Adinani Hamidu, Campbell Liane, El-Mallawany Nader Kim, Slone Jeremy, Mehta Parth, Bacha Jason
Department of Health and Social Welfare, Tanzania Ministry of Health, Community De-velopment, Gender, Elderly and Children, Tarime District, Mara Region 31401, Tanzania.
Department of Pediatrics, Baylor College of Medicine Children's Foundation-Tanzania, Mbeya 53107, Tanzania.
Children (Basel). 2021 Apr 2;8(4):275. doi: 10.3390/children8040275.
Treating Kaposi sarcoma (KS) in children, adolescents, and young adults (AYA) remains a challenge in low- and middle-income countries (LMIC) where chemotherapy options and availability are limited. We describe a retrospective cohort review of pediatric patients with KS treated with paclitaxel in Mbeya, Tanzania, between 1 March 2011 and 31 December 2019. Paclitaxel was given to patients who had KS relapse, a contraindication to bleomycin, vincristine, and doxorubicin (ABV), special circumstances in which a clinician determined that paclitaxel was preferable to ABV, or experienced treatment failure, defined as persistent KS symptoms at the completion of treatment. All patients also received multidisciplinary palliative care. Seventeen patients aged 5.1-21.3 years received paclitaxel, of whom 47.1% (8/17) had treatment failure, 29.4% (5/17) received paclitaxel as initial treatment, and 23.5% (4/17) had relapsed. All HIV positive patients (16/17) were given anti-retroviral therapy (ART) and 87.5% (14/16) achieved viral load <1000 cp/mL. At censure, 82.3% (14/17) of patients were alive-71.4% (10/14) achieved complete clinical remission and 28.6% (4/14) achieved a partial response. The median follow up was 37.3 months (range 8.0-83.5, IQR 19.7-41.6), and no patients were lost to follow up. In this cohort, high rates of long-term survival and favorable outcomes were possible with paclitaxel treatment.
在化疗选择和可及性有限的低收入和中等收入国家（LMIC），治疗儿童、青少年及青年成人（AYA）的卡波西肉瘤（KS）仍然是一项挑战。我们描述了一项对2011年3月1日至2019年12月31日期间在坦桑尼亚姆贝亚接受紫杉醇治疗的KS儿科患者的回顾性队列研究。紫杉醇给予那些出现KS复发、对博来霉素、长春新碱和多柔比星（ABV）有禁忌证、临床医生判定紫杉醇优于ABV的特殊情况或经历治疗失败（定义为治疗结束时KS症状持续）的患者。所有患者还接受了多学科姑息治疗。17名年龄在5.1 - 21.3岁的患者接受了紫杉醇治疗，其中47.1%（8/17）治疗失败，29.4%（5/17）接受紫杉醇作为初始治疗，23.5%（4/17）复发。所有HIV阳性患者（16/17）均接受了抗逆转录病毒治疗（ART），87.5%（14/16）实现病毒载量<1000 cp/mL。在随访结束时，82.3%（14/17）的患者存活，71.4%（10/14）实现完全临床缓解，28.6%（4/14）实现部分缓解。中位随访时间为37.3个月（范围8.0 - 83.5，四分位间距19.7 - 41.6），无患者失访。在该队列中，紫杉醇治疗有可能实现高长期生存率和良好结局。
