Safety and efficacy of pegylated liposomal doxorubicin in HIV-associated Kaposi's sarcoma.

Safety and efficacy of pegylated liposomal doxorubicin in HIV-associated Kaposi's sarcoma.

Biologics. 2009

Cainelli F, Vallone A.

Department of Internal Medicine, School of Medicine, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana.

Correspondence: Francesca Cainelli, Senior Lecturer in Internal Medicine, School of Medicine, Faculty of Health Sciences, University of Botswana, Private Bag 0022, Gaborone, Botswana, Tel +267.3554563, Email, francescacainelli@yahoo.it

Kaposi's sarcoma is a vascular tumor linked to the presence of Kaposi's sarcoma-associated herpesvirus (human herpesvirus-8) and the incidence of which has increased considerably the world over after the onset of the human immunodeficiency virus (HIV) pandemic. Antiretroviral therapy combined with cytotoxic agents has been established as the treatment of choice in the past 10 years. Among chemotherapeutic agents, pegylated liposomal doxorubicin has become the preferred one for patients with HIV-associated Kaposi's sarcoma in Western countries. The drug in this formulation localizes better to the tumor and has higher efficacy. Skin toxicity, mucositis, and leukopenia/neutropenia are the main side effects. Hepatotoxicity and mild cardiotoxicity are observed less frequently. Pegylated liposomal doxorubicin impacts favorably on quality of life. Although cost effective in Western countries, the drug is less so in developing countries.

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PubMedCentral/Fovepress

Kaposi's sarcoma after renal transplantation.

Kaposi's sarcoma after renal transplantation.
Saudi J Kidney Dis Transpl. 2009 Sep-Oct

Abbaszadeh S, Taheri S.
Dr. Taheri Medical Research Group, Baqiyatallah University of Medical Sciences, Tehran, Iran. taherimd@gmail.com.

In this study, we aimed to evaluate the incidence, features and outcome of post trans-plant KS among Iranian recipients of living kidney allograft. We studied 2211 kidney allograft reci-pients who underwent living renal transplantation at our center between January 1984 and August 2007. All patients in our study received cyclosporine based immunosuppressive agents. The diagno-sis of KS was confirmed with pathological evaluations of tissue biopsy specimens. There were 10 of 2211 (0.45%) incident cases of KS kidney transplant population at our center during a mean follow up of 57 +/- 38 months. Of the 10 KS patients, 8 were males and two were females with a median age of 52 years. The median time from transplantation to the development of KS was 8 months. Overall, two (20%) patients developed visceral involvement (one eye, one bladder), and eight patients mani-fested only KS restricted to the skin. Immunosuppression was reduced in 5 patients and thoroughly withdrawn in the remainder (including two cases of visceral involvement); KS did not abate in the patient with bladder involvement. All the KS patients remained alive after a mean of 35.6 +/- 39.3 months of follow up; two patients lost their allograft and underwent dialysis (one after 3 months and one another after 4 months of KS diagnosis). The KS patients were significantly older at their transplantation time (P= 0.008; [Table 1]). Survival analysis using Kaplan Meier method and log-rank test revealed no difference in graft and patient survival between both groups. In conclusion, we found low incidence of KS in our living renal transplant recipients. The outcome of the KS patients was excellent with low morbidity and mortality. The incidence of KS was significantly associated with an older age at transplantation time for the allograft recipients. Further studies with larger pa-tient population are warranted to confirm our results.

Saudi Journal of Kidney Diseases and Transplantation

Classic Kaposi sarcoma with sarcoid-like granulomas: A case report and literature review.

Classic Kaposi sarcoma with sarcoid-like granulomas: A case report and literature review.
Exp Mol Pathol. 2009 Aug

Onak Kandemir N, Yurdakan G, Bektas S, Tekin NS.
Department of Pathology, School of Medicine, Zonguldak Karaelmas University, 67600, Kozlu, Zonguldak, Turkey.

The occurrence of granulomatous reactions within lymph nodes that drain carcinomas is well known but uncommon. Even more rarely, granulomas may occur within the stroma of tumors. These lesions, called sarcoid-like reactions, commonly accompany carcinomas but are very rare in sarcomas. This study presents a case of classic Kaposi sarcoma that contained sarcoid-like granulomas, with a literature review. A soft tissue lesion of the foot was excised from a 74-year-old male. Histopathological examination showed that the tumor tissue consisted of spindle cells, areas of atypical vascular proliferation, and extravasated erythrocytes surrounded by non-caseating granulomas. The patient had no clinical or laboratory findings of sarcoidosis. The case was interpreted as "Kaposi sarcoma containing sarcoid-like granulomas". The association of soft tissue sarcomas with a granulomatous reaction is very rare. A granulomatous reaction is reported to be a good prognostic indicator in several carcinoma types, although its importance in sarcomas is unclear.

Elsevier/Science Direct

Clinical Presentation of Non-HIV Kaposi Sarcoma.

Clinical Presentation of Non-HIV Kaposi Sarcoma.

J Coll Physicians Surg Pak. 2009 Sep

Gilani JA, Ullah Khan A, Shahid S, Ullah Khan I, Ullah Khan S.
Department of Radiotherapy and Oncology, (IRNUM), Peshawar.

