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The development of cataract in children as a late side-effect of bone marrow transplantation
B Calissendorff1, P Bolme, M el Azazi
1Department of Ophthalmology, Karolinska Institute, Huddinge Hospital, Stockholm, Sweden.
Insights
Total body irradiation (TBI) during bone marrow transplantation (BMT) causes cataracts in children with hematological malignancies. Children without leukemia receiving TBI with eye shielding did not develop cataracts.
Area of Science:
- Pediatric Oncology
- Ophthalmology
- Hematology
Background:
- Bone marrow transplantation (BMT) is a critical treatment for pediatric hematological malignancies and other severe diseases.
- Cataract development is a potential long-term complication following BMT, particularly after conditioning regimens involving irradiation.
- The specific role of total body irradiation (TBI) and shielding in post-BMT cataractogenesis in children requires further elucidation.
Purpose of the Study:
- To investigate the incidence and risk factors for cataract development in children undergoing BMT.
- To determine the specific contribution of total body irradiation (TBI) with and without eye shielding to post-BMT cataract formation.
- To assess the correlation between cataract development and other factors such as disease type, steroid treatment, age, and sex.
Main Methods:
- A cohort of children with hematological malignancies, severe aplastic anemia (SAA), and other non-malignant diseases (n=44) were prospectively followed for cataract development post-BMT.
- Patients with hematological malignancies received TBI (10 Gy, single session, no eye shielding) as part of their conditioning regimen.
- Control groups (SAA and other non-malignant diseases) received either no irradiation or reduced-dose TBI (8 Gy) with eye shielding.
Main Results:
- All children (100%) who received TBI (10 Gy, no shielding) for hematological malignancies developed lens opacification within 3 years post-BMT.
- No cataracts were observed in children with SAA or other non-malignant diseases who did not receive leukemia-conditioning TBI or received TBI with eye shielding.
- No significant relationship was found between cataract development and steroid treatment for graft-versus-host disease, age at treatment, or patient sex.
Conclusions:
- Single-session, unshielded TBI at 10 Gy is the primary cause of cataract development in children undergoing BMT for hematological malignancies.
- Eye shielding during TBI significantly mitigates the risk of cataract formation in pediatric BMT recipients.
- These findings underscore the importance of optimizing TBI protocols to minimize ocular toxicity in pediatric BMT survivors.
Abstract:
Children with hematological malignancies (n = 33), severe aplastic anemia (SAA, n = 7) and other non-malignant diseases (n = 4) were followed for cataract development after bone marrow transplantation (BMT). The children with hematological malignancies were subjected to total body irradiation (TBI), 10 Gy, in one session with no shielding of the eyes as part of their conditioning regimen before BMT. The children with SAA or other non-malignant diseases received either no irradiation before BMT or a reduced dose, 8 Gy, with shielding of their eyes. After 3 years all patients who had undergone BMT for hematological malignancies had developed lens opacification. No patients in the other groups, without leukemia, showed any sign of cataract development. There was no relationship between steroid treatment for graft-versus-host disease and cataract development. No relation to age of onset of treatment or to the sex of the patient and cataract formation was seen. It seems evident from the present study that TBI given in one session was the main cause of cataract development after BMT.