Effect of Conditioning Regimens on Meibomian Gland Dysfunction in Allogeneic Hematopoietic Stem Cell Transplant...

Meibomian gland dysfunction (MGD) can occur after allogeneic hematopoietic stem cell transplantation (allo-HSCT). MGD is characterized by reduced lipid secretion by the meibomian glands, causing tear-film instability. Because chemotherapy and radiation can induce oxidative stress, we hypothesize that these exposures will increase the hazard of MGD after allo-HSCT.

This retrospective cohort study analyzed 139 allo-HSCT recipients at the University of Maryland Medical Center who completed post-transplant eye examinations from 2013 to 2025. Descriptive analysis summarized demographic characteristics in our sample. Unadjusted and adjusted Cox proportional hazard models were used to evaluate the independent effects of conditioning regimens on MGD.

Unadjusted Cox proportional hazards models showed that fludarabine was associated with a higher MGD hazard compared with nonfludarabine based regimens (HR = 3.671, 95% CI, 1.338-10.070; P = 0.012). After adjusting for age at transplant, sex, race, transplant type, cancer type, and presence of pretransplant ocular conditions, fludarabine-based conditioning remained associated with a higher hazard of MGD (HR = 5.242, 95% CI, 1.725-15.928; P = 0.003).

These findings suggest that fludarabine-based conditioning increases the hazard of developing MGD post-transplant. Alternatives to fludarabine in conditioning regimens are warranted to reduce the likelihood of MGD. Allo-HSCT patients who receive fludarabine may also benefit from education, monitoring, and interventions aimed at mitigating MGD severity.