Zöllner Stefan K, Herbrüggen Heidrun, Kolve Hedwig, Mihailovic Natasa, Schubert Friederike, Reicherts Christian, Rössig Claudia, Groll Andreas H
Department of Pediatric Hematology and Oncology, University Children's Hospital Muenster, Muenster, Germany.
Pharmacy Department, University Hospital Muenster, Muenster, Germany.
Transpl Infect Dis. 2019 Oct;21(5):e13089. doi: 10.1111/tid.13089. Epub 2019 Aug 13.
Cytomegalovirus 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.
巨细胞病毒性视网膜炎（CMVR）可能发生在异基因造血干细胞移植（HSCT）后。然而，对于小儿异基因HSCT受者中CMVR的发病率、眼科监测策略以及及时实施充分的抗病毒治疗，人们了解甚少。我们对本中心16年间接受移植的小儿异基因HSCT患者中CMVR的流行病学和临床特征进行了回顾性分析。本文介绍了该队列中的2例白血病患者。我们的分析还辅以对异基因HSCT背景下白血病小儿患者和CMVR的系统评价。我们队列中CMVR的总体发病率为1%（4/338），白血病患者中为14.2%（3/21）。在已发表的病例中，CMVR发生在移植后中位数143天，并且在大多数患者中，血液中CMV检测先于CMVR出现，中位数为93天。移植后持续的免疫抑制可能引发CMVR。以更昔洛韦作为标准的抢先治疗通常是成功的。对于对更昔洛韦耐药或药物诱导的粒细胞减少的情况，使用膦甲酸钠。总体而言，小儿白血病患者HSCT后CMVR很少见，但该人群眼部受累的潜在易感性更高，这需要一个标准化的眼科检查计划。
