PMID- 22657564
OWN - NLM
STAT- MEDLINE
DCOM- 20121123
LR  - 20120904
IS  - 1549-4713 (Electronic)
IS  - 0161-6420 (Linking)
VI  - 119
IP  - 9
DP  - 2012 Sep
TI  - Risk factors for cytomegalovirus retinitis in patients with cytomegalovirus 
      viremia after hematopoietic stem cell transplantation.
PG  - 1892-8
LID - 10.1016/j.ophtha.2012.03.032 [doi]
AB  - PURPOSE: To evaluate the risk factors for cytomegalovirus (CMV) retinitis in 
      patients with CMV viremia after hematopoietic stem cell transplantation (HSCT). 
      DESIGN: Retrospective cohort study. PARTICIPANTS: We included all patients with 
      CMV viremia detected by polymerase chain reaction after HSCT between April 2009 
      and August 2011. Risk factors for CMV retinitis were evaluated in the cohort of 
      270 patients with CMV viremia, who survived >/= 12 weeks after HSCT and were 
      screened for CMV retinitis. METHODS: Retrospective review of clinical records and 
      laboratory results. MAIN OUTCOME MEASURES: Survival analysis of patients in the 
      cohort and frequency of CMV retinitis in relation to various factors. Variables 
      analyzed were demographics, human leukocyte antigen (HLA) matched versus 
      mismatched, related versus unrelated donor, preconditioning regimens, delayed 
      engraftment of lymphocyte, presence of acute or chronic graft-versus-host 
      disease, highest CMV DNA level in blood (copies/ml), cumulative period of CMV 
      viremia (weeks), and CMV infection verified by culture or immunohistology in 
      bronchoalveolar lavage or visceral biopsy specimens. RESULTS: Of the 708 patients 
      who underwent HSCT during the study period, 363 (51%) developed CMV viremia after 
      HSCT. Of the 363 patients with CMV viremia, 270 underwent retinal examination for 
      CMV retinitis. We detected CMV retinitis in 15 of 270 patients with CMV viremia. 
      In the univariate analysis, HLA-mismatched HSCT, HSCT from an unrelated donor, 
      engraftment day, peak CMV DNA level, and duration of viremia were associated with 
      the development of CMV retinitis. In the adjusted multivariate analysis, only 
      peak CMV DNA blood levels predicted the development of CMV retinitis (hazard 
      ratio, 25.0; 95% confidence interval, 3.0-210.8). An additional validity analysis 
      by receiver operating characteristic area under curve suggested that a cutoff of 
      7.64 x 10(4) copies/mL best predicted the development of CMV retinitis by CMV DNA 
      levels in blood. CONCLUSIONS: The development of CMV retinitis should be 
      carefully monitored in patients with a significant viral load, which is 
      represented by a peak CMV DNA level >7.64 x 10(4) copies/ml and a long duration 
      of CMV viremia, especially when patients received HSCT from an unrelated or 
      HLA-mismatched donor and showed delayed lymphocyte engraftment.
CI  - Copyright (c) 2012 American Academy of Ophthalmology. Published by Elsevier Inc. 
      All rights reserved.
FAU - Jeon, Sohee
AU  - Jeon S
AD  - Department of Ophthalmology, Seoul St. Mary's Hospital, The Catholic University 
      of Korea College of Medicine, Seoul, South Korea.
FAU - Lee, Won Ki
AU  - Lee WK
FAU - Lee, Yongeun
AU  - Lee Y
FAU - Lee, Dong Gun
AU  - Lee DG
FAU - Lee, Jong Wook
AU  - Lee JW
LA  - eng
PT  - Journal Article
DEP - 20120530
PL  - United States
TA  - Ophthalmology
JT  - Ophthalmology
JID - 7802443
RN  - 0 (DNA, Viral)
RN  - 0 (Histocompatibility Antigens)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Cohort Studies
MH  - Cytomegalovirus/*physiology
MH  - Cytomegalovirus Retinitis/*epidemiology/virology
MH  - DNA, Viral/blood
MH  - Female
MH  - Graft vs Host Disease/diagnosis
MH  - *Hematopoietic Stem Cell Transplantation
MH  - Histocompatibility Antigens/immunology
MH  - Histocompatibility Testing
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Survival Analysis
MH  - Transplantation Conditioning
MH  - Viral Load
MH  - Viremia/*epidemiology/virology
MH  - Young Adult
EDAT- 2012/06/05 06:00
MHDA- 2012/12/10 06:00
CRDT- 2012/06/05 06:00
PHST- 2011/12/20 00:00 [received]
PHST- 2012/03/16 00:00 [revised]
PHST- 2012/03/16 00:00 [accepted]
PHST- 2012/06/05 06:00 [entrez]
PHST- 2012/06/05 06:00 [pubmed]
PHST- 2012/12/10 06:00 [medline]
AID - S0161-6420(12)00269-2 [pii]
AID - 10.1016/j.ophtha.2012.03.032 [doi]
PST - ppublish
SO  - Ophthalmology. 2012 Sep;119(9):1892-8. doi: 10.1016/j.ophtha.2012.03.032. Epub 
      2012 May 30.