Clinical Factors Associated with Long-Term Complete Remission versus Poor Response to Chemotherapy in HIV-Infected Children and Adolescents with Kaposi Sarcoma Receiving Bleomycin and Vincristine: A Retrospective Observational Study

Autor: Carrie M. Cox, Nader Kim El-Mallawany, Gordon E. Schutze, Parth S. Mehta, Jimmy Villiera, Peter N. Kazembe, Michael E. Scheurer, Saeed Ahmed, William Kamiyango, Jeremy Kim Slone, Carrie L. Kovarik, Dirk P. Dittmer
Jazyk: angličtina
Rok vydání: 2016
Předmět:
Male
Time Factors
medicine.medical_treatment
Cancer Treatment
lcsh:Medicine
HIV Infections
Pathology and Laboratory Medicine
Pediatrics
Kaposi Sarcoma
0302 clinical medicine
Antiretroviral Therapy
Highly Active
Antineoplastic Combined Chemotherapy Protocols
Medicine and Health Sciences
Edema
Public and Occupational Health
030212 general & internal medicine
lcsh:Science
Child
Lymph node
Multidisciplinary
Pharmaceutics
Sarcomas
Remission Induction
Prognosis
Vaccination and Immunization
medicine.anatomical_structure
Oncology
Vincristine
030220 oncology & carcinogenesis
Child
Preschool
Female
Sarcoma
Anatomy
medicine.drug
Research Article
Clinical Oncology
medicine.medical_specialty
Adolescent
Immunology
Antiretroviral Therapy
Malignancy
Lymphatic System
03 medical and health sciences
Bleomycin
Pharmacotherapy
Signs and Symptoms
Antiviral Therapy
Drug Therapy
Diagnostic Medicine
Internal medicine
medicine
Highly-Active Antiretroviral Therapy
Chemotherapy
Humans
Sarcoma
Kaposi
Retrospective Studies
business.industry
lcsh:R
Biology and Life Sciences
Cancers and Neoplasms
Infant
Retrospective cohort study
Odds ratio
medicine.disease
Surgery
Socioeconomic Factors
Lesions
HIV-1
lcsh:Q
Preventive Medicine
Lymph Nodes
Clinical Medicine
business
Zdroj: PLoS ONE
PLoS ONE, Vol 11, Iss 4, p e0153335 (2016)
ISSN: 1932-6203
Popis: Kaposi sarcoma (KS) is the most common HIV-associated malignancy in children and adolescents in Africa. Pediatric KS is distinct from adult disease. We evaluated the clinical characteristics associated with long-term outcomes. We performed a retrospective observational analysis of 70 HIV-infected children and adolescents with KS less than 18 years of age diagnosed between 8/2010 and 6/2013 in Lilongwe, Malawi. Local first-line treatment included bleomycin and vincristine plus nevirapine-based highly active anti-retroviral therapy (HAART). Median age was 8.6 years (range 1.7-17.9); there were 35 females (50%). Most common sites of presentation were: lymph node (74%), skin (59%), subcutaneous nodules (33%), oral (27%), woody edema (24%), and visceral (16%). Eighteen (26%) presented with lymphadenopathy only. Severe CD4 suppression occurred in 28%. At time of KS diagnosis, 49% were already on HAART. Overall, 28% presented with a platelet count < 100 x 109/L and 37% with hemoglobin < 8 g/dL. The 2-year event-free (EFS) and overall survival (OS) were 46% and 58% respectively (median follow-up 29 months, range 15-50). Multivariable analysis of risk of death and failure to achieve EFS demonstrated that visceral disease (odds ratios [OR] 19.08 and 11.61, 95% CI 2.22-163.90 and 1.60-83.95 respectively) and presenting with more than 20 skin/oral lesions (OR 9.57 and 22.90, 95% CI 1.01-90.99 and 1.00-524.13 respectively) were independent risk factors for both. Woody edema was associated with failure to achieve EFS (OR 7.80, 95% CI 1.84-33.08) but not death. Univariable analysis revealed that lymph node involvement was favorable for EFS (OR 0.28, 95% CI 0.08-0.99), while T1 TIS staging criteria, presence of cytopenias, and severe immune suppression were not associated with increased mortality. Long-term complete remission is achievable in pediatric KS, however outcomes vary according to clinical presentation. Based on clinical heterogeneity, treatment according to risk-stratification is necessary to improve overall outcomes.
Databáze: OpenAIRE
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