTRs) are at increased risk for the development of skin cancer compared with the general population, which requires consistent monitoring and management from a multidisciplinary team. The aim of this review is to provide a comprehensive overview for nondermatologist clinicians, outlining skin cancer diagnosis, treatment pearls, and skin cancer prevention strategies as they relate to SOTRs. A comprehensive search of the literature was conducted through the MEDLINE database with search terms including organ transplantation, transplant recipient, skin cancer, cutaneous neoplasms, management, and therapies. The search was limited to the English language and dates ranging from January 1, 2011, to December 28, 2021. All studies were reviewed for inclusion. Skin cancer will develop in more than half of SOTRs at some point in their life, most often nonmelanoma skin cancer such as basal cell carcinoma or squamous cell carcinoma. Melanoma and rarer cutaneous malignant neoplasms, such as Merkel cell carcinoma and Kaposi sarcoma, are also more frequent among SOTRs. A multidisciplinary effort at skin cancer screening and patient education is invaluable to prevent skin cancer-related morbidity and mortality in this population of patients. Reduction in immunosuppressive medications and surgical intervention are effective therapeutic approaches, and more novel systemic therapies including G protein-coupled receptor inhibitors and immune checkpoint inhibitors are possible options when traditional treatment approaches are not feasible. Checkpoint inhibitor therapy, however, comes with the risk of allograft rejection. With a growing and aging SOTR population, it is essential that SOTRs have support from dermatologists and nondermatologists alike in skin cancer prevention and treatment.
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Affiliation(s)
- Hannah Berman
- Department of Dermatology, Mayo Clinic, Jacksonville, FL
| | | | | | - Tara Brigham
- Mayo Clinic Medical Library, Mayo Clinic College of Medicine and Science, Jacksonville, FL
| | - Mary S Hedges
- Department of Internal Medicine, Division of Community Internal Medicine, Mayo Clinic, Jacksonville, FL
| | | | - Leila Tolaymat
- Department of Dermatology, Mayo Clinic, Jacksonville, FL.
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7
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Ferrándiz‐Pulido C, Gómez‐Tomás A, Llombart B, Mendoza D, Marcoval J, Piaserico S, Baykal C, Bouwes‐Bavinck J, Rácz E, Kanitakis J, Harwood C, Cetkovská P, Geusau A, del Marmol V, Masferrer E, Orte Cano C, Ricar J, de Oliveira W, Salido‐Vallejo R, Ducroux E, Gkini M, López‐Guerrero J, Kutzner H, Kempf W, Seçkin D. Clinicopathological features, MCPyV status and outcomes of Merkel cell carcinoma in solid-organ transplant recipients: a retrospective, multicentre cohort study. J Eur Acad Dermatol Venereol 2022; 36:1991-2001. [PMID: 35607918 PMCID: PMC9796956 DOI: 10.1111/jdv.18256] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 04/13/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND The proportion of Merkel cell carcinomas (MCCs) in solid-organ transplant recipients (SOTR) harbouring Merkel cell polyomavirus (MCPyV) is unknown, as are factors affecting their outcomes. OBJECTIVE To describe clinicopathological features of MCC in SOTR, investigate the tumoral MCPyV-status and identify factors associated with tumour outcomes. METHODS Retrospective, international, cohort-study. MCPyV-status was investigated by immunohistochemistry and polymerase chain reaction. RESULTS A total of 30 SOTR and 44 consecutive immunocompetent patients with MCC were enrolled. SOTR were younger at diagnosis (69 vs. 78 years, P < 0.001). Thirty-three percent of SOTR MCCs were MCPyV-positive vs. 91% of immunocompetent MCCs (P = 0.001). Solid-organ transplantation was associated with an increased cumulative incidence of progression (SHR: 3.35 [1.57-7.14], P = 0.002), MCC-specific mortality (SHR: 2.55 [1.07-6.06], P = 0.034) and overall mortality (HR: 3.26 [1.54-6.9], P = 0.002). MCPyV-positivity and switching to an mTOR inhibitor (mTORi) after MCC diagnosis were associated with an increased incidence of progression (SHR: 4.3 [1.5-13], P = 0.008 and SHR: 3.6 [1.1-12], P = 0.032 respectively) in SOTR. LIMITATIONS Retrospective design and heterogeneity of SOTR cohort. CONCLUSIONS MCPyV appears to play a less prominent role in the aetiopathogenesis of MCC in SOTR. SOTR have a worse prognosis than their immunocompetent counterparts and switching to an mTORi after the diagnosis of MCC does not improve progression.
