title: Incidence and risk factors for cataract after haematopoietic stem cell transplantation for childhood leukaemia: an LEA study.
abstract: Cataract was prospectively assessed by serial slip lamp tests in 271 patients included in the Leucémie Enfants Adolescents (LEA) programme, the French cohort of childhood leukaemia survivors. All had received haematopoietic stem cell transplantation (HSCT) after total body irradiation (TBI, n = 201) or busulfan-based (n = 70) myeloablative conditioning regimen. TBI was fractionated in all but six patients. The mean duration of follow-up from HSCT was 10·3 years. Cataract was observed in 113/271 patients (41·7%); 9/113 (8·1%) needed surgery. Cumulative incidence after TBI increased over time from 30% at 5 years to 70·8% and 78% at 15 and 20 years, respectively, without any plateau thereafter. The 15-year cumulative incidence was 12·5% in the Busulfan group. A higher cumulative steroid dose appeared to be a cofactor of TBI for cataract risk, in both univariate and multivariate Cox analysis. In the multivariate analysis, cataract had an impact in two quality of life domains: 'the role limitation due to physical problems' and 'the role limitation due to emotional problems'. These data suggest that with increasing follow-up, nearly all patients who receive TBI, even when fractionated, will suffer from cataract that can impact on their quality of life and that high cumulative steroid dose is a cofactor.
authors.affiliation: Department of Paediatric Haematology-Oncology, APHM, Aix Marseille Université, Marseille, France.
authors.forename: Meryl
authors.initials: M
authors.lastname: Horwitz
authors.forename: Pascal
authors.initials: P
authors.lastname: Auquier
authors.forename: Vincent
authors.initials: V
authors.lastname: Barlogis
authors.forename: Audrey
authors.initials: A
authors.lastname: Contet
authors.forename: Maryline
authors.initials: M
authors.lastname: Poiree
authors.forename: Justyna
authors.initials: J
authors.lastname: Kanold
authors.forename: Yves
authors.initials: Y
authors.lastname: Bertrand
authors.forename: Dominique
authors.initials: D
authors.lastname: Plantaz
authors.forename: Claire
authors.initials: C
authors.lastname: Galambrun
authors.forename: Julie
authors.initials: J
authors.lastname: Berbis
authors.forename: Virginie
authors.initials: V
authors.lastname: Villes
authors.forename: Pascal
authors.initials: P
authors.lastname: Chastagner
authors.forename: Nicolas
authors.initials: N
authors.lastname: Sirvent
authors.forename: Claire
authors.initials: C
authors.lastname: Oudin
authors.forename: Gérard
authors.initials: G
authors.lastname: Michel
mesh_terms: D000293:Adolescent; D000328:Adult; D002066:Busulfan / Q000627:therapeutic use; D002386:Cataract / Q000139:chemically induced / Q000453:epidemiology / Q000209:etiology*; D003131:Combined Modality Therapy; D019583:Dose Fractionation, Radiation; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000209:etiology; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D019653:Myeloablative Agonists / Q000627:therapeutic use; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications / Q000628:therapy*; D016016:Proportional Hazards Models; D011788:Quality of Life; D011878:Radiotherapy / Q000009:adverse effects*; D012307:Risk Factors; D019172:Transplantation Conditioning / Q000009:adverse effects; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D019653:Myeloablative Agonists; D002066:Busulfan
keywords: cataract; haematopoietic stem cell transplantation; irradiation; late effects; leukaemia