Eye graft-versus-host disease in patients with allogeneic hematopoietic stem cell transplantation (updated data)
Alexandra L. Mikhaylova1, Yuri S. Astakhov2, Boris V. Afanasyev1
1Memorial R.M. Gorbacheva Institute of Children Hematology and Transplantation, St. Petersburg Pavlov State Medical University, St. Petersburg, Russia; 2Chair of Ophthalmology of St. Petersburg Pavlov State Medical University, St. Petersburg, Russia
Summary
Graft versus-host-disease (GVHD) is a complication caused by allogeneic hematopoietic stem cell transplantation (HSCT). It can cause dry eye syndrome.
Objectives
To evaluate the probability of eye acute and chronic GVHD (aGVHD and cGVHD) occurrence and response to topical therapy, including drops with cyclosporine 0.05%.
Methods
Two hundred and twelve patients with different hematological malignancies were treated with allogenic HSCT and underwent ophthalmological examination (2006–2009). Dry eye disease stages were diagnosed according to clinical symptoms, positive staining with fluorescein, Schirmer’s I test results, and a tear film break-up time. The treatment schedules were: Stage 1: artificial tears b.i.d. or t.i.d.; Stage 2: artificial tears t.i.d. and dexamethasone 0.1% t.i.d. topical; Stage 3: artificial tears 4–6 times/day, dexamethasone 0.1% t.i.d. topical and cyclosporin A 0.05% 1 drop/eye b.i.d. The Wilcoxon pair matched test, Spearman test, and Pearson test were used for statistical analysis.
Results
Ophthalmologic complications were observed in 48.5% (103/212) of HSCT patients. Eye GVHD was revealed in 25% of patients. Forty-four patients were eligible for assessment of system cGVHD. Among them, 70% (31/44) of patients had signs of dry eye syndrome. All patients with aGVHD received systemic GVHD prophylaxis and eye component of aGVHD responded quickly to local dexamethasone 0.1% treatment. The median day of onset of eye cGVHD was D+145±29. The Table 1 represents eye cGVHD treatment results.
There was a strong correlation between both tests (p=0.004). Three patients could not tolerate cyclosporine topical treatment due to intensive local conjunctive irritation.
Conclusion
About half of treated patients had signs of different eye complications. The frequency of eye cGVHD was 70%. Cyclosporine local therapy proved to be an effective treatment of Stage 3 dry eye syndrome caused by cGVHD.
Keywords
graft-versus-host disease, GVHD, dry eye syndrome, cyclosporin, hematopoietic stem cell transplantation, HSCT
Table 1.
|
Stages of dry eye syndrome |
Schirmer’s I test |
Norn test |
||||
|
before treatment |
after 3 months treatment |
p value |
before treatment |
after 3 months treatment |
p value |
|
|
1 n=18 |
13.0±1.2
|
15.46±0.72 |
0.20 |
7.63±0.66 |
12.07±0.43 |
0.003 |
|
2 n=16 |
6.28±0.61 |
7.92±0.51 |
0.003 |
5.81±0.75 |
7.34±0.49 |
0.026 |
|
3 n=24 |
1.21±0.45 |
4.71±0.62 |
0.0004 |
1.69±0.48 |
5.65±0.43 |
0.0002 |