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Affiliation(s)
- C. Ferrándiz‐Pulido
- Department of DermatologyHospital Universitari Vall d'Hebron, Universitat Autònoma de BarcelonaBarcelonaSpain
| | - A. Gómez‐Tomás
- Department of DermatologyHospital Universitari Vall d'Hebron, Universitat Autònoma de BarcelonaBarcelonaSpain
| | - B. Llombart
- Servicio de DermatologíaInstituto Valenciano de OncologíaValenciaSpain
| | - D. Mendoza
- Department of DermatologyFundación Jiménez DíazMadridSpain
| | - J. Marcoval
- Department of DermatologyHospital de Bellvitge, IDIBELL, University of BarcelonaBarcelonaSpain
| | - S. Piaserico
- Dermatology Unit, Department of MedicineUniversità di PadovaPadovaItaly
| | - C. Baykal
- Department of DermatologyIstanbul University, Istanbul Medical FacultyIstanbulTurkey
| | - J.N. Bouwes‐Bavinck
- Department of DermatologyLeiden University Medical CenterLeidenThe Netherlands
| | - E. Rácz
- Department of DermatologyUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands
| | - J. Kanitakis
- Department of DermatologyEdouard Herriot Hospital Group, Hospices Civils de LyonLyonFrance
| | - C.A. Harwood
- Centre for Cell Biology and Cutaneous ResearchBlizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of LondonLondonUK
| | - P. Cetkovská
- Department of DermatovenereologyFaculty of Medicine, Charles UniversityPilsenThe Czech Republic
| | - A. Geusau
- Department of DermatologyMedical University of ViennaViennaAustria
| | - V. del Marmol
- Service de DermatologieHôpital Erasme, Université Libre de BruxellesBrusselsBelgium
| | - E. Masferrer
- Department of DermatologyHospital Universitari Mútua de TerrassaBarcelonaSpain
| | - C. Orte Cano
- Service de DermatologieHôpital Erasme, Université Libre de BruxellesBrusselsBelgium
| | - J. Ricar
- Department of DermatovenereologyFaculty of Medicine, Charles UniversityPilsenThe Czech Republic
| | | | - R. Salido‐Vallejo
- Department of DermatologyUniversity Clinic of Navarra, School of Medicine, University of NavarraPamplonaSpain
| | - E. Ducroux
- Department of DermatologyEdouard Herriot Hospital Group, Hospices Civils de LyonLyonFrance
| | - M.A. Gkini
- Centre for Cell Biology and Cutaneous ResearchBlizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of LondonLondonUK
| | - J.A. López‐Guerrero
- Laboratory of Molecular BiologyFundación Instituto Valenciano de OncologíaValenciaSpain,IVO‐CIPF Joint Research Unit of Cancer, Príncipe Felipe Research Center (CIPF)ValenciaSpain,Department of PathologySchool of Medicine, Catholic University of Valencia ‘San Vicente Martir’ValenciaSpain
| | | | - W. Kempf
- Kempf und Pfaltz Histologische Diagnostik and Department of DermatologyUniversity Hospital ZurichZürichSwitzerland
| | - D. Seçkin
- Department of DermatologyBaşkent University Faculty of MedicineAnkaraTurkey
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8
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Subramaniam A, Giani C, Napolitano A, Ravi V, Frezza AM, Jones RL. Management of Vascular Sarcoma. Surg Oncol Clin N Am 2022; 31:485-510. [PMID: 35715146 DOI: 10.1016/j.soc.2022.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Vascular sarcomas encompass 3 well-defined sarcoma types: hemangioendothelioma, Kaposi sarcoma, and angiosarcoma. These distinct types are exceedingly rare and very different in terms of clinical behavior, biological features, and treatment approach. Because of this rarity and heterogeneity, it is crucial that vascular sarcomas are treated in sarcoma reference centers or networks, in order to ensure optimal management. The diversity of vascular sarcomas also needs to be taken into account in the design of clinical trials, in order to produce meaningful results that can be consistently translated into everyday clinical practice.
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Affiliation(s)
- Aparna Subramaniam
- Department of Sarcoma Medical Oncology, University of Texas MD Anderson Cancer Center, 1400 Holcombe Blvd, Unit 0450, FC12.3044, Houston, TX 77030, USA
| | - Claudia Giani
- Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Via Giacomo Venezian 1, Milan 20133, Italy
| | - Andrea Napolitano
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, UK
| | - Vinod Ravi
- Department of Sarcoma Medical Oncology, University of Texas MD Anderson Cancer Center, 1400 Holcombe Blvd, Unit 0450, FC12.3044, Houston, TX 77030, USA.
| | - Anna Maria Frezza
- Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Via Giacomo Venezian 1, Milan 20133, Italy
| | - Robin L Jones
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, UK
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9
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Lamoureux C, Drak Alsibai K, Pradinaud R, Sainte-Marie D, Couppie P, Blaizot R. Kaposi Sarcoma with Mucocutaneous Involvement in French Guiana: An Epidemiological Study between 1969 and 2019. Acta Derm Venereol 2022; 102:adv00709. [DOI: 10.2340/actadv.v102.581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Data on Kaposi sarcoma in French Guiana are scarce and out of date. This territory presents unique epidemiological features. The objectives of this retrospective study were to analyse the clinical features, outcome and incidence of the different forms of Kaposi sarcoma in patients diagnosed between 1969 and 2019. The study population comprised a total of 52 patients. Clinical forms included epidemic Kaposi sarcoma (n=30), endemic (n=18), iatrogenic (n=2), classic (n=1) and unclassified Kaposi sarcoma (n=1). The mean annual incidence rate of epidemic Kaposi reached a peak in the 1990s (0.93/100,000) then decreased in the 2000s (0.33/100,000), while the incidence of endemic Kaposi sarcoma reached a peak in the 1980s (0.82/100,000) before decreasing in the 2000s (0.12/100,000). Factors associated with the epidemic form were: sexual intercourse between men (p=0.0054) and Haitian origin (p=0.035). The presence of nodules and/or tumour, lesions limited to the lower limbs, and age >65 years were associated with the endemic form. While Creole populations seem to be as affected by endemic Kaposi sarcoma as their African counterparts, the dynamics of Kaposi sarcoma in French Guiana are now dominated by the epidemic form.
