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Kaposi Sarcoma in HIV-positive Solid-Organ Transplant Recipients: A French Multicentric National Study and Literature Review. Transplantation 2019; 103:e22-e28. [PMID: 30273235 DOI: 10.1097/tp.0000000000002468] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Kaposi sarcoma is a vascular tumor related to herpesvirus-8 and is promoted by immunosuppression. For the last 15 years, human immunodeficiency virus (HIV) patients have had access to organ transplantation. The dual immunosuppression of HIV and immunosuppressive treatments might increase the risk and severity of Kaposi sarcoma. METHODS We conducted a multicentric retrospective study by collecting cases from French databases and society members of transplanted patients, among which 7 HIV-infected patients who subsequently developed Kaposi sarcoma were included. RESULTS In the CRISTAL database (114 511 patients) and the DIVAT (Données Informatisées et VAlidées en Transplantation) database (19 077 patients), the prevalence of Kaposi sarcoma was 0.18% and 0.46%, respectively, in transplanted patients; these values compare with 0.66% and 0.50%, respectively, in transplanted patients with HIV. The median time from HIV infection to Kaposi sarcoma was 20 years. Kaposi sarcoma occurred during the first year after transplantation in most cases, whereas HIV viral load was undetectable. Only 2 patients had visceral involvement. Five patients were treated with conversion of calcineurin inhibitor to mammalian target of rapamycin inhibitor, and 5 patients were managed by decreasing immunosuppressive therapies. At 1 year, 4 patients had a complete response, and 3 had a partial response. CONCLUSIONS In our study, Kaposi sarcoma in transplanted patients with HIV did not show any aggressive features and was treated with the usual posttransplant Kaposi sarcoma management protocol.
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Long-term care of transplant recipients: de novo neoplasms after liver transplantation. Curr Opin Organ Transplant 2019; 23:187-195. [PMID: 29324517 DOI: 10.1097/mot.0000000000000499] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW Since the first liver transplantation in the early 1960s, there have been significant improvements in the recipients' long-term outcome. Patients who have undergone transplantation are exposed to a high risk of developing neoplastic disease, not only because of their chronic immunosuppression, but also related to physiological aging, lifestyle, chronic viral infections, liver disease cause, and carcinogenic immunosuppressants. The present review covers the latest and most relevant data on de novo neoplasms after liver transplantation, and discusses their implications for clinical practice. RECENT FINDINGS Given the impact of de novo neoplasms, in terms of morbidity and mortality, transplant teams must be prepared to diagnose and treat these conditions promptly. Dedicated cancer screening protocols are warranted. Although surveillance strategies are based on data concerning the general population, they should be customized in the light of each transplant recipient's risk factors. The resulting risk stratification is crucially important to the design of early intervention programs, and for addressing the modulation of individualized immunosuppressive regimens. SUMMARY De novo malignancies are a significant issue for the liver transplant population, but targeted screening programs have shown that survival rates similar to those of nonimmunosuppressed patients can be achieved. New oncological surveillance strategies covering the prophylaxis, monitoring, and treatment of de novo neoplasms should take high priority in clinical research.
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Roshan R, Labo N, Trivett M, Miley W, Marshall V, Coren L, Cornejo Castro EM, Perez H, Holdridge B, Davis E, Matus-Nicodemos R, Ayala VI, Sowder R, Wyvill KM, Aleman K, Fennessey C, Lifson J, Polizzotto MN, Douek D, Keele B, Uldrick TS, Yarchoan R, Ohlen C, Ott D, Whitby D. T-cell responses to KSHV infection: a systematic approach. Oncotarget 2017; 8:109402-109416. [PMID: 29312617 PMCID: PMC5752530 DOI: 10.18632/oncotarget.22683] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 11/05/2017] [Indexed: 01/14/2023] Open
Abstract
Prior studies of T-cell responses to KSHV have included relatively few participants and focused on relatively few KSHV antigens. To provide a more comprehensive analysis, we investigated T-cell responses to the whole KSHV proteome using IFN-γ ELISpot. Using ∼7,500 overlapping 15mer peptides we generated one to three peptide pools for each of the 82 KSHV ORFs. IFN-γ ELISpot analysis of PBMCs from 19 patients with a history of KSHV-associated disease and 24 healthy donors (11 KSHV seropositive) detected widely varied responses. Fifty six of the 82 ORFs were recognized by at least one individual but there was little overlap between participants. Responses to at least one ORF pool were observed in all 19 patients and in 7 seropositive donors. Four seropositive donors and 10 seronegative donors had no detectable responses while 3 seronegative donors had weak responses to one ORF. Patients recognised more ORFs than the donors (p=0.04) but the response intensity (spot forming units: SFU per million cells) was similar in the two groups. In four of the responding donors, individual peptides eliciting the predominant responses were identified: three donors responded to only one peptide per ORF, while one recognized five. Using intracellular cytokine staining in four participant samples, we detected peptide-induced IFN-γ, MIP1-β, and TNF-α as well as CD107a degranulation, consistent with multifunctional effector responses in CD8+ and CD4+ T cells. Sequence analysis of TCRs present in peptide specific T-cell clones generated from two participants showed both mono- and multi-clonotypic responses. Finally, we molecularly cloned the KSHV specific TCRs and incorporated the sequences into retroviral vectors to transfer the specificities to fresh donor cells for additional studies. This study suggests that KSHV infected individuals respond to diverse KSHV antigens, consistent with a lack of shared immunodominance and establishes useful tools to facilitate KSHV immunology studies.
