Cataract formation after bone marrow transplantation.
OBJECTIVE
To evaluate the incidence, time course, and factors associated with cataract formation in bone marrow transplant recipients.


METHODS
Prospective cohort study.


METHODS
University Hospitals, Basel, Switzerland.


METHODS
197 patients treated with allogeneic or autologous bone marrow grafts at least 180 days before the start of the study.


METHODS
Three regimens for bone marrow transplant were used: 74 patients received single-dose, total-body irradiation (TBI), 90 patients received fractionated TBI, and 33 received chemotherapy alone.


RESULTS
Three and one half years after single-dose TBI, 51 of the 74 patients (69%) were alive and cataracts had developed in all of these 51 patients. Cataracts developed in 18 of the 90 (20%) patients treated with fractionated TBI, with an 83% (95% CI, 63% to 100%) risk for lens opacification at 6 years. Cataracts developed in only 1 of the 33 (3%) patients treated with chemotherapy alone. Incidence of cataracts is higher and lens opacification occurs earlier after single-dose TBI than after fractionated TBI (P < 0.01). With Cox regression analysis, the use of irradiation (relative risk, 21.0), the mode of irradiation (relative risk, 7.4), and the use of steroid treatment (relative risk, 2.9) for more than 3 months after bone marrow transplantation increased the risk for cataract formation. In contrast, age, sex, and chronic graft-versus-host disease did not influence the rate of cataract development. The probability of requiring cataract surgery after 6 years was 85% (CI, 75% to 95%) for the patients treated with single-dose TBI and 20% (CI, 0% to 49%) for those prepared with fractionated irradiation.


CONCLUSIONS
Patients treated with TBI, regardless of fractionation, are likely to have cataracts within 10 years, and some will need surgical repair. Long-term steroid treatment accelerates cataract formation. Preventive measures, such as lens shielding during TBI, should be considered.
Tichelli
A
A
University Hospitals, Basel, Switzerland.
Gratwohl
A
A
Egger
T
T
Roth
J
J
Prünte
A
A
Nissen
C
C
Speck
B
B
D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use; D016026:Bone Marrow Transplantation / Q000379:methods*; D002386:Cataract / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011829:Radiation Dosage; D012044:Regression Analysis; D012307:Risk Factors; D016019:Survival Analysis; D014916:Whole-Body Irradiation / Q000009:adverse effects*
D000970:Antineoplastic Agents