Hébert Mélanie, Archambault Cyril, Doyon Christelle, Ospina Luis H, Robert Marie-Claude
Faculty of Medicine, Université de Montréal, Montreal, Canada.
Department of Ophthalmology, Centre hospitalier universitaire Sainte-Justine, Montreal, Canada; and.
Cornea. 2021 Sep 1;40(9):1158-1164. doi: 10.1097/ICO.0000000000002659.
To identify risk factors for ocular graft-versus-host disease (oGVHD) in children with graft-versus-host disease (GVHD).
This retrospective cohort study identified 38 children diagnosed with GVHD who underwent an ophthalmological examination. Survival to onset of oGVHD after transplant was analyzed using Kaplan-Meier analyses with log-rank tests. A multivariable Cox proportional hazards model was run for time to oGVHD using univariate risk factors.
The average age was 10.0 ± 5.4 years at the time of transplant. Underlying illness was acute lymphoblastic leukemia in 19 (50%) and acute myeloid leukemia in 8 (21%). Nonocular GVHD organ involvement included skin (84%), lungs (16%), intestines (50%), liver (24%), and bone marrow (3%). Fifteen children (39%) had oGVHD, of which 47% were asymptomatic. oGVHD was diagnosed 601 ± 878 days after GVHD. A significant association between risk of oGVHD and diagnosis of acute lymphoblastic leukemia (P = 0.10) or acute myeloid leukemia (P = 0.08) was not found. Organ involvement associated with oGVHD included skin (P = 0.03) and lungs (P = 0.02). Survival curves were significantly influenced by GVHD organ involvement (P = 0.02), but not underlying disease (P = 0.51). The adjusted Cox regression model yielded an independent hazard ratio of 8.82 (95% CI: 1.51-51.49; P = 0.016) for the presence of concomitant GVHD involvement of skin, lungs, and another organ.
Children with multiorgan GVHD involvement including skin and lung disease are at increased risk for oGVHD. Given the proportion of asymptomatic cases found in this series, regular eye examinations are warranted in this population.
确定移植物抗宿主病（GVHD）患儿发生眼部移植物抗宿主病（oGVHD）的危险因素。
这项回顾性队列研究纳入了38例诊断为GVHD且接受眼科检查的患儿。采用Kaplan-Meier分析和对数秩检验分析移植后至oGVHD发病的生存率。使用单变量危险因素对oGVHD发生时间进行多变量Cox比例风险模型分析。
移植时的平均年龄为10.0±5.4岁。基础疾病为急性淋巴细胞白血病19例（50%），急性髓细胞白血病8例（21%）。非眼部GVHD器官受累包括皮肤（84%）、肺（16%）、肠道（50%）、肝脏（24%）和骨髓（3%）。15例患儿（39%）发生oGVHD，其中47%无症状。oGVHD在GVHD发生后601±878天被诊断。未发现oGVHD风险与急性淋巴细胞白血病诊断（P = 0.10）或急性髓细胞白血病诊断（P = 0.08）之间存在显著关联。与oGVHD相关的器官受累包括皮肤（P = 0.03）和肺（P = 0.02）。生存曲线受GVHD器官受累显著影响（P = 0.02），但不受基础疾病影响（P = 0.51）。调整后的Cox回归模型显示，皮肤、肺和另一器官同时发生GVHD受累时，独立风险比为8.82（95%CI：1.51 - 51.49；P = 0.016）。
有多器官GVHD受累（包括皮肤和肺部疾病）的患儿发生oGVHD的风险增加。鉴于本系列中无症状病例的比例，该人群有必要定期进行眼部检查。
