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Erschienen in: International Journal of Hematology 2/2008

01.09.2008 | Case Report

Immune reconstitution complicated by CMV retinitis in a pediatric patient who underwent haploidentical CD34+-selected hematopoietic stem cell transplant for acute lymphoblastic leukemia

verfasst von: Simone Cesaro, Maria Paola Boaro, Marta Pillon, Elisabetta Calore, Ivete Cermakova, Katia Perruccio, Carlo Mengoli, Chiara Messina

Erschienen in: International Journal of Hematology | Ausgabe 2/2008

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Abstract

We describe two episodes of CMV retinitis in a pediatric patient who underwent a CD34+ selected graft from his haploidentical father. Both recipient and donor were cytomegalovirus (CMV) seropositive. Both episodes occurred late post-grafting during a phase of complete immunological recovery with sufficient numbers of circulating CMV-specific clones. Antiviral treatment with foscarnet and ganciclovir was successful but prolonged treatment was required to prevent relapses. We hypothesize that this complication was more related to an immune reconstitution process than to an immune-deficient state post-grafting. We conclude that CMV retinitis is a late complication of HSCT that can occur despite satisfactory immune reconstitution. Usually, it is responsive to antiviral therapy. Dilated fundoscopic examination is essential both for examining patients with reduced visual acuity and for screening asymptomatic patients.
Literatur
1.
Zurück zum Zitat Jabs DA, Van Natta ML, Kempen JH, et al. Characteristics of patients with cytomegalovirus retinitis in the era of highly active antiretroviral therapy. Am J Ophthalmol. 2002;133:48–61.CrossRefPubMed Jabs DA, Van Natta ML, Kempen JH, et al. Characteristics of patients with cytomegalovirus retinitis in the era of highly active antiretroviral therapy. Am J Ophthalmol. 2002;133:48–61.CrossRefPubMed
2.
Zurück zum Zitat Dy Lin, Warren JF, Lazzeroni LC, Wolitz RA, Mansour SE. Cytomegalovirus retinitis after initiation of highly active antiretroviral therapy in HIV infected patients: natural history and clinical predictors. Retina. 2002;22:268–77.CrossRef Dy Lin, Warren JF, Lazzeroni LC, Wolitz RA, Mansour SE. Cytomegalovirus retinitis after initiation of highly active antiretroviral therapy in HIV infected patients: natural history and clinical predictors. Retina. 2002;22:268–77.CrossRef
3.
Zurück zum Zitat Nichols GN, Boeckh M. Recent advances in the therapy and prevention of CMV infections. J Clin Virol. 2000;16:25–40.CrossRefPubMed Nichols GN, Boeckh M. Recent advances in the therapy and prevention of CMV infections. J Clin Virol. 2000;16:25–40.CrossRefPubMed
4.
Zurück zum Zitat Chung H, Kim KH, Kim JG, Lee SY, Yoon YH. Retinal complications in patients with solid organ or bone marrow transplantations. Transplantation. 2007;83:694–9.CrossRefPubMed Chung H, Kim KH, Kim JG, Lee SY, Yoon YH. Retinal complications in patients with solid organ or bone marrow transplantations. Transplantation. 2007;83:694–9.CrossRefPubMed
5.
Zurück zum Zitat Crippa F, Corey L, Chuang EL, Sale G, Boeckh M. Virological, clinical and ophthalmogic features of cytomegalovirus retinitis after hematopoietic stem cell transplantation. Clin Infect Dis. 2001;32:214–9.CrossRefPubMed Crippa F, Corey L, Chuang EL, Sale G, Boeckh M. Virological, clinical and ophthalmogic features of cytomegalovirus retinitis after hematopoietic stem cell transplantation. Clin Infect Dis. 2001;32:214–9.CrossRefPubMed
