Julie Delyon1, Clementine Rabate2, Sylvie Euvrard3, Catherine A Harwood4, Charlotte Proby5, A Tülin Güleç6, Deniz Seçkin6, Veronique Del Marmol7, Jan Nico Bouwes-Bavinck8, Carla Ferrándiz-Pulido9, Maria Andrea Ocampo3, Stephane Barete10, Christophe Legendre2, Camille Francès11, Raphael Porcher12, Celeste Lebbe13. 1. Department of Dermatology, Assistance Publique-Hôpitaux de Paris (AP-HP) Hôpital Saint Louis, Institut National de la Santé et de la Recherche Médicale U976, Université Paris Diderot, Sorbonne Paris Cité, Paris, France. Electronic address: julie.delyon@aphp.fr. 2. Service de Néphrologie-Transplantation Adultes, Hôpital Necker, AP-HP, and Université Paris Descartes, Paris, France. 3. Department of Dermatology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France. 4. Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts, and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. 5. Dermatology, School of Medicine, University of Dundee, Dundee, United Kingdom. 6. Department of Dermatology, Başkent University Faculty of Medicine, Ankara, Turkey. 7. Dermatology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium. 8. Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands. 9. Department of Dermatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain. 10. Sorbonne Université, Unit of Dermatology, AP-HP Pitié-Salpêtrière Hospital, Paris, France. 11. Sorbonne Université, Service de Dermatologie et Allergologie, AP-HP Hôpital Tenon, Paris, France. 12. AP-HP, Centre d'Épidémiologie Clinique, Hôpital Hôtel-Dieu, and Centre of Research in Epidemiology and StatisticS (CRESS) Institut National de la Santé et de la Recherche Médicale U1153; Université Paris Descartes, Sorbonne Paris Cité, Paris, France. 13. Department of Dermatology, Assistance Publique-Hôpitaux de Paris (AP-HP) Hôpital Saint Louis, Institut National de la Santé et de la Recherche Médicale U976, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.
Abstract
BACKGROUND: Systemic therapeutic management of post-transplant Kaposi sarcoma (KS) is mainly based on 3 axes: reduction of immunosuppression, conversion to mammalian target of rapamycin (mTOR) inhibitors, chemotherapy, or a combination of these. OBJECTIVE: To obtain an overview of clinical strategies about the current treatment of KS. METHODS: We conducted a multicenter retrospective cohort study including 145 solid organ transplant recipients diagnosed with KS between 1985 and 2011 to collect data regarding first-line treatment and response at 6 months. RESULTS: Overall, 95%, 28%, and 16% of patients had reduction of immunosuppression, conversion to mTOR inhibitor, and chemotherapy, respectively. Patients treated with chemotherapy or mTOR inhibitor conversion were more likely to have visceral KS. At 6 months, 83% of patients had response, including 40% complete responses. LIMITATIONS: The retrospective design of the study. CONCLUSION: Currently available therapeutic options seem to be effective to control KS in most patients. Tapering down the immunosuppressive regimen remains the cornerstone of KS management.
BACKGROUND: Systemic therapeutic management of post-transplant Kaposi sarcoma (KS) is mainly based on 3 axes: reduction of immunosuppression, conversion to mammalian target of rapamycin (mTOR) inhibitors, chemotherapy, or a combination of these. OBJECTIVE: To obtain an overview of clinical strategies about the current treatment of KS. METHODS: We conducted a multicenter retrospective cohort study including 145 solid organ transplant recipients diagnosed with KS between 1985 and 2011 to collect data regarding first-line treatment and response at 6 months. RESULTS: Overall, 95%, 28%, and 16% of patients had reduction of immunosuppression, conversion to mTOR inhibitor, and chemotherapy, respectively. Patients treated with chemotherapy or mTOR inhibitor conversion were more likely to have visceral KS. At 6 months, 83% of patients had response, including 40% complete responses. LIMITATIONS: The retrospective design of the study. CONCLUSION: Currently available therapeutic options seem to be effective to control KS in most patients. Tapering down the immunosuppressive regimen remains the cornerstone of KS management.