Kaposi Sarcoma (KS) is a rare entity. In the north west of Pakistan and Aghanistan, we mostly come across non-HIV related Kaposi sarcoma as Human Immunedeficiency Virus (HIV). Infections are rare in this part of the world. Here, we present a case of a non-auto Immunedeficiency Disease (AIDS) related KS. A 45-year-old male, Afghan patient presented to our oncology outpatient's unit with multiple subcutaneous nodules. The sites of involvement were the periorbital region, retro-auricular region, forearms, legs, chest and back. Oral mucosa was spared at the nodules. The patient had no visceromegaly at the time of presentation. A biopsy specimen from the retro-auricular region revealed a KS with dermal lymphatic involvement. His serum was negative for the common types of viral infections including Human Immunodeficiency Virus (HIV) on routine serology. His total B-lymphocytes (CD 19+), total T-lymphocyte (CD3+), total CD4+ lymphocyte (CD3+, CD4+) and total CD8+ (CD3+, CD8+) counts were all normal or borderline high. The patient was under treatment with 3 weekly chemotherapeutic regimens of Adriamycin, Bleomycin, Vincristine (ABV) keeping in view socioeconomical constrains, logistical difficulties in getting proper medical care and side effects of other options like radiotherapy for extended surface areas.

PubMed

Targeted therapy for Kaposi sarcoma.

Targeted therapy for Kaposi sarcoma.
BioDrugs. 2009
Sullivan RJ, Pantanowitz L, Dezube BJ.
Division of Hematology/Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.

Kaposi sarcoma (KS) occurs as a result of Kaposi sarcoma-associated herpesvirus (KSHV) infection, typically in the context of one of several immunodeficient states. In the US, patients with KS may either be co-infected with HIV or receiving immunosuppressant therapy following solid-organ transplantation. Systemic treatment of KS has traditionally involved one of several chemotherapeutic agents administered either in combination or as single agents, which typically provide reasonable response rates and short-term control. However, recurrence of KS is common, and progression-free intervals are under 1 year. For these reasons, new therapies have been sought and with the elucidation of novel pathogenic mechanisms of KS infection, rational therapeutic targets have been identified. These include KSHV replication, restoration of immune competence, and signal transduction pathways utilized by KSHV in the propagation of KS. This review focuses on these emerging targets in the treatment of patients with KS and also highlights important clinicopathologic characteristics.

PubMed

Kaposi's sarcoma-associated herpesvirus transmission and primary infection

Kaposi's sarcoma-associated herpesvirus transmission and primary infection

Curr Opin HIV AIDS. 2009 Jan

Bagni R, Whitby D.
Viral Oncology Section, AIDS and Cancer Virus Program, SAIC-Frederick, NCI-Frederick, Frederick, Maryland 21702, USA.

PURPOSE OF REVIEW: Kaposi's sarcoma-associated herpesvirus (KSHV), also known as human herpesvirus 8, is the causal agent of Kaposi's sarcoma, one of the commonest cancers in HIV-infected individuals. Transmission and risk factors for infection by KSHV are not fully understood. The purpose of this review is to highlight recent advances in our understanding of KSHV transmission in various settings.

RECENT FINDINGS: KSHV and HIV are both common in southern Africa where KSHV infection occurs during childhood via saliva. HIV infection is a major risk factor for KSHV infection. In developed countries, KSHV transmission among men who have sex with men is related to sexual risk factors such as number of sexual partners and to sexual practices involving saliva. KSHV can be transmitted by transfusion of infected blood, but storage of blood products diminishes the risk.

SUMMARY: Recent reports have provided much additional insight into KSHV transmission in different populations, but have also provided a number of important questions for the research and public health communities. Most critically, the role of HIV in increasing risk for KSHV infection and the possible effects on KSHV prevalence, and consequently the incidence of Kaposi's sarcoma warrants urgent further study.

Lippincott, Williams & Wilkins

Dermoscopy of Kaposi's sarcoma: Areas exhibiting the multicoloured 'rainbow pattern'

Dermoscopy of Kaposi's sarcoma: Areas exhibiting the multicoloured 'rainbow pattern'
J Eur Acad Dermatol Venereol. 2009 Apr 10

Hu SC, Ke CL, Lee CH, Wu CS, Chen GS, Cheng ST.
Department of Dermatology.

Abstract Background Kaposi's sarcoma is a vascular tumour characterized by a proliferation of spindle cells and endothelial cells to form closely arranged slit-like vascular spaces. Currently, the definitive diagnosis of Kaposi's sarcoma relies on histology. The dermoscopic features of Kaposi's sarcoma are not clearly defined in the scientific literature. Objectives We seek to evaluate the dermoscopic features of Kaposi's sarcoma and compare them with other vascular tumours. Methods One hundred forty-one lesions from seven patients with histologically proven Kaposi's sarcoma were evaluated using polarized light dermoscopy for the presence of various dermoscopic features. Twenty patients with other vascular tumours were also examined. Results Dermoscopic examination revealed bluish-reddish coloration (84% of lesions), multicoloured areas showing various colours of the rainbow spectrum (36%), scaly surface (29%), and small brown globules (15%). The 'rainbow pattern' was found in six out of seven patients with Kaposi's sarcoma and was not observed in other vascular tumours. In addition, there was an absence of dermoscopic features specific for other vascular and non-vascular skin tumours, such as well-defined lacunae or structured vascular pattern, in most of the Kaposi's sarcoma lesions. Conclusions The most frequent dermoscopic patterns in Kaposi's sarcoma were found to be bluish-reddish coloration, the 'rainbow pattern', and scaly surface. The rainbow pattern is a dermoscopic feature which has not been previously described. We propose that dermoscopy, as an adjunct to clinical examination, may enhance accuracy in the preoperative diagnosis of Kaposi's sarcoma.

Conflicts of interest None declared

Wiley InterScience