Study Highlights Importance of Baseline Ophthalmology Evaluation Before HSCT

Systemic, chronic graft-versus-host disease (GVHD) occurs in many recipients of allogeneic hematopoietic stem cell transplant (allo-HSCT), and ocular effects occur in as many as 90% of patients with chronic GVHD. GVHD can affect the ocular surface, eyelids, lacrimal gland, conjunctiva, and/or cornea, causing conditions such as keratoconjunctivitis sicca, blepharitis, and Meibomian gland dysfunction.

In fact, the National Institutes of Health and other organizations have recommended that patients undergoing HSCT receive baseline ophthalmologic evaluation. An article recently published in Bone Marrow Transplantation sought to elucidate potential baseline factors that may indicate a higher risk for GVHD with ocular manifestations. Previous studies have explored tear and serum cytokines to identify predictive, diagnostic, and prognostic biomarkers for GVHD with ocular effects.

Researchers, led by Alexandra A. Pietraszkiewicz, MD, of the National Eye Institute, part of the National Institutes of Health, conducted a longitudinal cohort study of 40 allo-HSCT recipients and 20 healthy controls. The research team conducted comprehensive ophthalmologic evaluations on the entire sample, including the Ocular Surface Disease Index (OSDI) questionnaire, a detailed ocular surface assessment, and tear and serum biomarker analysis. Other data included tear osmolarity, Schirmer’s test, Oxford corneal staining score, and tear break-up time (TBUT). The researchers compared evaluation results between the two groups, then followed the HSCT recipients over time to see whether any particular factors could predict development of ocular GVHD.

According to analyses, individuals with hematologic disorders preparing for HSCT have a tendency toward dry eye disease. About 38% of the HSCT patients had clinically significant dry eye disease at baseline, compared to 25% of the controls.

Chronic GVHD occurred in 24 (71%) of the allo-HSCT patients, and 21 (62%) developed ocular manifestations. Most patients developed ocular complications within 12 months of transplantation (mean, 6 months).

Among the patients who developed GVHD with ocular effects, the researchers found several factors associated with increased risk of ocular GVHD:

  • increased Oxford corneal staining score
  • decreased TBUT
  • lower Schirmer’s test at diagnosis
  • older age

OSDI, tear osmolarity, and tear and serum biomarkers were not significantly different at baseline and time of GVHD diagnosis.

“These findings emphasize the importance of baseline ophthalmologic evaluations of patients prior to HSCT,” the authors wrote. “Diagnosing ocular GVHD and distinguishing it from dry eye disease in the months following HSCT can be challenging if baseline evaluations are unavailable.”