Abstract
Purpose :
Currently, there are no widely accepted Preferred Practice Pattern (PPP) guidelines for physicians to follow to detect ocular graft-versus-host-disease (oGVHD) in patients following a hematopoietic stem cell transplant (HSCT). Consequently, oGVHD is often missed during post-HSCT management. We performed a retrospective, observational cohort study to observe trends of oGVHD and determine frequency of ocular evaluations in post-HSCT patients at the University of Texas Medical Branch (UTMB), with the ultimate goal of PPP guideline proposal.
Methods :
We screened the EPIC electronic medical record database at UTMB using relevant international classification of diseases (ICD-10) codes for bone marrow transplants (BMT), stem cell transplants (SCT), and complications of BMT and SCT. We identified 50 patients with a history of SCT who were seen by oncologists at UTMB between 2000-2021. Patients who received a SCT and received follow-up care with UTMB were included in this study. There were 38 patients that met the inclusion criteria while 12 patients were excluded because they had no diagnosis of SCT or did not receive follow-up care with UTMB. Qualifying patients were chart-reviewed for oGVHD and non-ocular GVHD symptoms at their outpatient oncology visits. Referrals to the eye clinic, eye clinic evaluations, and time from the SCT to onset of symptoms and the severity of oGVHD were noted.
Results :
Of the 38 patients in our cohort, 23.7% (n=9) were noted to have oGVHD. The most common manifestations of oGVHD were ocular surface diseases including keratoconjunctivitis sicca, meibomian gland dysfunction, and dry eye syndrome (89%). Of the patients with oGVHD, 44% also had systemic GVHD. The prevalence of systemic GVHD was 21% (n=8) in the SCT group. Out of the 38 patients with SCT, only 29% (n=11) had referrals to Ophthalmology. Most referrals (55%) were made within a year of getting the SCT. None of the patients in our cohort received an ocular screening prior to SCT.
Conclusions :
The SCT patients in this study often developed complications of oGVHD with referrals to ophthalmology made after onset of symptoms. PPP guidelines should be established to improve management of post-SCT patients. Regularly assessing SCT patients for early signs and symptoms of oGVHD may limit adverse outcomes.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.