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Pesqué L, Delyon J, Lheure C, Baroudjian B, Battistella M, Merlet P, Lebbé C, Vercellino L. Yield of FDG PET/CT for Defining the Extent of Disease in Patients with Kaposi Sarcoma. Cancers (Basel) 2022; 14:cancers14092189. [PMID: 35565319 PMCID: PMC9102885 DOI: 10.3390/cancers14092189] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/15/2022] [Accepted: 04/21/2022] [Indexed: 11/18/2022] Open
Abstract
Simple Summary The potential role of positron emission tomography/computed tomography with fluorodeoxyglucose (FDG PET/CT) for assessing the extent of Kaposi sarcoma is not well studied. We analyzed FDG PET/CTs performed on 75 patients referred to our department for Kaposi sarcoma staging or restaging. FDG PET/CTs detected most lymph nodes, bone, and muscle lesions, whereas digestive and mucous lesions could be missed. Most cutaneous lesions can be identified when whole-body FDG PET/CT (including lower limbs) is performed. Thus, a true whole-body FDG PET/CT can be recommended for staging purposes in patients with active Kaposi sarcoma and, if positive, be useful for therapeutic evaluation and follow-up. Abstract Background: Positron emission tomography/computed tomography with fluorodeoxyglucose (F-18) (FDG PET/CT) is increasingly used in Kaposi sarcoma (KS), but its value has not been assessed. Objectives: In this study, we aimed to evaluate the diagnostic accuracy of FDG PET/CT to define the extent of disease in KS. Methods: Consecutive patients with KS referred to our department for FDG PET/CT were included. The diagnostic accuracy of FDG PET/CT for cutaneous and extra-cutaneous KS staging was assessed on a per lesion basis compared to staging obtained from clinical examination, standard imaging, endoscopy, histological analyses, and follow-up. Results: From 2007 to 2017, 75 patients with FDG PET/CT were analyzed. The sensitivity and specificity of FDG PET/CT for the overall detection of KS lesions were 71 and 98%, respectively. Sensitivity and specificity were 100 and 85% for lymph nodes, 87 and 98% for bone, 87 and 100% for lungs, and 100 and 100% for muscle involvement, whereas sensitivity was only 17% to detect KS digestive involvement. The sensitivity of the diagnostic for KS cutaneous involvement increased from 73 to 88% when using a whole-body examination. Conclusion: FDG PET/CT showed good sensitivity and specificity for KS staging (digestive involvement excepted) and could be used for staging patients with active KS.
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Affiliation(s)
- Louise Pesqué
- Nuclear Medicine Department, Saint Louis University Hospital, Assistance-Publique Hôpitaux de Paris, 1 Avenue Claude Vellefaux, 75010 Paris, France; (L.P.); (P.M.)
| | - Julie Delyon
- Department of Dermatology, Saint Louis University Hospital, Assistance-Publique Hôpitaux de Paris, 1 Avenue Claude Vellefaux, 75010 Paris, France; (J.D.); (B.B.); (C.L.)
- INSERM HIPI Team 1, U976, Saint Louis University Hospital, 1 Avenue Claude Vellefaux, 75010 Paris, France;
- Université de Paris Cité, 75006 Paris, France;
| | - Coralie Lheure
- Université de Paris Cité, 75006 Paris, France;
- Department of Dermatology, Cochin University Hospital, 27, Rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Barouyr Baroudjian
- Department of Dermatology, Saint Louis University Hospital, Assistance-Publique Hôpitaux de Paris, 1 Avenue Claude Vellefaux, 75010 Paris, France; (J.D.); (B.B.); (C.L.)
| | - Maxime Battistella
- INSERM HIPI Team 1, U976, Saint Louis University Hospital, 1 Avenue Claude Vellefaux, 75010 Paris, France;
- Université de Paris Cité, 75006 Paris, France;
- Department of Pathology, Saint Louis University Hospital, Assistance-Publique Hôpitaux de Paris, 1 Avenue Claude Vellefaux, 75010 Paris, France
| | - Pascal Merlet
- Nuclear Medicine Department, Saint Louis University Hospital, Assistance-Publique Hôpitaux de Paris, 1 Avenue Claude Vellefaux, 75010 Paris, France; (L.P.); (P.M.)
- Université de Paris Cité, 75006 Paris, France;
| | - Céleste Lebbé
- Department of Dermatology, Saint Louis University Hospital, Assistance-Publique Hôpitaux de Paris, 1 Avenue Claude Vellefaux, 75010 Paris, France; (J.D.); (B.B.); (C.L.)
- INSERM HIPI Team 1, U976, Saint Louis University Hospital, 1 Avenue Claude Vellefaux, 75010 Paris, France;
- Université de Paris Cité, 75006 Paris, France;
| | - Laetitia Vercellino
- Nuclear Medicine Department, Saint Louis University Hospital, Assistance-Publique Hôpitaux de Paris, 1 Avenue Claude Vellefaux, 75010 Paris, France; (L.P.); (P.M.)
