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Updated: Apr 30, 2026
Generation of Multivirus-specific T Cells to Prevent/treat Viral Infections after Allogeneic Hematopoietic Stem Cell Transplant
Published on: May 27, 2011
Seeing the Bigger Picture: Cytomegalovirus Retinitis Screening in Pediatric Hematopoietic Stem Cell Transplant
Katherine T Lind1, Kylene DeSmith2, Brittany Marks2
1Department of Pediatrics, Center for Cancer and Blood Disorders, University of Colorado School of Medicine, Aurora, Colorado, USA.
Insights
Cytomegalovirus (CMV) retinitis screening in pediatric stem cell transplant patients showed low adherence and limited benefit from frequent exams. Ocular screenings are necessary, but a streamlined approach is recommended for better adherence and protection.
Area of Science:
- Pediatric Hematology/Oncology
- Infectious Diseases
- Ophthalmology
Background:
- Cytomegalovirus (CMV) reactivation is a significant risk in pediatric allogeneic hematopoietic stem cell transplant (HSCT) patients.
- CMV retinitis can lead to severe ocular complications.
- Previous screening protocols involved intensive retinal photography exams.
Purpose of the Study:
- Evaluate CMV retinitis prevalence and incidence post-HSCT.
- Assess adherence to a published CMV retinitis screening protocol.
- Determine the impact and efficacy of the screening protocol.
Main Methods:
- Retrospective cohort study.
- Included 228 pediatric patients undergoing allogeneic HSCT.
- Data collected from 2015 to 2021 at Children's Hospital Colorado.
Main Results:
- 25.4% of patients developed CMV viremia; 5.2% of those developed CMV retinitis.
- Adherence to screening protocol was suboptimal (27.6% compliance).
- No significant long-term ocular complications were observed despite low adherence.
Conclusions:
- CMV retinitis developed 5-12 weeks after viremia detection, questioning the clinical significance of early screening.
- All patients with CMV retinitis were asymptomatic, underscoring the need for ocular screenings.
- A streamlined screening approach is advocated to improve adherence and protect ocular health.
Introduction:
Cytomegalovirus (CMV) reactivation poses significant risks in pediatric patients undergoing allogeneic hematopoietic stem cell transplant (HSCT), including the potential for CMV retinitis, which can cause severe ocular complications. A previously published CMV retinitis screening protocol called for intensive and frequent screening exams with retinal photography.
Objectives:
To evaluate the prevalence and incidence of CMV retinitis, assess institutional adherence to previously published protocol, and determine the impact and efficacy of the CMV retinitis screening protocol.
Methods:
Retrospective cohort study of 228 patients treated at Children's Hospital Colorado from 2015 to 2021.
Results:
Among allogeneic HSCT patients, 25.4% developed CMV viremia, and of these, three developed CMV retinitis (mean time from viremia to retinitis diagnosis: 53.6 days). Adherence to the protocol was suboptimal; 27.6% of patients with CMV viremia underwent recommended dilated fundus exam and photography within 2 weeks of diagnosis. Despite this, no significant long-term ocular complications were noted, suggesting limited benefit from early and frequent screenings.
Conclusions:
Within this cohort, 5.2% of patients with CMV viremia developed retinitis, and 15.4% of all patients developed at least one ocular complication. Universal pre-HSCT screening with fundus photography did not result in early detection of retinitis. In this cohort, CMV retinitis did not develop until 5-12 weeks after viremia was detected, making early screening unlikely to have clinical significance. This study highlights the necessity of ocular screenings-as all patients with CMV retinitis were asymptomatic-but advocates for a more streamlined approach to improve adherence and protect ocular health during the vulnerable post-transplant period.
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