title: Long-term, drug-free remission of sympathetic ophthalmia with high-dose, short-term chlorambucil therapy.
abstract: OBJECTIVE
  To evaluate the safety and effectiveness of short-term, high-dose chlorambucil therapy in achieving long-term, drug-free remission in the treatment of sympathetic ophthalmia (SO).
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Sixteen patients with SO treated with high-dose, short-term chlorambucil therapy between 1970 and 2010.
  
  
  METHODS
  Descriptive and bivariate analyses were used to characterize disease and outcomes.
  
  
  METHODS
  Months of disease-free remission, prevalence rate of relapse, and prevalence of serious treatment-related adverse events.
  
  
  RESULTS
  Sixteen patients with SO treated with short-term, high-dose chlorambucil were identified. Patients were treated with chlorambucil for a median of 14.0 weeks (mean, 14.5 weeks; range, 12.0-19.0 weeks). Median follow-up was 98.5 months (mean, 139.1 months; range, 48-441 months) from initiation of chlorambucil therapy. Control of inflammation was achieved in 100% of patients. Thirteen patients (81.3%) maintained vision of 20/40 or better in the sympathizing eye. Four patients (25%) relapsed after a median of 83 months (mean, 131 months) after cessation of systemic therapy. Seventy-five percent of relapses were controlled with topical therapy only. Conjunctival Kaposi's sarcoma developed in 1 patient. No patient demonstrated systemic malignancy.
  
  
  CONCLUSIONS
  Short-term, high-dose chlorambucil therapy provides sustained periods of drug-free remission. With median follow-up of more than 8 years (mean, 11.6 years; range, 4-37 years), there was a low rate of recurrence and minimal long-term serious health consequences or adverse events. Because SO may be a lifelong condition and because chlorambucil therapy may offer long-term, drug-free remission, this treatment may be worth considering early in the decision-making process for severe sight-threatening disease.
authors.affiliation: Illinois Eye and Ear Infirmary, University of Illinois Chicago, Chicago, Illinois; Weill Cornell College of Medicine, New York City, New York.
authors.forename: Sarju S
authors.initials: SS
authors.lastname: Patel
authors.affiliation: Consultores Oftalmologicos, Buenos Aires, Argentina.
authors.forename: Emilio M
authors.initials: EM
authors.lastname: Dodds
authors.affiliation: Consultores Oftalmologicos, Buenos Aires, Argentina.
authors.forename: Laura V
authors.initials: LV
authors.lastname: Echandi
authors.affiliation: Universidad of Buenos Aires, Buenos Aires, Argentina.
authors.forename: Cristobal A
authors.initials: CA
authors.lastname: Couto
authors.affiliation: Universidad of Buenos Aires, Buenos Aires, Argentina.
authors.forename: Ariel
authors.initials: A
authors.lastname: Schlaen
authors.affiliation: Illinois Eye and Ear Infirmary, University of Illinois Chicago, Chicago, Illinois.
authors.forename: Howard H
authors.initials: HH
authors.lastname: Tessler
authors.affiliation: Illinois Eye and Ear Infirmary, University of Illinois Chicago, Chicago, Illinois; Northwestern University, Feinberg School of Medicine, Chicago, Illinois. Electronic address: debrgold@yahoo.com.
authors.forename: Debra A
authors.initials: DA
authors.lastname: Goldstein
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage* / Q000009:adverse effects; D002648:Child; D002699:Chlorambucil / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009879:Ophthalmia, Sympathetic / Q000188:drug therapy* / Q000503:physiopathology; D012074:Remission Induction; D012189:Retrospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult
chemical_list: D018906:Antineoplastic Agents, Alkylating; D002699:Chlorambucil