- Université de Paris, INSERM, UMR_S942 MASCOT, 75006 Paris, France
- Correspondence: ; Tel.: +33-142499411
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11
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Molecular Mechanisms of Kaposi Sarcoma Development. Cancers (Basel) 2022; 14:cancers14081869. [PMID: 35454776 PMCID: PMC9030761 DOI: 10.3390/cancers14081869] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/03/2022] [Accepted: 04/05/2022] [Indexed: 01/08/2023] Open
Abstract
Simple Summary There are at least four forms of Kaposi’s sarcoma (KS) with the ‘HIV’-related form being the most aggressive and can involve mucosae or visceral organs. Kaposi’s sarcoma-associated herpes virus (KSHV) is the underlying cause of this disease. It can infect endothelial and/or mesenchymal cells and establish a latent phase in host cells in which latency proteins and various non-coding RNAs (ncRNAs) play a complex role in proliferation and angiogenesis. It also undergoes periods of sporadic lytic reactivation that are key for KS progression. Complex interactions with the microenvironment with production of inflammatory cytokines and paracrine signaling is a standout feature of KS development and maintenance. KSHV impairs the immune response by various mechanisms such as the degradation of a variety of proteins involved in immune response or binding to cellular chemokines. Treatment options include classical chemotherapy, but other novel therapies are being investigated. Abstract Kaposi’s sarcoma (KS) is a heterogeneous angioproliferative tumor that generally arises in the skin. At least four forms of this disease have been described, with the ‘HIV’-related form being the most aggressive and can involve mucosae or visceral organs. Three quarters of KS cases occur in sub-Saharan Africa (SSA) as geographic variation is explained by the disparate prevalence of KS-associated herpes virus (KSHV), which is the underlying cause of this disease. It can infect endothelial and/or mesenchymal cells that consequently transdifferentiate to an intermediate state. KSHV establishes a latent phase in host cells in which latency proteins and various non-coding RNAs (ncRNAs) play a complex role in proliferation and angiogenesis. It also undergoes periods of sporadic lytic reactivation triggered by various biological signals in which lytic stage proteins modulate host cell signaling pathways and are key in KS progression. Complex interactions with the microenvironment with production of inflammatory cytokines with paracrine signaling is a standout feature of KS development and maintenance. KSHV impairs the immune response by various mechanisms such as the degradation of a variety of proteins involved in immune response or binding to cellular chemokines. Treatment options include classical chemotherapy, but other novel therapies are being investigated.
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Zhou K, Xu J, Shang Z, Sun H, Shen K, Xiao Y. Case Report: Metagenomic Next-Generation Sequencing Can Contribute to the Diagnosis and Treatment of Disseminated Visceral Kaposi Sarcoma Following Allogeneic Haematopoietic Stem Cell Transplantation. Front Oncol 2022; 12:848976. [PMID: 35280783 PMCID: PMC8907446 DOI: 10.3389/fonc.2022.848976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 01/31/2022] [Indexed: 11/25/2022] Open
Abstract
Disseminated visceral Kaposi sarcoma (KS) following allogeneic haematopoietic stem cell transplantation (HSCT) is a rare but life-threatening posttransplant complication. A suitable management strategy for disseminated KS involvement in transplant patients is unclear. Here, we reported a patient who developed disseminated visceral KS following HSCT, which was the first detailed report documenting the relationship among KS development, delayed immune reconstitution, and HHV-8 DNA levels by metagenomic next-generation sequencing (mNGS). The HHV-8 viral load peaked at 2071 sequence reads with an absolute lymphocyte count of 0.17×109/L on day +242. On day +536, the HHV-8 viral load became undetectable, with an absolute lymphocyte count of 1.06×109/L and the KS disappearance. HHV-8 load in blood detected by mNGS may be used as an early prediction marker for KS, a guide for early withdrawal of immunosuppression, and a tool to monitor KS treatment response in the setting of HSCT, especially in patients with CMV-seropositive or graft failure postengraftment. Through whole-exome sequencing, we explored the molecular mechanism underlying the patient’s longer latency of haematopoietic or immune reconstitution and recurrent infections. Germline mutations in the FANCI and RAD51 genes might impair the patient’s DNA repair ability, leading to a degree of immunodeficiency and tumour susceptibility. We strongly recommended evaluating the clinical history of the donor and investigating whether there were possible germline mutations suspected for immunodeficiency or familial neoplasms. Disseminated visceral KS patients could likely benefit from chemotherapy, especially if the disease appears to be aggressive.
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Affiliation(s)
- Kuangguo Zhou
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jinhuan Xu
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhen Shang
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hanying Sun
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kefeng Shen
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi Xiao
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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13
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Valantin MA, Royston L, Hentzien M, Jary A, Makinson A, Veyri M, Ronot-Bregigeon S, Isnard S, Palich R, Routy JP. Therapeutic Perspectives in the Systemic Treatment of Kaposi’s Sarcoma. Cancers (Basel) 2022; 14:cancers14030484. [PMID: 35158752 PMCID: PMC8833559 DOI: 10.3390/cancers14030484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/07/2022] [Accepted: 01/14/2022] [Indexed: 11/28/2022] Open
Abstract
Simple Summary Alternative systemic treatments are needed for patients who develop chemotherapy-refractory KS. Anti-angiogenic therapies constitute interesting therapeutic targets in this context, due to the central role of angiogenesis in KS pathogenesis, and could represent attractive alternatives. Immune checkpoints blockade could also be an interesting therapeutic approach in order to restore anti-HHV-8 immunity and tumor control. Abstract In patients with Kaposi’s sarcoma (KS), the therapeutic goal is to achieve a durable remission in the size and number of skin and visceral lesions. Although most patients show tumor regression in response to standard systemic chemotherapy regimens, alternative systemic treatments are needed for patients who develop refractory KS. Anti-angiogenic therapies represent attractive therapeutic targets in this context, due to the central role of angiogenesis in KS pathogenesis. Pomalidomide, which exhibits such anti-angiogenic activity through inhibition of VEGF, currently constitutes the most promising agent of this class and has been recently approved by the FDA. In addition, immune checkpoint blockade also represents an interesting alternative therapeutic approach through the restoration of immunity against HHV-8, the causative agent of KS, and improvement of tumor control. Although small series of cases treated successfully with these drugs have been reported, there is no marketing approval for anti-immune checkpoint antibodies for KS to date. In the present review, we will discuss potential therapeutic options for patients with recurrent or refractory KS, including systemic chemotherapies, immune checkpoint inhibitors, anti-herpesvirus agents, and anti-angiogenic drugs. Well-conducted clinical trials in this population are urgently needed to correctly address the efficacy of targeted agents and immunomodulators, while monitoring for adverse effects.
