Ocular Chronic Graft-versus-Host Disease and Its Relation to Other Organ Manifestations and Outcomes after Allogeneic Hematopoietic Cell Transplantation

Helene Jeppesen*, Lars Klingen Gjærde, Jens Lindegaard, Hanne Olsen Julian, Steffen Heegaard, Henrik Sengeløv

*Corresponding author for this work
1 Citation (Scopus)


Ocular chronic graft-versus-host disease (cGVHD) has been shown to significantly reduce quality of life after allogeneic hematopoietic stem cell transplantation (HSCT). To learn more about this bothersome complication, we investigated the relationship between ocular cGVHD and cGVHD in other organs. We also investigated the associations between ocular cGVHD and overall mortality, nonrelapse mortality, and relapse. In this single-center study, we retrospectively included 1221 consecutive adults who underwent allogeneic HSCT. Patients were examined by an ophthalmologist before HSCT and annually for 5 years after HSCT or more frequently if needed. Patients with dry eye disease before HSCT were excluded. The International Chronic Ocular GVHD Consensus Group criteria were used to diagnose ocular cGVHD. Nonocular cGVHD was diagnosed using the National Institute of Health criteria. Out of 601 patients who were diagnosed with systemic cGVHD during follow-up, 279 (46%) developed ocular cGVHD. Ocular cGVHD was more frequent in patients with extensive cGVHD compared to those with limited cGVHD (50% versus 29%; P < .0001) and was associated with cGVHD in skin (P < .0001), oral cavity (P = .0024), genitals (P = .0023), and nails (P = .031). The frequency of ocular cGVHD was higher in patients with skin cGVHD with sclerosis compared to those with skin cGVHD without sclerosis (70% versus 49%; P = .0003). In an adjusted time-dependent Cox model, ocular cGVHD was associated with increased nonrelapse mortality (adjusted hazard ratio [HR], 1.61; 95% confidence interval [CI], 1.17 to 2.21; P = .003), whereas there was no support for an association with relapse (adjusted HR, .85; 95% CI, .53 to 1.36; P = .5). Special attention to eye problems after HSCT should be given to patients with extensive cGVHD and cGVHD in ectodermal-derived organs (skin, mouth, nails, and genitals). Furthermore, ocular cGVHD is a potential risk factor for nonrelapse mortality. © 2022 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc.

Original languageEnglish
JournalTransplantation and cellular therapy
Issue number12
Pages (from-to)833.e1-833.e7
Publication statusPublished - Dec 2022


  • Adult
  • Graft vs Host Disease/etiology
  • Hematopoietic Stem Cell Transplantation/adverse effects
  • Humans
  • Quality of Life
  • Recurrence
  • Retrospective Studies
  • Sclerosis/complications
  • Transplantation, Homologous/adverse effects
  • Ectoderm
  • Keratoconjunctivitis sicca
  • Bone marrow transplantation
  • Ocular surface disease
  • Germ layer
  • Chronic graft-versus-host disease
  • Ocular graft-versus-host disease
  • Dry eye
  • Hematopoietic stem cell transplantation


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