Ocular Graft-versus-Host Disease Underdiagnosis: A Survey Study

Area of Science:

• Hematology
• Ophthalmology
• Transplantation Medicine

Background:

• Allogeneic hematopoietic stem cell transplantation (allo-HSCT) can lead to graft-versus-host disease (GVHD), affecting various organs.
• Ocular GVHD (oGVHD) is a significant complication impacting patient quality of life.
• Underdiagnosis of oGVHD poses a challenge in post-transplant care.

Purpose of the Study:

• To investigate the extent of oGVHD underdiagnosis in patients who have undergone allo-HSCT.
• To explore potential reasons contributing to the underdiagnosis of oGVHD.

Main Methods:

• A survey was distributed to 6032 subscribers of the Blood and Marrow Transplant Information Network.
• 371 respondents with a history of allo-HSCT completed the survey, with 335 reporting symptoms.
• Analysis included self-reported ocular symptoms, onset, treatments, symptom control, and diagnoses of systemic chronic GVHD (cGVHD) and oGVHD.

Main Results:

• Among 335 symptomatic respondents, only 55.6% with new ocular symptoms after allo-HSCT received an oGVHD diagnosis.
• Underdiagnosis was also prevalent in patients with worsened pre-existing or stable ocular symptoms.
• Diagnosis of oGVHD strongly correlated with the number of reported symptoms and treatments.

Conclusions:

• Underdiagnosis of oGVHD may stem from outdated diagnostic criteria requiring concurrent cGVHD in other organs.
• The common association of oGVHD with severe dry eye disease might lead to its underdiagnosis in less severe or less treated cases.
• Revising diagnostic approaches is crucial for timely oGVHD identification and management.