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Su-Mi Choi, M.D., Dong-Gun Lee, M.D.
, Sun Hee Park, M.D., Si-Hyun Kim, M.D., Yoo-Jin Kim, M.D., Chang-Ki Min, M.D., Hee-Je Kim, M.D., Seok Lee, M.D., Jung-Hyun Choi, M.D., Jin-Hong Yoo, M.D., Dong-Wook Kim, M.D., Jong-Wook Lee, M.D., Woo-Sung Min, M.D., Wan-Shik Shin, M.D., Chun-Choo Kim, M.D.
, Sun Hee Park, M.D., Si-Hyun Kim, M.D., Yoo-Jin Kim, M.D., Chang-Ki Min, M.D., Hee-Je Kim, M.D., Seok Lee, M.D., Jung-Hyun Choi, M.D., Jin-Hong Yoo, M.D., Dong-Wook Kim, M.D., Jong-Wook Lee, M.D., Woo-Sung Min, M.D., Wan-Shik Shin, M.D., Chun-Choo Kim, M.D.
Abstract
Background
Studies on cytomegalovirus (CMV) diseases in Korean hematopoietic stem cell transplant (HSCT) recipients are lacking and do not reflect the recent trends of advances and changes. Therefore, we tried to analyze the clinical features of CMV diseases in HSCT recipients over the past 10 years at a tertiary university hospital in Korea.
Methods
Retrospective review of medical records was done for all adult HSCT patients who received transplant at the Catholic HSCT Center from January 1998 to January 2008.
Results
Forty-four cases (2.2%) of CMV diseases were identified. CMV pneumonia was diagnosed in 17 patients, retinitis in 16 patients, enterocolitis in 7 patients, esophagitis 1 patient, gastritis in 1 patient, duodenitis in 1 patient, and hepatitis in 1 patient. The median onset of symptom was 90 days after transplantation. Late CMV diseases accounted for 47.7%. CMV related death varied from 0 to 58.8% according to the involved organ. CMV retinitis was diagnosed relatively later in the course of transplantation mostly in patients who had chronic graft versus host disease (GVHD). On the contrary, CMV enterocolitis mainly occurred in patients who suffered from acute GVHD. The overall concurrent CMV reactivation was documented to be 63.6%; the concurrent CMV reactivation was observed only in 37.5% of patients with retinitis.
Conclusions
We observed some differences in the pattern of CMV disease manifestation according to the involved organ and reconfirmed the fact that CMV pneumonia is the most common and fatal disease in HSCT recipients. Additionally, CMV retinitis was not uncommon in HSCT recipients. Since specific marker does not exist in predicting retinitis, regular ocular examination should be done thoroughly, especially in patients with chronic GVHD.
Figures and Tables
Figure 1
Prevalence of CMV diseases in allogeneic stem cell transplant recipients according to transplant year (A). Trend of occurrence of CMV disease according to involved organ in stem cell transplant recipients including autologus transplantation (B).
*Two patients who had CMV diseases involving more than two sites, were classified into the retinitis.
Table 1
Clinical Features of Patients with Cytomegalovirus Pneumonia after Stem Cell Transplantation
Abbreviations : ABL, acute biphenotypic leukemia; Ag, antigenemia; AML, acute myelogenous leukemia; ALL, acute lymphocytic leukemia; ARDS, acute respiratory distress syndrome; CML, chronic myelogenous leukemia; FOS, foscarnet; GCV, ganciclovir; IVIG, intravenous immunoglobulins; M, male; m, HLA-matched; mis, HLA-mismatched; MDS, myelodysplastic syndrome; no., the number of preemptive therapy; Pt, patient; SAA, severe aplastic anemia; TP, transplantation; Tx, treatment
Table 2
Clinical Features of Patients with Cytomegalovirus Retinitis after Stem Cell Transplantation
*CMV pneumonia combined with retinitis was additionally diagnosed at post transplantation day 157.
†CMV ventriculo-encephalitis were additionally diagnosed at post transplantation day 184.
Abbreviations : ABL, acute biphenotypic leukemia; Ag, antigenemia; aGVHD, acute graft-versus-host disease; AML, acute myelogenous leukemia; ALL, acute lymphocytic leukemia; ARDS, acute respiratory distress syndrome; CML, chronic myelogenous leukemia; FOS, foscarnet; GCV, ganciclovir; IPA, invasive pulmonary aspergillosis; IVIG, intravenous immunoglobulins; M, male; m, HLA-matched; mis, HLA-mismatched; MDS, myelodysplastic syndrome; NHL, non-Hodgkin's lymphoma; no., the number of preemptive therapy; PP, pneumocystis pneumonia; Pt, patient; SAA, severe aplastic anemia; TP, transplantation; TTP, thrombotic thrombocytopenic purpura; Tx, treatment; VGCV, valganciclovir; VSAA, very severe aplastic anemia
Table 3
Clinical Features of Patients with Cytomegalovirus Enteritis and Hepatitis after Stem Cell Transplantation
Abbreviations : ABL, acute biphenotypic leukemia; Ag, antigenemia; GVHD, graft-versus-host disease; AML, acute myelogenous leukemia; ALL, acute lymphocytic leukemia; CHB, chronic hepatitis B; CML, chronic myelogenous leukemia; FOS, foscarnet; GCV, ganciclovir; IVIG, intravenous immunoglobulins; M, male; m, HLA-matched; mis, HLA-mismatched; MM, multiple myeloma; no., the number of preemptive therapy; PMC, pseudomembranous colitis; Pt, patient; TP, transplantation; TTP, thrombotic thrombocytopenic purpura; Tx, Treatment
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