Frequent Occurrence of Cytomegalovirus Retinitis During Immune Reconstitution Warrants Regular Ophthalmic Screening in High-Risk Pediatric Allogeneic Hematopoietic Stem Cell Transplant Recipients

Hiwarkar, Prashant; Gajdošová, Eva; Qasim, Waseem; Worth, Austen; Breuer, Judith; Chiesa, Robert; Ridout, Deborah; Edelsten, Clive; Moore, Anthony T.; Amrolia, P; Veys, Paul; Rao, Kanchan

doi:10.1093/cid/ciu201

Cited by 36 publications

(32 citation statements)

References 23 publications

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“…Typically, CMV mainly affects the lungs and gastrointestinal tract [6]. However, CMV retinitis is also common, occurring in 5% of high-risk pediatric allo-HSCT recipients [7]. …”

Section: Introductionmentioning

confidence: 99%

Cytomegalovirus Infection and Treatment in Allogeneic Hematopoietic Stem Cell Transplantation: A Retrospective Study from a Single Institution in an Endemic Area

Lin¹,

Han²,

Hwang³

et al. 2017

Tjh

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Objective:Although Cytomegalovirus (CMV) infection is a major complication after allogeneic hematopoietic stem cell transplantation (allo-HSCT), the risk factors for CMV reactivation and treatment failure in CMV endemic areas have remained unclear. This study investigated the risk factors for CMV reactivation among allo-HSCT recipients in an area where CMV is highly endemic.Materials and Methods:Medical records of 82 allo-HSCT recipients from a CMV endemic area were retrospectively reviewed. The patients were stratified into two groups: those with CMV reactivation (n=32) and those without CMV reactivation (n=50). We investigated possible variables associated with CMV reactivation and treatment failure.Results:Univariate analyses showed that non-remission disease status [hazard ratio (HR): 2.15; p=0.032] and ≥grade III acute graft-versus-host disease (GVHD) (HR: 3.07; p=0.002) were associated with CMV reactivation. Multivariate analysis further demonstrated that older age (HR: 1.03; p=0.029) and ≥grade III acute GVHD (HR: 2.98; p=0.012) were associated with CMV reactivation. Overall survival time seemed lower among patients with CMV reactivation than among patients without CMV reactivation, although the difference was not statistically significant (p=0.165). The absence of ≥grade III acute GVHD was associated with successful CMV treatment in the current study (odds ratio: 4.40; p=0.008).Conclusion:Prophylactic anti-CMV therapy might need to be considered for allo-HSCT recipients who have ≥grade III GVHD.

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“…Typically, CMV mainly affects the lungs and gastrointestinal tract [6]. However, CMV retinitis is also common, occurring in 5% of high-risk pediatric allo-HSCT recipients [7]. …”

Section: Introductionmentioning

confidence: 99%

Cytomegalovirus Infection and Treatment in Allogeneic Hematopoietic Stem Cell Transplantation: A Retrospective Study from a Single Institution in an Endemic Area

Lin¹,

Han²,

Hwang³

et al. 2017

Tjh

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“…Virus invasion in pregnant women can cause palacental infection, ultimately leading to abortion, stillbirth, or fetal damage 1, 2. CMV infection can also cause serious complications and death in transplant patients 3. In addition, many other diseases such as tumor, systemic lupus erythematosus and HIV are related to CMV 4–7.…”

Section: Introductionmentioning

confidence: 99%

Transalkylation of Higher Trifluoromethylated Fullerenes with C₇₀: A Pathway to New Addition Patterns of C₇₀(CF₃)₈

Belov

Apenova

Rybalchenko

et al. 2013

Chemistry A European J

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We report three new isomers of C70(CF3)8, structurally related to p(7)mp-C70(CF3)10, that are inaccessible by direct trifluoromethylation, but can be easily identified among the products of the transalkylation of higher trifluoromethylfullerenes with C70. The reported compounds are characterized by UV/Vis, 1 D and 2 D COSY (19)F NMR spectroscopy, and DFT calculations. A rather unusual addition pattern is observed in p(6),i-C70(CF3)8 in which one addend is attached remotely from the others; polarization of the adjacent unsaturated bonds by the addend makes the molecule readily oxidizable.

