ABSTRACT
A 29-year-old man with a history of HIV, previously noncompliant with antiretroviral therapy, restarted highly active antiretroviral therapy (HAART) 4 weeks prior to the sudden development of multiple tender exophytic friable tumors and subcutaneous nodules of the thighs. Herein we present a patient with Kaposi sarcoma in the setting of immune reconstitution inflammatory syndrome.
Subject(s)
HIV Infections/drug therapy , Immune Reconstitution Inflammatory Syndrome/pathology , Sarcoma, Kaposi/pathology , Skin Neoplasms/pathology , Adult , Antibiotics, Antineoplastic/therapeutic use , Antiretroviral Therapy, Highly Active/adverse effects , Doxorubicin/therapeutic use , Edema/complications , HIV Infections/complications , Humans , Immune Reconstitution Inflammatory Syndrome/chemically induced , Immune Reconstitution Inflammatory Syndrome/complications , Lower Extremity , Male , Sarcoma, Kaposi/complications , Sarcoma, Kaposi/drug therapy , Skin Neoplasms/complications , Skin Neoplasms/drug therapyABSTRACT
The treatment options for patients with primary cutaneous B- and T-cell lymphomas are as diverse as the diseases themselves, including both skin-directed and systemic therapies. Long-term remission can be attained in many cases; however, no treatment is curative with the possible exception of allogeneic stem cell transplant. Improved insight into the molecular biology and pathophysiology of these diseases has led to the development of novel drugs and targeted therapies, including monoclonal antibodies and antimetabolites, as well as improved radiotherapeutic techniques. We aim to summarize these new and emerging treatment modalities, and to outline how they may be integrated into the clinical management of patients with primary cutaneous lymphoma (CL).
Subject(s)
Lymphoma, B-Cell/drug therapy , Lymphoma, T-Cell, Cutaneous/drug therapy , Skin Neoplasms/drug therapy , Clinical Trials, Phase I as Topic , Clinical Trials, Phase II as Topic , Disease Management , Humans , Lymphoma, B-Cell/pathology , Lymphoma, B-Cell/therapy , Lymphoma, T-Cell, Cutaneous/pathology , Lymphoma, T-Cell, Cutaneous/therapy , Randomized Controlled Trials as Topic , Skin Neoplasms/pathology , Skin Neoplasms/therapyABSTRACT
PURPOSE: Human melanoma cells express shared antigens recognized by CD8(+) T lymphocytes, the most common of which are melanocytic differentiation proteins and cancer-testis antigens. However, peptide vaccines for melanoma usually target only one or two MHC class I-associated peptide antigens. Because melanomas commonly evade immune recognition by selective antigen loss, optimization of melanoma vaccines may require development of more complex multipeptide vaccines. EXPERIMENTAL DESIGN: In a prospective randomized clinical trial, we have evaluated the safety and immunogenicity of a vaccine containing a mixture of 12 peptides from melanocytic differentiation proteins and cancer-testis antigens, designed for human leukocyte antigen types that represent 80% of the melanoma patient population. This was compared with a four-peptide vaccine with only melanocytic differentiation peptides. Immune responses were assessed in peripheral blood and in vaccine-draining lymph nodes. RESULTS: These data show that (a) the 12-peptide mixture is immunogenic in all treated patients; (b) immunogenicity of individual peptides is maintained despite competition with additional peptides for binding to MHC molecules; (c) a broader and more robust immune response is induced by vaccination with the more complex 12-peptide mixture; and (d) clinical outcome in this peptide vaccine trial correlates with immune responses measured in the peripheral blood lymphocytes. CONCLUSIONS: These data support continued investigation of complex multipeptide vaccines for melanoma.
