Prognostic factors of cytomegalovirus retinitis after hematopoietic stem cell transplantation

Abstract

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

Antiviral therapy defiant mixed viral retinitis post hematopoietic allogeneic stem cell transplant

“…In contrast to this case, Sabbine et al reported on the use of letermovir as primary prophylaxis in 123 hematopoietic stem cell transplant patients, and of that cohort none of the patients on letermovir developed retinitis 5 (Table 1). Turner et al reported on the use of letermovir as a salvage therapy for drug‐resistant CMV retinitis 12 (Table 1).…”

“…It reduces viral spread by preventing viral component assembly and therefore interferes with both replicating and latent CMV forms. Due to its unique mechanism of action, letermovir has a high specificity for CMV 4,5 …”

Intraocular human cytomegaloviruses of ocular diseases are distinct from those of viremia and are capable of escaping from innate and adaptive immunity by exploiting HLA-E-mediated peripheral and central tolerance

“…The number of refractory CMV-retinitis cases with hematologic malignancies has been increasing in recent years ( 83 ). The potential use of UL40 peptide types and host HLA as predictors of the risk of retinitis development is one subject for future study ( 2 – 6 ). Moreover, these findings suggest routes for the development of new therapeutics for this difficult-to-treat disease entity.…”

“…Human cytomegalovirus (HCMV) latently infects 50-90% of the global population, and multiple subclinical reactivations occur over a host's lifetime. HCMV reactivation manifests as CMV-viremia in up to 65% of immunocompromised hosts who have undergone hematopoietic stem cell transplantation; however, only 5-11% of CMV-viremia patients develop CMV-retinitis, a typical CMV disease resultinginseverevisualimpairment (1)(2)(3)(4)(5)(6). Circulatingleukocytesare major sites for latent HCMV infection, and the vascular endothelium is considered the primary site of virus entry into local tissues, including the eye (7)(8)(9)(10).…”

Risk factors for the long-term prognosis and recurrence of HIV-negative cytomegalovirus retinitis in North China

“…In recent years, the incidence of CMVR after hematopoietic stem cell transplantation (HSCT) is on the rise [12] . With the increase of long-term survival rate of patients after HSCT, CMVR related severe vision loss compromised quality of life in these patients [13][14][15][16] . Although several studies reported the clinical features and prognosis of CMVR, most of them focused on HIV-positive patients [17][18][19][20] .…”