Tichelli A, Gratwohl A, Egger T, Roth J, Prünte A, Nissen C, Speck B
University Hospitals, Basel, Switzerland.
Ann Intern Med. 1993 Dec 15;119(12):1175-80. doi: 10.7326/0003-4819-119-12-199312150-00004.
To evaluate the incidence, time course, and factors associated with cataract formation in bone marrow transplant recipients.
Prospective cohort study.
University Hospitals, Basel, Switzerland.
197 patients treated with allogeneic or autologous bone marrow grafts at least 180 days before the start of the study.
Three regimens for bone marrow transplant were used: 74 patients received single-dose, total-body irradiation (TBI), 90 patients received fractionated TBI, and 33 received chemotherapy alone.
Three and one half years after single-dose TBI, 51 of the 74 patients (69%) were alive and cataracts had developed in all of these 51 patients. Cataracts developed in 18 of the 90 (20%) patients treated with fractionated TBI, with an 83% (95% CI, 63% to 100%) risk for lens opacification at 6 years. Cataracts developed in only 1 of the 33 (3%) patients treated with chemotherapy alone. Incidence of cataracts is higher and lens opacification occurs earlier after single-dose TBI than after fractionated TBI (P < 0.01). With Cox regression analysis, the use of irradiation (relative risk, 21.0), the mode of irradiation (relative risk, 7.4), and the use of steroid treatment (relative risk, 2.9) for more than 3 months after bone marrow transplantation increased the risk for cataract formation. In contrast, age, sex, and chronic graft-versus-host disease did not influence the rate of cataract development. The probability of requiring cataract surgery after 6 years was 85% (CI, 75% to 95%) for the patients treated with single-dose TBI and 20% (CI, 0% to 49%) for those prepared with fractionated irradiation.
Patients treated with TBI, regardless of fractionation, are likely to have cataracts within 10 years, and some will need surgical repair. Long-term steroid treatment accelerates cataract formation. Preventive measures, such as lens shielding during TBI, should be considered.
评估骨髓移植受者白内障形成的发生率、时间进程及相关因素。
前瞻性队列研究。
瑞士巴塞尔大学医院。
197例在研究开始前至少180天接受同种异体或自体骨髓移植的患者。
采用三种骨髓移植方案：74例患者接受单剂量全身照射（TBI），90例患者接受分次TBI，33例仅接受化疗。
单剂量TBI后三年半，74例患者中有51例（69%）存活，且这51例患者均发生了白内障。接受分次TBI治疗的90例患者中有18例（20%）发生白内障，6年时晶状体混浊风险为83%（95%CI，63%至100%）。仅接受化疗的33例患者中只有1例（3%）发生白内障。单剂量TBI后白内障发生率高于分次TBI，且晶状体混浊出现更早（P<0.01）。通过Cox回归分析，骨髓移植后使用照射（相对风险，21.0）、照射方式（相对风险，7.4）以及使用类固醇治疗超过3个月（相对风险，2.9）会增加白内障形成风险。相比之下，年龄、性别和慢性移植物抗宿主病不影响白内障发生速率。单剂量TBI治疗的患者6年后需要进行白内障手术的概率为85%（CI，75%至95%），分次照射预处理的患者为20%（CI，0%至49%）。
接受TBI治疗的患者，无论是否分次照射，10年内都可能发生白内障，部分患者需要手术修复。长期类固醇治疗会加速白内障形成。应考虑采取预防性措施，如在TBI期间进行晶状体防护。
