Incidence and risk factors for ocular GVHD after allogeneic hematopoietic stem cell transplantation

Abstract

We analyzed the incidence and risk factors for ocular GVHD in patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT) in Korea. In this retrospective, noncomparative, observational study, 635 subjects were included who had at least 2 years of follow-up ophthalmological examinations after allo-HSCT from 2009 to 2012 at Seoul St Mary's Hospital, Seoul, Korea. The mean duration between allo-HSCT and onset of ocular GVHD was 225.5 ± 194.3 days. The adjusted incidence for acute ocular GVHD was 1.33% and that for chronic GVHD was 33.33%. In the multivariate analysis, preexisting diabetes mellitus (odds ratio (OR): 4.22, 95% confidence interval (CI): 1.66-10.72), repeated allo-HSCT (OR: 29.10, 95% CI: 1.02-8.28) and the number of organs that chronically developed GVHD by stage I (OR: 14.63, 95% CI: 9.81-21.84) increased risk of ocular GVHD. Careful monitoring of ocular GVHD is needed in patients with chronic GVHD in multiple organs and preexisting diabetes.

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

“…The proportion (13/139) of conjunctival aGVHD in our cohort is consistent with the results of previous reports (7.2%-17%) [16–18]. All of our patients developed conjunctival complications during episodes of systemic aGVHD, which was also in line with previous findings [18, 23]. In our cohort, the 15 days median onset time of conjunctivitis after the first manifestation of systemic involvement was similar to a previous report (14 days) [17].…”

Ocular Graft-versus-Host Disease after Hematopoietic Cell Transplantation: Expert Review from the Late Effects and Quality of Life Working Committee of the Center for International Blood and Marrow Transplant Research and Transplant Complications Working Party of the European Society of Blood and Marrow Transplantation

“…Using this definition, ocular GVHD was present in 16% of patients by 100 days after allogeneic HCT, and the cumulative incidence increased to 35% at 2 years after HCT [10]. A similar incidence of 33% was reported in a study of 635 patients using the 2005 National Institutes of Health (NIH) diagnostic criteria that include the Schirmer test [30]. In a prospective multicenter study of patients with chronic GVHD (diagnosed according to the 2005 NIH criteria), the eyes were the third most commonly involved organ, affecting 51% of patients at the time of chronic GVHD diagnosis.…”

“…Risk factors associated with the onset of ocular GVHD are summarized in Table 2. Several studies have identified previous acute GVHD [10,30], use of peripheral blood stem cells [30,32], and HCT from a female donor to a male recipient [10,33] as associated with ocular GVHD. A single retrospective study identified the absence of antithymocyte globulin prophylaxis, more organs with GVHD, non-Caucasian patient, and Epstein-Barr virus-seropositive donor as associated with ocular GVHD [30,34].…”

Ocular and nasal symptoms prior to acute skin graft‐versus‐host disease

“…Ocular GVHD is a well known symptom of chronic phase GVHD . The most frequent manifestation is dry eye syndrome (keratoconjunctivitis sicca) .…”

“…The most frequent manifestation is dry eye syndrome (keratoconjunctivitis sicca) . Onset in the acute phase, however, is rare and usually occurs in the context of other systemic GVHD because the cornea and conjunctiva are immunological targets, with histology similar to that seen in cutaneous GVHD . Ocular involvement is considered to be a poor prognostic factor for mortality due to systemic acute GVHD .…”