Ocular outcomes after treatment of cytomegalovirus retinitis using adoptive immunotherapy with cytomegalovirus-specific cytotoxic t lymphocytes Journal Article
| Authors: | Gupta, M. P.; Koenig, L. R.; Doubrovina, E.; Hasan, A.; Dahi, P. B.; O'Reilly, R. J.; Koehne, G.; Orlin, A.; Chan, R. V. P.; D'Amico, D. J.; Park, S. S.; Burkholder, B. M.; Kiss, S. |
| Article Title: | Ocular outcomes after treatment of cytomegalovirus retinitis using adoptive immunotherapy with cytomegalovirus-specific cytotoxic t lymphocytes |
| Abstract: | Purpose: To describe ocular outcomes in eyes with cytomegalovirus (CMV) retinitis treated with adoptive immunotherapy using systemic administration of CMV-specific cytotoxic Tlymphocytes (CMV-specific CTLs). Design: Retrospective cohort study. Participants: Patients with active CMV retinitis evaluated at a tertiary care academic center. Methods: Treatment of CMV retinitis with standard-of-care therapy (systemic or intravitreal antivirals) or CMV-specific CTLs (with or without concurrent standard-of-care therapies). Main Outcome Measures: The electronic medical record was reviewed to determine baseline characteristics, treatment course, and ocular outcomes, including best-corrected visual acuity (BCVA), treatments administered (CMV-specific CTLs, systemic antivirals, intravitreal antivirals), resolution of CMV retinitis, any occurrence of immune recovery uveitis, cystoid macular edema, retinal detachment, or a combination thereof. Results: Seven patients (3 of whom had bilateral disease [n = 10 eyes]) were treated with CMV-specific CTLs, whereas 20 patients (6 of whom had bilateral disease [n = 26 eyes]) received standard-of-care treatment. Indications for CMV-specific CTL therapy included persistent or progressive CMV retinitis (71.4% of patients); CMV UL54 or UL97 antiviral resistance mutations (42.9%); side effects or toxicity from antiviral agents (57.1%); patient intolerance to longstanding, frequent antiviral therapy for persistent retinitis (28.6%); or a combination thereof. Two patients (28.6%; 4 eyes [40%]) received CMV-specific CTL therapy without concurrent systemic or intravitreal antiviral therapy for active CMV retinitis, whereas 5 patients (71.4%; 6 eyes [60%]) continued to receive concurrent antiviral therapies. Resolution of CMV retinitis was achieved in 9 eyes (90%) treated with CMV-specific CTLs, with BCVA stabilizing (4 eyes [40%]) or improving (4 eyes [40%]) in 80% of eyes over an average follow-up of 33.4 months. Rates of immune recovery uveitis, new-onset cystoid macular edema, and retinal detachment were 0%, 10% (1 eye), and 20% (2 eyes), respectively. These outcomes compared favorably with a nonrandomized cohort of eyes treated with standard-of-care therapy alone, despite potentially worse baseline characteristics. Conclusions: CMV-specific CTL therapy may represent a novel monotherapy or adjunctive therapy, or both, for CMV retinitis, especially in eyes that are resistant, refractory, or intolerant of standard-of-care antiviral therapies. More generally, adoptive cell transfer and adoptive immunotherapy may have a role in refractory CMV retinitis. Larger prospective, randomized trials are necessary. © 2021 American Academy of Ophthalmology |
| Keywords: | t cells; cell therapy; cmv retinitis |
| Journal Title: | Ophthalmology Retina |
| Volume: | 5 |
| Issue: | 9 |
| ISSN: | 2468-6530 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2021-09-01 |
| Start Page: | 838 |
| End Page: | 849 |
| Language: | English |
| DOI: | 10.1016/j.oret.2021.04.009 |
| PUBMED: | 33892135 |
| PROVIDER: | scopus |
| PMCID: | PMC9394456 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 1 October 2021 -- Source: Scopus |
Altmetric
Citation Impact
BMJ Impact Analytics
MSK Authors
-
101Doubrovina -
56Hasan -
747O'Reilly -
294Dahi
Related MSK Work