Pediatric Kaposi sarcoma in context of the HIV epidemic in sub-Saharan Africa: current perspectives

Figures & data

Figure 1 Photographic representations of lymphadenopathic Kaposi sarcoma.

Notes: The typical bulging, massive lymphadenopathy characteristic of lymphadenopathic Kaposi sarcoma is demonstrated in these photographs. Reprinted by permission from Springer Nature: Springer Nature, Br J Cancer. ⁴Childhood Kaposi’s sarcoma: clinical features and therapy, Olweny CL, Kaddumukasa A, Atine I, Owor R, Magrath I, Ziegler JL, ©1976;33(5):555–560.

Table 1 Comparison of clinical features among pediatric KS cohorts in Africa

Location	Years	n	Median age	LN involvement	Skin involvement	CD4 count
Uganda/Tanzania	1957–1965	51	10 years	53%	53%	n/a
Uganda	1968–1975	12	8 years	83%	17%	n/a
Uganda	2004–2007	73	10.1 years	60%	48%	median 210
Mozambique	2003–2008	28	8.3 years (mean)	61%	82%	43% were I0
Malawi/Botswana	2003–2009	82	8 years	52%	83%	median 297
South Africa	2005–2009	70	6.1 years (mean)	30%	57%	mean 440
Blantyre, Malawi	2009–2012	91	8 years (mean)	73%	56%	median 354
Lilongwe, Malawi	2010–2013	70	8.6 years	74%	59%	median 368
Mbeya, Tanzania	2011–2014	34	11.5 years	59%	56%	76% were I0
Blantyre, Malawi	2012–2015	56	8 years	93%	93%	median 401

Abbreviations: KS, Kaposi sarcoma; LN, lymph node; n/a, not applicable; I0, Immune Status 0 in the AIDS Clinical Trial Group TIS staging classification.

Table 2 Comparison of treatment outcomes among pediatric KS cohorts in Africa

Location	Years	n	On ART at time of KS diagnosis	Approximate overall survival	Survivors with ART alone, n (%)
Uganda	2004–2007	73	11%	unclear	2 (3)
Mozambique	2003–2008	28	0%	71%	0
Malawi/Botswana	2003–2009	82	27%	43%	7 (9)
South Africa	2005–2009	70	20%	40%	1 (1)
Blantyre, Malawi	2009–2012	91	54%	40%	0
Lilongwe, Malawi	2010–2013	70	49%	58%	0
Mbeya, Tanzania	2011–2014	34	71%	71%	0
Blantyre, Malawi	2012–2015	56	77%	59%	0

Abbreviations: KS, Kaposi sarcoma; ART, antiretroviral therapy.

Figure 2 The modified Lilongwe pediatric Kaposi sarcoma staging classification.

Notes: *See “Clinical characteristics” section for descriptions of clinical pulmonary or abdominal visceral involvement in resource-limited settings in the absence of bronchoscopy and endoscopy. Data from El-Mallawany et al.⁵⁵
Abbreviation: KS, Kaposi sarcoma.

Figure 3 Treatment design schema for a risk-stratified and response-adapted therapeutic approach to pediatric Kaposi sarcoma.

Notes: *Subjective determination of percent decrease in size of all lesions; # stage 4 patients achieving complete remission who have a persistently low CD4 count <350 or unsuppressed HIV viral load are at high risk for relapse and should be monitored closely (ideally every 2 weeks for 3 months). Please note that, for patients with endemic (HIV-unrelated KS), ART is not included in the therapeutic approach, and therefore patients with stage 1A disease would be treated the same as patients with stage 1B KS. Data from El-Mallawany et al.^23,55
Abbreviations: KS, Kaposi sarcoma; ART, antiretroviral therapy; progressive disease is defined as an increase in the size of existing lesions or the appearance of new lesions; BV, = bleomycin and vincristine; induction BV includes four cycles of BV given every 2 weeks, consolidation BV includes four cycles of BV given every 4 weeks; ABV, doxorubicin, bleomycin, and vincristine, QoL, quality-of-life; complete remission is defined as no clinical evidence of KS lesions; HIV, human immunodeficiency virus.

El-MallawanyNKKamiyangoWVillieraJProposal of a risk-stratification platform to address distinct clinical features of pediatric Kaposi sarcoma in Lilongwe, MalawiJ Glob Oncol2017JGO170005429272148

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El-MallawanyNKKamiyangoWSloneJSClinical 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 studyPloS One2016114e015333527082863

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