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Published on: August 4, 2022
Systemic Immunosuppressant Cessation/Tapering Linked to MGD Progression Post-HSCT
Wenxin Zhao1, Xiaohui Luo2, Jing Yang2
1From the State Key Laboratory of Ophthalmology (W.Z., X.L., J.Y., Y.L., L.J., Z.C., L.L.), Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China; Department of Ophthalmology (W.Z.), The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Purpose:
To observe the longitudinal changes in meibomian gland structure and function in patients after allogeneic hematopoietic stem cell transplantation (allo-HSCT) and to investigate the potential associated factors.
Design:
Single-center retrospective clinical cohort study.
Participants:
Sixty-eight patients after allo-HSCT, including 48 patients (92 eyes) with and 20 patients (40 eyes) without chronic ocular graft-versus-host disease (coGVHD).
Methods:
Medical records were retrospectively reviewed. Data collected included demographic characteristics, medical history, ocular surface disease index questionnaire, corneal fluorescein staining, bulbar conjunctival injection, Schirmer's test, noninvasive break-up time, lid margin abnormalities, meibum quality scores, and meibomian gland area ratio (MGAR). Follow-up data were compared. A generalized estimating equation was used to analyze the associated factors.
Main Outcome Measures:
Change in MGAR.
Results:
All patients were followed up for 22.9 ± 10.7 months since first visit (coGVHD group vs non-coGVHD group = 23.6 ± 10.8 months vs 21.3 ± 10.5 months, P = .441). Compared with baseline, the severity of coGVHD at the last follow-up visit improved (International Chronic Ocular Graft-versus-Host Disease [ICCGVHD] score: 7.3 ± 2.3 vs 8.5 ± 1.7, P < .001), but no significant change in MGAR (51.7% ± 14.8% vs 52.6% ± 14.8%, P = .341). Specifically, MGAR remained stable in 59 eyes (64.1%), deteriorated in 14 eyes (15.2%), and improved in 19 eyes (20.7%). In the non-coGVHD group, while ICCGVHD scores remained stable compared to baseline, MGAR showed a decrease at the final follow-up (70.2 ± 11.0% vs 73.5 ± 10.0%, P = .001). Cessation or tapering of systemic immunosuppressants was associated with MGAR worsening in both the coGHVD group (odds ratio [OR]: 4.60, 95% confidence interval [CI]: 1.24-17.00) and the non-coGHVD group (OR: 2.48, 95%CI: 1.14-5.40). Further subgroup analysis revealed that in coGVHD patients, the subgroup with cessation or tapering of systemic immunosuppressants showed a significant worsening in meibum quality (8.4 ± 5.3 vs 5.9 ± 4.6, P = .005).
Conclusions:
Improvement in coGVHD is not necessarily accompanied by improvement in Meibomian gland dysfunction (MGD). Cessation or tapering of systemic immunosuppressants was associated with the progression of MGD after allo-HSCT.
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