Seeing the Bigger Picture: Cytomegalovirus Retinitis Screening in Pediatric Hematopoietic Stem Cell Transplant Patients. Pediatr Blood Cancer 2025 Oct;72(10):e31910
Date
07/19/2025Pubmed ID
40682285Pubmed Central ID
PMC12330953DOI
10.1002/pbc.31910Scopus ID
2-s2.0-105011050069 (requires institutional sign-in at Scopus site)Abstract
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.
Author List
Lind KT, DeSmith K, Marks B, Deb A, Dexiang G, Mehner LC, Eissa HAuthors
Arpita Deb Biostatistician I in the Data Science Institute department at Medical College of WisconsinKatherine T. Lind Postdoctoral Researcher in the Cancer Center department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AdolescentChild
Child, Preschool
Cytomegalovirus
Cytomegalovirus Retinitis
Female
Follow-Up Studies
Hematopoietic Stem Cell Transplantation
Humans
Incidence
Infant
Male
Mass Screening
Prevalence
Prognosis
Retrospective Studies