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Affiliation(s)
- Marc-Antoine Valantin
- Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM U1136, Sorbonne University, 75013 Paris, France;
- Correspondence: (M.-A.V.); (L.R.); Tel.: +33-142-160-144 (M.-A.V.); +15-14-934-1934 (ext. 76487) (L.R.); Fax: +33-142-1601 (M.-A.V.)
| | - Léna Royston
- Infectious Diseases and Immunity in Global Health Program & Chronic Viral Illness Service, McGill University Health Centre, Montréal, QC H4A3J1, Canada; (S.I.); (J.-P.R.)
- Division of Infectious Diseases, Geneva University Hospitals, 1205 Geneva, Switzerland
- Correspondence: (M.-A.V.); (L.R.); Tel.: +33-142-160-144 (M.-A.V.); +15-14-934-1934 (ext. 76487) (L.R.); Fax: +33-142-1601 (M.-A.V.)
| | - Maxime Hentzien
- Service de Médecine Interne, Maladies Infectieuses, Immunologie Clinique, CHU Robert Debré, 51090 Reims, France;
| | - Aude Jary
- Service de Virologie, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM U1136, Sorbonne University, 75013 Paris, France;
| | - Alain Makinson
- Infectious Diseases Department, INSERM U1175, University Hospital of Montpellier, 34000 Montpellier, France;
| | - Marianne Veyri
- Service d’Oncologie Médicale, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM, Sorbonne University, 75013 Paris, France;
| | - Sylvie Ronot-Bregigeon
- Service d’Immuno-Hématologie Clinique, Hôpital Sainte-Marguerite, Aix Marseille Université, 13009 Marseille, France;
| | - Stéphane Isnard
- Infectious Diseases and Immunity in Global Health Program & Chronic Viral Illness Service, McGill University Health Centre, Montréal, QC H4A3J1, Canada; (S.I.); (J.-P.R.)
| | - Romain Palich
- Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM U1136, Sorbonne University, 75013 Paris, France;
| | - Jean-Pierre Routy
- Infectious Diseases and Immunity in Global Health Program & Chronic Viral Illness Service, McGill University Health Centre, Montréal, QC H4A3J1, Canada; (S.I.); (J.-P.R.)
- Division of Hematology, McGill University Health Centre, Montréal, QC H4A3J1, Canada
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14
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Munting A, Manuel O. Viral infections in lung transplantation. J Thorac Dis 2022; 13:6673-6694. [PMID: 34992844 PMCID: PMC8662465 DOI: 10.21037/jtd-2021-24] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/21/2021] [Indexed: 12/15/2022]
Abstract
Viral infections account for up to 30% of all infectious complications in lung transplant recipients, remaining a significant cause of morbidity and even mortality. Impact of viral infections is not only due to the direct effects of viral replication, but also to immunologically-mediated lung injury that may lead to acute rejection and chronic lung allograft dysfunction. This has particularly been seen in infections caused by herpesviruses and respiratory viruses. The implementation of universal preventive measures against cytomegalovirus (CMV) and influenza (by means of antiviral prophylaxis and vaccination, respectively) and administration of early antiviral treatment have reduced the burden of these diseases and potentially their role in affecting allograft outcomes. New antivirals against CMV for prophylaxis and for treatment of antiviral-resistant CMV infection are currently being evaluated in transplant recipients, and may continue to improve the management of CMV in lung transplant recipients. However, new therapeutic and preventive strategies are highly needed for other viruses such as respiratory syncytial virus (RSV) or parainfluenza virus (PIV), including new antivirals and vaccines. This is particularly important in the advent of the COVID-19 pandemic, for which several unanswered questions remain, in particular on the best antiviral and immunomodulatory regimen for decreasing mortality specifically in lung transplant recipients. In conclusion, the appropriate management of viral complications after transplantation remain an essential step to continue improving survival and quality of life of lung transplant recipients.
