Kaposi's sarcoma following allogeneic hematopoietic stem cell transplantation for chronic myelogenous leukemia.
Unlike solid organ transplantation, Kaposi's sarcoma (KS) occurs rarely following hematopoietic stem cell transplantation (HSCT). In fact, only 5 cases of KS have been reported after allogeneic or autologous HSCT. The usual treatment combines a substantial decrease in, or elimination of, immunosuppressive therapy along with local measures such as surgical excision, cryotherapy or radiation therapy. A 46-year-old woman with chronic myelogenous leukemia who had received an allogeneic HSCT previously from an HLA-identical sibling, presented on day +814 with human herpes virus-8-associated KS involving her left lower extremity. She had been on continuous immunosuppressive therapy since her transplant because of chronic graft-versus-host disease. The intensity of immunosuppressive therapy was decreased once a diagnosis of KS had been established. However, the nodular lesions continued to progress in size and number. Therefore, a course of irradiation was administered to sites of bulk disease on her legs. Furthermore, thalidomide was initiated along with a topical retinoid, alitretinoin 0.1% gel applied twice daily to the nonirradiated lesions. This approach yielded a partial response in both irradiated and nonirradiated lesions over the course of the following 7 months. Both thalidomide and alitretinoin 0.1% gel appear to be beneficial in HSCT-associated KS and exhibit tolerable side effects.
de Medeiros
B C
BC
Bone Marrow Transplant Program, University of Connecticut Health Center, Farmington, Conn 06030, USA.
Rezuke
W N
WN
Ricci
A
A
Tsongalis
G
G
Shen
P U
PU
Bona
R D
RD
Feingold
J M
JM
Edwards
R L
RL
Tutschka
P J
PJ
Bilgrami
S
S
D000284:Administration, Oral; D000287:Administration, Topical; D000328:Adult; D000077556:Alitretinoin; D000970:Antineoplastic Agents / Q000008:administration & dosage; D002648:Child; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D019288:Herpesvirus 8, Human / Q000235:genetics; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D012514:Sarcoma, Kaposi / Q000188:drug therapy / Q000209:etiology* / Q000532:radiotherapy / Q000821:virology; D013792:Thalidomide / Q000008:administration & dosage; D014212:Tretinoin / Q000008:administration & dosage
D000970:Antineoplastic Agents; D007166:Immunosuppressive Agents; D000077556:Alitretinoin; D013792:Thalidomide; D014212:Tretinoin