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Andrew Y. Chang, Myung Ko, Laura Johnston, MD, Christopher Ta, MD; Risk Factors for the Development of Ocular Graft Versus Host Disease after Hematopoietic Cell Transplantation. Invest. Ophthalmol. Vis. Sci. 2012;53(14):72.
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To describe the prevalence of ocular graft versus host disease (GVHD) in patients with chronic systemic GVHD following hematopoietic cell transplantation (HCT), and to identify risk factors associated with the prevalence of ocular GVHD.
Retrospective cohort study was conducted on 44 individuals from ages 26 to 73 years who were diagnosed with systemic chronic GVHD following HCT, and were subsequently referred to the Stanford Eye Institute for screening eye examinations between the years 2005-2011. Data on the presence and severity of ocular GVHD at the time of initial eye examination was collected. Transplantation records were used to identify patients’ age, gender, race, time until the onset of systemic chronic GVHD, history of acute GVHD, and kinship status to the donor. Prevalence of ocular GVHD was calculated. Logistic regression models were constructed to determine the odds ratio (OR) and 95% confidence intervals (CIs) for ocular GVHD, in association with putative risk factors (age, gender, race, time to the onset of systemic chronic GVHD, history of acute GVHD, and related versus unrelated donor).
In our patient population with systemic chronic GVHD, the prevalence of ocular GVHD was 63.6% (n=28). Patient age, gender, race, and time to the onset of systemic chronic GVHD were not independent predictors of any ocular GVHD. However, patients who received HCT from a related donor were significantly more likely to present with ocular GVHD during their initial eye examination (OR 125.72, CI= 2.87-5514.6, p=0.012) than those who received unrelated donor transplantations. The patients who also had a history of acute GVHD (either resolved or progressive) prior to the onset of systemic chronic GVHD had greater likelihood of developing ocular GVHD, though this relationship was not statistically significant (p=0.072).
Our study provides novel data on the prevalence of ocular GVHD in a select population with systemic chronic GVHD status post HCT, and the risk factors associated with development of ocular GVHD. Our data suggest that patients receiving HCT from related donors were more likely to develop ocular GVHD than those receiving unrelated donor transplantation. Patient age, gender, race, and time to the onset of systemic chronic GVHD were not independent predictors of ocular involvement.
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