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Affiliation(s)
- Romin Roshan
- AIDS and Cancer Virus Program, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Nazzarena Labo
- AIDS and Cancer Virus Program, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Matthew Trivett
- AIDS and Cancer Virus Program, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Wendell Miley
- AIDS and Cancer Virus Program, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Vickie Marshall
- AIDS and Cancer Virus Program, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Lori Coren
- AIDS and Cancer Virus Program, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Elena M. Cornejo Castro
- AIDS and Cancer Virus Program, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Hannah Perez
- AIDS and Cancer Virus Program, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Benjamin Holdridge
- AIDS and Cancer Virus Program, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Eliza Davis
- AIDS and Cancer Virus Program, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Rodrigo Matus-Nicodemos
- Vaccine Research Center, National Institute of Allergy and Infectious Disease, Bethesda, MD, USA
| | - Victor I. Ayala
- AIDS and Cancer Virus Program, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Raymond Sowder
- AIDS and Cancer Virus Program, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Kathleen M. Wyvill
- HIV and AIDS Malignancy Branch, National Cancer Institute, Bethesda, MD, USA
| | - Karen Aleman
- HIV and AIDS Malignancy Branch, National Cancer Institute, Bethesda, MD, USA
| | - Christine Fennessey
- AIDS and Cancer Virus Program, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Jeffrey Lifson
- AIDS and Cancer Virus Program, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Mark N. Polizzotto
- HIV and AIDS Malignancy Branch, National Cancer Institute, Bethesda, MD, USA
| | - Daniel Douek
- Vaccine Research Center, National Institute of Allergy and Infectious Disease, Bethesda, MD, USA
| | - Brandon Keele
- AIDS and Cancer Virus Program, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Thomas S. Uldrick
- HIV and AIDS Malignancy Branch, National Cancer Institute, Bethesda, MD, USA
| | - Robert Yarchoan
- HIV and AIDS Malignancy Branch, National Cancer Institute, Bethesda, MD, USA
| | - Claes Ohlen
- AIDS and Cancer Virus Program, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - David Ott
- AIDS and Cancer Virus Program, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Denise Whitby
- AIDS and Cancer Virus Program, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
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Association of CD4+ T-cell Count, HIV-1 RNA Viral Load, and Antiretroviral Therapy With Kaposi Sarcoma Risk Among HIV-infected Persons in the United States and Canada. J Acquir Immune Defic Syndr 2017; 75:382-390. [PMID: 28394855 DOI: 10.1097/qai.0000000000001394] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Kaposi sarcoma (KS) remains common among HIV-infected persons. To better understand KS etiology and to help target prevention efforts, we comprehensively examined a variety of CD4 T-cell count and HIV-1 RNA viral load (VL) measures, as well as antiretroviral therapy (ART) use, to determine independent predictors of KS risk. SETTING North American AIDS Cohort Collaboration on Research and Design. METHODS We followed HIV-infected persons during 1996-2009 from 18 cohorts. We used time-updated Cox regression to model relationships between KS risk and recent, lagged, trajectory, and cumulative CD4 count or VL measures, as well as ART use. We used Akaike's information criterion and global P values to derive a final model. RESULTS In separate models, the relationship between each measure and KS risk was highly significant (P < 0.0001). Our final mutually adjusted model included recent CD4 count [hazard ratio (HR) for <50 vs. ≥500 cells/μL = 12.4; 95% confidence interval (CI): 6.5 to 23.8], recent VL (HR for ≥100,000 vs. ≤500 copies/mL = 3.8; 95% CI: 2.0 to 7.3), and cumulative (time-weighted mean) VL (HR for ≥100,000 vs. ≤500 copies/mL = 2.5; 95% CI: 1.0 to 5.9). Each P-trend was <0.0001. After adjusting for these measures, we did not detect an independent association between ART use and KS risk. CONCLUSIONS Our results suggested a multifactorial etiology for KS, with early and late phases of development. The cumulative VL effect suggested that controlling HIV replication promptly after HIV diagnosis is important for KS prevention. We observed no evidence for direct anti-KS activity of ART, independent of CD4 count and VL.
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Zamoiski RD, Yanik E, Gibson TM, Cahoon EK, Madeleine MM, Lynch CF, Gustafson S, Goodman MT, Skeans M, Israni AK, Engels EA, Morton LM. Risk of Second Malignancies in Solid Organ Transplant Recipients Who Develop Keratinocyte Cancers. Cancer Res 2017; 77:4196-4203. [PMID: 28615224 PMCID: PMC5540772 DOI: 10.1158/0008-5472.can-16-3291] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 03/06/2017] [Accepted: 06/05/2017] [Indexed: 01/07/2023]
Abstract
Solid organ transplant recipients have increased risk for developing keratinocyte cancers, including cutaneous squamous cell carcinoma (SCC) and basal cell carcinoma (BCC), in part as a result of immunosuppressive medications administered to prevent graft rejection. In the general population, keratinocyte cancers are associated with increased risks of subsequent malignancy, however, the risk in organ transplant populations has not been evaluated. We addressed this question by linking the U.S. Scientific Registry of Transplant Recipients, which includes data on keratinocyte cancer occurrence, with 15 state cancer registries. Risk of developing malignancies after keratinocyte cancer was assessed among 118,440 Caucasian solid organ transplant recipients using multivariate Cox regression models. Cutaneous SCC occurrence (n = 6,169) was associated with 1.44-fold increased risk [95% confidence interval (CI), 1.31-1.59] for developing later malignancies. Risks were particularly elevated for non-cutaneous SCC, including those of the oral cavity/pharynx (HR, 5.60; 95% CI, 4.18-7.50) and lung (HR, 1.66; 95% CI, 1.16-2.31). Cutaneous SCC was also associated with increased risk of human papillomavirus-related cancers, including anal cancer (HR, 2.77; 95% CI, 1.29-5.96) and female genital cancers (HR, 3.43; 95% CI, 1.44-8.19). In contrast, BCC (n = 3,669) was not associated with overall risk of later malignancy (HR, 0.98; 95% CI, 0.87-1.12), including any SCC. Our results suggest that transplant recipients with cutaneous SCC, but not BCC, have an increased risk of developing other SCC. These findings somewhat differ from those for the general population and suggest a shared etiology for cutaneous SCC and other SCC in the setting of immunosuppression. Cutaneous SCC occurrence after transplantation could serve as a marker for elevated malignancy risk. Cancer Res; 77(15); 4196-203. ©2017 AACR.
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Affiliation(s)
- Rachel D Zamoiski
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Department of Health and Human Services, Bethesda, Maryland
| | - Elizabeth Yanik
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Department of Health and Human Services, Bethesda, Maryland
| | - Todd M Gibson
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Elizabeth K Cahoon
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Department of Health and Human Services, Bethesda, Maryland
| | - Margaret M Madeleine
- Public Health Science, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Charles F Lynch
- Department of Epidemiology, University of Iowa, Iowa City, Iowa
| | - Sally Gustafson
- Scientific Registry of Transplant Recipients, Minneapolis, Minnesota
| | - Marc T Goodman
- Cancer Prevention and Control Program, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Melissa Skeans
- Scientific Registry of Transplant Recipients, Minneapolis, Minnesota
| | - Ajay K Israni
- Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
| | - Eric A Engels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Department of Health and Human Services, Bethesda, Maryland
| | - Lindsay M Morton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Department of Health and Human Services, Bethesda, Maryland.
