Conjunctival Acute Graft-versus-Host Disease in Adult Patients Receiving Allogeneic Hematopoietic Stem Cell Transplantation: A Cohort Study

To investigate the incidence, risk factors and survival of conjunctival acute graft-versus-host disease (aGVHD) in adult patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT). This retrospective study included a total of 139 patients undergoing allogeneic HSCT between January...

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Bibliographic Details
Published in:PloS one 2016-11, Vol.11 (11), p.e0167129-e0167129
Main Authors: Liu, Yao-Chung, Gau, Jyh-Pyng, Lin, Pei-Yu, Liu, Catherine Jui-Ling, Liu, Chia-Jen, Liu, Jin-Hwang, Fan, Nai-Wen
Format: Article
Language:English
Subjects:
Acute Disease
Adolescent
Adult
Aged
Analysis
Biology and Life Sciences
Bone marrow
Cohort analysis
Cohort Studies
Complications and side effects
Conjunctival Diseases - etiology
Conjunctivitis
Cytomegalovirus
Development and progression
Eye diseases
Female
Graft versus host disease
Graft vs Host Disease - etiology
Graft vs. host disease
Graft-versus-host reaction
Hazards
Hematology
Hematopoietic stem cell transplantation
Hematopoietic Stem Cell Transplantation - adverse effects
Hematopoietic stem cells
Hospitals
Humans
Incidence
Male
Medical prognosis
Medicine
Medicine and Health Sciences
Middle Aged
Multivariate analysis
Patients
Physical Sciences
Prevalence studies (Epidemiology)
Quality of life
Research and Analysis Methods
Retrospective Studies
Risk analysis
Risk Factors
Skin
Statistical models
Stem cell transplantation
Stem cells
Subgroups
Survival
Survival Analysis
Transplantation
Transplantation, Homologous - adverse effects
Transplants & implants
Young Adult
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Summary:To investigate the incidence, risk factors and survival of conjunctival acute graft-versus-host disease (aGVHD) in adult patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT). This retrospective study included a total of 139 patients undergoing allogeneic HSCT between January 2012 and December 2014 at a tertiary referral hospital. Patients with ocular complaints after allogeneic HSCT or first donor lymphocyte infusion were evaluated by ophthalmologists. The risk factors for conjunctival aGVHD were analyzed using the Cox proportional hazards model. The overall survival was evaluated using Kaplan-Meier estimates. Thirteen (9.4%) patients developed conjunctival aGVHD, including eight patients with pseudomembranous conjunctivitis. The cumulative incidence of conjunctival aGVHD was 2.1 cases per 10,000 person-day. The median age at HSCT was 47 years (range, 18 to 66) in all patients and 42 years (range, 24 to 58) in the 13 patients with conjunctival aGVHD. Median time of follow-up after allogeneic HSCT was 353 days (range, 11 to 1184). In univariate analysis, grades II-IV skin aGVHD (P = 0.002) and advanced systemic aGVHD except skin aGVHD (overall grades III-IV) (P = 0.001) were significant predictors for conjunctival aGVHD. In multivariate analysis, grades II-IV skin aGVHD was a significant risk factor (P = 0.04). The severity of conjunctival aGVHD was generally correlated with the systemic aGVHD (P = 0.001). Overall survival was significantly shorter in patients with grades II-IV aGVHD compared to those with grade 0-I (P = 0.01). Survival in patients with conjunctival aGVHD did not differ significantly from those without this complication (P = 0.94). In the subgroup analysis of patients with grades III-IV aGVHD, survival was significantly longer in patients with conjunctival involvement than those without (P = 0.03). The severity of conjunctival aGVHD is correlated with systemic aGVHD, but not with inferior overall survival.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0167129