Journal of Clinical Oncology, Vol 15, 2371-2377, Copyright © 1997 by American Society of Clinical Oncology
Treatment of Kaposi's sarcoma after solid organ transplantation
FA Shepherd, E Maher, C Cardella, E Cole, P Greig, JA Wade and G Levy
Department of Medicine, The Multi-Organ Transplant Program of The Toronto Hospital, University of Toronto, Ontario, Canada. fshepherd@torhosp.toronto.on.ca
PURPOSE: This retrospective review of all patients who developed Kaposi's
sarcoma (KS) after solid organ transplantation at a single institution was
undertaken to define the clinical presentation of this malignancy in the
setting of iatrogenic immunodeficiency, and to determine the most
appropriate treatment for patients in this clinical setting. MATERIALS AND
METHODS: The records of 2,099 patients who underwent heart, lung, liver, or
kidney transplantation at The Toronto Hospital between January 1, 1981 and
June 30, 1995, were reviewed. Twelve patients were identified who developed
biopsy-proven KS in the posttransplantation period. Five patients who had
disseminated KS who had not responded to either reduction or withdrawal of
immunosuppression or to local radiotherapy were treated with combination
chemotherapy consisting of doxorubicin 20 to 30 mg/m2, bleomycin 10 mg/m2,
and vincristine 2 mg (ABV) administered intravenously every 3 weeks.
RESULTS: Eight of 12 patients were male and nine were of Italian origin. KS
was limited to a localized area of the skin for only six patients, all
after kidney transplantation. Visceral KS was present in three patients.
Four of five patients responded to ABV chemotherapy (two complete and two
partial remissions). The fifth patient responded to second-line etoposide
and cisplatin. The median duration of response was in excess of 13 months
(range, 8+ to 45+ months). Toxicity was limited to grade 1 neurotoxicity
and grade 1 skin toxicity. CONCLUSION: KS is an uncommon but recognized
complication of solid organ transplantation. Combination chemotherapy is a
safe and effective treatment for patients with disseminated or visceral KS
that fails to respond to changes in immunosuppression.
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