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Abstract
PURPOSE OF REVIEW To review current knowledge of different cancer states affecting women with HIV infection. RECENT FINDINGS With improved survival of persons with HIV in the post-cART era, the landscape of malignancies in this population has greatly changed with fewer AIDS-defining malignancies (ADM) and a growing number of non-AIDS defining malignancies (NADM). Women, however, continue to represent a vulnerable population at risk for certain ADM and NADM such as cervical, anal, and breast cancer. Human papillomavirus-mediated cancers disproportionately burden women in resource-poor settings such as sub-Saharan Africa. For cancers such as Kaposi's sarcoma, lung cancer, liver cancer, and colorectal cancer, women share a lower burden of disease compared with their male counterparts. However, there remains a dearth of evidence characterizing these disease states specifically among women. SUMMARY Cancer in women with HIV continues to be a major source of morbidity and mortality worldwide, especially in low-income countries. Screening strategies, primary prevention through vaccination against human papillomavirus and viral hepatitis, and treatment for HIV with combined antiviral therapy remain cornerstones in cancer prevention.
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Affiliation(s)
- Nora T. Oliver
- Department of Medicine, Section of Infectious Diseases, Atlanta VA Medical Center, Decatur, GA
| | - Elizabeth Y. Chiao
- Department of Medicine, Section of Infectious Diseases and Health Services Research, Baylor College of Medicine, Houston, TX
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Changing Incidence and Risk Factors for Kaposi Sarcoma by Time Since Starting Antiretroviral Therapy: Collaborative Analysis of 21 European Cohort Studies. Clin Infect Dis 2016; 63:1373-1379. [PMID: 27535953 PMCID: PMC5091347 DOI: 10.1093/cid/ciw562] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 08/04/2016] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Kaposi sarcoma (KS) remains a frequent cancer in human immunodeficiency virus (HIV)-positive patients starting combination antiretroviral therapy (cART). We examined incidence rates and risk factors for developing KS in different periods after starting cART in patients from European observational HIV cohorts. METHODS We included HIV-positive adults starting cART after 1 January 1996. We analyzed incidence rates and risk factors for developing KS up to 90 and 180 days and 1, 2, 5, and 8 years after cART start and fitted univariable and multivariable Cox regression models. RESULTS We included 109 461 patients from 21 prospective clinical cohorts in Europe with 916 incident KS cases. The incidence rate per 100 000 person-years was highest 6 months after starting cART, at 953 (95% confidence interval, 866-1048), declining to 82 (68-100) after 5-8 years. In multivariable analyses adjusted for exposure group, origin, age, type of first-line regimen, and calendar year, low current CD4 cell counts increased the risk of developing KS throughout all observation periods after cART initiation. Lack of viral control was not associated with the hazard of developing KS in the first year after cART initiation, but was over time since starting cART increasingly positively associated (P < .001 for interaction). CONCLUSION In patients initiating cART, both incidence and risk factors for KS change with time since starting cART. Whereas soon after starting cART low CD4 cell count is the dominant risk factor, detectable HIV-1 RNA viral load becomes an increasingly important risk factor in patients who started cART several years earlier, independently of immunodeficiency.
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8
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Begré L, Rohner E, Mbulaiteye SM, Egger M, Bohlius J. Is human herpesvirus 8 infection more common in men than in women? Systematic review and meta-analysis. Int J Cancer 2016; 139:776-83. [PMID: 27062038 DOI: 10.1002/ijc.30129] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 03/02/2016] [Accepted: 03/16/2016] [Indexed: 11/06/2022]
Abstract
All forms of Kaposi sarcoma (KS) are more common in men than in women. It is unknown if this is due to a higher prevalence of human herpesvirus 8 (HHV-8), the underlying cause of KS, in men compared to women. We did a systematic review and meta-analysis to examine the association between HHV-8 seropositivity and gender in the general population. Studies in selected populations like for example, blood donors, hospital patients and men who have sex with men were excluded. We searched Medline and Embase from January 1994 to February 2015. We included observational studies that recruited participants from the general population and reported HHV-8 seroprevalence for men and women or boys and girls. We used random-effects meta-analysis to pool odds ratios (OR) of the association between HHV-8 and gender. We used meta-regression to identify effect modifiers, including age, geographical region and type of HHV-8 antibody test. We included 22 studies, with 36,175 participants. Men from sub-Saharan Africa (SSA) [OR 1.21, 95% confidence interval (CI) 1.09-1.34], but not men from elsewhere (OR 0.94, 95% CI 0.83-1.06), were more likely to be HHV-8 seropositive than women (p value for interaction = 0.010). There was no difference in HHV-8 seroprevalence between boys and girls from SSA (OR 0.90, 95% CI 0.72-1.13). The type of HHV-8 assay did not affect the overall results. A higher HHV-8 seroprevalence in men than women in SSA may partially explain why men have a higher KS risk in this region.
