Clinical Features and Contribution of Virological Findings to the Management of Kaposi Sarcoma in Organ-Allograft Recipients

Barète, Stéphane; Cálvez, Vincent; Mouquet, C.; Barrou, B.; Kreis, Henri; Dantal, Jacques; Dorent, Richard; Durand, François; Dimitrov, Yves; Dupin, Nicolas; Marcelin, Anne‐Geneviève; Piette, Jean‐Charles; Bitker, Marc Olivier; Françès, Camille

doi:10.1001/archderm.136.12.1452

Cited by 67 publications

(43 citation statements)

References 25 publications

(23 reference statements)

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“…12,13,[16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] In particular, PT-KS was primarily observed in kidney recipients ( Figure 1A), whereas lower PT-KS incidences have been recorded in patients receiving other SOTs, mainly liver and heart. PT-KS usually occurs rather early after transplantation (median interval, 30 months), usually as cutaneous or mucosal lesions, whereas visceral involvement occurs in 25%-50% of the cases.…”

Section: Posttransplantation Ks Pel and MCDmentioning

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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Section: Posttransplantation Ks Pel and MCDmentioning

confidence: 99%

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

Riva¹,

Luppi²,

Barozzi³

et al. 2012

Blood

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“…Ovarian carcinoma Ocular lymphoma High [7,[23][24][25][26][27][28][29] Low [30] Low [33] Mycobacterium tuberculosis Lung carcinoma Kaposi"s sarcoma Low [38][39][40][41][42][43] Low [44,45] Schistosoma species [54][55][59][60][61][62][63][64][65][66][67]73] Low [56,[74][75][76][77][78] Low [70] Low [80] Low [81][82] Tropheryma whippelii Lymphoma Gastric adenocarcinoma Low [108] Low [110] Liver flukes 1.Opisthorchis viverrini 2. Clonorchis sinensis…”

Section: Lung Carcinomamentioning

confidence: 99%

“…Moreover, tuberculosis has been suggested to be a determinant of Kaposi"s sarcoma growth [44,45]. In two kidney allograft recipients with extensive cutaneous Kaposi"s sarcoma, disappearance of the sarcoma was reported, once pulmonary tuberculosis had been treated, without any reduction in immunosuppressive therapy [44].…”

Section: Mycobacterium Tuberculosis and Cancer Developmentmentioning

confidence: 99%

“…In two kidney allograft recipients with extensive cutaneous Kaposi"s sarcoma, disappearance of the sarcoma was reported, once pulmonary tuberculosis had been treated, without any reduction in immunosuppressive therapy [44]. Therefore, we suggest that Mycobacterium tuberculosis infection is characterized by a low level of evidence regarding its association with lung carcinoma and Kaposi"s sarcoma [table 1].…”

Section: Mycobacterium Tuberculosis and Cancer Developmentmentioning

confidence: 99%

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Chronic bacterial and parasitic infections and cancer: a review

Samaras

Rafailidis

Mourtzoukou

et al. 2010

J Infect Dev Ctries

111

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Background: A relatively underestimated facet of infectious diseases is the association of chronic bacterial and parasitic infections with cancer development. Therefore, we sought to evaluate the evidence regarding the association of such infections with the development of malignancy, excluding the overwhelming evidence of the association of Helicobacter pylori and cancer. Methodology: We searched Pubmed, Cochrane, and Scopus without time limits for relevant articles. Results: There is evidence that some bacterial and parasitic infections are associated with cancer development. The level of evidence of this association varies from high to low; in any case, a long time interval is mandatory for the development of cancer. A high level of evidence exists for the association of Salmonella Typhi with gallbladder and hepatobiliary carcinoma; Opisthorchis viverrini and Clonorchis sinensis with cholangiocarcinoma; Schistosoma hematobium with bladder cancer; chronic osteomyelitis with squamous cell carcinoma of the skin; and hidradenitis suppurativa with squamous cell carcinoma of the skin. In contrast, the level of evidence regarding the association of Chlamydia spp. with cancer is low. Mycobacterium tuberculosis is associated with lung cancer, albeit probably not etiopathogenetically. Conclusions: A considerable number of bacterial infections and parasitic infections are associated with the development of cancer. Further research into recognizing additional associations of bacterial and parasitic infections with cancer is mandatory.

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“…In a previous study conducted in Italy on the incidence of cancer after kidney transplant, the average time to cancer development after transplant was 1200 days (Pedotti et al, 2003), while the average follow-up in this study is 670 days. However, Kaposi sarcoma (KS) and post transplantation lymphoproliferative disorders (PTLDs) are more likely generated by patient viral reactivation or viral transmission from the donor to recipients (Barete et al, 2000), and such tumours require less time to develop than solid organ tumours. Viral infection from Epstein -Barr virus (EBV) or HHV8, for example, was associated with PTLDs or KS, with incidences that were maximal during the first year (Gulley et al, 2003;Snanoudj et al, 2003;Faull et al, 2005) after transplant.…”

Section: Discussionmentioning

confidence: 99%

Role of simian virus 40 in cancer incidence in solid organ transplant patients

et al. 2006

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Transplant recipients have an increased risk of developing cancer in comparison with the general population. We present here data on cancer development in transplanted subjects who received organs from donors whose DNA was previously examined for the genomic insertion of Simian Virus 40 (SV40). Active follow-up of 387 recipients of solid organs donated by 134 donors, not clinically affected by cancer, was performed through the National Transplant Center (NTC). The average length of follow-up after transplant was 6717219 days (range 0 -1085 days). Out of 134 proposed donors, 120 were utilised for organ donation. Of these, 12 (10%) were classified as positive for SV40 genomic insertion. None of the 41 recipients of organs from SV40 positive donors developed a tumour during the follow-up. In all, 11 recipients of organs given by SV40 negative donors developed a tumour (cancer incidence: 0.015 per year). In conclusion, cancer rates observed in our study are comparable to what reported by the literature in transplanted patients. Recipients of solid organs from SV40 positive donors do not have an increased risk of cancer after transplant. The role of SV40 in carcinogenesis in transplanted patients may be minimal.

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Clinical Features and Contribution of Virological Findings to the Management of Kaposi Sarcoma in Organ-Allograft Recipients

Cited by 67 publications

References 25 publications

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

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

Chronic bacterial and parasitic infections and cancer: a review

Role of simian virus 40 in cancer incidence in solid organ transplant patients

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