Are Adverse Environmental Conditions during Allogeneic Hematopoietic Stem Cell Transplantation a Risk Factor for Ocular Graft-versus-Host Disease?

Abstract

Purpose : Few risk factors for ocular Graft-versus-host disease (GvHD) following allogeneic hematopoietic stem cell transplantation (aSCT) are known. Unlike systemic GvHD that may be detected through hemato-oncologists before discharge from transplantation wards (TW) ocular findings at this timepoint are lacking. As our institution setup the first ophthalmic unit on a TW, we performed this retrospective, observational clinical study to answer the question whether early signs of ocular surface disease are present prior to discharge from this highly climatized environment.

Methods : 30 patients (n=9/21 female/male; 53±12 years of age) undergoing aSCT between 2014-2015 were included in this retrospective analysis. Patients were examined prior to aSCT and also prior to discharge of the TW as part of routine examinations. Data was collected including visual acuity, Schirmer’s test, corneal fluoresceine staining, tear film break up time, conjunctival redness analysis and corneal esthesiometry. Results were analyzed statistically and correlated with measurements of air temperature and humidity that were monitored subsequently.

Results : Corneal staining, conjunctival redness, Schirmers test and corneal esthesiometry increased significantly after aSCT. During the winter periods humidity on the TW was decreased to 30 %. Further analysis of follow-up data revealed that 5/14 patients (36 %) transplanted during the winter developed ocular GvHD versus 3/16 patients (19 %) transplanted in the summer period. However at time of discharge from TW there was no detectable difference in ophthalmological parameters between both groups. Similarly the time from transplantation duration until first diagnosis of ocular GvHD was independent of season.

Conclusions : This study revealed for the first time that patients undergoing aSCT develop early signs of ocular surface disease during their stay on a climatized TW. aSCT during winter periods seem to be accompanied with higher numbers of ocular GvHD. In contrast ocular findings at the time of discharge did not differ according to season. These results suggest that ocular changes are frequent after aSCT and that environmental factors such as humidity seem to influence the later development of ocular GvHD. These findings need to be confirmed and further elucidated in larger scale studies.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.