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This article is part of the supplement: Proceedings of the 12th International Conference on Malignancies in AIDS and Other Acquired Immunodeficiencies (ICMAOI)

Open Access Meeting abstracts

Clinical presentation and outcome of epidemic Kaposi sarcoma in Ugandan children

Soren Gantt12*, Abel Kakuru34, Anna Wald2, Victoria Walusansa34, Lawrence Corey25, Corey Casper25 and Jackson Orem34

Author Affiliations

1 Seattle Children’s Hospital, Seattle, WA, USA

2 University of Washington, Seattle, WA, USA

3 Uganda Cancer Institute, Kampala, Uganda

4 Makerere University College of Health Sciences, Kampala, Uganda

5 Fred Hutchinson Cancer Research Center, Seattle, WA, USA

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Infectious Agents and Cancer 2010, 5(Suppl 1):A12  doi:10.1186/1750-9378-5-S1-A12


The electronic version of this article is the complete one and can be found online at: http://www.infectagentscancer.com/content/5/S1/A12


Published:11 October 2010

© 2010 Gantt et al; licensee BioMed Central Ltd.

Background

Kaposi sarcoma (KS) is one of the most common pediatric cancers in sub-Saharan Africa. Few data are available about the clinical presentation or response to treatment of children with epidemic (HIV-associated) KS.

Methods

Medical records of all children with KS and HIV infection referred to the Uganda Cancer Institute from October 2004 to June 2007 were reviewed. Charts were abstracted for age, sex, location of KS lesions, biopsy results, CD4 T-cell counts, and KS treatment and outcome. (Table 1)

Those children with lymphadenopathic KS were younger (mean difference 3.7 years; p = 0.01), and had higher CD4 T-cell counts (mean difference 242 cells/μL; p = 0.03) than those without lymph node involvement. CD4 T-cell count was not associated with KS presentations other than lymph node involvement (Figure 1).

thumbnailFigure 1. CD4 T-cell count quartiles (boxes and whiskers) and outliers (dots) for those patients with and without KS involvement of the lymph nodes (A), skin (B), oral cavity (C), and viscera (D).

Twenty children (62.5%) of the 32 patients with outcome data available had a complete resolution of KS. Eleven patients had a partial response, and only one patient had a documented lack of response. No association was apparent between outcome and age, sex, or type of KS presentation. Thirty (93.8%) of the 32 patients with outcome data available received cancer chemotherapy (10 with vincristine, 20 with vincristine plus bleomycin). No difference was observed in outcome with respect to whether cancer chemotherapy was used, or whether one or two drugs were given. Of those patients with a known outcome, a higher proportion had a complete resolution of KS among those who received any antiretroviral therapy (ART) regimen compared to those who did not receive ART (19 of 26 vs. 1 of 6; P=0.02).

Conclusions

Compared to skin involvement, lymph node involvement of epidemic KS occurs at younger ages and at higher CD4 levels. This presentation may reflect recent infection with human herpesvirus 8 followed by a rapid progression to malignancy. Favorable response to treatment was observed in some cases, but the observed response rate was almost certainly biased by the large number of children lost to followup, among whom we expect disproportionately poor outcomes. Prospective studies are needed to determine optimal management.

Acknowledgements

This article has been published as part of Infectious Agents and Cancer Volume 5 Supplement 1, 2010: Proceedings of the 12th International Conference on Malignancies in AIDS and Other Acquired Immunodeficiencies (ICMAOI).The full contents of the supplement are available online at http://www.biomedcentral.com/1750-9378/5?issue=S1.