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Affiliation(s)
- Lorin Begré
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Eliane Rohner
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Sam M Mbulaiteye
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Centre for Infectious Disease Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Julia Bohlius
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
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Gorsane I, Bacha MM, Abderrahim E, Amri N, Hajri M, Ounissi M, Harzallah A, El Younsi F, Hedri H, Ben Abdallah T. Post kidney transplantation Kaposi's sarcoma: the experience of a Mediterranean North African center. Clin Transplant 2016; 30:372-9. [DOI: 10.1111/ctr.12694] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2015] [Indexed: 12/31/2022]
Affiliation(s)
- Imen Gorsane
- Department of Internal Medicine A (M8); Charles Nicolle Hospital; Tunis Tunisia
- Laboratory of Research in Immunology of Renal Transplantation and Immunopathology (LR03SP01); Charles Nicolle Hospital; Tunis Tunisia
- Faculty of Medicine; University of Tunis El Manar; Tunis Tunisia
| | - Mohamed Mongi Bacha
- Department of Internal Medicine A (M8); Charles Nicolle Hospital; Tunis Tunisia
- Laboratory of Research in Immunology of Renal Transplantation and Immunopathology (LR03SP01); Charles Nicolle Hospital; Tunis Tunisia
- Faculty of Medicine; University of Tunis El Manar; Tunis Tunisia
| | - Ezzedine Abderrahim
- Department of Internal Medicine A (M8); Charles Nicolle Hospital; Tunis Tunisia
- Faculty of Medicine; University of Tunis El Manar; Tunis Tunisia
| | - Nadia Amri
- Department of Internal Medicine A (M8); Charles Nicolle Hospital; Tunis Tunisia
- Faculty of Medicine; University of Tunis El Manar; Tunis Tunisia
| | - Malika Hajri
- Department of Internal Medicine A (M8); Charles Nicolle Hospital; Tunis Tunisia
- Faculty of Medicine; University of Tunis El Manar; Tunis Tunisia
| | - Mondher Ounissi
- Department of Internal Medicine A (M8); Charles Nicolle Hospital; Tunis Tunisia
- Laboratory of Research in Immunology of Renal Transplantation and Immunopathology (LR03SP01); Charles Nicolle Hospital; Tunis Tunisia
- Faculty of Medicine; University of Tunis El Manar; Tunis Tunisia
| | - Amel Harzallah
- Department of Internal Medicine A (M8); Charles Nicolle Hospital; Tunis Tunisia
- Faculty of Medicine; University of Tunis El Manar; Tunis Tunisia
| | - Fathi El Younsi
- Department of Internal Medicine A (M8); Charles Nicolle Hospital; Tunis Tunisia
- Faculty of Medicine; University of Tunis El Manar; Tunis Tunisia
| | - Hafedh Hedri
- Department of Internal Medicine A (M8); Charles Nicolle Hospital; Tunis Tunisia
- Faculty of Medicine; University of Tunis El Manar; Tunis Tunisia
| | - Taieb Ben Abdallah
- Department of Internal Medicine A (M8); Charles Nicolle Hospital; Tunis Tunisia
- Laboratory of Research in Immunology of Renal Transplantation and Immunopathology (LR03SP01); Charles Nicolle Hospital; Tunis Tunisia
- Faculty of Medicine; University of Tunis El Manar; Tunis Tunisia
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Coordes A, Albers AE, Lenarz M, Seehofer D, Puhl G, Pascher A, Neuhaus R, Neuhaus P, Pratschke J, Andreou A. Incidence and long-term survival of patients with de novo head and neck carcinoma after liver transplantation. Head Neck 2015; 38:707-14. [PMID: 25521431 DOI: 10.1002/hed.23943] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2014] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Liver transplant recipients have an increased risk of developing de novo malignancies. METHODS We conducted a prospective evaluation of clinicopathological data and predictors for overall survival (OS) in patients with head and neck squamous cell carcinoma (HNSCC) after liver transplantation (1988 to 2010). RESULTS Thirty-three of 2040 patients who underwent liver transplantation (1.6%) developed de novo HNSCC. The incidence of HNSCC in liver transplant recipients with end-stage alcoholic liver disease (26) was 5%. After a median follow-up of 9 years, 1-year, 3-year, and 5-year OS rates were 74%, 47%, and 34%, respectively. Tumor size, cervical lymph node metastases, tumor site, and therapy (surgery only vs surgery and adjuvant radiotherapy [RT]/chemoradiotherapy [CRT] vs RT/CRT only; p < .0001) were significantly associated with OS in univariate analysis. However, surgery only predicted OS independently in multivariate analysis. CONCLUSION Early diagnosis and surgical treatment of de novo HNSCC are crucial to the outcome. HNSCC risk should be taken into close consideration during posttransplantation follow-up examinations, especially among patients with a positive history of smoking and alcohol consumption.
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Affiliation(s)
- Annekatrin Coordes
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Andreas E Albers
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Minoo Lenarz
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Daniel Seehofer
- Department of General, Visceral and Transplant Surgery, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Gero Puhl
- Department of General, Visceral and Transplant Surgery, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Andreas Pascher
- Department of General, Visceral and Transplant Surgery, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Ruth Neuhaus
- Department of General, Visceral and Transplant Surgery, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Peter Neuhaus
- Department of General, Visceral and Transplant Surgery, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Johann Pratschke
- Department of General, Visceral and Transplant Surgery, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Andreas Andreou
- Department of General, Visceral and Transplant Surgery, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
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11
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Grulich AE, Vajdic CM. The epidemiology of cancers in human immunodeficiency virus infection and after organ transplantation. Semin Oncol 2014; 42:247-57. [PMID: 25843729 DOI: 10.1053/j.seminoncol.2014.12.029] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The authors provide an update on the association between immune deficiency and cancer risk in people with human immunodeficiency virus (HIV) and in solid organ transplant recipients. Over the past decade, it has become clear that a wider range of about 20 mostly infection-related cancers occur at increased rates in people with immune deficiency. The human herpes virus 8 (HHV8) and Epstein Barr Virus (EBV)-related cancers of Kaposi sarcoma (KS) and non-Hodgkin lymphoma (NHL) are most closely related to level of immune deficiency. Transplant recipients also have a greatly increased risk of squamous cell carcinoma (SCC) of the skin, related to direct carcinogenic effects of the pharmaceuticals used for immune suppression. For those three cancer types, the increased cancer risk is largely reversed when immune deficiency is decreased by treatment of HIV or by reduction of iatrogenic immune suppression. Other infection-related cancers also occur at increased rates, but it is not clear whether reduction of immune deficiency reduces cancer risk. Prostate and breast cancer do not occur at increased rates, providing strong evidence that these cancers are unlikely to be related to infection. Epidemiological and clinical trends in these two populations have led to substantial recent changes in cancer occurrence.
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Affiliation(s)
- Andrew E Grulich
- HIV Epidemiology and Prevention Program, The Kirby Institute, University of New South Wales, Sydney, Australia.
