Ocular graft-versus-host disease and dry eye disease after paediatric haematopoietic stem cell transplantation - incidence and risk factors

Helene Jeppesen*, Katrine Kielsen, Volkert Siersma, Jens Lindegaard, Hanne Olsen Julian, Steffen Heegaard, Henrik Sengeløv, Klaus Müller

*Corresponding author for this work

Abstract

Ocular graft-versus-host disease (oGVHD) contributes substantially to morbidity after allogeneic haematopoietic stem cell transplantation (HSCT) but is sparsely investigated in children. We assessed incidence and risk factors for oGVHD and dry eye disease (DED) in a nationwide, single-centre study of 484 consecutive children receiving HSCT during the period 1980-2016. Ophthalmological examinations were performed before and annually at least until five years after HSCT. Twenty-five patients had DED before transplantation (5.6%). The cumulative incidence was 1.9% for acute oGVHD, 6.0% for chronic oGVHD, 8.7% for new onset DED, and 12.7% for new onset Corneal Fluorescein Staining (CFS). In adjusted Fine-Gray regression models, the use of Busulfan was a risk factor for developing acute oGVHD (HR 5.01, p = 0.03), and malignant disease was a risk factor for developing CFS (HR 2.00, p = 0.047). Younger recipient age was associated with reduced risk of DED when comparing children aged 0-4 years with 10-16 years (HR 0.33, p = 0.03). These data underscore the need of attention to DED and oGVHD in relation to HSCT leading to our recommendation of performing ophthalmic examinations in all children before HSCT, and after HSCT when needed, in order to secure diagnosis and treatment of these complications.

Original languageEnglish
JournalBone Marrow Transplantation
Volume57
Issue number3
Pages (from-to)487-498
Number of pages12
ISSN0268-3369
DOIs
Publication statusPublished - Mar 2022

Keywords

  • Child
  • Dry Eye Syndromes/epidemiology
  • Fatigue Syndrome, Chronic/etiology
  • Graft vs Host Disease/diagnosis
  • Hematopoietic Stem Cell Transplantation/adverse effects
  • Humans
  • Incidence
  • Risk Factors

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