title: Prevalence and risk factors associated with development of ocular GVHD defined by NIH consensus criteria.
abstract: We studied 172 patients for development of ocular graft-versus-host disease (GVHD) after allogeneic stem cell transplantation (allo-SCT) from 2002 to 2009. Ocular GVHD was diagnosed in 60 patients (38%), with 27 (16%) being diagnosed at days 100 and 33 (23%) beyond day 100 for a 2-year cumulative incidence of 35% (95% confidence interval (CI), 28-43). The positive and negative predictive values of a Schirmer I test score (using 5 mm as a cutoff) in predicting ocular GVHD (day 100) were 41 and 82%, respectively. In patients with ocular GVHD beyond day 100, extraocular manifestations of GVHD preceded the development of ocular GVHD in most patients (27 of 33, 81%). Prior acute skin GVHD (odds ratio 2.57, 95% CI 1.17-5.64, P=0.019) and male recipients of female donors (odds ratio 2.57, 95% CI 1.09-6.06, P=0.03) were independent risk factors for ocular GVHD. We recommend comprehensive ocular evaluation rather than a screening Schirmer's test to establish the diagnosis of ocular GVHD. Early diagnosis and preventive strategies in high-risk populations need to be studied in clinical trials to prevent devastating impact on quality of life in patients with prolonged ocular GVHD.
authors.affiliation: Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232-5505, USA.
authors.forename: R
authors.initials: R
authors.lastname: Jacobs
authors.forename: U
authors.initials: U
authors.lastname: Tran
authors.forename: H
authors.initials: H
authors.lastname: Chen
authors.forename: A
authors.initials: A
authors.lastname: Kassim
authors.forename: B G
authors.initials: BG
authors.lastname: Engelhardt
authors.forename: J P
authors.initials: JP
authors.lastname: Greer
authors.forename: S G
authors.initials: SG
authors.lastname: Goodman
authors.forename: C
authors.initials: C
authors.lastname: Clifton
authors.forename: C
authors.initials: C
authors.lastname: Lucid
authors.forename: L A
authors.initials: LA
authors.lastname: Vaughan
authors.forename: B N
authors.initials: BN
authors.lastname: Savani
authors.forename: M
authors.initials: M
authors.lastname: Jagasia
mesh_terms: D000328:Adult; D000368:Aged; D015975:Consensus Development Conferences, NIH as Topic; D015352:Dry Eye Syndromes / Q000453:epidemiology / Q000209:etiology; D005128:Eye Diseases / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006086:Graft vs Host Disease / Q000453:epidemiology* / Q000209:etiology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009316:National Institutes of Health (U.S.); D015995:Prevalence; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult