Incidence and outcome of Kaposi sarcoma after hematopoietic stem cell transplantation: a retrospective analysis and a review of the literature, on behalf of infectious diseases working party of EBMT



The incidence, the clinical characteristics, and the outcome of Kaposi sarcoma (KS) in patients after hematopoietic stem cell transplantation (HSCT) were assessed. During the period 1987–2018, 13 cases of KS were diagnosed, 3 females and 10 males, median age of 50 years, median time from HSCT of 7 months. KS had an incidence of 0.17% in allogeneic and 0.05% in autologous HSCT. HHV-8 was documented in eight of nine tumor tissue samples assessed. The organ involvement was: skin in nine, lymph nodes in six, oral cavity in four, and visceral in three patients, respectively; seven patients had >1 organ involved. Five patients had immunosuppression withdrawn, whereas four and three patients received radiotherapy and chemotherapy, respectively. Eight patients are alive (median follow-up 48 months, range 5–128), whereas five patients died after a median time of 8 months from the diagnosis of KS. However, no death was caused by KS. We conclude that the incidence of KS after HSCT is very low. Although KS can be managed with the reduction of immunosuppression, visceral forms may require chemotherapy and/or radiotherapy. The low prevalence of KS indicates that screening for HHV-8 serology and surveillance for HHV-8 viremia are not indicated in HSCT patients.

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  1. 1.

    Mesri EA, Cesarman E, Boshoff C. Kaposi’s sarcoma and its associated herpesvirus. Nat Rev Cancer. 2010;10:707–19.

  2. 2.

    Chang Y, Cesarman E, Pessin MS, Culpepper J, Knowles DM, et al. Identification of herpesvirus-like DNA sequences in AIDS-associated Kaposi’s sarcoma. Science. 1994;266:1865–9.

  3. 3.

    Woodle ES, Hanaway M, Buell J, Gross T, First MR, Trofe J, et al. Kaposi sarcoma: an analysis of the US and international experiences from the Israel Penn International TransplantTumor Registry. Transplant Proc. 2001;33:3660–1.

  4. 4.

    Deauna-Limayo D, Rajabi B, Qiu W, Htut M, Sweetenham J. Kaposi sarcoma after non myeloablative hematopoietic stem cell transplant: response to withdrawal of immunosuppressant therapy correlated with whole blood human herpesvirus-8 reverse transcriptase-polymerase chain reaction levels. Leuk Lymphoma. 2013;54:2299–302.

  5. 5.

    Sala I, Faraci M, Magnano GM, Sementa A, di Marco E, Garaventa A, et al. HHV-8-related visceral Kaposi’s sarcoma following allogeneic HSCT: report of a pediatric case and literature reviewHHV-8-related visceral Kaposi!s sarcoma following allogeneic HSCT: report of a pediatric case and literature review. Pediatr Transplant. 2011;15:E8–11.

  6. 6.

    Heyrman B, De Becker A, Schots R. A case report of immunosuppression-related Kaposi’s sarcoma after autologous stem cell transplantation. BMC Res Notes. 2016;9:188.

  7. 7.

    Porta F, Bongiorno M, Locatelli F, Gibardi A, Lanfranchi A, Rosso R, et al. Kaposi’s sarcoma in a child after autologous bone marrow transplantation for non-Hodgkin’s lymphoma. Cancer. 1991;68:1361–4.

  8. 8.

    Helg C, Adatto M, Salomon D, Roux E, Miralbell R, Chapuis B, et al. Kaposi’s sarcoma following allogeneic bone marrow transplantation. Bone Marrow Transplant. 1994;14:999–1001.

  9. 9.

    Gluckman E, Parquet N, Scieux C, Deplanche M, Traineau R, Betheau P, et al. KS-associated herpesvirus-like DNA sequences after allogeneic bone-marrow transplantation. Lancet. 1995;346:1558–9.

  10. 10.

    Vivancos P, Sarrá J, Palou J, Valls A, Garćia J, Grañena A. Kaposi’s sarcoma after autologous bone marrow transplantation for multiplemyeloma. Bone Marrow Transplant. 1996;17:669–71.

  11. 11.

    Erer B, Angelucci E, Muretto P, Ripalti M, Rapa S, Gaziev D, et al. Kaposi’s sarcoma after allogeneic bone marrow transplantation. Bone Marrow Transplant. 1997;19:629–31.

  12. 12.

    de Medeiros BC, Rezuke WN, Ricci A Jr, Tsongalis G, Shen PU, Bona RD, et al. Kaposi’s sarcoma following allogeneic hematopoietic stem cell transplantation for chronic myelogenous leukemia. Acta Haematol. 2000;104:115–8.

  13. 13.

    Tamariz-Martel R, Maldonado MS, Carrillo R, Crespo D, Pérez-Caballero C, Muñoz A. Kaposi’s sarcoma after allogeneic bone marrow transplantation in a child. Haematologica. 2000;85:884–5.

  14. 14.

    Palencia SI, Rodríguez-Peralto JL, Castaño E, de la Serna J, Vanaclocha F, Iglesias-Díez L. Kaposi’s sarcoma after allogeneic peripheral blood stem cell transplantation. Int J Dermatol. 2003;42:647–9.

  15. 15.

    Bruno B, Sorasio R, Barozzi P, Vieira J, Omedè P, Giaretta F, et al. Kaposi’s sarcoma triggered by endogenous HHV-8 reactivation after non-myeloablative allogeneic haematopoietic transplantation. Eur J Haematol. 2006;76:342–7.

  16. 16.

    Marco de F, Infante B, Giovanni S, Gesualdo L. Rapamycin for Kaposi’s sarcoma and graft-versus-host disease in bone marrow transplant recipient. Transplantation. 2010;89:633–4.

  17. 17.

    Ye X, Feng Y, Pang Y, Liu Y, Lin S. Kaposi’s sarcoma developed after allogeneic hematopoietic stem cell transplantation. Oncol Lett. 2011;2:515–8.

  18. 18.

    Avivi I, Fineman R, Haddad N, Katz T, Oren I, Rowe JM, et al. Fatal Kaposi sarcoma after allogeneic stem cell transplant. Leuk Lymphoma. 2011;52:2402–4.

  19. 19.

    Abbas AA, Jastaniah WA. Extensive gingival and respiratory tract Kaposi sarcoma in a child after allogenic hematopoietic stem cell transplantation. J Pediatr Hematol Oncol. 2012;34:e53–5.

  20. 20.

    Guo HX, Huang K, Zhou DH, Wang L, Xiao JH, Weng WJ, et al. Acute leukemia child with ocular Kaposi’s sarcoma after hematopoietic stem cell transplantation: a case report and literature review. Zhonghua Xue Ye Xue Za Zhi. 2013;34:445–8.

  21. 21.

    Innes AJ, Lee M, Francis N, Olavarria E. Immunosuppression-associated Kaposi sarcoma following stem cell transplantation. Br J Haematol. 2017;178:9.

  22. 22.

    Ramzi M, Vojdani R, Haghighinejad H. Kaposi Sarcoma After Allogeneic Hematopoietic Stem Cell Transplant: A Rare Complication. Exp Clin Transplant. 2018.

  23. 23.

    Cesaro S, Berger M Tridello G, Mikulska M, Ward KN, Ljungman P, et al. A survey on incidence and management of adenovirus infection after allogeneic HSCT. Bone Marrow Transplant. 2018.

  24. 24.

    Luppi M, Barozzi P, Schulz TF, Setti G, Staskus K, Trovato R, et al. Bone marrow failure associated with human herpesvirus 8 infection aftertransplantation. N Engl J Med. 2000;343:1378–85.

  25. 25.

    Ljungman P, de la Camara R, Cordonnier C, Einsele H, Engelhard D, Reusser P, et al. Management of CMV, HHV-6, HHV-7 and Kaposi-sarcoma herpesvirus (HHV-8) infections in patients with hematological malignancies and after SCT. European Conference on Infections in Leukemia. Bone Marrow Transplant. 2008;42:227–40.

  26. 26.

    Gentile G, Capobianchi A, Volpi A, Palù G, Pica F, Calistri A, et al. Human herpesvirus 8 DNA in serum during seroconversion in allogeneic bone marrow transplant recipients. J Natl Cancer Inst. 2005;97:1008–11.

  27. 27.

    Rosenzwajg M, Fery N, Bons V, Damaj G, Gluckman E, Gluckman JC. Human herpes virus 8 (HHV8) serology in allogeneic bone marrow transplant recipients. Bone Marrow Transplant. 1999;24:351–4.

  28. 28.

    Chiereghin A, Barozzi P, Petrisli E, Piccirilli G, Gabrielli L, Riva G, et al. Multicenter prospective study for laboratory diagnosis of HHV8 infection in solid organ donors and transplant recipients and evaluation of the clinical impact after transplantation. Transplantation. 2017;101:1935–44.

  29. 29.

    Mazzi R, Parisi SG, Sarmati L, Uccella I, Nicastri E, Carolo G, et al. Efficacy of cidofovir on human herpesvirus 8 viraemia and Kaposi’s sarcoma progression in two patients with. AIDS. 2001;15:2061–2.

  30. 30.

    Verucchi G, Calza L, Trevisani F, Zambruni A, Tadolini M, Giuliani R, et al. Human herpesvirus-8-related Kaposi’s sarcoma after liver transplantation successfully treated with cidofovir and liposomal daunorubicin. Transplant Infect Dis. 2005;7:34–7.

  31. 31.

    Mocroft A, Youle M, Gazzard B, Morcinek J, Halai R, Phillips AN. Anti-herpesvirus treatment and risk of Kaposi’s sarcoma in HIV infection. AIDS. 1996;10:1101–5.

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P.J. (Pilsen Czech Republic) was supported by the grant AZV NV18–03–00277 of the Ministry of Health.

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Correspondence to Simone Cesaro.

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Cesaro, S., Tridello, G., van der Werf, S. et al. Incidence and outcome of Kaposi sarcoma after hematopoietic stem cell transplantation: a retrospective analysis and a review of the literature, on behalf of infectious diseases working party of EBMT. Bone Marrow Transplant 55, 110–116 (2020) doi:10.1038/s41409-019-0644-8

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