Cytomegalovirus Retinitis in an ALL Child during Maintenance Therapy Treated Successfully with Intravenous Ganciclovir

Çeliker, Hande; Karaaslan, Ayşe; Kadayıfçı, Eda Kepenekli; Atıcı, Serkan; Soysal, Ahmet; Kazokoğlu, Haluk; Köç, Ahmet

doi:10.1155/2014/294238

Cited by 10 publications

(11 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Symptomatic CMV infection was reported in 28 patients (19 boys, 9 girls; median age 8.5 years, range, 1‐15 years; Table 1). 10‐30 All but one patient suffered from ALL, and one patient had relapsed AML. The infection occurred in most of the patients ( n = 22) during maintenance therapy, and main symptoms were persisting fever not to be explained by other causes (19 patients), visual disturbances (10 patients), acute visual loss (one patient) or retinitis (two patients), pancytopenia (six patients) or hepatomegaly (eight patients).…”

Section: Resultsmentioning

confidence: 99%

Systemic viral infection in children receiving chemotherapy for acute leukemia

Buus-Gehrig

Bochennek

Hennies

et al. 2020

Pediatric Blood & Cancer

View full text Add to dashboard Cite

Systemic viral diseases frequently occur in allogeneic hematopoietic stem cell transplantation, but data in children receiving chemotherapy for acute leukemia are scarce. We therefore collected and analyzed the published data on symptomatic infection from cytomegalovirus, herpes simplex virus, varicella zoster virus, parvovirus B19, or adenovirus in pediatric acute leukemia. Reports on 68 children were identified, of whom 16 patients have died from the infection. Further studies have to (1) evaluate the true incidence of these infections in pediatric acute leukemia, (2) their impact on outcome, and (3) whether a subpopulation of patients could benefit from screening and prophylactic strategies. K E Y W O R D S acute leukemia, adenovirus, child, cytomegalovirus, herpes simplex virus, parvovirus B19, systemic viral disease, varicella zoster virus We performed a MEDLINE (including MEDLINE In Process) search to identify relevant English-language articles indexed from January 1, 2000, up to December 31, 2019. The search included a combination of indexed terms and free text terms (child OR adolescent OR pediatr*); (cancer OR malignancy OR leukemia); (parvovirus OR b19)/(adenovirus)/(varicella or VZV)/(cytomegalovirus or CMV)/(herpes simplex virus or HSV). The hits were screened manually by two of the authors (CBG and TL). Only case reports and case series about systemic infections or studies on the prevalence of viremia with CMV, HSV, VZV, PVB19, and ADV, respectively, occurring in children

show abstract

Section: Resultsmentioning

confidence: 99%

Systemic viral infection in children receiving chemotherapy for acute leukemia

Buus-Gehrig

Bochennek

Hennies

et al. 2020

Pediatric Blood & Cancer

View full text Add to dashboard Cite

show abstract

“…Till date, there are only a few reports of CMVR in children with ALL on maintenance phase chemotherapy. [ 2 3 4 5 6 ] Maintenance therapy in ALL can cause severe immunosuppression leading to opportunistic infections including CMVR. Immunosuppression occurs due to low total leukocyte count, decreased total lymphocyte count, decreased CD4 count, reduced functional CD4 cells in the presence of normal absolute CD4 count,[ 1 ] and reduced immunoglobulin levels.…”

Section: Discussionmentioning

confidence: 99%

“…Oral valganciclovir has good bioavailability, does not need IV access, is well tolerated, and has similar efficacy compared to IV ganciclovir. [ 10 ] Although oral valganciclovir has been used prophylactically in pediatric patients to prevent CMV infection in various immunosuppressive therapies and as maintenance therapy for CMVR in ALL,[ 4 ] induction and maintenance therapy of CMVR by valganciclovir with intravitreal ganciclovir in pediatric ALL patients have not been described before. Contraindication of oral valganciclovir includes hemoglobin <8 g/dL, absolute neutrophil count <500 cells/μL, and platelet count <25,000/μL.…”

