title: 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.
abstract: 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.
authors.affiliation: Acute Leukemia Working Party of the European Group for Blood and Marrow Transplantation, Paris, France.
authors.forename: Y
authors.initials: Y
authors.lastname: Belkacemi
authors.forename: M
authors.initials: M
authors.lastname: Labopin
authors.forename: J P
authors.initials: JP
authors.lastname: Vernant
authors.forename: H G
authors.initials: HG
authors.lastname: Prentice
authors.forename: A
authors.initials: A
authors.lastname: Tichelli
authors.forename: A
authors.initials: A
authors.lastname: Schattenberg
authors.forename: M A
authors.initials: MA
authors.lastname: Boogaerts
authors.forename: P
authors.initials: P
authors.lastname: Ernst
authors.forename: A
authors.initials: A
authors.lastname: Della Volpe
authors.forename: A H
authors.initials: AH
authors.lastname: Goldstone
authors.forename: J P
authors.initials: JP
authors.lastname: Jouet
authors.forename: L F
authors.initials: LF
authors.lastname: Verdonck
authors.forename: A
authors.initials: A
authors.lastname: Locasciulli
authors.forename: B
authors.initials: B
authors.lastname: Rio
authors.forename: M
authors.initials: M
authors.lastname: Ozsahin
authors.forename: N C
authors.initials: NC
authors.lastname: Gorin
mesh_terms: 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*