Optic disc and retinal microvasculopathy after high-dose chemotherapy and autologous hematopoietic progenitor cell support.
The purpose of this study was to prospectively evaluate the retinal and optic nerve changes in patients undergoing high-dose chemotherapy (HDC) followed by autologous hematopoietic progenitor cell support (AHPCS). One hundred and forty patients undergoing HDC and AHPCS underwent extensive pre- and post-transplant ophthalmologic evaluations for development of retinal microvascular complications. One hundred and ten patients received high-dose cyclophosphamide, cisplatin and BCNU; thirty received identical doses of cyclophosphamide and cisplatin, but received paclitaxel instead of BCNU. Thirty-four patients (24%) had retinal findings of either cotton wool spots (CWS) (n = 20) or retinal hemorrhages (n = 18) during follow-up, which ranged from 1 to 12 months. Ten (7%) of these patients, all of whom received BCNU, showed ocular toxicity characterized by CWS 1 to 4 months post transplant (n = 10); optic disc edema (n = 3); and variable vision loss associated with the onset of BCNU-induced pulmonary toxicity. Retinal and optic disc microvascular complications may occur after high-dose chemotherapy followed by AHPCS. The association of ischemic retinal lesions and/or optic disc edema with BCNU-induced pulmonary toxicity and the lack of ocular toxicity in patients that did not receive BCNU may suggest that BCNU is the etiologic agent.
Johnson
D W
DW
Department of Ophthalmology, University of Colorado Health Sciences Center, Denver, Colorado 80262, USA.
Cagnoni
P J
PJ
Schossau
T M
TM
Stemmer
S M
SM
Grayeb
D E
DE
Baron
A E
AE
Shpall
E J
EJ
Bearman
S I
SI
McDermitt
J
J
Jones
R B
RB
D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects*; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D008171:Lung Diseases / Q000139:chemically induced; D008297:Male; D008833:Microcirculation / Q000187:drug effects / Q000473:pathology; D008875:Middle Aged; D009898:Optic Disk / Q000187:drug effects / Q000473:pathology*; D010211:Papilledema / Q000139:chemically induced / Q000473:pathology*; D011446:Prospective Studies; D012171:Retinal Vessels / Q000187:drug effects / Q000473:pathology*
D000970:Antineoplastic Agents