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Delayed diagnosis of ocular graft-versus-host disease after allogeneic hematopoietic stem cell transplantation
Yinglin Liao1, Wenxin Zhao1, Jing Yang1
1State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Disease, Guangzhou, China.
Insights
Delayed diagnosis of chronic ocular graft-versus-host disease (coGVHD) is common in allogeneic stem cell transplant recipients. Improving patient awareness and ophthalmologist knowledge can lead to earlier detection of this severe condition.
Area of Science:
- Ophthalmology
- Hematology
- Transplantation Medicine
Background:
- Chronic ocular graft-versus-host disease (coGVHD) is a significant post-transplant complication.
- Delayed diagnosis of coGVHD can lead to increased disease severity and complications.
Purpose of the Study:
- To investigate the delayed diagnosis of coGVHD after allogeneic hematopoietic stem cell transplantation (alloHCT).
- To analyze potential confounding factors associated with delayed coGVHD diagnosis.
Main Methods:
- A cross-sectional study of 118 patients diagnosed with coGVHD post-alloHCT.
- Diagnosis and grading of coGVHD followed International Chronic Ocular GVHD Consensus Group (ICOGCG) criteria.
- Lag time of diagnosis (TN-D) was calculated and compared between groups.
Main Results:
- The median diagnostic delay (TN-D) was 6.3 months, with 70% experiencing delays longer than 3 months.
- Delayed diagnosis was associated with higher ICOGCG scores and more severe ocular signs.
- Seeking prior ophthalmic care multiple times and accurate symptom knowledge influenced diagnostic delay.
Conclusions:
- Delayed diagnosis of coGVHD is prevalent in alloHCT recipients and linked to disease severity.
- Enhancing patient education and ophthalmologist awareness is crucial for early coGVHD detection.
Purpose:
To investigate the delayed diagnosis of chronic ocular graft-versus-host disease (coGVHD) after allogeneic hematopoietic stem cell transplantation (alloHCT), and further analyze potential confounding factors.
Methods:
This cross-sectional study included 118 patients newly diagnosed as coGVHD after alloHCT at Zhongshan Ophthalmic Center, Sun Yat-sen University. All participants finished the flow path of medical history taking, detailed ophthalmological examination and questionnaire-based survey. coGVHD was diagnosed and graded by International Chronic Ocular GVHD Consensus Group (ICOGCG) criteria. Lag time of diagnosis was defined as interval between noting of ocular symptoms and confirmed diagnosis of coGVHD (TN-D). We further compared the clinical parameters between groups categorized by the median TN-D as medium and long delay groups.
Results:
The median TN-D was 6.3 [IQR 2.8-14.5] months. Most coGVHD patients underwent delayed diagnosis of coGVHD longer than 3 months (70 %, 83 of 118), with 90 of 118 diagnosed as severe coGVHD (76 %). The long delay group exhibited higher ICOGCG scores (10 [IQR 9-10.5] vs. 9 [IQR 8-10], P = 0.039) and more pronounced ocular signs, including conjunctival injection, meibomian gland loss, fibrotic tarsal conjunctiva, symblepharon, and corneal complications (all P < 0.05). Delayed diagnosis was strikingly correlated with seeking ophthalmic medical care twice or more prior to diagnosis (adjusted OR = 5.42, 95%CI: 1.40-21.06, P = 0.015) and accurate knowledge of ocular discomfort symptoms in coGVHD (adjusted OR = 0.29, 95%CI: 0.08-1.00, P = 0.050).
Conclusions:
Delayed diagnosis of coGVHD, associated with disease severity, was common among alloHCT recipients in southern China. Improving patient education and the awareness of ophthalmologists may facilitate early diagnosis of coGVHD.
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