Increased Donor Age Leads to Greater Severity of Ocular Graft-Versus-Host Disease Following Allogeneic Hematopoietic Stem Cell Transplantation

Abstract

Introduction Ocular graft-versus-host disease (GVHD) is a common complication of allogeneic hematopoietic stem cell transplantation (HSCT), affecting 40-60% of patients within 3 years after transplant. While the most common clinical manifestation is dry eye disease (DED), ocular GVHD can result in epithelial changes in the cornea that contribute to ocular pain and vision loss. Objectives We sought to investigate potential risk factors for the development of ocular GVHD and for increased severity of disease. Methods This was a retrospective study analyzing the outcomes of patients who underwent allogeneic HSCT between 2014-2017. Patients with ocular symptoms were referred for eye exams, which included a slit lamp evaluation to assess the ocular surface. The ocular surface disease index (OSDI) survey was conducted to assess patient symptoms; results were scored from 0-100 with 100 being the most severe. Exams also monitored for the development of filamentary keratitis, a condition in which degenerated epithelial cells and mucus adhere to the corneal surface and cause pain and discomfort. Statistical analysis was performed using the Fisher Exact Probability Test with p-values Results A total of 26 patients who had previously undergone allogeneic HSCT were included in the study. The incidence of ocular symptoms was 30%, with the most common symptom being DED (73%) followed by light sensitivity (35%) and eye pain (31%). In patients with transplant donors of age >50 years compared to those with donors Conclusions Ocular GVHD is an important complication in patients undergoing allogeneic HSCT that contributes to patient morbidity and mortality. Cataracts is one previously documented risk factor for increased severity of disease, though further studies to investigate for other contributing factors are lacking. In our study, donor age >50 years was found to be a risk factor for a significantly higher OSDI score in allogeneic transplant patients. In addition, greater donor age also led to a higher incidence of filamentary keratitis in this patient population. These findings are important with regards to donor selection in allogeneic HSCT, as donors of age