Colarusso Bradley A, Bligdon Shannon M, Ganjei Allen Y, Kwok Alan, Brocks Daniel, Luo Zhonghui K
Massachusetts Eye and Ear, Boston, MA, USA.
Ajax Eye Care, Ajax, ON, Canada.
Clin Ophthalmol. 2022 May 3;16:1419-1426. doi: 10.2147/OPTH.S359539. eCollection 2022.
To understand the degree and explore the possible causes of ocular graft-versus-host disease (oGVHD) underdiagnosis in patients following allogeneic hematopoietic stem cell transplantation (allo-HSCT).
A 15-question survey was emailed to 6032 subscribers to the Blood and Marrow Transplant Information Network. A total of 371 respondents confirmed the history of allo-HSCT, of which 335 were symptomatic. Their self-reported symptoms, onset, treatments tried, degree of symptom control and established diagnoses of systemic chronic graft-versus-host disease (cGVHD) and oGVHD were analyzed.
Among the 335 symptomatic survey respondents, 306 reported their ocular symptom onset was after allo-HSCT, with only 170 [55.6% (170/306)] ever receiving a diagnosis of oGVHD; 23 reported worsening pre-existing ocular symptoms after allo-HSCT, with only 5 [21.7% (5/23)] ever receiving a diagnosis of oGVHD; 6 reported stable symptoms before and after allo-HSCT, with 1 ever receiving a diagnosis of oGVHD. Of the 176 respondents carrying the diagnosis of oGVHD, 167 [94.9% (167/176)] also had the diagnosis of cGVHD. Logistic regression analysis showed that the diagnosis of oGVHD was highly correlated with the number of symptoms and treatments one reported. Furthermore, 35% of the respondents with new onset ocular symptoms reported onset within the first 6 months after allo-HSCT (previously reported), as well as 39% of the respondents with worsened existing symptoms.
oGVHD underdiagnosis is likely associated with the previous diagnostic criteria, in which cGVHD of another organ system was required. The correct notion that oGVHD commonly causes severe dry eye disease has likely led to its underdiagnosis in patients with fewer number of symptoms and/or who tried fewer treatments.
了解异基因造血干细胞移植（allo-HSCT）患者眼部移植物抗宿主病（oGVHD）漏诊的程度，并探究其可能原因。
向血液与骨髓移植信息网络的6032名订阅者发送了一份包含15个问题的调查问卷。共有371名受访者确认有allo-HSCT病史，其中335人有症状。对他们自我报告的症状、发病时间、尝试过的治疗方法、症状控制程度以及系统性慢性移植物抗宿主病（cGVHD）和oGVHD的确诊情况进行了分析。
在335名有症状的调查受访者中，306人报告其眼部症状在allo-HSCT后出现，其中只有170人[55.6%（170/306）]曾被诊断为oGVHD；23人报告allo-HSCT后原有眼部症状加重，其中只有5人[21.7%（5/23）]曾被诊断为oGVHD；6人报告allo-HSCT前后症状稳定，其中1人曾被诊断为oGVHD。在176名被诊断为oGVHD的受访者中，167人[94.9%（167/176）]也被诊断为cGVHD。逻辑回归分析表明，oGVHD的诊断与报告的症状数量和治疗方法高度相关。此外，35%新发眼部症状的受访者报告症状在allo-HSCT后的前6个月内出现（先前报道），39%原有症状加重的受访者也是如此。
oGVHD漏诊可能与之前的诊断标准有关，之前的标准要求有其他器官系统的cGVHD。oGVHD通常会导致严重干眼症这一正确观念可能导致症状较少和/或尝试治疗较少的患者被漏诊。
