Prevalence and risk factors associated with development of ocular GVHD defined by NIH consensus criteria.
Jacobs, R 1; Tran, U 2; Chen, H 3; Kassim, A 4; Engelhardt, B G 4; Greer, J P 4; Goodman, S G 4; Clifton, C 4; Lucid, C 4; Vaughan, L A 4; Savani, B N 4; Jagasia, M 4
[Article] Bone Marrow Transplantation. 47(11):1470-1473, November 2012.

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: We studied 172 patients for development of ocular graft-versus-host disease (GVHD) after allogeneic stem cell transplantation (allo-SCT) from 2002 to 2009. Ocular GVHD was diagnosed in 60 patients (38%), with 27 (16%) being diagnosed at days 100 and 33 (23%) beyond day 100 for a 2-year cumulative incidence of 35% (95% confidence interval (CI), 28-43). The positive and negative predictive values of a Schirmer I test score (using <=5 mm as a cutoff) in predicting ocular GVHD (day 100) were 41 and 82%, respectively. In patients with ocular GVHD beyond day 100, extraocular manifestations of GVHD preceded the development of ocular GVHD in most patients (27 of 33, 81%). Prior acute skin GVHD (odds ratio 2.57, 95% CI 1.17-5.64, P = 0.019) and male recipients of female donors (odds ratio 2.57, 95% CI 1.09-6.06, P = 0.03) were independent risk factors for ocular GVHD. We recommend comprehensive ocular evaluation rather than a screening Schirmer's test to establish the diagnosis of ocular GVHD. Early diagnosis and preventive strategies in high-risk populations need to be studied in clinical trials to prevent devastating impact on quality of life in patients with prolonged ocular GVHD.

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