6.
Zurück zum Zitat Larsson K, Lonnqvist B, Ringden O, Hedquist B, Ljungman P. CMV retinitis after allogeneic bone marrow transplantation: a report of five cases. Transpl Infect Dis. 2002;4:75–9.CrossRefPubMed Larsson K, Lonnqvist B, Ringden O, Hedquist B, Ljungman P. CMV retinitis after allogeneic bone marrow transplantation: a report of five cases. Transpl Infect Dis. 2002;4:75–9.CrossRefPubMed
7.
Zurück zum Zitat Xhaard A, Robin M, Scieux C, et al. Increased incidence of cytomegalovirus retinitis after allogeneic hematopoietic stem cell transplantation. Transplantation. 2007;83:80–3.CrossRefPubMed Xhaard A, Robin M, Scieux C, et al. Increased incidence of cytomegalovirus retinitis after allogeneic hematopoietic stem cell transplantation. Transplantation. 2007;83:80–3.CrossRefPubMed
8.
Zurück zum Zitat Miyoshi H, Tanaka-Taya K, Nagae Y, et al. Cytomegalovirus retinitis after transplantation of positively selected CD 34+ cells from HLA mismatched donors. Ped Infect Dis J. 1998;17:345–8.CrossRef Miyoshi H, Tanaka-Taya K, Nagae Y, et al. Cytomegalovirus retinitis after transplantation of positively selected CD 34+ cells from HLA mismatched donors. Ped Infect Dis J. 1998;17:345–8.CrossRef
9.
Zurück zum Zitat Miyamoto T, Gondo H, Miyoshi Y, et al. Early viral complications following CD34-selected autologous peripheral blood stem cell transplantation for non-Hodgkin’s lymphoma. Br J Haematol. 1998;100:348–50.CrossRefPubMed Miyamoto T, Gondo H, Miyoshi Y, et al. Early viral complications following CD34-selected autologous peripheral blood stem cell transplantation for non-Hodgkin’s lymphoma. Br J Haematol. 1998;100:348–50.CrossRefPubMed
10.
Zurück zum Zitat Ohta H, Matsuda Y, Tokimasa S, et al. Foscarnet therapy for ganciclovir-resistant cytomegalovirus retinitis after stem cell transplantation: effective monitoring of CMV infection by quantitative analysis of CMV mRNA. Bone Marrow Transplant. 2001;27:1141–5.CrossRefPubMed Ohta H, Matsuda Y, Tokimasa S, et al. Foscarnet therapy for ganciclovir-resistant cytomegalovirus retinitis after stem cell transplantation: effective monitoring of CMV infection by quantitative analysis of CMV mRNA. Bone Marrow Transplant. 2001;27:1141–5.CrossRefPubMed
11.
Zurück zum Zitat Aversa F, Tabilio A, Velardi A, et al. Hematopoietic stem cell transplantation from alternative donors for high-risk acute leukemia: the haploidentical option. Curr Stem Cell Res Ther. 2007;2:105–12.CrossRefPubMed Aversa F, Tabilio A, Velardi A, et al. Hematopoietic stem cell transplantation from alternative donors for high-risk acute leukemia: the haploidentical option. Curr Stem Cell Res Ther. 2007;2:105–12.CrossRefPubMed
12.
Zurück zum Zitat Aversa F, Terenzi A, Tabilio A, et al. Full haplotype-mismatched hematopoietic stem-cell transplantation: a phase II study in patients with acute leukemia at high risk of relapse. J Clin Oncol. 2005;23:3447–54.CrossRefPubMed Aversa F, Terenzi A, Tabilio A, et al. Full haplotype-mismatched hematopoietic stem-cell transplantation: a phase II study in patients with acute leukemia at high risk of relapse. J Clin Oncol. 2005;23:3447–54.CrossRefPubMed
13.
Zurück zum Zitat Boeckh M, Gooley TA, Myerson D, Cunnigham T, Schonch G, Bowden RA. Cytomegalovirus pp65 antigenemia-guided early treatment with ganciclovir versus ganciclovir at engraftment after allogeneic marrow transplantation: a randomized double-blind study. Blood. 1996;88:4063–71.PubMed Boeckh M, Gooley TA, Myerson D, Cunnigham T, Schonch G, Bowden RA. Cytomegalovirus pp65 antigenemia-guided early treatment with ganciclovir versus ganciclovir at engraftment after allogeneic marrow transplantation: a randomized double-blind study. Blood. 1996;88:4063–71.PubMed
