Cataracts after total body irradiation and bone marrow transplantation in patients with acute leukemia in complete remission: a study of the European Group for Blood and Marrow Transplantation.
OBJECTIVE
Advances in bone marrow transplantation (BMT) have consistently improved long-term survival. Therefore, evaluation of late complications such as cataracts is of paramount importance.


METHODS
We analyzed data of 2149 patients from the EBMT registry. A cohort of 1063 patients were evaluable for survival and ophthalmologic status after transplant for acute leukemia (AL) in first or second complete remission. Conditioning therapy included either single-dose total body irradiation (STBI) or fractionated TBI (FTBI) grouped in different dose rates (low: LDR < or = 0.04 Gy/min; high: HDR > 0.04 Gy/min).


RESULTS
The overall 10-year estimated cataract incidence (ECI) was 50%. It was 60% in the STBI group, 43% in the FTBI group < or = 6 fractions, and 7% in the FTBI group > 6 fractions (p < 10(-4)). It was significantly lower (30%) in the LDR than in the HDR groups (59%;p < 10(-4)). Patients receiving heparin for veno-occlusive disease prophylaxis had fewer cataracts than those who did not (10-year ECI: 33% vs. 53%, respectively;p = 0.04). The 10-year ECI was 65% in the allogeneic vs. 46% in the autologous BMT patients (p = 0.0018). Factors independently associated with an increased risk of cataract were an older age (> 23 years), higher dose rate (> 0.04 Gy/min), allogeneic BMT, and steroid administration (> 100 days). The use of FTBI was associated with a decreased risk of cataract. Heparin administration was a protective factor in patients receiving STBI. In terms of cataract surgery, the unfavorable factors for requiring surgery were: age > 23 yr, STBI, dose rate > 0.04 Gy/min, chronic graft-vs.-host disease (cGvHD), and absence of heparin administration. Among the patients who required cataract surgery (111 out of 257), secondary posterior capsular opacification was observed in 15.7%.


CONCLUSIONS
High dose rate and STBI are the main risk factors for cataract development and the need for surgery, and the administration of heparin has a protective role in cataractogenesis.
Belkacemi
Y
Y
Acute Leukemia Working Party of the European Group for Blood and Marrow Transplantation, Paris, France.
Labopin
M
M
Vernant
J P
JP
Prentice
H G
HG
Tichelli
A
A
Schattenberg
A
A
Boogaerts
M A
MA
Ernst
P
P
Della Volpe
A
A
Goldstone
A H
AH
Jouet
J P
JP
Verdonck
L F
LF
Locasciulli
A
A
Rio
B
B
Ozsahin
M
M
Gorin
N C
NC
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000704:Analysis of Variance; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D002386:Cataract / Q000209:etiology*; D002387:Cataract Extraction; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D019172:Transplantation Conditioning / Q000009:adverse effects*; D014916:Whole-Body Irradiation / Q000009:adverse effects*