Open AccessConjunctival Acute Graft-versus-Host Disease in Adult Patients Receiving Allogeneic Hematopoietic Stem Cell Transplantation: A Cohort Study
Author(s) -
Yao Chung Liu,
Jyh Pyng Gau,
Pei Yu Lin,
Catherine Jui Ling Liu,
Chia Jen Liu,
Jin Hwang Liu,
Nai Wen Fan
Publication year - 2016
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0167129
Subject(s) - medicine , hematopoietic stem cell transplantation , cumulative incidence , gastroenterology , incidence (geometry) , proportional hazards model , univariate analysis , transplantation , retrospective cohort study , graft versus host disease , cohort , multivariate analysis , immunology , physics , optics
Background 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) Methods 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. Results 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). Conclusions The severity of conjunctival aGVHD is correlated with systemic aGVHD, but not with inferior overall survival.