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Sirolimus conversion for patients with posttransplant Kaposi's sarcoma.
1APHP, Department of Dermatology, Hôpital Saint-Louis, Paris VII University, Paris, France. celeste.lebbe@sls.aphp.fr
Summary
Switching to sirolimus can benefit patients with posttransplant Kaposi
Area of Science:
- Oncology
- Nephrology
- Immunology
Background:
- Posttransplant Kaposi's sarcoma (KS) is a significant concern in organ transplant recipients.
- Calcineurin inhibitors (CnI), commonly used immunosuppressants, are associated with KS development.
- Alternative immunosuppressive strategies are needed to manage KS while maintaining graft survival.
Purpose of the Study:
- To evaluate the efficacy and safety of switching from calcineurin inhibitors (CnI) to sirolimus in patients with posttransplant Kaposi's sarcoma (KS).
- To assess response rates, time to response, and long-term outcomes after switching immunosuppression.
- To identify factors influencing treatment response and potential mechanisms of resistance.
Main Methods:
- Retrospective study of 14 patients with posttransplant KS across five French departments.
- Patients were switched from CnI to sirolimus, either abruptly (n=9) or progressively (n=5).
- Sirolimus trough levels were maintained between 5-12 ng/mL, with a mean follow-up of 16 months.
Main Results:
- Overall response: 2 complete remissions, 8 partial responses, and 5 no significant improvement.
- Mean time to response was 3.9 months.
- Three patients with severe, refractory KS experienced KS progression 5-9 months after switching, despite no other adverse events.
Conclusions:
- Sirolimus is generally beneficial in managing posttransplant Kaposi's sarcoma.
- However, it may be ineffective or offer only transient benefit in patients with severe or refractory KS.
- Further prospective studies with pharmacodynamic evaluations are crucial to understand response duration and resistance mechanisms.