Prevalence and risk factors associated with development of ocular GVHD defined by NIH consensus criteria

• Published in: Bone marrow transplantation (Basingstoke) Vol. 47; no. 11; pp. 1470 - 1473
• Main Authors: Jacobs, R, Tran, U, Chen, H, Kassim, A, Engelhardt, B G, Greer, J P, Goodman, S G, Clifton, C, Lucid, C, Vaughan, L A, Savani, B N, Jagasia, M
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.11.2012; Nature Publishing Group
• Subjects: 631/250/1904; 692/499; 692/699/249/1529; 692/700/478/174; Adult; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Bone marrow; Bone marrow transplantation; Bone marrow, stem cells transplantation. Graft versus host reaction; Cell Biology; Clinical trials; Confidence intervals; Consensus Development Conferences, NIH as Topic; Demographic aspects; Diagnosis; Distribution; Donors; Dry Eye Syndromes - epidemiology; Dry Eye Syndromes - etiology; Eye Diseases - epidemiology; Eye Diseases - etiology; Eye infections; Female; Graft versus host disease; Graft versus host reaction; Graft vs Host Disease - epidemiology; Graft vs Host Disease - etiology; Hematology; Hematopoietic Stem Cell Transplantation - adverse effects; Hematopoietic Stem Cell Transplantation - statistics & numerical data; Humans; Internal Medicine; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; National Institutes of Health (U.S.); original-article; Patients; Population studies; Prevalence; Public Health; Quality of life; Risk analysis; Risk Factors; Risk groups; Skin; Stem cell transplantation; Stem Cells; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation; United States - epidemiology; Young Adult; United States; ocular GVHD; stem cell transplant; risk factors; dry eye; Immunopathology; Graft versus host disease; Prevalence; Hematology; Stem cell; Hematopoietic cell; Epidemiology; Consensus; Eye; Visual system; Dry eye syndrome; Eye disease; Dry eye; Risk factor; Graft
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/bmt.2012.56

We studied 172 patients for development of ocular graft-versus-host disease (GVHD) after allogeneic stem cell transplantation (allo-SCT) from 2002 to 2009. Ocular GVHD was diagnosed in 60 patients (38%), with 27 (16%) being diagnosed at days 100 and 33 (23%) beyond day 100 for a 2-year cumulative incidence of 35% (95% confidence interval (CI), 28–43). The positive and negative predictive values of a Schirmer I test score (using ⩽5 mm as a cutoff) in predicting ocular GVHD (day 100) were 41 and 82%, respectively. In patients with ocular GVHD beyond day 100, extraocular manifestations of GVHD preceded the development of ocular GVHD in most patients (27 of 33, 81%). Prior acute skin GVHD (odds ratio 2.57, 95% CI 1.17–5.64, P =0.019) and male recipients of female donors (odds ratio 2.57, 95% CI 1.09–6.06, P =0.03) were independent risk factors for ocular GVHD. We recommend comprehensive ocular evaluation rather than a screening Schirmer's test to establish the diagnosis of ocular GVHD. Early diagnosis and preventive strategies in high-risk populations need to be studied in clinical trials to prevent devastating impact on quality of life in patients with prolonged ocular GVHD.