Thirty patients with CMV-retinitis (CMVR) after haematopoietic stem cell transplantation (SCT) were reported in an EBMT survey, initiated in 2000. The aims of the study were to investigate if CMVR after SCT has become more common, to describe its clinical features, and to perform a risk factor analysis. All but one patient were transplanted due to malignant disease. Three cases were seen after autologous SCT and 27 after allogeneic SCT, of whom fourteen were transplanted with alternative donors and sixteen with T-cell depleted grafts. CMVR was diagnosed at a median of 145 days (range 19-547) after SCT. In 23/28 patients (82%), where CMV-monitoring was performed regularly, CMV-reactivation and/or disease were seen before CMVR, but in 5/28 cases (18%) the retinitis was the first sign of CMV. At the time for diagnosis of CMVR, 22/30 patients (73%) had systemic CMV-infection. The clinical presentation was mostly diffuse visual symptoms, the most common being blurred vision. However, four patients (13%) had no visual symptoms at all. All patients were given systemic antiviral treatment, in four patients combined with local treatment. The outcome was reduced vision in 18/25 evaluable patients (72%), seven of whom became blind or had severely reduced vision. The risk for developing CMVR was almost four times higher for patients transplanted after 1996 when compared to those transplanted before; with a one-year probability of 1.9 ± 0.56 compared to 0.53 ± 0.24 (p<0.01). A risk factor analysis was then performed, including 27 patients all having undergone allogeneic SCT after 1990. In this study also patients from the Fred Hutchinson Cancer Research Center, Seattle, Washington, were included. Four controls were reported for each retinitis case, matched for transplant centre and year. A multivariate risk factor analysis was performed using a Cox model with stepwise selection. Significant risk factors for CMVR were the combination of CMV-negative donor and CMV-positive recipient (RR=4 95% CI=1.7-9.6, p=0.002), and CMV prophylaxis (RR2.9, 95%CI=1.2-6.7, p=0.015). Factors not influencing the risk for CMV retinitis were diagnosis, age, patient and donor sex, type of donor, TBI containing conditioning, source of stem cells, T-cell depletion of the graft, and acute or chronic GVHD. CMV retinitis has become a more frequent complication after SCT and many patients get permanent visual damage. Therefore, early diagnosis and therapy is very important.
CMV-retinitis after haematopoietic stem cell transplantation; the final report on a survey from the EMBT Working Party for Infectious Diseases / Larsson, K; Maertens, J; Arvidson, J; Juliusson, G; Einsele, H; Békássy, An; Lindmark, A; Gentile, G; De la Camara, R.; Dekker, A; Zander, A; Socié, G; Boeckh, M; Ljungman, P; Cordonnier, C; Party., on behalf of the Infectious Diseases Working. - In: BONE MARROW TRANSPLANTATION. - ISSN 1476-5365. - 33:(2004), pp. S30-S30. ((Intervento presentato al convegno 30th Annual Meeting of the European-Group-for-Blood-and-Marrow-Transplantation/20th Meeting of the EBMT-Nurses-Group/3rd Meeting of the EBMT-Data-Management-Group tenutosi a Barcelona, SPAIN.
CMV-retinitis after haematopoietic stem cell transplantation; the final report on a survey from the EMBT Working Party for Infectious Diseases
G, Gentile;
2004
Abstract
Thirty patients with CMV-retinitis (CMVR) after haematopoietic stem cell transplantation (SCT) were reported in an EBMT survey, initiated in 2000. The aims of the study were to investigate if CMVR after SCT has become more common, to describe its clinical features, and to perform a risk factor analysis. All but one patient were transplanted due to malignant disease. Three cases were seen after autologous SCT and 27 after allogeneic SCT, of whom fourteen were transplanted with alternative donors and sixteen with T-cell depleted grafts. CMVR was diagnosed at a median of 145 days (range 19-547) after SCT. In 23/28 patients (82%), where CMV-monitoring was performed regularly, CMV-reactivation and/or disease were seen before CMVR, but in 5/28 cases (18%) the retinitis was the first sign of CMV. At the time for diagnosis of CMVR, 22/30 patients (73%) had systemic CMV-infection. The clinical presentation was mostly diffuse visual symptoms, the most common being blurred vision. However, four patients (13%) had no visual symptoms at all. All patients were given systemic antiviral treatment, in four patients combined with local treatment. The outcome was reduced vision in 18/25 evaluable patients (72%), seven of whom became blind or had severely reduced vision. The risk for developing CMVR was almost four times higher for patients transplanted after 1996 when compared to those transplanted before; with a one-year probability of 1.9 ± 0.56 compared to 0.53 ± 0.24 (p<0.01). A risk factor analysis was then performed, including 27 patients all having undergone allogeneic SCT after 1990. In this study also patients from the Fred Hutchinson Cancer Research Center, Seattle, Washington, were included. Four controls were reported for each retinitis case, matched for transplant centre and year. A multivariate risk factor analysis was performed using a Cox model with stepwise selection. Significant risk factors for CMVR were the combination of CMV-negative donor and CMV-positive recipient (RR=4 95% CI=1.7-9.6, p=0.002), and CMV prophylaxis (RR2.9, 95%CI=1.2-6.7, p=0.015). Factors not influencing the risk for CMV retinitis were diagnosis, age, patient and donor sex, type of donor, TBI containing conditioning, source of stem cells, T-cell depletion of the graft, and acute or chronic GVHD. CMV retinitis has become a more frequent complication after SCT and many patients get permanent visual damage. Therefore, early diagnosis and therapy is very important.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
