Molecular Immunology Unit Department of Blood and Marrow Transplantation.
Department of Ophthalmology.
Clin Infect Dis. 2014 Jun;58(12):1700-6. doi: 10.1093/cid/ciu201. Epub 2014 Apr 3.
Although cytomegalovirus (CMV) retinitis (CMVR) is a well-recognized complication after allogeneic hematopoietic stem cell transplantation (HSCT), standard operating procedures for ophthalmic monitoring are variable. In particular, authors perceived a greater risk of CMVR after pediatric HSCT for inherited immunodeficiencies, in patients who often have pretransplantation viremia. This study was therefore performed to identify high-risk pediatric HSCT recipients who would benefit from regular ophthalmic monitoring.
During a 5-year study period, we retrospectively analyzed findings in 56 of 304 consecutive HSCT recipients (age range, 0.5-197 months) in whom significant CMV viremia developed (CMV level at PCR, ≥4000 copies/mL). All HSCT recipients with significant CMV viremia underwent retinal examination weekly (inpatients) or every other week (outpatients), with examinations performed by a skilled ophthalmologist.
CMVR developed in 13 (4%) of 304 HSCT recipients, 23% (13 of 56) of those with significant CMV viremia. Pretransplant viremia (odds ratio, 11.3; P < .01), acute (grade ≥2) graft-vs-host disease (odds ratio, 8.2; P < .02) and mismatched graft (odds ratio, 8; P < .02) were identified as independent risk factors. Compared with other invasive CMV diseases, CMVR was more often a late-onset disease, occurring at a median of 199 days after HSCT. At diagnosis, a significantly higher CD4 T-cell count (≥200/µL; P < .03) and a lower CMV load (P < .004) was observed in children with CMVR, compared with those in whom lung, gut, or liver CMV disease developed.
We report an increased risk of CMVR in high-risk pediatric HSCT recipients. This form of CMV disease differs from other invasive CMV disease in its relationship to immune reconstitution and viral dynamics. We have studied the relationship between these variables and suggested a risk-stratified ophthalmic screening strategy.
虽然巨细胞病毒（CMV）视网膜炎（CMVR）是异基因造血干细胞移植（HSCT）后一种公认的并发症，但眼部监测的标准操作规程存在差异。特别是，作者认为在因遗传性免疫缺陷而进行儿科 HSCT 的患者中，由于患者常有移植前病毒血症，CMVR 的风险更高。因此，本研究旨在确定需要定期眼部监测的高危儿科 HSCT 受者。
在 5 年的研究期间，我们回顾性分析了 304 例连续 HSCT 受者（年龄 0.5-197 个月）中 56 例（CMV 水平在 PCR 时≥4000 拷贝/ml）出现显著 CMV 病毒血症患者的发现。所有出现显著 CMV 病毒血症的 HSCT 受者均接受视网膜检查，每周（住院患者）或每两周（门诊患者）一次，由熟练的眼科医生进行检查。
304 例 HSCT 受者中有 13 例（4%）发生 CMVR，56 例出现显著 CMV 病毒血症的患者中有 23%（13 例）发生 CMVR。移植前病毒血症（比值比，11.3；P <.01）、急性（≥2 级）移植物抗宿主病（比值比，8.2；P <.02）和不合型移植物（比值比，8；P <.02）被确定为独立危险因素。与其他侵袭性 CMV 疾病相比，CMVR 更常为迟发性疾病，发生于 HSCT 后中位数 199 天。在诊断时，与发生肺部、肠道或肝脏 CMV 疾病的患者相比，CMVR 患者的 CD4 T 细胞计数（≥200/µL；P <.03）更高，CMV 载量更低（P <.004）。
我们报告了高危儿科 HSCT 受者 CMVR 风险增加。这种形式的 CMV 疾病与免疫重建和病毒动力学的关系不同于其他侵袭性 CMV 疾病。我们研究了这些变量之间的关系，并提出了一种基于风险分层的眼部筛查策略。
