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Incidence, risk factors, and outcomes of cytomegalovirus retinitis after haploidentical hematopoietic stem cell transplantation

Bone Marrow Transplantation volume 55, pages 1147–1160 (2020)Cite this article

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Abstract

This study investigated the epidemiological characteristics of cytomegalovirus retinitis (CMVR) after haploidentical hematopoietic stem cell transplantation (HSCT). We studied a cohort of 1466 consecutive patients who had undergone haploidentical HSCT between 2013 and 2017. We documented 34 episodes of CMVR in 31 patients, with a median onset of 167 days after the transplant. The cumulative incidence of CMVR was 2.3% 1 year after the transplant. Multivariate analysis suggested that platelet engraft failure at 100 days, EBV DNAemia, refractory or recurrent CMV DNAemia, and acute graft-versus-host disease were related to the development of CMVR in patients with CMV DNAemia. Patients with ≥3 risk factors (high risk) had a higher 1-year incidence of CMVR than patients with ≤2 risk factors (low risk) (26.2% vs. 0.6%, P < 0.001). In patients with CMVR, visual acuity (VA) improved in 16 episodes, remained stable in 10 episodes, and worsened in 8 episodes. The variable related to the improvement of VA was VA ≥ 0.1 at time of CMVR diagnosis. Our study showed that CMVR was a rare complication after haploidentical HSCT but that the risk was greater in patients with multiple risk factors.

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Fig. 1: Cumulative incidence of cytomegalovirus retinitis (CMVR) after haploidentical transplant.
Fig. 2: Comparison of immune reconstitution between patients with cytomegalovirus retinitis and patients without.
Fig. 3: Comparison of immune reconstitution between low-risk group and high-risk group after haploidentical transplant.
Fig. 4: Landmark plots illustrating impact of cytomegalovirus retinitis on outcomes after haploidentical transplant.

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Funding

This study was supported by the National Natural Science Foundation of China (Grant no. 81400142). The funding organization had no role in the design or conduct of this research.

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Authors and Affiliations

  1. Peking University People’s Hospital, Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Xi Zhimen South Street No. 11, Beijing, 100044, China

    Chen-Hua Yan, Yu Wang, Xiao-dong Mo, Yu-Qian Sun, Feng-rong Wang, Hai-xia Fu, Yao Chen, Ting-ting Han, Jun Kong, Yi-fei Cheng, Xiao-hui Zhang, Lan-Ping Xu, Kai-Yan Liu & Xiao-Jun Huang

  2. Collaborative Innovation Center of Hematology, Suzhou, China

    Chen-Hua Yan, Yu Wang & Xiao-hui Zhang

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  1. Chen-Hua Yan
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Contributions

X-JH participated in the research design. C-HY participated in the writing of the manuscript and data analysis. All other authors participated in providing patient data. Yi-lin Yuan, Jia-xiang Gao, and Shi-ning Fu participated in collecting patient information.

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Correspondence to Xiao-Jun Huang.

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Yan, CH., Wang, Y., Mo, Xd. et al. Incidence, risk factors, and outcomes of cytomegalovirus retinitis after haploidentical hematopoietic stem cell transplantation. Bone Marrow Transplant 55, 1147–1160 (2020). https://doi.org/10.1038/s41409-020-0790-z

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