Ocular chronic graft‐versus‐host disease after allogeneic haematopoietic stem cell transplantation in Denmark (1971–2011): Incidence and risk factors in adults

Abstract

PurposeOcular chronic graft‐versus‐host disease (cGVHD) is a bothersome complication to allogeneic hematopoietic stem cell transplantation (HSCT). The objective of this study was to assess incidence and risk factors of developing ocular cGVHD.MethodsA retrospective study of 1021 consecutive patients who underwent HSCT at a single institution. The patients were examined by an ophthalmologist before HSCT, annually up to five years after HSCT and more frequently if ocular symptoms occurred. Ocular cGVHD was diagnosed using the criteria proposed by The International Chronic Ocular GVHD Consensus Group. Myeloablative(MA) and non‐myeloablative(NMA) transplants were analysed separately due to great differences in patient age, conditioning regimen and stem cell source.ResultsOut of 1021 patients 99 (9.7%) had dry eye disease before HSCT. The 5‐year cumulative incidence of ocular cGVHD was 0.16(95%CI 0.13–0.19) in the MA group and 0.30(95%CI 0.25–0.36) in the NMA group. In adjusted cox regression models, we identified five risk factors of developing ocular cGVHD in the MA group: Schirmer's test ≤10 mm/5 min before transplantation; malignant disease; peripheral blood as stem cell source; female donor and the use of an unrelated donor. Risk factors in the NMA group were: Schirmer's test ≤10 mm/5 min before transplantation, higher recipient age and the use of an unrelated donor.ConclusionsThe 5‐year cumulative incidence of ocular cGVHD was 16% after MA conditioning and 30% after NMA conditioning. A low Schirmer's test before transplantation is a potential predictive factor of ocular cGVHD. Surprisingly, many of the patients had dry eye disease already before transplantation. Special attention should be directed toward patients with malignant disease, older age and patients receiving graft from peripheral blood and the use of a female donor or an unrelated donor.