Ocular Graft-Versus-Host Disease in Allogeneic Stem Cell Transplant Recipients: A Longitudinal Cohort Study Evaluating Ocular Surface Parameters Before and After Transplantation.

PURPOSE

The objective of this longitudinal cohort study was to identify predictors of progression to ocular graft-versus-host disease in allogeneic hematopoietic stem cell transplant recipients.

METHODS

Patients (n = 49) were examined before hematopoietic stem cell transplantation (HSCT) and 3, 6, 12, 24, and 36 months after HSCT. Outcome measures included ocular surface disease index questionnaire, Schirmer I test, corneal fluorescein staining, tear break-up time, and tear cytokine concentration. Diagnosis of ocular GVHD (oGVHD) was made in accordance with the International Consensus Criteria for chronic oGVHD. A group of healthy controls (n = 20) without dry eye disease was recruited for comparison.

RESULTS

At baseline, the intended HSCT group had a lower Schirmer test value, a higher corneal fluorescein staining score, and a lower tear film break-up time compared with the control group. There was no significant difference in ocular surface disease index score. The intended HSCT group had significantly higher tear interleukin (IL)-1, IL-6, IL-8, IL-10, interferon gamma-induced protein (IP)-10, and TNF-α concentrations at baseline. When considering an increase of at least 2 points of the International Consensus Criteria for chronic oGVHD score after HSCT to exclude preexisting dry eye disease, only 19% (n = 7) developed either probable (11%, n = 4) or definite (8%, n = 3) oGVHD. In a longitudinal analysis, a significant association between progression to oGVHD and tear IL-6, IL-8, IL-17A, and IP-10 concentration was detected.

CONCLUSIONS

This study highlights the added value of performing a baseline ophthalmological examination in intended HSCT recipients. Posttransplant oGVHD rates may be overestimated if pretransplant ocular surface disease is not considered. Longitudinal tear cytokine analysis in our cohort suggests that IL-6, IL-8, IL-17A, and IP-10 may be useful as biomarkers for oGVHD.