Rapid onset retinopathy in a diabetic patient following bone marrow transplantation

Gray, Roger; Tighe, Mary; Russell, NH

doi:10.1038/sj.bmt.1702578

Cited by 8 publications

(10 citation statements)

References 4 publications

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“…However, due to the presence of background diabetic retinopathy in a patient with known diabetes and hypertension, the macular detachments were mistaken to be due to diabetic macular oedema and treated accordingly. Rapid progression of diabetic retinopathy following bone marrow transplantation in a known case of multiple myeloma in a newly diagnosed diabetic has been reported 17. Our case also showed similar rapid progression of diabetic retinopathy with proliferative changes in the follow-up period of 8 months only.…”

Section: Discussionsupporting

confidence: 83%

Multiple myeloma masquerading as diabetic macular oedema

Rao¹,

Murthy²,

Muralidhar³

et al. 2018

BMJ Case Reports

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A 58-year-old man, a known diabetic and hypertensive for 5 years was presented to us with a drop in reading vision in both eyes of 2 months duration. His best-corrected visual acuity was 6/24, N36 in both eyes. Fundus findings revealed moderate non-proliferative diabetic retinopathy with bilateral diffuse macular oedema. When conventional therapy with intravitreal ranibizumab did not alter the clinical picture, we looked into the differential diagnosis of bilateral persistent macular detachments and investigated further. Haematological tests revealed severe anaemia with pancytopenia, which prompted further investigations including a bone marrow biopsy confirming a diagnosis of multiple myeloma. Chemotherapy gradually caused resolution of the macular detachments at 8 months follow-up. This report illustrates that a high index of suspicion regarding systemic condition is required in certain cases presenting as diabetic macular oedema, but not responding to the conventional treatment.

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Section: Discussionsupporting

confidence: 83%

Multiple myeloma masquerading as diabetic macular oedema

Rao¹,

Murthy²,

Muralidhar³

et al. 2018

BMJ Case Reports

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“…Two analyses of the primary and secondary outcomes were prespecified. First, analyses were performed according to the intention-to-treat principle, with group allocation based only on matched sibling donor availability . Second, to control for confounding (eFigure 1 in Supplement 2), the propensity score for undergoing transplantation was estimated by a multivariable logistic regression model, with donor availability as the dependent variable and age, sex, and number of siblings without SCA as covariates.…”

Section: Methodsmentioning

confidence: 99%

Association of Matched Sibling Donor Hematopoietic Stem Cell Transplantation With Transcranial Doppler Velocities in Children With Sickle Cell Anemia

