Sirolimus Conversion for Patients with Posttransplant Kaposi's Sarcoma

Lebbe, Célèste; Euvrard, Sylvie; Barrou, B.; Pouteil‐Noble, Claire; Garnier, J. L.; Glotz, Denis; Legendre, Christophe; Françès, Camille

doi:10.1111/j.1600-6143.2006.01412.x

Cited by 116 publications

(70 citation statements)

References 24 publications

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“…These results have been independently replicated (189), though not all centers report equally high response rates (190). Even allowing for variability in response rates, this is a great advance in KS management.…”

Section: Ks Clinical Investigation: the Gift That Keeps On Givingmentioning

confidence: 76%

KSHV and the pathogenesis of Kaposi sarcoma: listening to human biology and medicine

Ganem¹

2010

J. Clin. Invest.

341

380

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Section: Ks Clinical Investigation: the Gift That Keeps On Givingmentioning

confidence: 76%

KSHV and the pathogenesis of Kaposi sarcoma: listening to human biology and medicine

Ganem¹

2010

J. Clin. Invest.

341

380

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“…83 However, switching to sirolimus may be ineffective or transiently effective in patients with severe PT-KS, particularly if not timely and abruptly performed, as suggested by the report of Lebbè et al in a series of 14 patients, showing 5 refractory cases and 3 disease progressions after partial response. 93 According to our clinical practice, we tend to use a stratified approach, using single-agent liposomal anthracycline infusions (20 mg/m 2 ), 94 in association with modifications of immunosuppression, as front-line therapy for disseminated aggressive PT-KS. In localized skin KS, the switch from CNI-to sirolimus-based immunosuppressive regimens is the first option, while reserving chemotherapy as salvage treatment for refractory or relapsing diseases, despite the reduction of the immunosuppressive levels.…”

Section: Pt-ksmentioning

confidence: 99%

How I treat HHV8/KSHV-related diseases in posttransplant patients

Riva¹,

Luppi²,

Barozzi³

et al. 2012

Blood

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Posttransplantation human herpesvirus-8 (HHV8)/Kaposi sarcoma herpesvirus (KSHV) primary infection and/or reactivations are associated with uncommon and sometimes fatal, neoplastic, and nonneoplastic diseases. HHV8-related clinical manifestations notably range from Kaposi sarcoma (KS) to either primary effusion lymphoma or multicentric Castleman disease B-cell malignancies, and from polyclonal HHV8-positive plasmacytic lymphoproliferative disorders to bone marrow failure and peripheral cytopenias, associated or not with hemophagocytic syndromes, and to acute hepatitis syndromes. We reviewed the patient series reported in the literature and summarized clinical management aspects, in terms of diagnosis, follow-up, and treatment. We described typical clinical presentations and histopathologic diagnostic features of these diseases, and we discussed the role of HHV8-specific serologic, molecular, and immunologic assays, particularly focusing on recent data from HHV8-specific T-cell monitoring in posttransplantation KS patients. We finally discussed actual therapeutic options, namely, the reduction or discontinuation of immunosuppressive therapy or the switch from calcineurin inhibitors to mTOR inhibitors, as alternatives to antineoplastic chemotherapy, along with the use of antiherpesvirus agents as prophylactic or therapeutic measures, and treatment with rituximab in posttransplantation multicentric Castleman disease patients and non-neoplastic HHV8-associated syndromes. IntroductionHerpesvirus-associated hematologic diseases often represent primary clinical challenges during the multidisciplinary follow-up of posttransplant patients, either with hematopoietic stem cell transplant (HSCT) or with solid organ transplant (SOT). In immunosuppressed organ recipients, latent human ␥-herpesvirus, namely, EBV and human herpesvirus-8 (HHV8)/Kaposi sarcoma herpesvirus (KSHV) are typically responsible for several virus-driven neoplastic proliferations, as well as they may sometimes cause uncommon, but equally life-threatening, non-neoplastic infectious complications. During the past decade, large amounts of experimental evidence have come out on these topics, and some of them have yet begun to influence the clinical behavior, in terms of diagnosis and treatment. Chiefly, EBV-related complications have been extensively studied and discussed, so that now physicians can rely on accurate and updated clinical recommendations, in particular dealing with early diagnosis, monitoring and treatment of EBV ϩ posttransplantation lymphoproliferative diseases (PTLDs). 1 With regards to HHV8, practical management of the virus-associated neoplastic lymphoproliferations has deeply been revised in HIVpositive subjects, 2,3 whereas in SOT and HSCT settings, the diagnostic and therapeutic issues about the various HHV8-driven manifestations (either neoplastic or non-neoplastic) are only occasionally reported in the literature, but most of these diseases revealed to be rapidly lethal if not timely recognized and adequately treated. Indeed, posttra...

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“…[11][12][13] This dual role may be important in some cases. In our case, the dosage of tacrolimus was already low.…”

Section: Discussionmentioning

confidence: 99%

Kaposi Sarcoma of the Ureter After Liver Transplant: Case Report and Literature Review

Chen

Zhao

Qiu³

et al. 2012

Exp Clin Transplant

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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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Sirolimus Conversion for Patients with Posttransplant Kaposi's Sarcoma

Cited by 116 publications

References 24 publications

KSHV and the pathogenesis of Kaposi sarcoma: listening to human biology and medicine

KSHV and the pathogenesis of Kaposi sarcoma: listening to human biology and medicine

How I treat HHV8/KSHV-related diseases in posttransplant patients

Kaposi Sarcoma of the Ureter After Liver Transplant: Case Report and Literature Review

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