Kaposi's sarcoma after alpha-interferon treatment for HIV-negative T-cell lymphoma

54-year-old HIV-negative patient suffering from T -cell lymphoma of Lennert's lymphoma (Lel) type was treated for 13 months with interferon α-2b. While on treatment with interferon the patient demonstrated suppression of total and CD4+ lymphocytes to levels < 0,5 and 0,2 x 109/1, respectively. Although interferon was successful in controlling the lymphoma the clinical course was complicated by the rapid development of aggressive, fatal Kaposi's sarcoma shortly after cessation of interferon treatment.It is suggested that the immunosuppressive effect of interferon therapy (or the T -cell lymphoma or both) may have played a role in the development of Kaposi's sarcoma as a second malignancy

Kaposi's sarcoma in renal transplant recipients: Experience at Johannesburg Hospital, 1966 - 1989

Between August 1966 and December 1989, 989 renal transplant recipients were followed up at the Renal Transplant Unit of Johannesburg Hospital. Seventy-five (7%) patients developed a total of 95 malignancies of which 5 (6%) were Kaposi's sarcoma. All patients received immunosuppressive agents; steroids, azathioprine and/or cyclosporin A. Clinical presentations included both limited skin involvement (1 patient) and disseminated forms of the disease: necrotic oral lesions (1 patient); disseminated skin involvement and lung metastases (1 patient); and widespread skin lesions with lymphadenopathy (2 patients). Four patients responded with complete tumour regression at all sites upon withdrawal of the immunosuppressive drugs. One patient suffered disease progression, and immunosuppression was continued, albeit at reduced dosages. These cases illustrate a relatively rare complication of immunosuppressive therapy. However, complete withdrawal of iInmunosuppressive drugs may result in sustained complete regression, despite the presence of advanced KS

Breast lymphoma: A clinical and pathological review and 10-year treatment results

Sixteen patients presenting with lymphoma involving the breast are described. Seven fulfilled the criteria for primary breast lymphoma, while the other 9 had evidence (sometimes only detected after extensive staging procedures) of concurrent lymphomatous involvement outside the breast. Histological diagnoses of the so-called primary breast lymphomas included 1 case of Hodgkin's disease and 6 of non-Hodgkin's lymphoma (including 2 with T-cell phenotypes). The patients with so-called secondary breast involvement included 8 with nonHodgkin's lymphoma and 1 with a plasmacytoma of the breast with concomitant myelomatous involvement of bone marrow. Among the non-Hodgkin's lymphomas involving the breast the whole range of histological subtypes from low-grade to high-grade lesions were seen. There was no subtype of lymphoma with a specific predilection for breast involvement. Expression of oestrogen receptor protein as determined by immunocytochemical investigation using specific monoclonal antibodies was uniformly negative in lymphoid cells of 11 patients studied. Most of the patients in this series were treated by chemotherapy with uniformly good local control of lymphomatous involvement of the breast and an outcome similar to that of lymphomas presenting at other body sites. It is concluded that the approach to lymphomas of the breast should be similar to that of the equivalent types presenting elsewhere

Multiple Myeloma

The clinical, biochemical and immunochemical features of 52 patients suffering from multiple myelomatosis are reported. Three major criteria were used to establish the diagnosis: serum and urine protein chemistry, bone marrow morphology and the radiological appearances of bone. The fact that abnormalities of gamma globulin synthesis were present in 49 of the 52 patients indicates the importance of adequate examination of urine by electrophores's and immunochemical techniques in the early diagnosis of multiple myeloma. Bradshaw's test, which is a simple screening test for fence-Jones proteinuria, was positive in 63% of patients.S. Afr. Med. J., 48, 1023 (1974)

Lymphoproliferative disorders in non-AIDS associated Kaposi's sarcoma

The association of the non-AIDS-related, classic fonn of Kaposi's sarcoma (KS) with secondary malignancies, especially Iymphoproliferative disorders, has frequently been noted. However, in endemic: African-type KS, such an association has been reported only rarely. A review of 62 non-AIDS-related cases of KS treated and followed up at Johannesburg General Hospital between 1980 and 1992 revealed 8 patients (13%)'in whom KS was associated with malignant Iymphoproliferative disorders. The prevalence of secondary Iymphoproliferative disorders was not significantly different among patients with classic KS (3/15; 20%) when compared with those who had African KS (4/47; 8%). In both forms of KS subtle disturbances of immunity have been described which may play a role in the pathogenesis of secondary Iymphoproliferative disorders, although the factors responsible and the pathogenetic mechanisms involved in malignant lymphoid transfonnation in these patients have not been fully elucidated

Multiple Myeloma

The results of the use of melphalan in 52 patients with multiple myeloma have been analysed. The median survival of the whole group of patients was 30 months, and of those w:th renal insufficiency only 12,5 months. Bence-lones proteinuria was also a poor prognostic finding,. but only because of its association with renal failure. Patients with Bence-Jones protcinur;a and normal renal function had a median survival of 41 months. Responsiveness to therapy by criteria based on those of the Chronic Leukemial Multip!e Myeloma Task Force could be assessed in 25 patients. Dramatic symptomatic relief occurred in all but one of the responsive patients, but in only one-fifth of those who did not respond to therapy.S. Afr. Med. J., 48, 1026 (1974