| | - Claire M Vajdic
- Adult Cancer Program, Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
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12
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Stiller CA, Trama A, Brewster DH, Verne J, Bouchardy C, Navarro C, Chirlaque MD, Marcos-Gragera R, Visser O, Serraino D, Weiderpass E, Dei Tos AP, Ascoli V. Descriptive epidemiology of Kaposi sarcoma in Europe. Report from the RARECARE project. Cancer Epidemiol 2014; 38:670-8. [PMID: 25454979 DOI: 10.1016/j.canep.2014.09.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 08/06/2014] [Accepted: 09/26/2014] [Indexed: 11/18/2022]
Abstract
Kaposi sarcoma (KS) is a virus-related malignancy which most frequently arises in skin, though visceral sites can also be involved. Infection with Kaposi sarcoma herpes virus (KSHV or HHV-8) is required for development of KS. Nowadays, most cases worldwide occur in persons who are immunosuppressed, usually because of HIV infection or as a result of therapy to combat rejection of a transplanted organ, but classic Kaposi sarcoma is predominantly a disease of the elderly without apparent immunosuppression. We analyzed 2667 KS incident cases diagnosed during 1995-2002 and registered by 75 population-based European cancer registries contributing to the RARECARE project. Total crude and age-standardized incidence rate was 0.3 per 100,000 per year with an estimated 1642 new cases per year in the EU27 countries. Age-standardized incidence rate was 0.8 per 100,000 in Southern Europe but below 0.3 per 100,000 in all other regions. The elevated rate in southern Europe was attributable to a combination of classic Kaposi sarcoma in some Mediterranean countries and the relatively high incidence of AIDS in several countries. Five-year relative survival for 2000-2002 by the period method was 75%. More than 10,000 persons were estimated to be alive in Europe at the beginning of 2008 with a past diagnosis of KS. The aetiological link with suppressed immunity means that many people alive following diagnosis of KS suffer comorbidity from a pre-existing condition. While KS is a rare cancer, it has a relatively good prognosis and so the number of people affected by it is quite large. Thus it provides a notable example of the importance of networking in diagnosis, therapy and research for rare cancers.
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Affiliation(s)
- C A Stiller
- Childhood Cancer Research Group, Department of Paediatrics, University of Oxford, Oxford, UK.
| | - A Trama
- Department of Preventive and Predictive Medicine, Fondazione IRCSS, Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, Italy
| | - D H Brewster
- Scottish Cancer Registry, Information Services Division, National Services Scotland Gyle Square, 1 South Gyle Crescent, Edinburgh EH12 9EB, Scotland, UK
| | - J Verne
- Public Health England Knowledge & Intelligence Team (South West), Grosvenor House, 149 Whiteladies Road, Bristol BS8 2RA, UK
| | - C Bouchardy
- Geneva Cancer Registry, IMSP - University of Geneva 55, Bd de la Cluse, CH-1205 Geneva, Switzerland
| | - C Navarro
- Department of Epidemiology, Murcia Regional Health Authority, Ronda de Levante 11, 30008 Murcia, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Department of Health and Social Sciences, Universidad de Murcia, Murcia, Spain
| | - M D Chirlaque
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - R Marcos-Gragera
- Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Department of Health, Autonomous Government of Catalonia and Descriptive Epidemiology, Genetics and Cancer Prevention Group [Girona Biomedical Research Institute (IdIBGi)], Catalan Institute of Oncology, Carrer del Sol, 15, 17004 Girona, Spain
| | - O Visser
- Comprehensive Cancer Centre the Netherlands, Registration & Research, PO Box 19.079, 3501 DB Utrecht, The Netherlands
| | - D Serraino
- SOC Epidemiologia e Biostatistica, Friuli Venezia Giulia Cancer Registry, IRCCS Centro di Riferimento Oncologico, Aviano, Italy
| | - E Weiderpass
- Department of Research, Cancer Registry of Norway, Oslo, Norway; Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Samfundet Folkhälsan, Helsinki, Finland
| | - A P Dei Tos
- Department of Oncology and Anatomic Pathology and General Hospital of Treviso, Piazza Ospedale 1, Treviso, Italy
| | - V Ascoli
- Dipartimento di Scienze Radiologiche, Oncologiche ed Anatomopatologiche, Università Sapienza, Viale Regina Elena 324, 00161 Roma, Italy
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13
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Piselli P, Verdirosi D, Cimaglia C, Busnach G, Fratino L, Ettorre GM, De Paoli P, Citterio F, Serraino D. Epidemiology of de novo malignancies after solid-organ transplantation: immunosuppression, infection and other risk factors. Best Pract Res Clin Obstet Gynaecol 2014; 28:1251-65. [PMID: 25209964 DOI: 10.1016/j.bpobgyn.2014.08.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 08/13/2014] [Accepted: 08/14/2014] [Indexed: 12/18/2022]
Abstract
Organ transplantation is an increasingly used medical procedure for treating otherwise fatal end-stage organ diseases, and a large number of anti-rejection drugs have been developed to prolong long-term survival of both the individual and the transplanted organ. However, the prolonged use of immunosuppressive drugs is well known to increase the risk of opportunistic diseases, particularly infections and virus-related malignancies. Although transplant recipients experience a nearly twofold elevated risk for all types of de novo cancers, persistent infections with oncogenic viruses are associated with up to hundredfold increased risks. Women of the reproductive age are growing in number among the recipients of solid-organ transplants, but specific data on cancer outcomes are lacking. This article updates evidences linking iatrogenic immunosuppression, persistent infections with oncogenic viruses, other risk factors and post-transplant malignancies. Epidemiological aspects, tumourigenesis related to oncogenic viruses, clinical implications, as well as primary and secondary prevention issues are discussed to offer clinicians and researchers alike an update of an increasingly important topic.
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Affiliation(s)
- Pierluca Piselli
- National Institute for Infectious Diseases "L. Spallanzani", Rome, Italy.
| | - Diana Verdirosi
- National Institute for Infectious Diseases "L. Spallanzani", Rome, Italy
| | - Claudia Cimaglia
- National Institute for Infectious Diseases "L. Spallanzani", Rome, Italy
| | | | - Lucia Fratino
- IRCCS Centro di Riferimento Oncologico, Aviano, Italy
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14
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Speicher DJ, Sehu MM, Mollee P, Shen L, Johnson NW, Faoagali JL. Successful treatment of iatrogenic multicentric Castleman's disease arising due to recrudescence of HHV-8 in a liver transplant patient. Am J Transplant 2014; 14:1207-13. [PMID: 24674650 DOI: 10.1111/ajt.12693] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 01/28/2014] [Accepted: 01/28/2014] [Indexed: 01/25/2023]
Abstract
We describe the case of a 59-year-old HIV-negative male who developed multicentric Castleman's disease (MCD) 1 year postliver transplantation due to recrudescence of a pretransplant human herpesvirus-8 (HHV-8) infection. He presented with fevers, dry cough, weight loss and drenching night sweats. Routine investigations were all unremarkable. Computerized axial tomography (CT) scans showed splenomegaly and intra-abdominal lymphadenopathy, confirmed by positron emission tomography. Cervical lymph node biopsies were consistent with MCD. The presence of HHV-8 was confirmed on immunohistochemistry. Peripheral blood HHV-8 quantitative polymerase chain reaction (qPCR) monitoring showed a threefold decrease in viremia in the first week of treatment with ganciclovir but had little impact on clinical symptoms. Reducing immunosuppression and switching to rituximab resolved clinical symptoms and produced a negative HHV-8 qPCR result. Retrospective molecular testing of sera collected pre- and immediately posttransplantation confirmed preexisting HHV-8 in the host. This is the first reported case of an HIV-negative postliver transplant patient developing MCD that manifested as posttransplant lymphoproliferative disorder due to recrudescence of HHV-8. We propose (1) the introduction of the term iatrogenic Castleman's disease (CD) for this and similar cases, (2) rituximab should be considered as a treatment option for CD and (3) consideration be given to a change to the World Health Organization classification of CD to incorporate such cases.
