CMV Retinitis in Pediatric Patients After Stem Cell Transplantation
American Journal of Ophthalmology, January 2017
As part of their regimen for allogeneic hematopoietic stem cell transplantation (HSCT), patients must take immunosuppressant drugs. Thus, they have a high risk of reactivation of previously subclinical cytomegalovirus (CMV) infection, which may lead to CMV retinitis. Larochelle et al. conducted a cross-sectional study of pediatric patients who received allogeneic HSCT at Children’s Hospital of Colorado and identified a cluster of CMV retinitis among patients treated in 2014, although no cases had been seen in the previous 4 years.
The authors retrospectively examined the records of 28 children who underwent allogeneic HSCT in 2014 and compared their rates of CMV viremia and CMV retinitis with those of 101 pediatric patients who had the same procedure between 2010 and 2013. Thirty-two patients (32%) in the earlier group tested positive for CMV viremia, but no cases of CMV retinitis were identified. Of the 28 patients who received HSCT in 2014, 13 patients (46%) had CMV viremia. Five cases of CMV retinitis were identified in this group, representing a significant increase from the previous 4 years.
Based on these findings and those of a multidisciplinary team that reviewed current literature, the authors developeda more aggressive ophthalmic screening protocol aimed at earlier detection of retinitis—while still asymptomatic—among pediatric HSCT recipients. As part of this protocol, patients who become viremic or have CMV organ disease receive dilated eye exams starting within 2 weeks of viremia onset and continuing every 6-8 weeks until viremia is no longer detected.
The authors concluded that the burden of more-frequent exams is balanced by the benefits of earlier identification of CMV retinitis in this vulnerable patient population. Further, application of the protocol will help researchers determine whether the cluster was an anomaly or represents an actual increase in incidence of CMV.
The original article can be found here.