Virological, clinical, and ophthalmologic features of cytomegalovirus retinitis after hematopoietic stem cell transplantation
Virological, clinical, and ophthalmologic features of cytomegalovirus retinitis after hematopoietic stem cell transplantation
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DOI：
10.1086/318447
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发表时间：
2001-01-15
影响因子：
11.8
通讯作者：
Boeckh, M
中科院分区：
文献类型：
--
作者：
Crippa, F;Corey, L;Boeckh, M
我们确定了10名患者谁开发的巨细胞病毒（CMV）视网膜炎后HSCT在14年期间。移植后诊断CMV视网膜炎的中位天数为251天（范围，106-365天）。CMV视网膜炎与供体或受体的CMV血清状态（P = 0.01）、100天前的CMV再激活（P = 0.007）、延迟的淋巴细胞植入（P < 0.05）和慢性移植物抗宿主病（GVHD; P < 0.001）相关。在移植后100天存活的异基因HSCT受者中，有慢性临床广泛GVHD，GVHD的发生率为1.4%（8/577）。10例患者中有5例在视网膜炎发生前有其他CMV疾病表现（4例胃肠道疾病，1例间质性肺炎;中位时间，CMV视网膜炎发作前70天;范围，58-279天），另外4例有CMV排泄。4名患者的CMV视网膜炎是双侧的; 10名患者中有9名有眼部症状（即，视力下降和飞蚊症）。7例患者中有6例对更昔洛韦或膦甲酸全身治疗反应良好，1例仅在改用西多福韦后才有所改善，1例在1983年接受移植的患者对阿昔洛韦治疗无反应。总之，巨细胞病毒视网膜炎是一种罕见的晚期并发症HSCT后，主要发生在血清阳性移植受体与以前的巨细胞病毒再激活和慢性GVHD，并延迟植入的淋巴细胞。
We identified 10 patients who developed cytomegalovirus (CMV) retinitis after HSCT during a 14-year period. The median day of diagnosis of CMV retinitis after transplantation was day 251 (range, days 106-365). CMV retinitis was associated with CMV serostatus of donor or recipient (P = 0.01), CMV reactivation before day 100 (P = 0.007), delayed lymphocyte engraftment (P < 0.05), and chronic graft versus host disease (GVHD; P < 0.001). In allogeneic recipients of HSCT who were alive at day 100 after transplantation and had chronic clinical extensive GVHD, the incidence of GVHD was 1.4% (8 of 577). Five of 10 patients had other manifestation of CMV disease before retinitis occurred (4 with gastrointestinal disease and 1 with interstitial pneumonia; median time, 70 days before onset of CMV retinitis; range, 58-279 days), and 4 others had CMV excretion. CMV retinitis was bilateral in 4 patients; 9 of 10 patients had ocular symptoms (i.e., decreased vision and floaters). Six of 7 patients responded well to ganciclovir or foscarnet systemic treatment, 1 improved only after switching to cidofovir, and 1 patient who received a transplant in 1983 did not respond to acyclovir treatment. In conclusion, CMV retinitis is an uncommon late complication after HSCT that occurs mainly in seropositive allograft recipients with previous CMV reactivation and chronic GVHD, and with delayed engraftment of lymphocytes.