Conjunctival Acute Graft-versus-Host Disease in Adult Patients Receiving Allogeneic Hematopoietic Stem Cell Transplantation: A Cohort Study.

Yao-Chung Liu,Catherine Jui-Ling Liu,Chia-Jen Liu,Jin-Hwang Liu,Nai-Wen Fan,Pei-Yu Lin,Jyh-Pyng Gau,Senthilnathan Palaniyandi

doi:10.1371/journal.pone.0167129

Abstract

BackgroundTo investigate the incidence, risk factors and survival of conjunctival acute graft-versus-host disease (aGVHD) in adult patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT)MethodsThis retrospective study included a total of 139 patients undergoing allogeneic HSCT between January 2012 and December 2014 at a tertiary referral hospital. Patients with ocular complaints after allogeneic HSCT or first donor lymphocyte infusion were evaluated by ophthalmologists. The risk factors for conjunctival aGVHD were analyzed using the Cox proportional hazards model. The overall survival was evaluated using Kaplan-Meier estimates.ResultsThirteen (9.4%) patients developed conjunctival aGVHD, including eight patients with pseudomembranous conjunctivitis. The cumulative incidence of conjunctival aGVHD was 2.1 cases per 10,000 person-day. The median age at HSCT was 47 years (range, 18 to 66) in all patients and 42 years (range, 24 to 58) in the 13 patients with conjunctival aGVHD. Median time of follow-up after allogeneic HSCT was 353 days (range, 11 to 1184). In univariate analysis, grades II-IV skin aGVHD (P = 0.002) and advanced systemic aGVHD except skin aGVHD (overall grades III-IV) (P = 0.001) were significant predictors for conjunctival aGVHD. In multivariate analysis, grades II-IV skin aGVHD was a significant risk factor (P = 0.04). The severity of conjunctival aGVHD was generally correlated with the systemic aGVHD (P = 0.001). Overall survival was significantly shorter in patients with grades II-IV aGVHD compared to those with grade 0-I (P = 0.01). Survival in patients with conjunctival aGVHD did not differ significantly from those without this complication (P = 0.94). In the subgroup analysis of patients with grades III-IV aGVHD, survival was significantly longer in patients with conjunctival involvement than those without (P = 0.03).ConclusionsThe severity of conjunctival aGVHD is correlated with systemic aGVHD, but not with inferior overall survival.

Highlights

Allogeneic hematopoietic stem cell transplantation (HSCT) can cure both benign and malignant hematological disorders, but is associated with many significant complications [1, 2]
The severity of conjunctival acute GVHD (aGVHD) was generally correlated with the systemic aGVHD (P = 0.001)
Overall survival was significantly shorter in patients with grades II-IV aGVHD compared to those with grade 0-I (P = 0.01)

Summary

Introduction

Allogeneic hematopoietic stem cell transplantation (HSCT) can cure both benign and malignant hematological disorders, but is associated with many significant complications [1, 2]. We recently observed that unexplained post-transplant pericardial effusion, a life-threatening complication, was a rare presentation of chronic GVHD (cGVHD) in adult HSCT patients [7]. We are interested in exploring another rare post-transplant complication: conjunctival acute GVHD (aGVHD). Most ocular complications occur during the chronic stage. These include dry eye syndrome, corneal ulcers, cataract, glaucoma, cytomegalovirus (CMV) retinitis, fungal endophthalmitis, and acquisition of allergic conjunctivitis from atopic donors [8,9,10,11, 13,14,15,16]. Risk factors and survival of conjunctival acute graft-versus-host disease (aGVHD) in adult patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT)

Methods

Results

Conclusion