Bernaudin

Verlhac

Latour

et al. 2019

JAMA

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In children with sickle cell anemia (SCA), high transcranial Doppler (TCD) velocities are associated with stroke risk, which is reduced by chronic transfusion. Whether matched sibling donor hematopoietic stem cell transplantation (MSD-HSCT) can reduce velocities in patients with SCA is unknown. OBJECTIVE To determine the association of MSD-HSCT with TCD velocities as a surrogate for the occurrence of ischemic stroke in children with SCA. DESIGN, SETTING, AND PARTICIPANTS Nonrandomized controlled intervention study conducted at 9 French centers. Patients with SCA were enrolled between December 2010 and June 2013, with 3-year follow-up ending in January 2017. Children with SCA were eligible if younger than 15 years, required chronic transfusions for persistently elevated TCD velocities, and had at least 1 sibling without SCA from the same 2 parents. Families agreed to HLA antigen typing and transplantation if a matched sibling donor was identified or to standard care in the absence of a matched sibling donor. EXPOSURES MSD-HSCT (n = 32), compared with standard care (n = 35) (transfusions for Ն1 year with potential switch to hydroxyurea thereafter), using propensity score matching. MAIN OUTCOMES AND MEASURES The primary outcome was the highest time-averaged mean of maximum velocities in 8 cerebral arteries, measured by TCD (TCD velocity) at 1 year. Twenty-five of 29 secondary outcomes were analyzed, including the highest TCD velocity at 3 years and normalization of velocities (<170 cm/s) and ferritin levels at 1 and 3 years. RESULTS Sixty-seven children with SCA (median age, 7.6 years; 35 girls [52%]) were enrolled (7 with stroke history). In the matched sample, highest TCD velocities at 1 year were significantly lower on average in the transplantation group (129.6 cm/s) vs the standard care group (170.4 cm/s; difference, −40.8 cm/s [95% CI, −62.9 to −18.6]; P < .001). Of the 25 analyzed secondary end points, 4 showed significant differences, including the highest TCD velocity at 3 years (112.4 cm/s in the transplantation group vs 156.7 cm/s in the standard care group; difference, −44.3 [95% CI, −71.9 to −21.1]; P = .001); normalization rate at 1 year (80.0% in the transplantation group vs 48.0% in the standard care group; difference, 32.0% [95% CI, 0.2% to 58.6%]; P = .045); and ferritin levels at 1 year (905 ng/mL in the transplantation group vs 2529 ng/mL in the standard care group; difference, −1624 [95% CI, −2370 to −879]; P < .001) and 3 years (382 ng/mL in the transplantation group vs 2170 ng/mL in the standard care group; difference, −1788 [95% CI, −2570 to −1006]; P < .001). CONCLUSIONS AND RELEVANCE Among children with SCA requiring chronic transfusion because of persistently elevated TCD velocities, MSD-HSCT was significantly associated with lower TCD velocities at 1 year compared with standard care. Further research is warranted to assess the effects of MSD-HSCT on clinical outcomes and over longer follow-up.

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“…1 There have been reports of a retinopathy associated with Hodgkins lymphoma, which is thought to be paraneoplastic, getting worse with chemotherapy. 2 Retinal anti-bipolar cell antibodies have been found to be present in paraneoplastic retinopathy associated with other gastrointestinal tumours like colonic carcinoma.…”

Section: Discussionmentioning

confidence: 99%

“…Diabetic retinopathy has been reported to worsen when treatments like bone marrow transplant and immunosuppresive chemotherapy for coexistent malignancies like multiple myeloma are initiated. 1 There have been reports of a retinopathy associated with Hodgkins lymphoma, which is thought to be paraneoplastic, getting worse with chemotherapy. 2 Retinal anti-bipolar cell antibodies have been found to be present in paraneoplastic retinopathy associated with other gastrointestinal tumours like colonic carcinoma.…”

Section: Discussionmentioning

confidence: 99%

Changes in diabetic retinopathy noticed after chemotherapy for duodenal carcinoma

Varughese

Rao²,

Barton³

et al. 2004

Diabetes & Vascular Disease

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D iabetic retinopathy is a well recognised complication of diabetes, which tends to progress with poor metabolic control, ultimately requiring laser therapy. Diabetic retinopathy has been found to worsen in patients requiring chemotherapy for other coexistent conditions like Hodgkins lymphoma. We describe a patient who was on treatment for type 2 diabetes for approximately six years from 1994 and had developed advanced non-proliferative diabetic retinopathy, (figure 1A) by the year 2000. These changes remained stable (February 2001, figure 1B). In August 2001 he was diagnosed to have a duodenal carcinoma and within a few months of commencing chemotherapy there were marked improvements to his retinopathy (March 2002, figure 1C). Improvement in diabetic retinopathy following immunosuppressive therapy is not well recognised and further work is required to evaluate the potential benefits of chemotherapeutic agents in the medical management of diabetic retinopathy.

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Rapid onset retinopathy in a diabetic patient following bone marrow transplantation

Cited by 8 publications

References 4 publications

Multiple myeloma masquerading as diabetic macular oedema

Multiple myeloma masquerading as diabetic macular oedema

Association of Matched Sibling Donor Hematopoietic Stem Cell Transplantation With Transcranial Doppler Velocities in Children With Sickle Cell Anemia

Changes in diabetic retinopathy noticed after chemotherapy for duodenal carcinoma

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