Cataract in children after bone marrow transplantation:: relation to conditioning regimen

Purpose: To compare the frequency of cataract development in bone marrow transplanted children who have been given either total body irradiation (TBI) or busulphan as conditioning treatment before bone marrow transplantation (BMT). Material and methods: Forty-five children who underwent BMT between 1987 and 1994 were included in the study. Twenty-one children were conditioned with TBI and 24 with busulphan before BMT. AD children underwent an ophthalmic examination before BMT in order to exclude lens opacities. Yearly examinations for 2-10 years were performed after BMT. Results: Cataracts developed in 20 of the 21 (95%) children conditioned with TBI and in five of the 24 (21%) children conditioned with busulphan. There was no relationship between cataract development and age at BMT, or between cataract development and prednisolone given before or after BMT. Conclusion: The present study confirms earlier reports of the high risk of cataract development after TBI and suggests that busulphan is related to cataract development, although less frequently than TBI. The report discusses the possible additive effect of the disease itself, of any corticosteroid treatment and of other cytostatic drugs. It then stresses the importance of early diagnosis of cataracts in children in order to prevent the development of amblyopia.