Ocular Graft vs Hosts Disease (oGVHD) After Allogenic Hematopoietic Stem Cell Transplant (allo-HSCT): A 2 Year Longitudinal, Observational Study

Abstract

Purpose : To determine the pre-existing ocular findings that predispose to developing oGVHD in patients following allo-HSCT and evaluate the benefits of early treatment intervention. We performed a 2-year longitudinal, observational clinical study in patients undergoing allo-HSCT (n=105).

Methods : Patients received ocular examination and oGVHD grading in study visits. Examinations included slit lamp biomicroscopy, symptom analysis, Schirmer’s I test, Corneal and Conjunctival staining, Bulbar redness scoring, Non-invasive Keratograph Tear Film Break-up Time, MMP-9 test, Lipid Layer Thickness, and Meibomian gland imaging. oGVHD grading was determined using the International Consensus Criteria on chronic oGVHD classification systems.

Results : 61 patients had at least one post-HSCT visit. Of these patients, 74% did not progress to oGVHD. 26% of patients progressed to Probable (n=7) or Definite (n=9) oGVHD. As compared to None oGVHD, greater number of Probable/Definite oGVHD patients had Meibomian gland dysfunction (reduced LLT), ocular surface inflammation (MMP-9 positive), and tear fluid deficiency (Schirmer’s <10 mm/5min) in their pre-HSCT examination. Signs and symptoms of oGVHD appeared between 6-9 months post-HSCT. Topical steroid treatment was given in patients with None oGVHD (n=4) or Probable oGVHD (n=3), and these patients did not progress to Definite oGVHD. Topical anti-inflammatory treatment was initiated most commonly due to MMP9 becoming positive. Other common reasons were: (i) tear production reduced to <10 mm/5min; and (ii) increase in OSDI symptom analysis score to >13.6.

Conclusions : Patients who have reduced tear production, Meibomian gland dysfunction, or ocular surface inflammation have a higher likelihood of developing oGVHD after HSCT. Starting anti-inflammatory treatment earlier, based on MMP-9 positivity, increased symptoms of ocular discomfort, or reduced tear production, may prevent progression to Definite oGVHD. Ocular examinations pre-HSCT and every three months post-HSCT, may help to reduce the incidence of oGVHD by facilitating early diagnosis and early therapeutic interventions.

This is a 2021 ARVO Annual Meeting abstract.