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Affiliation(s)
- Aline Munting
- Infectious Diseases Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Oriol Manuel
- Infectious Diseases Service, Lausanne University Hospital, Lausanne, Switzerland.,Transplantation Center, Lausanne University Hospital, Lausanne, Switzerland
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15
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Lupinacci S, Perri A, Toteda G, Vizza D, Lofaro D, Pontrelli P, Stallone G, Divella C, Tessari G, La Russa A, Zaza G, Bonofiglio R. Rapamycin promotes autophagy cell death of Kaposi's sarcoma cells through P75NTR activation. Exp Dermatol 2021; 31:143-153. [PMID: 34331820 DOI: 10.1111/exd.14438] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 05/10/2021] [Accepted: 07/22/2021] [Indexed: 12/27/2022]
Abstract
The mammalian target of rapamycin inhibitor (mTOR-I) Rapamycin, a drug widely used in kidney transplantation, exerts important anti-cancer effects, particularly in Kaposi's Sarcoma (KS), through several biological interactions. In this in vivo and in vitro study, we explored whether the activation of the autophagic pathway through the low-affinity receptor for nerve growth factor, p75NTR , may have a pivotal role in the anti-cancer effect exerted by Rapamycin in S. Our Kimmunohistochemistry results revealed a significant hyper-activation of the autophagic pathway in KS lesions. In vitro experiments on KS cell lines showed that Rapamycin exposure reduced cell viability by increasing the autophagic process, in the absence of apoptosis, through the transcriptional activation of p75NTR via EGR1. Interestingly, p75NTR gene silencing prevented the increase of the autophagic process and the reduction of cell viability. Moreover, p75NTR activation promoted the upregulation of phosphatase and tensin homolog (PTEN), a tumour suppressor that modulates the PI3K/Akt/mTOR pathway. In conclusion, our in vitro data demonstrated, for the first time, that in Kaposi's sarcoma, autophagy triggered by Rapamycin through p75NTR represented a major mechanism by which mTOR inhibitors may induce tumour regression. Additionally, it suggested that p75NTR protein analysis could be proposed as a new potential biomarker to predict response to Rapamycin in kidney transplant recipients affected by Kaposi's sarcoma.
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Affiliation(s)
- Simona Lupinacci
- Department of Nephrology, Dialysis and Transplantation, "Kidney and Transplantation" Research Centre, Annunziata Hospital, Cosenza, Italy
| | - Anna Perri
- Department of Nephrology, Dialysis and Transplantation, "Kidney and Transplantation" Research Centre, Annunziata Hospital, Cosenza, Italy
| | - Giuseppina Toteda
- Department of Nephrology, Dialysis and Transplantation, "Kidney and Transplantation" Research Centre, Annunziata Hospital, Cosenza, Italy
| | - Donatella Vizza
- Department of Nephrology, Dialysis and Transplantation, "Kidney and Transplantation" Research Centre, Annunziata Hospital, Cosenza, Italy
| | - Danilo Lofaro
- Department of Nephrology, Dialysis and Transplantation, "Kidney and Transplantation" Research Centre, Annunziata Hospital, Cosenza, Italy
| | - Paola Pontrelli
- Nephrology Unit, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Giovanni Stallone
- Nephrology Dialysis and Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Chiara Divella
- Nephrology Unit, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Gianpaolo Tessari
- Section of Dermatology and Venereology, University-Hospital of Verona, Verona, Italy
| | - Antonella La Russa
- Department of Nephrology, Dialysis and Transplantation, "Kidney and Transplantation" Research Centre, Annunziata Hospital, Cosenza, Italy
| | - Gianluigi Zaza
- Renal Unit, Department of Medicine, University-Hospital of Verona, Verona, Italy
| | - Renzo Bonofiglio
- Department of Nephrology, Dialysis and Transplantation, "Kidney and Transplantation" Research Centre, Annunziata Hospital, Cosenza, Italy
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16
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Posttransplant Kaposi sarcoma: Analysis of a series of 13 patients. Med Clin (Barc) 2021; 157:339-343. [PMID: 34246484 DOI: 10.1016/j.medcli.2021.04.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 04/17/2021] [Accepted: 04/20/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION AND OBJECTIVES This study reflects our experience in the management of posttransplant Kaposi Sarcoma (KS) and assesses the clinical relevance of monitoring HHV-8 DNA viral load in peripheral blood by qPCR. PATIENTS AND METHODS Retrospective study of all patients diagnosed with posttransplant KS during the period 1995-2019. In 8 patients, we performed a qPCR in serum for HHV-8 DNA detection at diagnosis and/or during follow-up. RESULTS Data from 13 organ transplant recipients with a diagnosis of iatrogenic KS were collected. Reduction and/or discontinuation of one or more immunosuppressive agent(s) along with switching to an mTOR inhibitor was part of the treatment approach in 12 (92%) patients. Overall response rate (including complete response, partial response, and stable disease) was observed in 9 patients. At diagnosis, HHV-8 qPCR in serum was positive in 2 out of 5 patients. During follow-up, both positive cases turned negative, as a clinical response. CONCLUSIONS Our work highlights the critical role of reduction of immunosuppression and conversion to an mTOR inhibitor in the management of posttransplant KS.
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17
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Anderson MA, Ying T, Wyburn K, Ferguson PM, Strach MC, Grimison P, Chadban S, Gracey DM. Transplant-associated penile Kaposi sarcoma managed with single agent paclitaxel chemotherapy: a case report. BMC Urol 2021; 21:87. [PMID: 34098936 PMCID: PMC8186205 DOI: 10.1186/s12894-021-00855-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 05/26/2021] [Indexed: 02/07/2023] Open
Abstract
Background Kaposi’s sarcoma is an uncommon complication in renal transplant patients, and typically presents with cutaneous lesions on the lower extremities. Penile involvement has been reported only rarely. Management of cutaneous-limited disease is primarily reduction of immunosuppression and conversion to an mTOR-inhibitor, whereas the treatment of disseminated disease in transplant patients is more variable. Case presentation A 75-year-old male, originally from Somalia, received a deceased-donor kidney transplant for diabetic and hypertensive nephropathy. Seven months post-transplant he presented with lower limb lesions, oedema and bilateral deep vein thromboses. He then developed a fast-growing painful lesion on his penile shaft. A biopsy of this lesion confirmed KS, and a PET scan demonstrated disseminated disease in the lower extremities, penis and thoracic lymph nodes. His tacrolimus was converted to sirolimus, and his other immunosuppression was reduced. He was treated with single agent paclitaxel chemotherapy in view of his rapidly progressing, widespread disease. The penile lesion completely resolved, and the lower extremity lesions regressed significantly. His kidney allograft function remained stable throughout treatment. Conclusion This case illustrates a rare presentation of an uncommon post-transplant complication and highlights the need for a high index of suspicion of KS in transplant patients presenting with atypical cutaneous lesions. It serves to demonstrate that the use of single agent paclitaxel chemotherapy, switch to an mTORi and reduction in immunosuppression where possible produces excellent short-term outcomes, adding to the body of evidence for this management strategy in disseminated Kaposi’s sarcoma.
