       Document 0035
 DOCN  M95A0035
 TI    Kaposi's sarcoma: a reevaluation.
 DT    9510
 AU    Orfanos CE; Husak R; Wolfer U; Garbe C; Department of Dermatology,
       University Medical Center Steglitz,; Free University of Berlin, Germany.
 SO    Recent Results Cancer Res. 1995;139:275-96. Unique Identifier : AIDSLINE
       MED/95320439
 AB    Kaposi's sarcoma (KS) is a multicentric neoplasia of microvascular
       origin arising during development of immunodeficiency in human
       immunodeficiency virus (HIV)-infected individuals. More than 130
       patients with HIV-associated KS (98% male homosexuals; median age, 35
       years) have been diagnosed at the Department of Dermatology, University
       Medical Center Steglitz, Berlin, during the years 1982-1992.
       Mucocutaneous and visceral involvement was a common finding in patients
       with HIV-associated KS, increasing from 39% at the first visit to 65% at
       the last observation. In 90% of the patients significant
       immunosuppression was found (75% had a CD4+ count < 200/mm3) at the time
       of first diagnosis. However, immunosuppression was not a prerequisite
       for the development of KS, since the tumor had been diagnosed before
       severe immunosuppression was present in about 10% of the patients.
       Significant prognostic predictors for the final outcome were: (a) the
       degree of immunosuppression, (b) the presence of mucosal and visceral
       manifestation, and (c) the past history of opportunistic infections. The
       median survival time was 28 months in KS patients with more than 300
       CD4+ lymphocytes (n = 18), but only 14 months in immunosuppressed (less
       than 300 CD4+ lymphocytes) individuals with KS (n = 70). The median
       survival time in the entire group evaluated (n = 89 patients) was 17
       months after first diagnosis. In 71 HIV-infected individuals who died at
       the Berlin Department during the last 8 years, disseminated KS was the
       major direct or indirect cause of death (49% of cases). Therapeutic
       benefit for KS patients was observed after long-term administration of
       recombinant interferon alpha (rIFN-alpha; 9-18 million IU s.c. every 2
       days) alone or combined with antiretroviral drugs such as zidovudine
       over several months. Prolongation of survival was found after such
       treatment modalities in 30%-40% of treated patients. Bleomycin and
       vincristine and other systemically used cytostatics have also been
       applied with moderate results. The etiology of HIV-associated KS is
       still unknown and coinfection with herpes simplex virus (HSV),
       cytomegalovirus (CMV), or human papillomavirus (HPV) as well as certain
       growth-stimulating cytokines (transforming growth factors, TGF; tumor
       necrosis factor alpha, TNF-alpha; interleukin-6, IL-6; tat; vascular
       endothelial growth factors, VEGF; oncostatin M) produced by HIV-infected
       cells may be cofactors. Overall, KS was found to be a tumor with high
       malignant potential, and the median survival times were short.(ABSTRACT
       TRUNCATED AT 400 WORDS)
 DE    Acquired Immunodeficiency Syndrome/*COMPLICATIONS/DRUG THERAPY  Adult
       Antineoplastic Agents, Combined/THERAPEUTIC USE  AIDS-Related
       Opportunistic Infections/EPIDEMIOLOGY  Biological Response
       Modifiers/THERAPEUTIC USE  Combined Modality Therapy  Comorbidity
       Follow-Up Studies  Germany/EPIDEMIOLOGY  Homosexuality, Male  Human
       Immunocompromised Host  Interferon Alfa, Recombinant/THERAPEUTIC USE
       Male  Palliative Treatment  Prognosis  Risk  *Sarcoma,
       Kaposi's/DIAGNOSIS/EPIDEMIOLOGY/ETIOLOGY/PATHOLOGY/  THERAPY  Skin
       Diseases/EPIDEMIOLOGY  *Skin
       Neoplasms/DIAGNOSIS/EPIDEMIOLOGY/ETIOLOGY/PATHOLOGY/THERAPY  Survival
       Analysis  Viscera/PATHOLOGY  Zidovudine/THERAPEUTIC USE  JOURNAL ARTICLE
       REVIEW  REVIEW, ACADEMIC  REVIEW, TUTORIAL

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).

