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Cataracts after autologous bone marrow transplantation in children
Insights
Total body irradiation (TBI) significantly increases posterior subcapsular cataract (PSC) risk in pediatric bone marrow transplant (BMT) patients. High PSC incidence necessitates monitoring, especially after TBI-based conditioning regimens.
Area of Science:
- Ophthalmology
- Hematology
- Oncology
Background:
- Pediatric bone marrow transplantation (BMT) is a crucial treatment for hematologic and lymphoid malignancies.
- Cataract development, particularly posterior subcapsular cataract (PSC), is a known complication following BMT.
- Understanding risk factors for PSC is vital for long-term patient care.
Purpose of the Study:
- To determine the incidence and severity of PSC in children undergoing autologous or syngeneic BMT.
- To investigate the role of total body irradiation (TBI) and other pre-transplant therapies in PSC development.
- To assess the impact of PSC on visual acuity and the need for surgical intervention.
Main Methods:
- Retrospective analysis of 29 children post-BMT (autologous or syngeneic).
- Assessment of PSC incidence and degree, correlated with conditioning regimens (chemotherapy +/- TBI) and prior cranial irradiation.
- Follow-up for 4-10 years to evaluate visual acuity and need for cataract surgery.
Main Results:
- 22 out of 29 patients developed PSC within 4 years post-BMT.
- All patients receiving TBI (n=21) developed PSC, with 38% experiencing significant visual impairment (<0.8 acuity).
- Six patients required cataract surgery; TBI was identified as the primary cause of PSC.
Conclusions:
- Autologous BMT conditioning regimens including TBI are associated with a high incidence of PSC in pediatric patients.
- TBI is the main etiological factor for PSC development in this cohort.
- Close ophthalmologic monitoring is recommended for pediatric BMT survivors, especially those who received TBI.
Abstract:
We recorded the incidence and degree of posterior subcapsular cataract (PSC) in 29 children who had undergone autologous (n = 28) or syngeneic (n = 1) bone marrow transplantation (BMT) due to haematologic or lymphoid malignancy. Conditioning prior to transplantation consisted either of a combination of chemotherapy and total body irradiation (TBI) (n = 21) or of chemotherapy only (n = 8). TBI was given in one fraction of 7.5 Gy. Nine patients had received previous cranial irradiation. The patients were followed for 4-10y (median 8 y) after transplantation. Of 29 patients, 22 developed PSC, all within 4 y after BMT. With the exception of one patient who developed unilateral PSC, all had received TBI. Conversely, 100% of those who received TBI developed PSC. In this group (+TBI), eight patients (38%) developed significant PSC, defined as best corrected visual acuity <0.8 in either eye. Six patients (10 eyes) have since needed surgical repair consisting of extracapsular cataract extraction and intraocular lens implantation. There was no clear relationship between previous cranial irradiation and cataract development, nor any other obvious baseline differences between those in the +TBI group who developed significant PSC and those who did not. Although effects of previous therapy cannot be ruled out, TBI appears to be the main cause of PSC in this group of patients. Twelve patients in the +TBI group had well-preserved visual acuity throughout the study, reflecting a slow progression of PSC. This compares favourably with previous reports of allogeneic BMT, possibly owing to less need for corticosteroids after autologous BMT. We conclude that the incidence of PSC was high after autologous BMT where the conditioning regimen included total body irradiation.