Abstract
Purpose :
To perform a longitudinal study for determining the development of oGVHD after allogeneic hematopoietic stem cell transplant (HSCT) and report cases that illustrate the ‘window of opportunity’ concept in oGVHD treatment.
Methods :
Patients (n=61) were examined at pre-scheduled clinic visits before HSCT and three-month intervals after HSCT for two years. The presence or absence of oGVHD was determined using the international chronic oGVHD consensus group diagnostic criteria (ICCGVHD). Ocular surface washings (OSW) were obtained at each visit and analyzed for cytokine levels.
Results :
In the longitudinal study, 26.2% (n=16; Progressed group) developed either Probable (11.5%, n=7) or Definite oGVHD (14.8%, n=9). In the Progressed group, clinically significant changes in signs (corneal staining and Schirmer’s I test) and symptoms at the post-HSCT visit as compared to the pre-HSCT visit occurred at nine months. Significant differences in clinical signs and symptoms (whether average post-HSCT values or changes in values over pre-HSCT levels) between Progressed and Non-progressed groups occurred at a 9-month visit or later. In the Progressed group, 55.6% of eyes that had negative MMP-9 test at pre-HSCT turned MMP-9 positive at 3 to 6 months post-HSCT. In the Progressed group, IL-8 levels in OSW were significantly increased at six months post-HSCT. In the case reports, the ‘window of opportunity’ was detected by MMP-9 turning positive, early corneal staining, IL-8 increase in OSW, and peripheral corneal epithelial thinning, which resolved with treatment initiation.
Conclusions :
A ‘window of opportunity’ exists prior to patients developing symptomatic tear-deficient dry eye after HSCT for initiating treatment that may pre-empt oGVHD development; however, larger-scale longitudinal studies are needed for definitive recommendations.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.