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Affiliation(s)
- Matthew A Anderson
- Department of Renal Medicine and Renal Transplant, Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW, Australia.
| | - Tracey Ying
- Department of Renal Medicine and Renal Transplant, Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW, Australia.,Kidney Node, Charles Perkins Centre, University of Sydney, Camperdown, NSW, Australia.,Central Clinical School, Faculty of Medicine, University of Sydney, Camperdown, NSW, Australia
| | - Kate Wyburn
- Department of Renal Medicine and Renal Transplant, Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW, Australia.,Kidney Node, Charles Perkins Centre, University of Sydney, Camperdown, NSW, Australia.,Central Clinical School, Faculty of Medicine, University of Sydney, Camperdown, NSW, Australia
| | - Peter M Ferguson
- Central Clinical School, Faculty of Medicine, University of Sydney, Camperdown, NSW, Australia.,Department of Tissue Pathology, Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW, Australia
| | - Madeleine C Strach
- Department of Medical Oncology, Chris O'Brien Lifehouse, Camperdown, NSW, Australia
| | - Peter Grimison
- Central Clinical School, Faculty of Medicine, University of Sydney, Camperdown, NSW, Australia.,Department of Medical Oncology, Chris O'Brien Lifehouse, Camperdown, NSW, Australia
| | - Steve Chadban
- Department of Renal Medicine and Renal Transplant, Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW, Australia.,Kidney Node, Charles Perkins Centre, University of Sydney, Camperdown, NSW, Australia.,Central Clinical School, Faculty of Medicine, University of Sydney, Camperdown, NSW, Australia
| | - David M Gracey
- Department of Renal Medicine and Renal Transplant, Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW, Australia.,Kidney Node, Charles Perkins Centre, University of Sydney, Camperdown, NSW, Australia.,Central Clinical School, Faculty of Medicine, University of Sydney, Camperdown, NSW, Australia
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18
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Story MT, Sanders ML, Bashir AA, Longo JM, Abel SL, Dollard SC, Grodstein EI, Thomas CP, Katz DA. Infiltrating Kaposi sarcoma presenting as acute kidney injury: An unexpected consequence of deliberate hepatitis C-positive organ transplantation. Transpl Infect Dis 2021; 23:e13481. [PMID: 33012057 DOI: 10.1111/tid.13481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 08/06/2020] [Accepted: 09/20/2020] [Indexed: 11/30/2022]
Abstract
Kaposi sarcoma (KS) following kidney transplantation can result from recipient reactivation of latent human herpesvirus 8 (HHV-8) infection or activation of donor-acquired HHV-8 infection. Post-transplant KS typically manifests with cutaneous pathology, but rare cases of renal allograft involvement have been reported. We describe two cases of donor-derived HHV-8 infection in two hepatitis C (HCV) viremia-negative transplant recipients who each received a kidney from a donor with HCV viremia. One recipient did not develop KS while the other presented with acute kidney injury caused by extensive KS infiltration of the renal parenchyma and metastatic disease. This report reviews the literature for cases of KS involving the renal allograft and highlights an unexpected consequence of deliberate HCV-positive organ transplantation.
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Affiliation(s)
- Maria T Story
- Department Medicine, Division of Nephrology, University of Iowa Roy and Lucille Carver College of Medicine, Iowa City, IA, USA
| | - M Lee Sanders
- Department Medicine, Division of Nephrology, University of Iowa Roy and Lucille Carver College of Medicine, Iowa City, IA, USA
- Iowa City VA Health Care System, Iowa City, IA, USA
| | - Amani A Bashir
- Department of Pathology, University of Iowa Roy and Lucille Carver College of Medicine, Iowa City, IA, USA
| | - Jude M Longo
- Iowa City VA Health Care System, Iowa City, IA, USA
- Department of Radiology, University of Iowa Roy and Lucille Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Stacy L Abel
- Iowa City VA Health Care System, Iowa City, IA, USA
| | | | - Elliot I Grodstein
- Department of Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Christie P Thomas
- Department Medicine, Division of Nephrology, University of Iowa Roy and Lucille Carver College of Medicine, Iowa City, IA, USA
- Iowa City VA Health Care System, Iowa City, IA, USA
| | - Daniel A Katz
- Iowa City VA Health Care System, Iowa City, IA, USA
- Department of Surgery, University of Iowa Roy and Lucille Carver College of Medicine, Iowa City, IA, USA
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Harzallah A, Ounissi M, Hajji M, Chargui S, Hedri H, Abderrahim E, Ben Hamida F, Bacha M, Ben Abdallah T. [Successful treatment with paclitaxel of a visceral relapse of post-transplant Kaposi's sarcoma]. Nephrol Ther 2021; 17:132-136. [PMID: 33563572 DOI: 10.1016/j.nephro.2020.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/23/2020] [Accepted: 10/11/2020] [Indexed: 10/22/2022]
Abstract
We report the observation of a patient who presented with post-transplant Kaposi's sarcoma after a delay of eight months with a dual cutaneous and palatal localisation. The reduction in immunosuppressive treatment and the introduction of Rapamune® allowed good clinical progress initially with regression of the skin lesions. He subsequently presented later a skin relapse with visceral localisation. Chemotherapy was conducted based on weekly paclitaxel infusions allowing partial remission and maintenance of renal graft function with good clinical tolerance.