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Affiliation(s)
- D J Speicher
- School of Dentistry and Oral Health, Griffith University, Gold Coast Campus, QLD, Australia; Molecular Basis of Disease Research Program, Griffith Health Institute, Griffith University, Gold Coast Campus, QLD, Australia; Population & Social Health Research Program (Population Oral Health) Griffith Health Institute, Griffith University, Gold Coast Campus, QLD, Australia
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15
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Bouzidi H, Gallouj S, Amraoui N, Mernissi FZ, Harmouch T. [Classic Kaposi botriomycome disease-like: a diagnostic trap]. Pan Afr Med J 2014; 17:283. [PMID: 25317231 PMCID: PMC4194204 DOI: 10.11604/pamj.2014.17.283.3877] [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: 01/16/2014] [Accepted: 04/14/2014] [Indexed: 12/01/2022] Open
Abstract
La maladie de kaposi (MK) botriomycome-like et une variante clinique et anatomopathologique rare de la MK, rapportée aussi bien dans la forme classique et épidémique de la MK. C'est une entité difficile à diagnostiquer car ses caractéristiques cliniques et histologiques englobent à la fois celles du botriomycome et de la MK. En plus du contexte clinique l’étude histologique et immunohistochimique restent primordiales pour établir son diagnostic. Nous rapportons un cas de MK botriomycome-like assez particulier pas sa localisation et son siège unique.
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Affiliation(s)
- Hanae Bouzidi
- Service de Dermatologie-Vénérologie, CHU Hassan II, Fès, Maroc
| | - Salim Gallouj
- Service de Dermatologie-Vénérologie, CHU Hassan II, Fès, Maroc
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16
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Bouzidi H, Gallouj S, Krich S, Mernissi FZ. [Classic Kaposi disease with adrenal involvement: a new case]. Pan Afr Med J 2014; 17:234. [PMID: 25170378 PMCID: PMC4145280 DOI: 10.11604/pamj.2014.17.234.3901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 02/17/2014] [Indexed: 11/30/2022] Open
Abstract
La maladie de kaposi est une pathologie connue généralement dans sa forme épidémique associée au sida ou celle endémique présente dans l'Afrique subsaharienne. La forme classique de cette maladie ou dite également méditerranéenne n'est pas bien connue étant assez rare. Elle touche les hommes âgés HIV séronégatifs originaires de l'Europe centrale, l'Europe de l'Est et les méditerranéens. Elle se manifeste essentiellement par une atteinte cutanée, éventuellement muqueuse mais l'atteinte viscérale reste moins fréquente, dominée par l'atteinte osseuse, pulmonaire et gastrique. La localisation surrénalienne est inhabituelle et très rare. Nous rapportons ce nouveau cas pour mettre le point sur cette pathologie rare et signaler cette localisation atypique.
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Affiliation(s)
- Hanae Bouzidi
- Service de Dermatologie Vénérologie, CHU Hassan II, Fès, Maroc
| | - Salim Gallouj
- Service de Dermatologie Vénérologie, CHU Hassan II, Fès, Maroc
| | - Sanae Krich
- Service de Dermatologie Vénérologie, CHU Hassan II, Fès, Maroc
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17
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Sachithanandham J, Kannangai R, Abraham A, Fletcher G, Abraham O, Daniel D, Pulimood S. Human Herpes Virus-8 Infections among Subjects with Human Immunodeficiency Virus Infection and Normal Healthy Individuals in India. Intervirology 2013; 56:253-7. [DOI: 10.1159/000349890] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Accepted: 02/12/2013] [Indexed: 11/19/2022] Open
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18
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Chen Y, Zhao L, Qiu SP, He XS. Kaposi sarcoma of the ureter after liver transplant: case report and literature review. EXP CLIN TRANSPLANT 2012; 10:70-2. [PMID: 22309424 DOI: 10.6002/ect.2011.0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Kaposi sarcoma after an organ transplant is rare and infrequently involves internal organs. There are 2 reported cases in the English literature of Kaposi sarcoma originating from the transplant ureter after kidney transplant. We report a case of Kaposi sarcoma that occurred in the native ureter of the liver transplant recipient. Initially, the patient refused any further investigation and management and 2 years subsequent, had to undergo a left radical nephroureterectomy owing to the loss of renal function and distending pain. He recovered very well and no recurrence was detected at 47 months' follow-up. To our knowledge, it is the first report in English. We review the literature on this topic and explore the therapeutic principles and histologic features of this sarcoma.
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Affiliation(s)
- Yu Chen
- Department of Urology, The First Affiliated Hospital, SUN Yat-sen University, Guangzhou 510080, China
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19
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Kaposi sarcoma: review and medical management update. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 113:2-16. [DOI: 10.1016/j.tripleo.2011.05.011] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Revised: 05/11/2011] [Accepted: 05/15/2011] [Indexed: 12/21/2022]
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20
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Länger F, Kreipe HH. [Immunodeficiency and immunocompromised patients. Opportunistic infection of the lungs]. DER PATHOLOGE 2011; 32:411-7. [PMID: 21935762 DOI: 10.1007/s00292-011-1497-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The number of patients suffering from innate, acquired or iatrogenic immunodeficiency is constantly rising. Thus the number of clinically relevant infections caused by rare or unusual pathogens is also increasing. Histopathological investigations allow the identification of difficult to culture infectious agents as well as the differentiation of tissue invasive infections from superficial colonization. In this review morphological reaction patterns and their differential diagnoses of the most common bacterial, viral and mycotic infections in the lungs of immunocompromised patients are discussed.
