Conjunctival Acute Graft-versus-Host Disease in Adult Patients Receiving Allogeneic Hematopoietic Stem Cell Transplantation: A Cohort Study

Abstract

BackgroundTo investigate the incidence, risk factors and survival of conjunctival acute graft-versus-host disease (aGVHD) in adult patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT)MethodsThis retrospective study included a total of 139 patients undergoing allogeneic HSCT between January 2012 and December 2014 at a tertiary referral hospital. Patients with ocular complaints after allogeneic HSCT or first donor lymphocyte infusion were evaluated by ophthalmologists. The risk factors for conjunctival aGVHD were analyzed using the Cox proportional hazards model. The overall survival was evaluated using Kaplan-Meier estimates.ResultsThirteen (9.4%) patients developed conjunctival aGVHD, including eight patients with pseudomembranous conjunctivitis. The cumulative incidence of conjunctival aGVHD was 2.1 cases per 10,000 person-day. The median age at HSCT was 47 years (range, 18 to 66) in all patients and 42 years (range, 24 to 58) in the 13 patients with conjunctival aGVHD. Median time of follow-up after allogeneic HSCT was 353 days (range, 11 to 1184). In univariate analysis, grades II-IV skin aGVHD (P = 0.002) and advanced systemic aGVHD except skin aGVHD (overall grades III-IV) (P = 0.001) were significant predictors for conjunctival aGVHD. In multivariate analysis, grades II-IV skin aGVHD was a significant risk factor (P = 0.04). The severity of conjunctival aGVHD was generally correlated with the systemic aGVHD (P = 0.001). Overall survival was significantly shorter in patients with grades II-IV aGVHD compared to those with grade 0-I (P = 0.01). Survival in patients with conjunctival aGVHD did not differ significantly from those without this complication (P = 0.94). In the subgroup analysis of patients with grades III-IV aGVHD, survival was significantly longer in patients with conjunctival involvement than those without (P = 0.03).ConclusionsThe severity of conjunctival aGVHD is correlated with systemic aGVHD, but not with inferior overall survival.

The role of Th17 immunity in chronic ocular surface disorders

“…oGVHD is a common and potentially severe complication of allogeneic hematopoietic stem cell transplantation (HSCT) [27,28]. Patients who receive allogeneic HSCT develop oGVHD in 40-60% of cases, which significantly impairs their quality of life [29,30]. Using a murine model of hematopoietic stem cell transplantation based on major histocompatibility match and minor histocompatibility mismatch, Heretes et al have demonstrated the infiltration of donor CD4 (and also CD8) T cells in GVHD associated corneal ulcerations [25].…”

Involvement of ocular surface in graft‐versus‐host disease: An update from immunopathogenesis to treatment

“…A clinical severity score has been proposed for this ocular complication: 0 = absence of ocular surface disease, 1 = presence of conjunctival hyperemia, 2 = presence of conjunctival hyperemia associated with serosanguinous discharge, 3 = presence of pseudomembranous conjunctivitis, 4 = presence of pseudomembranous conjunctivitis associated with corneal epithelial sloughing (Jabs et al, 1989). Recent evidence describes that the severity of ocular surface disorders are correlated with the severity of systemic aGVHD, but it does not affect the patient's survival (Liu et al, 2016).…”