Management of Kaposi sarcoma after solid organ transplantation: A European retrospective study - 20/06/19

Doi : 10.1016/j.jaad.2019.03.028

Julie Delyon, MD, PhD ^a,^⁎ , Clementine Rabate, MD ^b, Sylvie Euvrard, MD ^c, Catherine A. Harwood, MD, PhD ^d, Charlotte Proby, FRCP ^e, A.Tülin Güleç, MD ^f, Deniz Seçkin, MD ^f, Veronique Del Marmol, MD, PhD ^g, Jan Nico Bouwes-Bavinck, MD, PhD ^h, Carla Ferrándiz-Pulido, MD, PhD ⁱ, Maria Andrea Ocampo, MD ^c, Stephane Barete, MD, PhD ^j, Christophe Legendre, MD, PhD ^b, Camille Francès, MD, PhD ^k, Raphael Porcher, MD, PhD ^l, Celeste Lebbe, MD, PhD ^a
the
Skin Care in Organ Transplant Patients Europe (SCOPE) group
^a 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
^b Service de Néphrologie-Transplantation Adultes, Hôpital Necker, AP-HP, and Université Paris Descartes, Paris, France
^c Department of Dermatology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
^d 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
^e Dermatology, School of Medicine, University of Dundee, Dundee, United Kingdom
^f Department of Dermatology, Başkent University Faculty of Medicine, Ankara, Turkey
^g Dermatology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
^h Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
ⁱ Department of Dermatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
^j Sorbonne Université, Unit of Dermatology, AP-HP Pitié-Salpêtrière Hospital, Paris, France
^k Sorbonne Université, Service de Dermatologie et Allergologie, AP-HP Hôpital Tenon, Paris, France
^l 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

^∗Correspondence to: Julie Delyon, MD, PhD, Dermatology Department, AP-HP Hôpital Saint Louis, 1 avenue Claude Vellefaux, 75475 Paris Cedex 10, France.Dermatology DepartmentAP-HP Hôpital Saint Louis1 avenue Claude VellefauxParis Cedex 1075475France

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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.

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Key words : chemotherapy, immunosuppression, Kaposi sarcoma, mTOR inhibitor, organ transplantation, post-transplant malignancies

Abbreviations used : CI, CNI, CR, HHV-8, HR, IPTW, KS, mTORi, OS, OTR, PFS, PR, SCOPE

Plan

Materials and methods

Patients

Statistical analyses

Results

Patient characteristics

First-line therapeutic management

Characteristics associated with first-line therapeutic management of KS

KS response to first-line therapeutic management

	Dr Ocampo is currently affiliated with Dermatology Department, Sanitas Foundation, Colsanitas Clinic, Bogotá, Colombia.
	Drs Delyon and Rabate are co-first authors, and Drs Francès, Porcher, and Lebbe are co-last authors.
	Funding sources: None.
	Conflicts of interest: Dr Legendre reports personal fees from Astellas and other from Alexion, outside the submitted work. Dr Lebbe received research grants or honoraria from Roche, BMS, MSD, GSK, Novartis, and Amgen, outside the submitted work. Drs Güleç, Ferrándiz-Pulido, Harwood, Proby, Seçkin, Delyon, Bouwes-Bavinck, Ocampo, Porcher, Barete, and Del Marmol have no conflicts of interest to declare.
	Reprints not available from the authors.