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Cataract formation after bone marrow transplantation

A Tichelli¹, A Gratwohl, T Egger

¹University Hospitals, Basel, Switzerland.

Annals of Internal Medicine

|December 15, 1993

Summary

This summary is machine-generated.

Bone marrow transplant recipients, especially those receiving single-dose total-body irradiation (TBI), have a high incidence of cataracts. Long-term steroid use also accelerates cataract formation, necessitating preventive measures.

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Area of Science:

Hematology
Oncology
Ophthalmology

Background:

Bone marrow transplantation (BMT) is a critical treatment for various hematologic malignancies and other diseases.
Cataract formation is a known complication following BMT, particularly with radiation-based conditioning regimens.
Understanding the incidence and risk factors for post-BMT cataracts is crucial for long-term patient care.

Purpose of the Study:

To investigate the incidence, temporal progression, and associated risk factors of cataract development in patients undergoing bone marrow transplantation.
To compare cataract rates between different conditioning regimens, including single-dose total-body irradiation (TBI), fractionated TBI, and chemotherapy alone.
To identify factors influencing the need for cataract surgery post-BMT.

Main Methods:

A prospective cohort study was conducted with 197 patients receiving allogeneic or autologous BMT.
Patients were stratified based on conditioning regimens: single-dose TBI (n=74), fractionated TBI (n=90), and chemotherapy alone (n=33).
Data on cataract development, time course, and potential risk factors (irradiation dose, steroid use, age, sex, graft-versus-host disease) were collected and analyzed using Cox regression.

Main Results:

High incidence of cataracts observed: 69% in single-dose TBI, 20% in fractionated TBI, and 3% in chemotherapy-alone groups.
Single-dose TBI led to earlier and more frequent cataract development compared to fractionated TBI (P < 0.01).
Significant risk factors for cataracts included irradiation (RR 21.0), mode of irradiation (RR 7.4), and prolonged steroid use (>3 months, RR 2.9).

Conclusions:

Patients receiving TBI for BMT face a high likelihood of developing cataracts within 10 years, often requiring surgical intervention.
Long-term corticosteroid therapy significantly accelerates cataract formation post-transplant.
Consideration of preventive strategies, such as ocular shielding during TBI, is recommended to mitigate cataract risk.