J Korean Ophthalmol Soc.  2014 Jul;55(7):969-977.

Clinical Manifestations and Risk Factors of Ocular Graft-versus-Host Disease (GVHD) after Hematopoietic Stem Cell Transplantation

• Lee MG
• Bae GH
• Lim DH
• Chung ES
• Chung TY

Abstract

PURPOSE
To investigate the incidence, clinical manifestations, and risk factors of ocular graft-versus-host disease (GVHD) as well as the survival of the patients after allogeneic hematopoietic stem cell transplantation (HSCT).
METHODS
The medical records of 99 patients who visited our clinic and were screened for ocular GVHD after allogeneic HSCT were reviewed retrospectively. Subjects were divided into 2 groups depending on the occurrence of ocular GVHD on slit-lamp biomicroscopy. We compared clinical manifestations and survival between the 2 groups and analyzed the risk factors associated with the development of ocular GVHD.
RESULTS
Ocular GVHD was diagnosed in 38 patients (38.38%) at a mean of 315 days after HSCT. Out of the 38 patients who developed ocular GVHD, 22 patients (57.89%) were diagnosed with dry eye only and 16 patients (42.11%) were diagnosed with conjunctival disease. The presence of extraocular GVHD (hazard ratio (HR) 35.76, p < 0.001), the number of extraocular GVHD (HR 3.07, p < 0.001), skin GVHD (HR 2.31, p = 0.029), oral GVHD (HR 8.16, p < 0.001), and gastrointestinal tract GVHD (HR 5.00, p = 0.002) were independent risk factors of ocular GVHD. Comparisons of the survival demonstrated decreased survival of patients with conjunctival disease compared to patients without ocular GVHD and patients with dry eye only, but there was no statistically significant differences (log rank test, p = 0.208).
CONCLUSIONS
Ocular GVHD is common after allogeneic HSCT. The majority of ocular GVHD occurs in the chronic stage and is associated with decreased survival. Therefore, more intensive and long-term follow-up with ophthalmic and systemic monitoring is necessary, especially in patients who have extraocular GVHD, for early recognition and proper treatment of ocular GVHD.

Keyword

Allogeneic hematopoietic stem cell transplantation (HSCT); Incidence; Ocular graft-versus-host disease (GVHD); Risk factors; Survival

MeSH Terms

Conjunctival Diseases
Follow-Up Studies
Gastrointestinal Tract
Graft vs Host Disease*
Hematopoietic Stem Cell Transplantation*
Humans
Incidence
Medical Records
Retrospective Studies
Risk Factors*
Skin

Figure

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  Figure 1. Cumulative incidence of ocular GVHD after allogeneic hematopoietic stem cell transplantation. Probability of developing ocular GVHD was 48.33% at 2 years. GVHD = graft-versus-host disease; HSCT = hematopoietic stem cell transplantation.

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  Figure 2. Categorization of subjects who developed ocular graft-versus-host disease after allogeneic hematopoietic stem cell transplantation by clinical courses. GVHD = graft-versus-host disease.

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  Figure 3. Kaplan-Meier survival curves of 3 groups according to the manifestation of ocular GVHD in patients who underwent allogeneic hematopoietic stem cell transplantation. Survival rates of groups of patients without ocular GVHD, with dry eye only, and with conjunctival disease are 79.8%, 95.5%, and 72.7% at 1 year, 56.9%, 70.9%, and 46.5% at 2 years, and 52.2%, 60.8%, and 34.9% at 3 years after allogeneic hematopoietic stem cell transplantation, respectively (log rank test, p = 0.208). GVHD = graft-versus-host disease; HSCT = hematopoietic stem cell transplantation.

Reference

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