Song Won Kyung, Min Yoo Hong, Kim Yu Ri, Lee Sung Chul
Department of Ophthalmology, The Institute of Vision Research, Yonsei University College of Medicine, Seoul, Korea.
Ophthalmology. 2008 Oct;115(10):1766-70. doi: 10.1016/j.ophtha.2008.04.015. Epub 2008 Jun 17.
To report on the clinical characteristics and treatment outcomes of cytomegalovirus (CMV) retinitis cases that occurred after allogeneic hematopoietic stem cell transplantation (HSCT) using an alemtuzumab-based (Campath-1H, Genzyme, Cambridge, MA) conditioning regimen.
A retrospective noncomparative interventional case series.
Seven eyes of 4 patients in whom CMV retinitis developed after allogeneic HSCT using alemtuzumab.
A retrospective chart review was performed. CMV retinitis was diagnosed by the presence of characteristic ophthalmoscopic findings and confirmed by polymerase chain reaction-based detection of CMV in vitreal biopsy specimens. The affected eyes received intravitreal injections of 2 mg/0.1 mL of ganciclovir twice weekly during induction therapy until the lesions were inactive, followed by weekly injections as maintenance therapy. Maintenance intravitreal therapy continued until the lesions consisted of an atrophic retina with pigment epithelium mottling and attenuated vessels.
Visual acuity, response of retinitis lesions, and postoperative complications.
From 1999 to 2007, 294 patients received allogeneic HSCTs at our institution. Among the HSCTs, 65 were unrelated transplants, and of these, 17 were performed using alemtuzumab-based conditioning regimens. Only 4 patients went on to develop CMV retinitis. These 4 patients had several features in common. All patients received transplants from unrelated donors after an alemtuzumab-conditioning regimen for acute leukemia. One patient died before initiation of treatment. Three patients exhibited a bilateral disease, and 3 patients had neutropenia. Patients underwent a mean of 8.3 intravitreal ganciclovir injections in each eye. All 3 treated patients showed a good response. The treatment was well tolerated without serious adverse events during the mean follow-up period of 8.5 months (range, 4.5-16 months).
An increased incidence of CMV retinitis was noted in unrelated patients undergoing HSCT using a nonmyeloablative alemtuzumab-based conditioning regimen. Intravitreal ganciclovir therapy seems to be an acceptable therapeutic option in these patients given the nature of their systemic illness, which prohibits the use of typical systemic anti-CMV drugs.
报告使用基于阿仑单抗（Campath-1H，健赞公司，马萨诸塞州剑桥）的预处理方案进行异基因造血干细胞移植（HSCT）后发生的巨细胞病毒（CMV）视网膜炎病例的临床特征和治疗结果。
一项回顾性非对照干预性病例系列研究。
4例患者的7只眼睛，这些患者在使用阿仑单抗进行异基因HSCT后发生了CMV视网膜炎。
进行回顾性病历审查。通过特征性眼底镜检查结果诊断CMV视网膜炎，并通过基于聚合酶链反应的玻璃体活检标本中CMV检测加以证实。在诱导治疗期间，患眼每周两次接受玻璃体内注射2mg/0.1mL更昔洛韦，直至病变静止，随后作为维持治疗每周注射一次。维持性玻璃体内治疗持续至病变变为萎缩性视网膜伴色素上皮斑驳和血管变细。
视力、视网膜炎病变反应及术后并发症。
1999年至2007年，我院有294例患者接受了异基因HSCT。在这些HSCT中，65例为非亲缘移植，其中17例采用基于阿仑单抗的预处理方案。只有4例患者发生了CMV视网膜炎。这4例患者有几个共同特征。所有患者在接受阿仑单抗预处理方案治疗急性白血病后均接受了非亲缘供者的移植。1例患者在开始治疗前死亡。3例患者表现为双侧疾病，3例患者有中性粒细胞减少症。患者每只眼睛平均接受8.3次玻璃体内更昔洛韦注射。所有3例接受治疗的患者均显示出良好反应。在平均8.5个月（范围4.5 - 16个月）的随访期内，治疗耐受性良好，未出现严重不良事件。
在接受基于阿仑单抗的非清髓性预处理方案进行HSCT的非亲缘患者中，CMV视网膜炎的发病率有所增加。鉴于这些患者全身性疾病的性质禁止使用典型的全身性抗CMV药物，玻璃体内更昔洛韦治疗似乎是这些患者可接受的治疗选择。
