Incidence of cataracts after single fraction total body irradiation: the role of steroids and graft versus host disease.
Eighty-eight patients who received single fraction total body irradiation (sfTBI) as part of their conditioning for allogeneic BMT have been evaluated for the risk of cataract formation. Thirty-eight (43%) have developed cataracts; 11 required surgery. With 9.5-13.6 years follow-up (median 10.7 years), all 12 recipients of unmanipulated marrow allografts have developed cataracts; the actuarial risk of needing surgery was 32 (+/- 18%, 95% confidence intervals (CI)). Ten of these 12 required high-dose steroids (prednisolone > 1 mg/kg/day) for the treatment of GVHD. Seventy-six patients received T cell-depleted allografts; 14 of 76 required post-transplant immunosuppression with high-dose steroids. With 1-9.4 years follow-up (median 5 years), the actuarial risk of cataract formation in T cell-depleted allograft recipients is 72% (+/- 52% CI), the actuarial risk for needing surgery is 20% (+/- 9% CI). Recipients of sfTBI and non-T cell-depleted allografts had a significantly greater risk of developing cataracts (p = 0.003, long rank test) and of needing surgery (p < 0.05, log rank test) than patients receiving T cell-depleted BM. Cataracts occurred more frequently in patients requiring post-transplant immunosuppression with steroids (relative risk 2.12, p < 0.01 log rank test).
Hamon
M D
MD
Department of Hematology, Royal Free Hospital, London, UK.
Gale
R F
RF
Macdonald
I D
ID
Smith
O P
OP
Collis
C H
CH
Skeggs
D B
DB
Gandhi
L
L
Prentice
H G
HG
D000293:Adolescent; D000328:Adult; D016465:Bone Marrow Purging / Q000009:adverse effects*; D016026:Bone Marrow Transplantation / Q000009:adverse effects; D002386:Cataract / Q000453:epidemiology / Q000209:etiology*; D002387:Cataract Extraction / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D006086:Graft vs Host Disease / Q000150:complications* / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D015993:Life Tables; D008212:Lymphocyte Depletion; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications / Q000628:therapy; D011239:Prednisolone / Q000008:administration & dosage / Q000009:adverse effects*; D011832:Radiation Injuries / Q000453:epidemiology / Q000209:etiology*; D012306:Risk; D014916:Whole-Body Irradiation / Q000009:adverse effects*
D011239:Prednisolone; D008727:Methotrexate