Clinical Manifestations and Risk Factors of Ocular Graft-versus-Host Disease (GVHD) after Hematopoietic Stem Cell Transplantation.
10.3341/jkos.2014.55.7.969
- Author:
Min Gyu LEE
1
;
Gi Hyun BAE
;
Dong Hui LIM
;
Eui Sang CHUNG
;
Tae Young CHUNG
Author Information
1. Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. tychung@skku.edu
- Publication Type:Original Article
- Keywords:
Allogeneic hematopoietic stem cell transplantation (HSCT);
Incidence;
Ocular graft-versus-host disease (GVHD);
Risk factors;
Survival
- MeSH:
Conjunctival Diseases;
Follow-Up Studies;
Gastrointestinal Tract;
Graft vs Host Disease*;
Hematopoietic Stem Cell Transplantation*;
Humans;
Incidence;
Medical Records;
Retrospective Studies;
Risk Factors*;
Skin
- From:Journal of the Korean Ophthalmological Society
2014;55(7):969-977
- CountryRepublic of Korea
- Language:Korean
-
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.
