title: Prevalence and risk factors of cataract after chemotherapy with or without central nervous system irradiation for childhood acute lymphoblastic leukaemia: an LEA study.
abstract: Corticosteroid and central nervous system (CNS) irradiation can induce cataract in childhood lymphoblastic leukaemia survivors. Few prospective studies with systematic ophthalmological evaluation have been published. Cataract was prospectively assessed by serial slip lamp tests in 517 patients. All had acute lymphoblastic leukaemia, all had been treated by chemotherapy with or without CNS irradiation, and none had received haematopoietic stem cell transplantation. Median ages at last evaluation and follow-up duration from leukaemia diagnosis were 16·8 and 10·9 years, respectively. Cataract was observed in 21/517 patients (4·1%). Cumulative incidence was 4·5 ± 1·2% at 15 years and reached 26 ± 8·1% at 25 years. CNS irradiation was the only risk factor: prevalence was 11·1% in patients who had received irradiation and 2·8% in those who did not. We did not detect any steroid dose effect: cumulative dose was 5133 and 5190 mg/m(2) in patients with and without cataract, respectively. Cataract occurrence did not significantly impact quality of life. We conclude that, in the range of steroid dose reported here, the cataract risk proves very low 15 years after treatment without CNS irradiation but an even more prolonged follow-up is required because of potential very late occurrence.
authors.affiliation: Department of Paediatric Haematology-Oncology, APHM, La Timone Hospital, Aix-Marseille University, Marseille, France.
authors.forename: Anne-Lise
authors.initials: AL
authors.lastname: Alloin
authors.forename: Vincent
authors.initials: V
authors.lastname: Barlogis
authors.forename: Pascal
authors.initials: P
authors.lastname: Auquier
authors.forename: Audrey
authors.initials: A
authors.lastname: Contet
authors.forename: Maryline
authors.initials: M
authors.lastname: Poiree
authors.forename: François
authors.initials: F
authors.lastname: Demeocq
authors.forename: Iris
authors.initials: I
authors.lastname: Herrmann
authors.forename: Virginie
authors.initials: V
authors.lastname: Villes
authors.forename: Yves
authors.initials: Y
authors.lastname: Bertrand
authors.forename: Dominique
authors.initials: D
authors.lastname: Plantaz
authors.forename: Justyna
authors.initials: J
authors.lastname: Kanold
authors.forename: Pascal
authors.initials: P
authors.lastname: Chastagner
authors.forename: Hervé
authors.initials: H
authors.lastname: Chambost
authors.forename: Nicolas
authors.initials: N
authors.lastname: Sirvent
authors.forename: Gérard
authors.initials: G
authors.lastname: Michel
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D002386:Cataract / Q000139:chemically induced / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D016371:Cranial Irradiation / Q000009:adverse effects*; D003907:Dexamethasone / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy*; D011241:Prednisone / Q000008:administration & dosage / Q000009:adverse effects; D015995:Prevalence; D011446:Prospective Studies; D011788:Quality of Life; D011832:Radiation Injuries / Q000209:etiology*; D012307:Risk Factors; D016019:Survival Analysis; D017741:Survivors
chemical_list: D003907:Dexamethasone; D011241:Prednisone
keywords: acute leukaemia; cataracts; chemotherapy; late effects