High ocular CMV copies and mismatched receipts may predict poor visual prognosis in CMV retinitis patients following allogeneic haematopoietic stem cell transplantation

Abstract

BackgroundTo summarize the clinical characteristics and potential factors affecting the visual outcomes in patients with cytomegalovirus retinitis following allogeneic haematopoietic stem cell transplantation (HSCT).MethodsThis retrospective study enrolled 12 patients (19 eyes) with cytomegalovirus retinitis after HSCT at Guangzhou First People’s Hospital in China between January 2013 and December 2014. Demographic and clinical characteristics, ocular manifestations and visual outcomes were evaluated by reviewing medical records at the Departments of Hematology and Ophthalmology. All patients were followed up at least 6 months after stopping antiviral therapy. The visual outcome was defined as improvement, stabilization and deterioration.ResultsThe subjects were composed of 7 human leucocyte antigen-matched and 5 mismatched receipts. All patients received combined systemic and intravitreous antiviral therapy. Eleven eyes gained improved or stabilized visual acuity, while 8 eyes suffered deterioration. Eyes with cytomegalovirus load less than 1 × 104 copies/ml in vitreous accounted for higher rate in eyes with good visual prognosis than those with cytomegalovirus copies above 1 × 104 copies/ml (52.63% vs 5.26%, P < 0.001). Human leucocyte antigen-matched receipts gained better visual prognosis than those mismatched ones (47.37% vs10.53%, P < 0.05). The virus types, cytomegalovirus peak in the blood, involved retinal zone and size had no influence on the visual outcomes (all P > 0.05).ConclusionsHigh ocular cytomegalovirus copies and mismatched receipts may be potential adverse factors affecting visual outcomes in cytomegalovirus retinitis patients following allogeneic HSCT.

Cytomegalovirus retinitis in children and adolescents with acute leukemia following allogeneic hematopoietic stem cell transplantation

“…One study suggested DNAemia above 1000 copies/mL or a >5‐fold increase over baseline of CMV DNA when lower DNA levels are detected; nevertheless, recent data revealed that even low levels around 150 copies/mL of CMV DNA in plasma may be clinically significant in HSCT recipients . In a single‐center study, the level of CMV DNAemia did not affect visual outcome, while high ocular CMV copies >10 000 copies/mL and mismatched receipts both predicted poor visual prognosis in CMVR patients following allogeneic HSCT . Although the beneficial effects of early antiviral therapy must be balanced against the risk of drug‐related toxicity due to overtreatment, recent studies suggest that early initiation of preemptive therapy is actually associated with shorter duration of CMV DNAemia and reduced antiviral exposure …”

Pre-Transplant Platelet Refractoriness and Alternative Donors Are Associated With Cytomegalovirus Retinitis in Hematopoietic Stem Cell Transplantation for Severe Aplastic Anemia

“…However, there have been some reports on the particular risk of HSCT-related CMV infection among recipients of alternative grafts (Whited et al, 2020;Cho et al, 2021). We previously also demonstrated the high risk of CMVR associated with HLA-mismatched donors in a retrospective study based on SAA and malignant hematological diseases (Zhang et al, 2017). The nomogram for evaluating the risk for cytomegalovirus retinitis, with the rows ranging from 2 to 4 representing the included variables.…”

CMV retinitis in a stem cell transplant recipient treated with foscarnet intravitreal injection and CMV specific immunoglobulins

“…As reported elsewhere, it is not surprising that, in our patient, CMV DNA was not detectable in whole blood at the time of CMVR diagnosis. 8 , 13 , 16 In fact, it is possible to speculate that the eyes may represent a sanctuary site where immunocompetent cells as well as antiviral therapies penetrate with extreme difficulty. 17 According to these observations, our therapeutic approach included the association of both intravenous and intravitreal injections of foscarnet.…”

“… 2 , 7 – 10 , 12 , 18 Only a few patients have been treated with intravitreal injection of GCV ( Table 1 ). Larsson et al described two patients who received combined systemic and local treatment with intravitreal injections of GCV, 12 while Zhang et al described 12 patients who received combined systemic and intravitreal injection 16 ; 11 eyes showed improvements or stabilization whereas 8 eyes deteriorated. Transplant from a HLA-mismatched donor and CMV DNA copies higher than 1 × 10 4 were adverse factors for visual outcomes.…”