OBJECTIVE: To evaluate the incidence, time course, and factors associated with cataract formation in bone marrow transplant recipients. DESIGN: Prospective cohort study. SETTING: University Hospitals, Basel, Switzerland. PATIENTS: 197 patients treated with allogeneic or autologous bone marrow grafts at least 180 days before the start of the study. INTERVENTION: Three regimens for bone marrow transplant were used: 74 patients received single-dose, total-body irradiation (TBI), 90 patients received fractionated TBI, and 33 received chemotherapy alone. RESULTS: Three and one half years after single-dose TBI, 51 of the 74 patients (69%) were alive and cataracts had developed in all of these 51 patients. Cataracts developed in 18 of the 90 (20%) patients treated with fractionated TBI, with an 83% (95% CI, 63% to 100%) risk for lens opacification at 6 years. Cataracts developed in only 1 of the 33 (3%) patients treated with chemotherapy alone. Incidence of cataracts is higher and lens opacification occurs earlier after single-dose TBI than after fractionated TBI (P < 0.01). With Cox regression analysis, the use of irradiation (relative risk, 21.0), the mode of irradiation (relative risk, 7.4), and the use of steroid treatment (relative risk, 2.9) for more than 3 months after bone marrow transplantation increased the risk for cataract formation. In contrast, age, sex, and chronic graft-versus-host disease did not influence the rate of cataract development. The probability of requiring cataract surgery after 6 years was 85% (CI, 75% to 95%) for the patients treated with single-dose TBI and 20% (CI, 0% to 49%) for those prepared with fractionated irradiation. CONCLUSIONS: Patients treated with TBI, regardless of fractionation, are likely to have cataracts within 10 years, and some will need surgical repair. Long-term steroid treatment accelerates cataract formation. Preventive measures, such as lens shielding during TBI, should be considered.
OBJECTIVE: To evaluate the incidence, time course, and factors associated with cataract formation in bone marrow transplant recipients. DESIGN: Prospective cohort study. SETTING: University Hospitals, Basel, Switzerland. PATIENTS: 197 patients treated with allogeneic or autologous bone marrow grafts at least 180 days before the start of the study. INTERVENTION: Three regimens for bone marrow transplant were used: 74 patients received single-dose, total-body irradiation (TBI), 90 patients received fractionated TBI, and 33 received chemotherapy alone. RESULTS: Three and one half years after single-dose TBI, 51 of the 74 patients (69%) were alive and cataracts had developed in all of these 51 patients. Cataracts developed in 18 of the 90 (20%) patients treated with fractionated TBI, with an 83% (95% CI, 63% to 100%) risk for lens opacification at 6 years. Cataracts developed in only 1 of the 33 (3%) patients treated with chemotherapy alone. Incidence of cataracts is higher and lens opacification occurs earlier after single-dose TBI than after fractionated TBI (P < 0.01). With Cox regression analysis, the use of irradiation (relative risk, 21.0), the mode of irradiation (relative risk, 7.4), and the use of steroid treatment (relative risk, 2.9) for more than 3 months after bone marrow transplantation increased the risk for cataract formation. In contrast, age, sex, and chronic graft-versus-host disease did not influence the rate of cataract development. The probability of requiring cataract surgery after 6 years was 85% (CI, 75% to 95%) for the patients treated with single-dose TBI and 20% (CI, 0% to 49%) for those prepared with fractionated irradiation. CONCLUSIONS:Patients treated with TBI, regardless of fractionation, are likely to have cataracts within 10 years, and some will need surgical repair. Long-term steroid treatment accelerates cataract formation. Preventive measures, such as lens shielding during TBI, should be considered.
Authors: Barbara Spitzer; Ann A Jakubowski; Esperanza B Papadopoulos; Kirsten Fuller; Patrick D Hilden; James W Young; Juliet N Barker; Guenther Koehne; Miguel-Angel Perales; Katharine C Hsu; Marcel R van den Brink; Nancy A Kernan; Susan E Prockop; Andromachi Scaradavou; Hugo Castro-Malaspina; Richard J O'Reilly; Farid Boulad Journal: Biol Blood Marrow Transplant Date: 2017-07-12 Impact factor: 5.742
Authors: N S Majhail; J D Rizzo; S J Lee; M Aljurf; Y Atsuta; C Bonfim; L J Burns; N Chaudhri; S Davies; S Okamoto; A Seber; G Socie; J Szer; M T Van Lint; J R Wingard; A Tichelli Journal: Hematol Oncol Stem Cell Ther Date: 2012
Authors: N S Majhail; J D Rizzo; S J Lee; M Aljurf; Y Atsuta; C Bonfim; L J Burns; N Chaudhri; S Davies; S Okamoto; A Seber; G Socie; J Szer; M T Van Lint; J R Wingard; A Tichelli Journal: Bone Marrow Transplant Date: 2012-03 Impact factor: 5.483
Authors: Yoshihiro Inamoto; Igor Petriček; Linda Burns; Saurabh Chhabra; Zachariah DeFilipp; Peiman Hematti; Alicia Rovó; Raquel Schears; Ami Shah; Vaibhav Agrawal; Aisha Ahmed; Ibrahim Ahmed; Asim Ali; Mahmoud Aljurf; Hassan Alkhateeb; Amer Beitinjaneh; Neel Bhatt; Dave Buchbinder; Michael Byrne; Natalie Callander; Kristina Fahnehjelm; Nosha Farhadfar; Robert Peter Gale; Siddhartha Ganguly; Shahrukh Hashmi; Gerhard C Hildebrandt; Erich Horn; Ann Jakubowski; Rammurti T Kamble; Jason Law; Catherine Lee; Sunita Nathan; Olaf Penack; Ravi Pingali; Pinki Prasad; Drazen Pulanic; Seth Rotz; Aditya Shreenivas; Amir Steinberg; Khalid Tabbara; André Tichelli; Baldeep Wirk; Jean Yared; Grzegorz W Basak; Minoo Battiwalla; Rafael Duarte; Bipin N Savani; Mary E D Flowers; Bronwen E Shaw; Nuria Valdés-Sanz Journal: Biol Blood Marrow Transplant Date: 2018-12-03 Impact factor: 5.742
Authors: Alicia Rovó; Thomas Daikeler; Jörg Halter; Dominik Heim; Dimitrios A Tsakiris; Martin Stern; Tuomas Waltimo; Jan Dirk Studt; Alan Tyndall; Alois Gratwohl; André Tichelli Journal: Haematologica Date: 2010-09-17 Impact factor: 9.941
Authors: Gabriel Chodick; Alice J Sigurdson; Ruth A Kleinerman; Charles A Sklar; Wendy Leisenring; Ann C Mertens; Marilyn Stovall; Susan A Smith; Rita E Weathers; Lene H S Veiga; Leslie L Robison; Peter D Inskip Journal: Radiat Res Date: 2016-03-29 Impact factor: 2.841