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Affiliation(s)
- Amel Harzallah
- Faculté de médecine de Tunis, université de Tunis El Manar, 1007 Tunis, Tunisie; Service de médecine A, hôpital Charles-Nicolle, 1006 Tunis, Tunisie.
| | - Mondher Ounissi
- Faculté de médecine de Tunis, université de Tunis El Manar, 1007 Tunis, Tunisie; Service de médecine A, hôpital Charles-Nicolle, 1006 Tunis, Tunisie
| | - Meriem Hajji
- Faculté de médecine de Tunis, université de Tunis El Manar, 1007 Tunis, Tunisie; Service de médecine A, hôpital Charles-Nicolle, 1006 Tunis, Tunisie
| | - Soumaya Chargui
- Faculté de médecine de Tunis, université de Tunis El Manar, 1007 Tunis, Tunisie; Service de médecine A, hôpital Charles-Nicolle, 1006 Tunis, Tunisie
| | - Hafedh Hedri
- Faculté de médecine de Tunis, université de Tunis El Manar, 1007 Tunis, Tunisie; Service de médecine A, hôpital Charles-Nicolle, 1006 Tunis, Tunisie
| | - Ezzeddine Abderrahim
- Faculté de médecine de Tunis, université de Tunis El Manar, 1007 Tunis, Tunisie; Service de médecine A, hôpital Charles-Nicolle, 1006 Tunis, Tunisie
| | - Fathi Ben Hamida
- Service de médecine A, hôpital Charles-Nicolle, 1006 Tunis, Tunisie; Laboratoire de pathologie rénale LR00SP01, hôpital Charles-Nicolle, 1006 Tunis, Tunisie
| | - Mongi Bacha
- Faculté de médecine de Tunis, université de Tunis El Manar, 1007 Tunis, Tunisie; Service de médecine A, hôpital Charles-Nicolle, 1006 Tunis, Tunisie
| | - Taieb Ben Abdallah
- Faculté de médecine de Tunis, université de Tunis El Manar, 1007 Tunis, Tunisie; Service de médecine A, hôpital Charles-Nicolle, 1006 Tunis, Tunisie
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20
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Peters LL, Ambardekar AV. An immunosuppression tightrope: Successful heart transplantation after giant cell myocarditis in a patient with HIV complicated by recurrent giant cell myocarditis and Kaposi sarcoma. J Heart Lung Transplant 2020; 39:1506-1508. [PMID: 33067104 DOI: 10.1016/j.healun.2020.09.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 09/12/2020] [Accepted: 09/24/2020] [Indexed: 11/18/2022] Open
Affiliation(s)
- Laura L Peters
- Section of Advanced Heart Failure and Transplantation, Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado.
| | - Amrut V Ambardekar
- Section of Advanced Heart Failure and Transplantation, Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
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Abstract
Viral hepatitis can cause a wide spectrum of clinical presentations from a benign form with minimal or no symptoms to acute liver failure or death. Hepatitis D coinfection and superinfection have distinct clinical courses, with the latter more likely leading to chronic infection. Management of chronic hepatitis D virus is individualized because of the paucity of treatment options and significant side effect profile of currently available treatments. Sporadic cases of hepatitis E caused by contaminated meats are becoming increasingly prevalent in immunocompromised hosts. Human herpesviruses are an important cause of disease also in immunocompromised individuals.
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22
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23
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Barete S. Quoi de neuf en médecine interne ? Ann Dermatol Venereol 2019; 146:12S24-12S31. [DOI: 10.1016/s0151-9638(20)30103-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Craig PJ. An Overview of Uncommon Cutaneous Malignancies, Including Skin Appendageal (Adnexal) Tumours and Sarcomas. Clin Oncol (R Coll Radiol) 2019; 31:769-778. [PMID: 31466845 DOI: 10.1016/j.clon.2019.07.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 06/07/2019] [Accepted: 07/23/2019] [Indexed: 01/25/2023]
Abstract
A standardised classification of malignant skin appendageal (adnexal) tumours and sarcomas is required for improved patient management and prognosis. This has been hindered by considerable morphological variation both within and between tumour types, the use of many synonyms for the same tumour types and variation in classification between pathologists. This update uses the improved classification in the 2018 WHO classification of skin tumours as the basis to discuss malignant skin appendageal tumours, sarcomas and cutaneous metastases that regularly present to skin cancer clinicians, multidisciplinary skin cancer teams and tumour boards, with current evidence for management, where appropriate.
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Affiliation(s)
- P J Craig
- Gloucestershire Cellular Pathology Laboratory, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham General Hospital, Cheltenham, UK.
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