Section: Discussionmentioning

confidence: 99%

“…[ 1 ] Recently, various case reports of CMV retinitis (CMVR) have been reported following intraocular or periocular corticosteroid administration and in children with leukemia, especially acute lymphoblastic leukemia (ALL). [ 2 3 4 5 6 ] Herein, we report a case of unilateral CMVR in a child during maintenance phase therapy for ALL who was not treated with autologous or allogeneic HSCT before.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Treatment of unilateral zone I cytomegalovirus retinitis in acute lymphoblastic leukemia with oral valganciclovir and intravitreal ganciclovir

et al. 2017

View full text Add to dashboard Cite

Cytomegalovirus retinitis (CMVR) is an opportunistic infection seen in immunocompromised patients, especially suffering from acquired immune deficiency syndrome. It is uncommonly seen in hematological malignancies and in patients on immunosuppressants. The authors present a 12-year-old girl with unilateral CMVR who was on maintenance phase therapy for mixed phenotype (B/myeloid) leukemia. Serology for human immunodeficiency virus was negative. The child was successfully treated with oral valganciclovir and repeated intravitreal ganciclovir injections. CMVR in pediatric population with leukemia can be successfully treated with oral valganciclovir and intravitreal ganciclovir injections.

show abstract

“…The 1st case is a 12-year-old boy with ALL who was admitted to the hospital with blurred vision in the right eye (RE) (2). The patient was in the maintenance phase of chemotherapy on the ALL-BFM-2003 protocol and was receiving oral methotrexate and mercaptopurine.…”

mentioning

confidence: 99%

Cytomegalovirus Retinitis in Three Pediatric Cases with Acute Lymphoblastic Leukemia: Case Series and Review of the Literature

et al. 2016

Self Cite

View full text Add to dashboard Cite

SUMMARY: Cytomegalovirus (CMV) retinitis is typically diagnosed in patient with AIDS and those who underwent allogeneic hematopoietic cell transplant. However, it may develop in patients with acute lymphoblastic leukemia (ALL) who have not undergone hematopoietic cell transplantation. To increase awareness of CMV retinitis in this group, we describe 3 patients ages 3, 9, and 12, with ALL who developed CMV retinitis. The diagnosis of CMV retinitis was made on the basis of ophthalmological findings suggesting typical retinal lesions. In 2 cases, CMV DNAemia was present, while in 1 patient CMV DNA was detected only in vitreous fluid using the PCR technique. All cases were treated with intravenous ganciclovir for 2 or 3 weeks as induction therapy, followed by oral valganciclovir prophylaxis. Initially, active retinitis lesions resolved in all cases; however, in 1 patient CMV retinitis relapsed 3 times during follow-up. In this case, by using foscarnet therapy, satisfactory responses were achieved and the progression of CMV retinitis lesions stopped and eventually regressed.Cytomegalovirus (CMV) may cause asymptomatic infection or self-limiting illness in most infected, immunocompetent individuals. In patients with reduced cellular immunity, such as patients infected with human immunodeficiency virus, solid organ transplant recipients, hematopoietic cell transplant (HCT) recipients, and those receiving immune suppression therapy, it may lead to end-organ diseases (1), one of which is CMV retinitis. The majority of CMV retinitis cases are related to the hematogenous spread of the virus to the retina, usually after systemic reactivation of a latent infection, and are usually diagnosed by an experienced ophthalmologist on the basis of typical retinal changes. To the best of our knowledge, CMV retinitis in patients with acute lymphoblastic leukemia (ALL) without autologous or allogeneic HCT, has rarely been reported. This report, in the light of the published literature, describes 3 pediatric patients with ALL who developed CMV retinitis while receiving chemotherapy.The 1st case is a 12-year-old boy with ALL who was admitted to the hospital with blurred vision in the right eye (RE) (2). The patient was in the maintenance phase of chemotherapy on the ALL-BFM-2003 protocol and was receiving oral methotrexate and mercaptopurine. His white blood cell (WBC) count was 3,200/mL and his neutrophil count was 1,600/mL. The ophthalmological examination revealed a best corrected visual acuity (BCVA) of 20/20 in both the RE and the left eye (LE). The slit lamp examination of the anterior chamber of the LE was normal, whereas a 3＋ anterior chamber cellular reaction was observed in the RE. The retinal examination revealed active retinitis lesions (creamcolored lesions associated with hemorrhages) and perivascular cuffing in the retinal periphery in the RE (Fig. 1A). The LE retina was normal. Laboratory studies revealed positive CMV IgM, but negative CMV IgG,

show abstract

Cytomegalovirus Retinitis in an ALL Child during Maintenance Therapy Treated Successfully with Intravenous Ganciclovir

Cited by 10 publications

References 13 publications

Systemic viral infection in children receiving chemotherapy for acute leukemia

Systemic viral infection in children receiving chemotherapy for acute leukemia

Treatment of unilateral zone I cytomegalovirus retinitis in acute lymphoblastic leukemia with oral valganciclovir and intravitreal ganciclovir

Cytomegalovirus Retinitis in Three Pediatric Cases with Acute Lymphoblastic Leukemia: Case Series and Review of the Literature

Contact Info

Product

Resources

About