Ocular complications in a young pediatric population following bone marrow transplantation

Hoehn, Mary Ellen; Calderwood, Julie; Gannon, Edwin; Cook, Brittany; Rochester, Richard; Hartford, Christine; Sunkara, Anusha; Kang, Guolian; Walton, R. Christopher

doi:10.1016/j.jaapos.2017.10.010

Cited by 15 publications

(5 citation statements)

References 20 publications

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“…This may be due to our small sample size. Unlike other authors, 28 our study showed an association between oGVHD and cataracts. The potentially significant visual impact of cataracts highlights the importance of ophthalmological assessments in this population.…”

Section: Rationale For Ogvhd Associationscontrasting

confidence: 90%

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Risk Factors for Ocular Involvement in Pediatric Graft-Versus-Host Disease

Hébert

Archambault

Doyon

et al. 2021

Cornea

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To identify risk factors for ocular graft-versus-host disease (oGVHD) in children with graft-versus-host disease (GVHD).Methods: This retrospective cohort study identified 38 children diagnosed with GVHD who underwent an ophthalmological examination. Survival to onset of oGVHD after transplant was analyzed using Kaplan-Meier analyses with log-rank tests. A multivariable Cox proportional hazards model was run for time to oGVHD using univariate risk factors. Results:The average age was 10.0 6 5.4 years at the time of transplant. Underlying illness was acute lymphoblastic leukemia in 19 (50%) and acute myeloid leukemia in 8 (21%). Nonocular GVHD organ involvement included skin (84%), lungs (16%), intestines (50%), liver (24%), and bone marrow (3%). Fifteen children (39%) had oGVHD, of which 47% were asymptomatic. oGVHD was diagnosed 601 6 878 days after GVHD. A significant association between risk of oGVHD and diagnosis of acute lymphoblastic leukemia (P = 0.10) or acute myeloid leukemia (P = 0.08) was not found. Organ involvement associated with oGVHD included skin (P = 0.03) and lungs (P = 0.02). Survival curves were significantly influenced by GVHD organ involvement (P = 0.02), but not underlying disease (P = 0.51). The adjusted Cox regression model yielded an independent hazard ratio of 8.82 (95% CI: 1.51-51.49; P = 0.016) for the presence of concomitant GVHD involvement of skin, lungs, and another organ.Conclusions: Children with multiorgan GVHD involvement including skin and lung disease are at increased risk for oGVHD. Given the proportion of asymptomatic cases found in this series, regular eye examinations are warranted in this population.

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Section: Rationale For Ogvhd Associationscontrasting

confidence: 90%

“…In addition, the increased prevalence of ocular complications related or unrelated to oGVHD after transplants has led other authors to advocate for yearly examinations. 19,28 Based on our findings, we advocate for frequent follow-ups, especially in patients with cutaneous, pulmonary, or multiorgan involvement of GVHD.…”

Section: Discussionmentioning

confidence: 79%

Risk Factors for Ocular Involvement in Pediatric Graft-Versus-Host Disease

Hébert

Archambault

Doyon

et al. 2021

Cornea

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“…Suh et al 16 reported that ocular changes developed in 51% of pediatric patients after HSCT and the frequency of dry eye syndrome was 12.5% at a mean age of 8.4 years. Hoehn et al 17 found the prevalence of dry eye syndrome in 14-year-olds as 41.4%. In our series, dry eye was detected in 30 (63.8%) of 47 patients with GVHD at a mean age of 11.8 years.…”

Section: Discussionmentioning

confidence: 99%

Ocular Findings of Pediatric Dry Eye Related to Graft-Versus-Host Disease

Kızıltunç¹,

Büyüktepe²,

Yalçındağ³

et al. 2021

tjo

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Objectives: To evaluate the frequency and findings of dry eye associated with ocular graft-versus-host disease (GVHD) in pediatric hematopoietic stem cell transplantation (HSCT) patients. Materials and Methods: Retrospectively the records of pediatric patients with ocular GVHD were evaluated and ophthalmologic examination findings as well as Schirmer test results, tear film break-up time, and corneal staining grades were recorded. In severe dry eye patients topical cyclosporine-A was prescribed and the results were evaluated. Results: GVHD was detected in 51 (23.4%) of 218 HSCT patients, 4 of whom died during follow-up. Thirty (63.8%) of the remaining 47 patients had chronic ocular GVHD and 4 patients with severe dry eye were treated with topical cyclosporine-A with a median follow-up of 12.1 months. Severe dry eye symptoms and findings significantly improved in 2 patients. However, 1 patient had to stop treatment due to side effects. Conclusion: In children, chronic ocular GVHD is a common finding of GVHD after HSCT. Therefore, these patients should be examined periodically for dry eye.

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“…For example, we found a 10-year cumulative incidence of cataracts of 15% (95% CI, 11%-19%) for patients exposed to TBI, whereas other studies in children and adults have reported rates of 30% to 70% for cataract development at 10 years after transplant for patients exposed to fractionated TBI. [40][41][42] However, it is possible that technological advances in radiotherapy techniques beginning in the year 2000 may have contributed to less ocular toxicity in recent years. Similarly, as mentioned earlier, the low rate of gonadal dysfunction reported in this cohort was quite low.…”

Section: Discussionmentioning

confidence: 99%

Late effects after ablative allogeneic stem cell transplantation for adolescent and young adult acute myeloid leukemia

Lee

Kim

Tecca³

et al. 2020

Blood Advances

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There is marked paucity of data regarding late effects in adolescents and young adults (AYAs) who undergo myeloablative conditioning (MAC) allogeneic hematopoietic cell transplantation (HCT) for acute myeloid leukemia (AML). We evaluated late effects and survival in 826 1-year disease-free survivors of MAC HCT for AYA AML, with an additional focus on comparing late effects based upon MAC type (total body irradiation [TBI] vs high-dose chemotherapy only). The estimated 10-year cumulative incidence of subsequent neoplasms was 4% (95% confidence interval [CI], 2%-6%); 10-year cumulative incidence of nonmalignant late effects included gonadal dysfunction (10%; 95% CI, 8%-13%), cataracts (10%; 95% CI, 7%-13%), avascular necrosis (8%; 95% CI, 5%-10%), diabetes mellitus (5%; 95% CI, 3%-7%), and hypothyroidism (3%; 95% CI, 2%-5%). Receipt of TBI was independently associated with a higher risk of cataracts only (hazard ratio [HR], 4.98; P < .0001) whereas chronic graft-versus-host disease (cGVHD) was associated with an increased risk of cataracts (HR, 3.22; P = .0006), avascular necrosis (HR, 2.49; P = .006), and diabetes mellitus (HR, 3.36; P = .03). Estimated 10-year overall survival and leukemia-free survival were 73% and 70%, respectively, and did not differ on the basis of conditioning type. In conclusion, late effects among survivors of MAC HCT for AYA AML are frequent and are more closely linked to cGVHD than type of conditioning.

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Ocular complications in a young pediatric population following bone marrow transplantation

Cited by 15 publications

References 20 publications

Risk Factors for Ocular Involvement in Pediatric Graft-Versus-Host Disease

Risk Factors for Ocular Involvement in Pediatric Graft-Versus-Host Disease

Ocular Findings of Pediatric Dry Eye Related to Graft-Versus-Host Disease

Late effects after ablative allogeneic stem cell transplantation for adolescent and young adult acute myeloid leukemia

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