Divergent clinical presentations and outcomes among children and adolescents with Kaposi sarcoma in Malawi and Tanzania.

Autor: Campbell LR; Baylor College of Medicine International Pediatric AIDS Initiative at Texas Children's Hospital, Houston, Texas, USA.; Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.; Baylor College of Medicine Children's Foundation-Tanzania, Mbeya, Tanzania., Silverstein A; Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.; Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.; Texas Children's Cancer and Hematology Centers Global HOPE (Hematology-Oncology Pediatric Excellence) Program, Lilongwe, Malawi.; Department of Hospice and Palliative Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA., Peckham-Gregory E; Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.; Center for Epidemiology and Population Health, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA., Kamiyango W; Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.; Texas Children's Cancer and Hematology Centers Global HOPE (Hematology-Oncology Pediatric Excellence) Program, Lilongwe, Malawi., Villiera J; Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.; Texas Children's Cancer and Hematology Centers Global HOPE (Hematology-Oncology Pediatric Excellence) Program, Lilongwe, Malawi., McAtee CL; Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.; Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.; Texas Children's Cancer and Hematology Centers Global HOPE (Hematology-Oncology Pediatric Excellence) Program, Lilongwe, Malawi.; Global HOPE, Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Houston, Texas, USA., Bacha JM; Baylor College of Medicine International Pediatric AIDS Initiative at Texas Children's Hospital, Houston, Texas, USA.; Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.; Baylor College of Medicine Children's Foundation-Tanzania, Mbeya, Tanzania., Kovarik CL; University of Pennsylvania, Philadelphia, Pennsylvania, USA., Mehta PS; Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.; Global HOPE, Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Houston, Texas, USA., Chanroo T; Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.; Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.; Texas Children's Cancer and Hematology Centers Global HOPE (Hematology-Oncology Pediatric Excellence) Program, Lilongwe, Malawi., Kapesa A; Baylor College of Medicine Children's Foundation-Tanzania, Mbeya, Tanzania., Malingoti B; Baylor College of Medicine Children's Foundation-Tanzania, Mbeya, Tanzania., Mzikamanda R; Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.; Texas Children's Cancer and Hematology Centers Global HOPE (Hematology-Oncology Pediatric Excellence) Program, Lilongwe, Malawi., Ozuah NW; Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.; Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.; Texas Children's Cancer and Hematology Centers Global HOPE (Hematology-Oncology Pediatric Excellence) Program, Lilongwe, Malawi.; Global HOPE, Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Houston, Texas, USA., Allen CE; Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.; Global HOPE, Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Houston, Texas, USA., Scheurer ME; Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.; Center for Epidemiology and Population Health, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA., El-Mallawany NK; Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.; Global HOPE, Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Houston, Texas, USA.
Jazyk: angličtina
Zdroj: HIV medicine [HIV Med] 2023 Jun; Vol. 24 (6), pp. 664-675. Date of Electronic Publication: 2023 Jan 10.
DOI: 10.1111/hiv.13455
Abstrakt: Objectives: The Kaposi sarcoma (KS) T0 versus T1 staging classification does not address the unique clinical features of paediatric KS in human gammaherpesvirus 8 (HHV-8) endemic regions of Africa. This study seeks to define patterns of childhood KS using a paediatric-specific approach.
Methods: The Lilongwe paediatric KS staging classification categorizes disease based on clinical phenotype: stage 1 = mild/moderate KS limited to cutaneous/oral involvement, stage 2 = primarily lymphadenopathic disease, stage 3 = woody edema KS, stage 4 = visceral and/or severe/disseminated mucocutaneous disease. Characteristics and outcomes were evaluated from paediatric referral centres in Lilongwe, Malawi, and Mbeya, Tanzania.
Results: Among 171 patients, the median age was 9.3 years, 37% (n = 63) were female, and 87% (n = 149) had HIV. Breakdown by stage was as follows: 18% (n = 31) stage 1, 33% (n = 56) stage 2, 19% (n = 33) stage 3, and 30% (n = 51) stage 4. Age (younger stage 2 and older stage 3), severe CD4 count suppression (lower CD4 for stages 1 and 4), and presence of severe anaemia and thrombocytopenia (worse for stages 2 and 4) differed across stages. Estimated 2-year event-free survival/progression-free survival/overall survival by stage was as follows: stage 1, 81%/81%/87%; stage 2, 50%/50%/63%; stage 3, 24%/49%/81%; and stage 4, 29%/34%/54%. Sub-analysis of stage 2 lymphadenopathic KS demonstrated superior long-term 6-year event-free survival of 70% (95% confidence interval [CI] 49-83) for younger children (aged <7 years) versus 27% (95% CI 8-51) for older children.
Conclusions: This paediatric-specific staging classification categorizes patients with distinct characteristics and patterns of treatment response. This platform may guide clinicians to provide risk-stratified treatment with the hope of improving survival among children with KS.
(© 2023 British HIV Association.)
Databáze: MEDLINE
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