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Affiliation(s)
- F Länger
- Institut für Pathologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
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21
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Kiely B, O'Flaherty J, Surah S, Kieran J, O'Donnell D, Bergin C, Mulcahy F. HIV-related malignancies pre- and post-highly active antiretroviral therapy: experiences in an inner city tertiary referral centre. Int J STD AIDS 2010; 21:332-6. [PMID: 20498102 DOI: 10.1258/ijsa.2009.009486] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
With highly active antiretroviral therapy (HAART), AIDS-defining malignancies are becoming less common. The outcomes with standard chemotherapy are improving. In the last 10 years there have been significant changes in our patient demographics due to immigration. The aim of this study was to review the demographics and outcomes of patients with cancer in the post-HAART era and to assess the impact of changing demographics and HAART through comparing them with previously published pre-HAART data from the same centre. A retrospective chart review of 42 patients diagnosed with malignancy from 2000 to 2007 was performed and compared with pre-HAART (1987-1994) data. The incidence of malignancies has decreased from 5.2% to 2.4%. The incidence of Kaposi's sarcoma and primary cerebral lymphoma has decreased. Non-Hodgkin's lymphoma incidence has remained stable, but survival has improved with 44% of patients achieving remission. Non-AIDS-defining malignancies have increased and were associated with longer duration of HIV infection. The change in patient demographics did not have an impact on the type of malignancies diagnosed. Overall the incidence of malignancy has decreased; however, the increase in non-AIDS-defining malignancies highlights the importance of early diagnosis, use of HAART and prospective surveillance.
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Affiliation(s)
- B Kiely
- Department of Genitourinary Medicine and Infectious Diseases, St James's Hospital, Dublin, Ireland.
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22
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Kaposi’s sarcoma of the head and neck: A review. Oral Oncol 2010; 46:135-45. [DOI: 10.1016/j.oraloncology.2009.12.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2009] [Revised: 12/17/2009] [Accepted: 12/18/2009] [Indexed: 12/15/2022]
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23
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Francès C, Marcelin AG, Legendre C, Chevret S, Dussaix E, Lejeune J, Euvrard S, Bigorie A, Schulz TF, Agbalika F, Lebbé C. The impact of preexisting or acquired Kaposi sarcoma herpesvirus infection in kidney transplant recipients on morbidity and survival. Am J Transplant 2009; 9:2580-6. [PMID: 19775317 DOI: 10.1111/j.1600-6143.2009.02816.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The impact of preexisting or acquired Kaposi sarcoma herpesvirus (KSHV) infection in kidney transplant recipients was evaluated in a prospective study. Serum collected from kidney donors and recipients before transplantation were tested for antibodies against KSHV latent nuclear antigen. Three groups of recipients were defined: group A (KSHV+), group B (KSHV-, KSHV+ donor) and group C (donor and recipient KSHV-). Blood was collected from recipients, every 3 months for 3 years, for KSHV viremia (groups A and B), quantitative (group A) and qualitative serology (group B). Data of group C recipients were extracted from a French database. The prevalence of KSHV antibodies was 1.1% in donors and 3.2% in recipients. There were respectively 161, 64 and 4744 recipients in groups A, B and C. In group A, 13% developed Kaposi's sarcoma (KS). Age >53.5 years (p = 0.025) and black skin (p = 0.0054) were associated with KS development. In group B, three recipients developed clinical manifestations related to KSHV infection. There was no difference in terms of survival and graft loss between the three groups. In conclusion, although kidney recipients should be aware of the additional risk of KSHV morbidity, KSHV+ recipients should not be systematically excluded from kidney transplantation.
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Affiliation(s)
- C Francès
- Department of Dermatology-Allergology, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Hôpital Tenon, Paris, France.
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24
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Clifford GM, Franceschi S. Cancer risk in HIV-infected persons: influence of CD4(+) count. Future Oncol 2009; 5:669-78. [PMID: 19519206 DOI: 10.2217/fon.09.28] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Persons infected with HIV are at increased risk for all cancers known or suspected to have an infectious cause, an effect believed to be primarily mediated by lowered host immunity via the depletion of CD4(+) cells. Whereas Kaposi sarcoma and non-Hodgkin lymphoma were recognised as AIDS-defining illnesses early in the HIV epidemic, the influence of declining CD4(+) count on other infection-related cancers has taken longer to establish, undoubtedly because the association is weaker and the dose-response relationship is less steep. However, following improved survival made possible by combined antiretroviral therapy, declining CD4(+) count starts showing an impact on the natural history of various carcinogenic infections and on the risk for an increasingly wide range of cancers, including Hodgkin lymphoma, cervical, anal and liver cancers.
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Affiliation(s)
- Gary M Clifford
- International Agency for Research on Cancer, Lyon Cedex 08, France.
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25
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Affiliation(s)
- Camille Francès
- Department of Dermatology, APHP Hospital Tenon Paris, Paris, France
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26
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Euvrard S, Claudy A. Post-transplant skin cancer: the influence of organ and pre-transplant disease. Cancer Treat Res 2009; 146:65-74. [PMID: 19415193 DOI: 10.1007/978-0-387-78574-5_6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Sylvie Euvrard
- Department of Dermatology, Hôpital Edouard Herriot, 69437 Lyon, Cedex 03, France
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27
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[Skin cancers after organ transplants]. Presse Med 2008; 37:1475-9. [PMID: 18775633 DOI: 10.1016/j.lpm.2008.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2008] [Revised: 06/24/2008] [Accepted: 06/25/2008] [Indexed: 11/21/2022] Open
Abstract
Squamous cell carcinoma and basal cell carcinoma are the most common cancers after transplants, affecting more than half of all patients in the long term. In the 5 years after a first squamous cell carcinoma, 90 to 100% of transplant patients subsequently develop multiple skin carcinomas of various types and at least 20% develop noncutaneous cancers. Management of these patients requires, beyond the usual dermatologic treatments, a revision of their immunosuppression regimen to reduce the tumor risk. New immunosuppressants that inhibit the m-TOR protein (sirolimus and everolimus) appear to offer promising perspectives, and patients treated with these drugs from the time of their transplantation have fewer skin cancers than patients with the standard protocols. On the other hand, the benefit of prescribing them later after the transplant remains to be shown, because of the frequency of intolerance phenomena. Several prospective French multicenter studies are currently assessing the effect of replacing anticalcineurins by sirolimus or everolimus for secondary prevention of skin cancers in renal or cardiac transplant patients who have already developed skin cancer. Primary prevention requires that patients be educated about strict sun protection from the transplant onwards and have a routine annual dermatologic examination enabling early treatment of lesions.
