Onset of Ocular Graft-Versus-Host Disease Symptoms After Allogeneic Hematopoietic Stem Cell Transplantation

Abstract

Objective

To study the factors affecting the time to onset of ocular GVHD in patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT).

Methods

A retrospective chart review of 200 patients with ocular GVHD was performed to evaluate the association between various donor-recipient characteristics on the time to onset of ocular GVHD after allo-HSCT.

Results

The median time to onset of chronic ocular GVHD after allo-HSCT was 293 days (range 26 to 2308). Patients receiving fully HLA-matched transplants had a delayed onset of ocular GVHD (median 294 days) compared to mismatched transplants (219 days; P=0.029). HLA-matched transplants from related donors had delayed onset of ocular GVHD (307 days) compared to HLA-matched (286 days; P=0.168) and HLA-mismatched (231 days; P=0.015) transplants from unrelated donors. Ocular GVHD followed systemic GVHD in 76% of patients but preceded systemic disease in 7%, occurred concurrently in 15%, and was not associated with systemic GVHD in 2% of patients. The time elapsed between the occurrence of systemic and ocular GVHD was significantly longer in matched-related transplants (250 days) than in matched-unrelated transplants (120 days; P=0.004).

Conclusion

The onset of ocular GVHD after allogeneic hematopoietic stem cell transplantation is variable and is influenced by the donor-recipient matching characteristics. In the majority of patients with GVHD ocular involvement follows the occurrence of systemic manifestations; however, importantly, it can also precede or develop independently of systemic disease in a minority. Regular ophthalmic follow-up is recommended after allo-HSCT regardless the concurrent systemic GVHD status.