Impact of Ocular Chronic Graft-versus-Host Disease on Quality of Life.

Publication Type:

Journal Article

Source:

Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation (2015)

Abstract:

Ocular involvement can be quite symptomatic in patients with chronic graft-versus-host disease (GVHD). The prevalence of and risk factors for ocular GVHD and its impact on quality of life (QOL) in patients with chronic GVHD were studied in a prospective, multicenter, longitudinal, observational study. This study enrolled 342 patients with 1,483 follow-up visits after allogeneic hematopoietic cell transplantation. All patients in this analysis were diagnosed with chronic GVHD requiring systemic treatment and enrolled within 3 months of chronic GVHD diagnosis. The symptom burden of ocular GVHD was based on the degree of dry eye symptoms, frequency of artificial tear usage, and impact on activities of daily living. Patients' quality of life (QOL) was measured by self-administered questionnaires. Variables associated with ocular GVHD at enrollment and subsequent new onset ocular GVHD, and the associations with QOL were studied. Of the 284 chronic GVHD patients, 116 (41%) had ocular GVHD within 3 months of chronic GVHD diagnosis ("early ocular GVHD"). Late ocular GVHD (new onset > 3 months after chronic GVHD diagnosis) occurred in 64 patients. Overall cumulative incidence at 2 years was 57%. Female gender (p=0.005), higher acute GVHD grade (p=0.04) and higher prednisone dose at study entry (p=0.04) were associated with early ocular GVHD. For patients who did not have ocular GVHD within 3 months of chronic GVHD diagnosis, presence of prior grade I-IV acute GVHD (HR 1.78, P=0.04) was associated with shorter time to late ocular GVHD, while female donor into male recipient (HR 0.53, P=0.05) was associated with longer time to late ocular GVHD onset. Utilizing all visit data, patients with ocular GVHD had worse quality of life as measured by FACT-BMT (P=0.002), and greater chronic GVHD symptom burden, as measured by the Lee symptom overall score excluding the eye component (P<0.001) compared to patients who did not have ocular GVHD. In conclusion, this large multicenter, prospective study shows that ocular GVHD affects 57% of patients within 2 year of chronic GVHD diagnosis. Women, patients on higher doses of prednisone at study entry, and those with a history of acute GVHD were at higher risk for ocular GVHD. Strong evidence suggests that ocular GVHD is associated with worse overall health-related QOL.