Ocular graft-versus-host disease and vision-related quality of life following allogeneic haematopoietic stem cell transplantation in Hong Kong

Abstract

Purpose : Allogeneic hematopoietic stem cell transplantation (HSCT) is an effective treatment for all array of haematological disorders, rendering improved disease prognosis and long-term survival rate. However, ocular graft-versus-host-disease (oGVHD) as a chronic complication of allogeneic HSCT affects patients’ ocular health and their daily living. Vision-related quality of life (QOL) and its association with oGVHD were examined.

Methods : 134 patients who received allogeneic HSCT between year 2000 to 2010, and aged 18 or above at the time of transplant were recruited. oGVHD related ocular surface and adnexa changes were assessed by various ophthalmological examinations: Schirmer test without anaesthesia, measurement of tear meniscus height (TMH), non-invasive tear break-up time (NIBUT), conjunctival injection, corneal fluorescein staining, subconjunctival fibrosis (SCF) and meibomian gland dysfunction. Infrared meibographs were taken to assess meibomian gland dropout percentage by ImageJ software. Diagnosis of oGVHD was made based on both the National Institutes of Health (NIH) consensus criteria and the scoring system of International Chronic Ocular Graft-vs-Host-Disease Consensus Group (ICC). Ocular Surface Disease Index (OSDI) and National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ25) were used for measurement of vision-related QOL.

Results : Of the 130 patients included in analysis (4 excluded as they had two or more allogeneic HSCT), 72 (55.3%) of them were male. Age at the year of BMT was 19-60 (s.d.= 10.9) and follow-up months since BMT was 133-262 months (s.d.= 39.5). With NIH dignosis criteria, 61.5% had oGVHD, with 43.1% having grade 1 severity and 18.5% having grade 2 severity. Diagnosis by ICC criteria showed 56.2% oGVHD in worst eye, with 27.7% having probable oGVHD and 28.5% having definite oGVHD. Mean MG atrophy in oGVHD patients by NIH criteria was 37.9% (s.d.=14.1) and non-oGVHD patients had 36.3% (s.d.=14.2) MG atrophy. OSDI in oGVHD and non-oGVHD patients by NIH criteria was 26.0 (s.d.=21.9) and 20.4 (s.d.=18.8) respectively.

Conclusions : Although MG atrophy did not show significant difference between oGVHD and non-oGVHD patients in this study, with oGVHD becoming more prevalent as allogenic HSCT advances, further studies are needed to correlate clinical findings and patient perceived QOL.