Posttransplant Kaposi’s Sarcoma Restricted to the Site of a Previous Deep Venous Thrombosis: Abrupt Onset after Withdrawal of Sirolimus

González‐López, Marcos A.; Rodrigo, Emilio; González‐Vela, M. Carmen; Fernández‐Llaca, Héctor; Arias-Rodríguez, Manuel; Val-Bernal, J. Fernando

doi:10.1159/000092834

Cited by 14 publications

(13 citation statements)

References 49 publications

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“…Patient 1 had iatrogenic KS but skin manifestations did not improve when the immunosuppressant dose was halved. However, in this case the reduction of immunosuppressive treatment could already explain the improvement of KS observed, sometimes delayed until after the interruption of the immunosuppressive drug [20]. Although our series of non-AIDS-related KS patients was small, our results seem to confirm the effectiveness and relative safety of thalidomide treatment as already found in AIDS-related KS [15, 16].…”

Section: Discussionsupporting

confidence: 77%

Thalidomide in the Treatment of Kaposi’s Sarcoma

Rubegni¹,

Sbano²,

Aloe³

et al. 2007

Dermatology

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Background: Kaposi’s sarcoma (KS) is a lymphangioproliferative tumour. Therapy of KS depends on the characteristics of the disease, especially area and growth rate of lesions, and patient condition. Currently symptomatic resectable lesions are excised, whereas more advanced disease and unresectable lesions are treated with radiotherapy. If a large area or internal organs are affected or other treatments fail, chemotherapy is used. Recently some authors have reported their encouraging experience in the use of thalidomide in patients with AIDS-related KS. Objective: To evaluate the efficacy of thalidomide in 3 patients with non-AIDS-related KS. Methods: Two patients with classic widespread cutaneous and 1 with iatrogenic cutaneous and visceral KS were treated with thalidomide (100 mg/day) for 12 months. Results: In all 3 patients partial remission was evident after 4 months of thalidomide therapy; in 2 out of 3 complete remission was achieved after 12 months of treatment. Conclusions: Our results seem to confirm the utility of thalidomide in the treatment of non-AIDS-related KS.

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Section: Discussionsupporting

confidence: 77%

Thalidomide in the Treatment of Kaposi’s Sarcoma

Rubegni¹,

Sbano²,

Aloe³

et al. 2007

Dermatology

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“…Is DVT associated with KS? In the literature, there are two case reports where a DVT preceded the development of KS as with our patient 10. In conclusion, our patient presented with KS despite having a high CD4 count and suppressed viral load, which may have been explained by cofactors such as DM, not smoking and a previous DVT.…”

Section: Discussionsupporting

confidence: 51%

Delayed diagnosis of Kaposi's sarcoma in a HIV positive man with a high CD4 count and suppressed viral load: Figure 1

Chan

Pakianathan²

2011

Sex Transm Infect

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A HIV positive man with a CD4 count of 777×10(6)/l and suppressed viral load on antiretroviral medication had a delayed diagnosis of Kaposi's sarcoma (KS) affecting his left leg. He was diabetic and on a controlled diet and had a previous deep vein thrombosis affecting the same leg. Factors that have been studied in HIV-related KS as well as classical KS, such as diabetes mellitus, not smoking and previous deep vein thrombosis, may have increased our patient's risk for the development of this disease. Clinicians should consider KS as a possible diagnosis even in patients with well-controlled HIV.

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“…Recently, regression of visceral KS after conversion to sirolimus has also been reported, with complete regression of visceral and cutaneous lesions occurring in a transplant recipient within a few months of conversion [14]. In accordance with these data, abrupt onset of KS was reported in a renal transplant recipient following the withdrawal of sirolimus [15]. Recent studies have suggested a possible mechanism for the action of PSIs on preventing angiogenesis in tumours [5].…”

Section: Conversion To Proliferation Signal Inhibitorsmentioning

confidence: 57%

Kaposi's sarcoma in renal transplant recipients--the impact of proliferation signal inhibitors

Campistol

Schena

2007

Nephrology Dialysis Transplantation

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The incidence of Kaposi's sarcoma (KS) is greatly increased in renal transplant recipients compared with the general population, with particular prevalence in certain ethnic groups where it can occur in up to 5% of transplant recipients. The increased incidence of disease in transplant populations may, in part, be attributed to the choice of immunosuppressive regimen, with calcineurin inhibitor (CNI)-based immunosuppression being associated with the development of the tumour. A number of small studies have recently demonstrated that conversion to proliferation signal inhibitors (PSIs) along with the concomitant withdrawal of CNIs leads to a rapid resolution of both cutaneous and visceral Kaposi's lesions. In agreement with these data the abrupt onset of KS has been observed following the withdrawal of PSIs. Histological examination of lesions from patients with KS supports data from animal models which suggests that PSIs inhibit tumour angiogenesis through impaired vascular endothelium growth factor production, a key element in the development of the tumour. Previously unpublished data on renal transplant recipients from a number of European and Australian centres have been pooled to provide further insight into the use of PSIs in the management of post-transplant KS. Both members of the PSI class, everolimus and sirolimus, along with CNI withdrawal lead to regression of KS lesions in 11 out of 12 patients. Conversion to PSIs was generally well tolerated with stable renal function maintained in most patients and no episodes of acute rejection recorded. PSIs provide a potential treatment option in the management of post-transplant KS and should be considered for use in renal transplant recipients who develop the disease.

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Posttransplant Kaposi’s Sarcoma Restricted to the Site of a Previous Deep Venous Thrombosis: Abrupt Onset after Withdrawal of Sirolimus

Cited by 14 publications

References 49 publications

Thalidomide in the Treatment of Kaposi’s Sarcoma

Thalidomide in the Treatment of Kaposi’s Sarcoma

Delayed diagnosis of Kaposi's sarcoma in a HIV positive man with a high CD4 count and suppressed viral load: Figure 1

Kaposi's sarcoma in renal transplant recipients--the impact of proliferation signal inhibitors

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