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28
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Wang J, Stebbing J, Bower M. HIV-Associated Kaposi Sarcoma and Gender. ACTA ACUST UNITED AC 2007; 4:266-73. [DOI: 10.1016/s1550-8579(07)80045-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2007] [Indexed: 12/12/2022]
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29
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Serraino D, Piselli P, Busnach G, Burra P, Citterio F, Arbustini E, Baccarani U, De Juli E, Pozzetto U, Bellelli S, Polesel J, Pradier C, Dal Maso L, Angeletti C, Carrieri MP, Rezza G, Franceschi S. Risk of cancer following immunosuppression in organ transplant recipients and in HIV-positive individuals in southern Europe. Eur J Cancer 2007; 43:2117-23. [PMID: 17764927 DOI: 10.1016/j.ejca.2007.07.015] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2007] [Revised: 06/07/2007] [Accepted: 07/12/2007] [Indexed: 11/27/2022]
Abstract
This investigation highlighted the risk of cancer in 8074 HIV-infected people and in 2875 transplant recipients in Italy and France. Observed and expected numbers of cancer were compared through sex- and age-standardised incidence ratios (SIRs) and 95% confidence intervals (CIs). After 15 years of follow-up, the cumulative probability of cancer was 14.7% in transplant recipients and 13.3% in HIV-positives. The SIRs for all cancers were 9.8 in HIV-positives and 2.2 in transplants. Kaposi's sarcoma (SIR=451 in HIV-positives, 125 in transplants) and non-Hodgkin lymphoma (SIR=62 and 11.1, respectively) were the most common cancers. A significantly increased SIR for liver cancer also emerged in both groups. The risk of lung cancer was significantly elevated in heart transplant recipients (SIR=2.8), and of borderline statistical significance in HIV-positive people (95% CI:0.9-2.8). Immune depression entails a two-fold increased overall risk of cancers, mainly related to cancers associated with a viral aetiology.
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Affiliation(s)
- Diego Serraino
- Unità di Epidemiologia e Biostatistica, Centro di Riferimento Oncologico, via F Gallini, 2, 33081 Aviano (PN), Italy.
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30
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Boratyńska M, Zmonarski SC, Klinger M. Reccurence of Kaposi's sarcoma after increased exposure to sirolimus. Int Immunopharmacol 2006; 6:2018-22. [DOI: 10.1016/j.intimp.2006.09.018] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2006] [Accepted: 09/15/2006] [Indexed: 12/26/2022]
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31
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Busnach G, Piselli P, Arbustini E, Baccarani U, Burra P, Carrieri MP, Citterio F, De Juli E, Bellelli S, Pradier C, Rezza G, Serraino D. Immunosuppression and Cancer: A Comparison of Risks in Recipients of Organ Transplants and in HIV-Positive Individuals. Transplant Proc 2006; 38:3533-5. [PMID: 17175324 DOI: 10.1016/j.transproceed.2006.10.144] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2006] [Indexed: 11/24/2022]
Abstract
The comparison of cancers occurring excessively among HIV-infected and transplanted individuals may help to elucidate the relationship between immune surveillance, viral infections, and cancer. A longitudinal study was conducted on 2002 HIV-infected Italian subjects, 6072 HIV-infected French individuals, and 2878 Italian recipients of solid organ transplants. Standardized incidence ratios (SIR) and 95% confidence intervals (CI) were computed to quantify the risk for cancer, compared with the French and Italian general populations. The SIRs for all cancers were 9.8 (95% CI: 9.0-10.6) for HIV-infected individuals versus 2.2 (95% CI: 1.9-2.5) for transplant recipients. In both groups, most of the excess risk was attributable to virus-related cancers, such as Kaposi's sarcoma (KS; SIR = 451 in HIV-positive individuals, 125 in transplant recipients), non-Hodgkin's lymphoma (NHL; SIR = 62.1 and 11.1, respectively), and liver cancer (SIR = 9.4 and 4.1, respectively). Significantly increased SIRs for anal cancer and Hodgkin's lymphoma were found only among HIV-positive individuals. Among women younger than 40 years of age, a more than 10-fold increase in cervical cancer risk was found in both groups. Among HIV-infected individuals treatment with highly active antiretroviral therapies drastically reduced SIRs for KS and NHL only. These results show that HIV-infected individuals and transplant recipients share a similar pattern of cancer risk, largely due to virus-related cancers.
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Affiliation(s)
- G Busnach
- Unità Nefrologia, Dialisi & Terapia Trapianto Renale, Ospedale Niguarda Ca' Granda, Milan, Italy
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Mbulaiteye SM, Engels EA. Kaposi's sarcoma risk among transplant recipients in the United States (1993–2003). Int J Cancer 2006; 119:2685-91. [PMID: 16929513 DOI: 10.1002/ijc.22233] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Kaposi's sarcoma (KS) risk is high in immunosuppressed transplant recipients. KS develops in recipients with pre-existing infection with human herpesvirus 8 (HHV-8), the causative agent for KS, but it can also occur in recipients infected by donors. The relative importance of these sources of infection in recipients in the United States is unknown. We report recipient and donor characteristics associated with KS among transplant recipients in the United States. KS risk, after solid organ transplantation during 1993-2003, was analyzed using data from the Organ Procurement and Tissue Network. Associations were determined using proportional hazards regression. Sixtyfive KS cases were identified among 234,127 transplants (incidence 8.8 per 100,000 person-years). Most cases occurred in the first 2 years after transplantation (incidence 12.5 per 100,000 person-years). KS risk increased steadily with recipient age (p(trend) < 0.001) and was associated with the recipient being male (HR 1.8, 95% CI, 1.0-3.2), Hispanic (2.1, 1.1-3.8) and a non-U.S. citizen (3.9, 1.8-8.6). Mismatch at the HLA-B locus, but not at HLA-A or HLA-DR loci, was associated with heightened risk (HR 3.6, 95%CI 1.1-11 for 1-2 vs. 0 HLA-B mismatches). KS was unrelated to donor characteristics and was not significantly related to use of specific antirejection medications. Our study found that KS incidence was low among transplant recipients in the United States, but it was associated with recipient age, sex and citizenship, perhaps reflecting pre-existing HHV-8 infection. The high KS risk immediately posttransplant and in persons with HLA-B mismatch highlights the role of immunosuppression and/or immune stimulation in KS pathogenesis.
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Affiliation(s)
- Sam M Mbulaiteye
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA.
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Affiliation(s)
- Eric Alamartine
- Service de Nephrologie Dialyse Transplantation Renale, Hopital Nord, Saint Etienne, France.
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