14.
Zurück zum Zitat Reusser P, Einsele H, Lee J, et al. Infectious diseases working party of the European group for blood and marrow transplantation. Randomized multicenter trial of foscarnet versus ganciclovir for pre-emptive therapy of cytomegalovirus infection after allogeneic stem cell transplantation. Blood. 2002;99(4):1159–64.CrossRefPubMed Reusser P, Einsele H, Lee J, et al. Infectious diseases working party of the European group for blood and marrow transplantation. Randomized multicenter trial of foscarnet versus ganciclovir for pre-emptive therapy of cytomegalovirus infection after allogeneic stem cell transplantation. Blood. 2002;99(4):1159–64.CrossRefPubMed
15.
Zurück zum Zitat Perruccio K, Tosti A, Burichelli E, et al. Transferring functional immune response to pathogens after haploidentical haematopoietic transplantation. Blood. 2005;106(13):4397–406.CrossRefPubMedPubMedCentral Perruccio K, Tosti A, Burichelli E, et al. Transferring functional immune response to pathogens after haploidentical haematopoietic transplantation. Blood. 2005;106(13):4397–406.CrossRefPubMedPubMedCentral
16.
Zurück zum Zitat Suzuki N, Kudoh T, Mizue N, et al. CMV retinitis after cessation of ganciclovir therapy for CMV antigenemia in a unrelated BMT recipient. Bone Marrow Transplant. 1998;22:931–2.CrossRefPubMed Suzuki N, Kudoh T, Mizue N, et al. CMV retinitis after cessation of ganciclovir therapy for CMV antigenemia in a unrelated BMT recipient. Bone Marrow Transplant. 1998;22:931–2.CrossRefPubMed
17.
Zurück zum Zitat Kuriyama K, Todo S, Ikishima S, et al. Risk factors for cytomegalovirus retinitis following bone marrow transplantation from unrelated donors in patients with severe aplastic anemia or myelodisplasia. Int J Hematol. 2001;74:455–60.CrossRefPubMed Kuriyama K, Todo S, Ikishima S, et al. Risk factors for cytomegalovirus retinitis following bone marrow transplantation from unrelated donors in patients with severe aplastic anemia or myelodisplasia. Int J Hematol. 2001;74:455–60.CrossRefPubMed
18.
Zurück zum Zitat Ghosh F, Hansson LJ, Bynke G, Bekassy A. Intravitreal sustained-release ganciclovir implants for severe bilateral cytomegalovirus retinitis after stem cell transplantation. Acte Ophthalmol Scand. 2002;80:101–4.CrossRef Ghosh F, Hansson LJ, Bynke G, Bekassy A. Intravitreal sustained-release ganciclovir implants for severe bilateral cytomegalovirus retinitis after stem cell transplantation. Acte Ophthalmol Scand. 2002;80:101–4.CrossRef
19.
Zurück zum Zitat Einsele H, Kapp M, Grigoleit GU. CMV-specific T cell therapy. Bllod Cells Mol Dis. 2008;40:71–5.CrossRef Einsele H, Kapp M, Grigoleit GU. CMV-specific T cell therapy. Bllod Cells Mol Dis. 2008;40:71–5.CrossRef
Metadaten
Titel
Immune reconstitution complicated by CMV retinitis in a pediatric patient who underwent haploidentical CD34+-selected hematopoietic stem cell transplant for acute lymphoblastic leukemia
verfasst von
Simone Cesaro
Maria Paola Boaro
Marta Pillon
Elisabetta Calore
Ivete Cermakova
Katia Perruccio
Carlo Mengoli
Chiara Messina
Publikationsdatum
01.09.2008
Verlag
Springer Japan
Erschienen in
International Journal of Hematology / Ausgabe 2/2008
Print ISSN: 0925-5710
Elektronische ISSN: 1865-3774
DOI
https://doi.org/10.1007/s12185-008-0126-z

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