Prognostic factors of cytomegalovirus retinitis after hematopoietic stem cell transplantation.

Published on Sep 2, 2020in PLOS ONE2.74
· DOI :10.1371/JOURNAL.PONE.0238257
Joo Young Kim4
Estimated H-index: 4
(Catholic University of Korea),
Joo Young Kim27
Estimated H-index: 27
(Catholic University of Korea)
+ 7 AuthorsYoung-Hoon Park13
Estimated H-index: 13
(Catholic University of Korea)
Purpose To identify the visual prognostic factors in patients with cytomegalovirus (CMV) retinitis after hematopoietic stem cell transplantation (HSCT). Methods This retrospective cohort study included 4241 patients who underwent HSCT from April 1, 2010 to March 31, 2019 at Seoul St. Mary's Hospital. Of them, 1063 patients presented CMV viremia, and 67 patients (93 eyes) were diagnosed with CMV retinitis. We enrolled 66 patients (91 eyes). The main outcomes included the initial best-corrected visual acuity (BCVA), BCVA at the diagnosis of retinitis and last visit, involved retinal zone, peak CMV DNA levels in the peripheral blood and aqueous humor, time between HSCT and the diagnosis of retinitis, time between the diagnosis of viremia and retinitis, complications, recurrence, survival, and so on. Results The mean BCVA (logarithm of the minimum angle of resolution) values before HSCT, at the time of retinitis diagnosis, and at the last visit were 0.041 ± 0.076, 0.262 ± 0.529, and 0.309 ± 0.547, respectively. Multiple regression analysis revealed that the involved zone (P = 0.001), time between HSCT and retinitis diagnosis (P = 0.019), and survival status (P = 0.001) were associated with the final visual acuity. Conclusions The final visual prognosis was worse in patients with greater invasion of the central retinal zone, those with a longer interval between HSCT and the diagnosis of retinitis, and those who died. Prompt diagnosis of CMV retinitis through periodic fundus examinations of patients with CMV viremia can prevent severe vision loss. Once CMV viremia is confirmed, we recommend fundus examinations to be immediately performed and repeated every 2 weeks for at least 2 months, even if the CMV DNA titer in the peripheral blood becomes negative.
#1Remco P. H. Peters (University of Pretoria)H-Index: 22
#2Philippe Kestelyn (UGent: Ghent University)H-Index: 23
Last. John H. Kempen (Harvard University)H-Index: 62
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#1Chen-Hua Yan (PKU: Peking University)H-Index: 25
#2Yu Wang (PKU: Peking University)H-Index: 33
Last. Xiao-Jun Huang (PKU: Peking University)H-Index: 67
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This study investigated the epidemiological characteristics of cytomegalovirus retinitis (CMVR) after haploidentical hematopoietic stem cell transplantation (HSCT). We studied a cohort of 1466 consecutive patients who had undergone haploidentical HSCT between 2013 and 2017. We documented 34 episodes of CMVR in 31 patients, with a median onset of 167 days after the transplant. The cumulative incidence of CMVR was 2.3% 1 year after the transplant. Multivariate analysis suggested that platelet engr...
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#1Laura Diaz (ICESI University)H-Index: 1
#2Joaquín Rosales (ICESI University)H-Index: 3
Last. Francisco Javier Jaramillo (ICESI University)H-Index: 1
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Abstract Objective Cytomegalovirus infection and disease are significant causes of morbidity and mortality among patients with hematopoietic stem cell transplantation. The aim of this study was to assess the frequency of cytomegalovirus infection and characterize the patients who developed the disease. Methods A retrospective cohort study was performed among adult patients, recipients of allogeneic HSTC between 2008 and 2015. Taking into account the institutional protocol of prophylaxis infectio...
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#1Gary N. Holland (UCLA: University of California, Los Angeles)H-Index: 74
#2Mark L. Van Natta (Johns Hopkins University)H-Index: 47
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Purpose: To evaluate risk factors for severity of cytomegalovirus (CMV) retinitis lesion whitening (opacity), using a standardized scoring system. Methods: We performed a cross-sectional, observational investigation of all individuals with newly diagnosed AIDS-related CMV retinitis in three randomized clinical trials and one prospective observational study. Opacity was scored by masked readers, using a prospectively defined ordinal 6-point scale. Demographic factors, laboratory data (CD4+, CD8+ ...
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#1Mohamed ZuhairH-Index: 2
#2G. Suzanne A. Smit (UGent: Ghent University)H-Index: 5
Last. Paul D. Griffiths (UCL: University College London)H-Index: 105
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Cytomegalovirus (CMV) infection does not usually produce symptoms when it causes primary infection, reinfection, or reactivation because these three types of infection are all controlled by the normal immune system. However, CMV becomes an important pathogen in individuals whose immune system is immature or compromised, such as the unborn child. Several vaccines against CMV are currently in clinical trials that aim to induce immunity in seronegative individuals and/or to boost the immunity of th...
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#1Sae Rom Choi (SMC: Samsung Medical Center)H-Index: 1
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#1Alexander D. Port (NewYork–Presbyterian Hospital)H-Index: 7
#2Anton Orlin (NewYork–Presbyterian Hospital)H-Index: 16
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Abstract Cytomegalovirus (CMV) is a ubiquitous DNA herpes virus that causes significant morbidity and mortality in immunocompromised individuals. CMV retinitis is a potentially blinding manifestation of CMV infection that was commonly seen in advanced acquired immunodeficiency syndrome (AIDS) in the era before modern combination antiretroviral therapy era, but is also recognized in patients with immune deficiency from multiple causes. The advent of and advances in antiretroviral therapies for hu...
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#1Sara Gianella (UCSD: University of California, San Diego)H-Index: 34
#2Scott Letendre (UCSD: University of California, San Diego)H-Index: 65
Author(s): Gianella, Sara; Letendre, Scott | Abstract: Human immunodeficiency virus (HIV)-infected adults who take stable antiretroviral therapy (ART) are at risk for early onset of age-related diseases. This is likely due to a complex interaction between traditional risk factors, HIV infection itself, and other factors, such as underlying immune dysfunction and persistent inflammation. HIV disrupts the balance between the host and coinfecting microbes, worsening control of these potential patho...
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#1Douglas A. Jabs (ISMMS: Icahn School of Medicine at Mount Sinai)H-Index: 93
#2Alka Ahuja (Johns Hopkins University)H-Index: 8
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#1Sohee Jeon (Catholic University of Korea)H-Index: 14
#2Won Ki Lee (Catholic University of Korea)H-Index: 24
AbstractPurpose: To examine the clinical outcomes achieved by using intravitreal ganciclovir injections combined with systemic anti-viral therapy in treating cytomegalovirus (CMV) retinitis in patients without human immunodeficiency virus (HIV) infection.Methods: Twenty-three eyes of 15 HIV-negative patients diagnosed with CMV retinitis were included in this retrospective study.Results: The median follow-up was 68 weeks (range, 12–156), and median number of injections was 10 (range, 2–22). The r...
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