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

Shikari, Hasanain MD, DNB; Amparo, Francisco MD; Saboo, Ujwala MD; Dana, Reza MD, MPH, MSc

doi: 10.1097/ICO.0000000000000340
Clinical Science

Objective: To study the factors affecting the time to onset of ocular graft-versus-host disease (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 and 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, 26–2308 days). Patients receiving fully human leukocyte antigen (HLA)–matched transplants had a delayed onset of ocular GVHD (median, 294 days) compared with mismatched transplants (219 days; P = 0.029). HLA-matched transplants from related donors had delayed onset of ocular GVHD (307 days) compared with 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).

Conclusions: The onset of ocular GVHD after allo-HSCT is variable and is influenced by 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 of patients. Regular ophthalmic follow-up is recommended after allo-HSCT regardless of concurrent systemic GVHD status.

Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA.

Reprints: Reza Dana, MD, MPH, MSc, Department of Ophthalmology, Cornea Service, Massachusetts Eye and Ear Infirmary, 243 Charles St, Boston, MA 02114 (e-mail:

Supported by the National Institutes of Health (grant EY19098).

The authors have no conflicts of interest to disclose.

All the authors had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Received June 18, 2014

Received in revised form November 10, 2014

Accepted November 10, 2014

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.