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Cytomegalovirus retinitis after allogeneic hematopoietic stem cell transplantation under cytomegalovirus antigenemia-guided active screening

Abstract

Although cytomegalovirus (CMV) remains a leading cause of morbidity and mortality after allogeneic hematopoietic stem cell transplantation (HSCT), the incidence of CMV retinitis is considered to be lower than the incidence of CMV infection in other organs following allogeneic HSCT. In this study, the incidence and characteristics of CMV retinitis were retrospectively evaluated in recipients of allogeneic HSCT. Ophthalmological screening was performed at the development of ocular symptoms or positive CMV infection using peripheral blood evaluated by pp65 antigenemia or polymerase chain reaction. Of the 514 patients, 13 patients developed CMV retinitis. The median onset of CMV retinitis was day 34 (range, 21–118) post transplant, and the cumulative incidence was 2.5% (95% CI, 1.6–4.2) at 6 months after transplantation. Five patients presented ocular symptoms at the onset. In the remaining eight asymptomatic patients, the diagnosis of CMV retinitis was made by the screening guided by positive CMV infection. All evaluable patients responded to antiviral treatment but three showed incomplete improvement with ocular sequela. Our results suggest that the incidence of CMV retinitis after allogeneic HSCT is not negligible and active ophthalmological screening based not only on symptoms but also positive CMV infection monitoring contributes to the early diagnosis of CMV retinitis.

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Fig. 1: Cumulative incidence of cytomegalovirus retinitis after transplantation.

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Correspondence to Takehiko Mori.

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Conflict of interest

TM received research funding from MSD K.K., Novartis Pharma, LSI Medience, Medical & Biological Laboratories, Otsuka Pharmaceutical, Kyowa Kirin Co., Ltd., and Asahi Kasei Corporation, and personal fees from Pfizer Inc., MSD, Janssen Pharma, Sumitomo Dainippon Pharma, Novartis Pharma K.K., Kyowa Kirin Co., Ltd., Chugai Pharmaceutical, Shionogi & Co., Japan Blood Products Organization, Takeda Pharmaceutical, Ono Pharmaceutical, Shire, Eisai, and Astellas Pharma. TK received personal fees from Celgene, Bristol-Myers Squibb, Takeda Pharmaceutical, Otsuka Pharmaceutical, Eisai Pharmaceuticals, Sanofi K.K., and Janssen Pharma. MS received research funding from MSD K.K. and Nippon Shinyaku Co., Ltd., and personal fees from Nippon Shinyaku Co., Ltd., Takeda Pharmaceutical, Eisai Co., Ltd., and Otsuka Pharmaceutical. MS received personal fees from Bristol-Myers Squibb, Novartis Pharma, Sumitomo Dainippon Pharma, Chugai Pharma, Meiji Seika Parma, and Nippon Shinyaku.

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Mori, T., Kikuchi, T., Koh, M. et al. Cytomegalovirus retinitis after allogeneic hematopoietic stem cell transplantation under cytomegalovirus antigenemia-guided active screening. Bone Marrow Transplant 56, 1266–1271 (2021). https://doi.org/10.1038/s41409-020-01176-8

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