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“…A systematic literature analysis revealed a total of 32 previously published cases of patients <25 years of age undergoing allogeneic HSCT for acute leukemia who developed CMVR in the post‐transplant course (Table ). Further 15 cases were reported in two publications, which are not considered in this review as the clinical data were presented in summary without detailed information on the individual cases.…”

Section: Discussion and Literature Reviewmentioning

confidence: 99%

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

Zöllner

Herbrüggen

Kolve

et al. 2019

Transplant Infectious Dis

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Most children diagnosed with acute leukemia are cured without hematopoietic stem cell transplantation (HSCT), but for some high-risk subgroups and in relapsed disease, allogeneic HSCT can significantly enhance the probability of relapse-free survival. 1 Cytomegalovirus (CMV) infection is of minor clinical significance in immunocompetent hosts, but occurs frequently in patients with impaired cellular immunity including allogeneic HSCT recipients. 2 Despite major advances in management, recurrent CMV infection and disease remain the most important viral cause for morbidity and mortality in patients post HSCT. Recurrent CMV infection is defined as new CMV infection in patients with previous evidence of CMV infection but no virus detection for an interval of at least 4 weeks during active surveillance. It may result from either reactivation of latent virus (endogenous) or reinfection (exogenous). 3The occurrence of CMV detection in blood in pediatric patients undergoing allogeneic HSCT for leukemia has been estimated at up to 43%. 4 Ocular manifestations of CMV disease in the form of CMV retinitis (CMVR) are more rarely reported in the general population of HSCT recipients (0.2%-8%), but, relative to adults, appear to be more frequent in children. 5-10 For acute leukemia, the exact AbstractCytomegalovirus retinitis (CMVR) may occur after allogeneic hematopoietic stem cell transplantation (HSCT). However, little is known about its incidence, strategies for ophthalmic surveillance, and timely implementation of adequate antiviral treatment in pediatric allogeneic HSCT recipients. We provide a retrospective analysis of the epidemiology and clinical features of CMVR in pediatric allogeneic HSCT patients transplanted at our center over a 16-year period. Two patients of this cohort with leukemia are presented. Our analysis is supplemented by a systematic review on pediatric patients with leukemia and CMVR in the setting of allogeneic HSCT. The overall incidence of CMVR in our cohort was 1% (4/338) and 14.2% (3/21) in leukemic patients. In published cases, CMVR occurred at a median of 143 days after transplantation, and, in the majority of patients, was preceded by CMV detection in blood by a median of 93 days. Continued immune suppression following engraftment likely triggers CMVR. Preemptive treatment with ganciclovir as standard is usually successful. Foscarnet is used in case of resistance to ganciclovir or drug-induced granulocytopenia. Overall, CMVR after HSCT in pediatric leukemic patients is rare, but a potentially higher vulnerability of this population for involvement of the eye warrants a standardized ophthalmological examination plan. K E Y W O R D Schildren, cytomegalovirus, leukemia, retinitis, transplantation

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Frequent Occurrence of Cytomegalovirus Retinitis During Immune Reconstitution Warrants Regular Ophthalmic Screening in High-Risk Pediatric Allogeneic Hematopoietic Stem Cell Transplant Recipients

Cited by 36 publications

References 23 publications

Cytomegalovirus Infection and Treatment in Allogeneic Hematopoietic Stem Cell Transplantation: A Retrospective Study from a Single Institution in an Endemic Area

Cytomegalovirus Infection and Treatment in Allogeneic Hematopoietic Stem Cell Transplantation: A Retrospective Study from a Single Institution in an Endemic Area

Transalkylation of Higher Trifluoromethylated Fullerenes with C₇₀: A Pathway to New Addition Patterns of C₇₀(CF₃)₈

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

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Frequent Occurrence of Cytomegalovirus Retinitis During Immune Reconstitution Warrants Regular Ophthalmic Screening in High-Risk Pediatric Allogeneic Hematopoietic Stem Cell Transplant Recipients

Cited by 36 publications

References 23 publications

Cytomegalovirus Infection and Treatment in Allogeneic Hematopoietic Stem Cell Transplantation: A Retrospective Study from a Single Institution in an Endemic Area

Cytomegalovirus Infection and Treatment in Allogeneic Hematopoietic Stem Cell Transplantation: A Retrospective Study from a Single Institution in an Endemic Area

Transalkylation of Higher Trifluoromethylated Fullerenes with C70: A Pathway to New Addition Patterns of C70(CF3)8

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

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Transalkylation of Higher Trifluoromethylated Fullerenes with C₇₀: A Pathway to New Addition Patterns of C₇₀(CF₃)₈