Cataracts after total body irradiation and bone marrow transplantation in patients with acute leukemia in complete remission: A study of the European Group for Blood and Marrow Transplantation

被引:68
作者
Belkacemi, Y
Labopin, M
Vernant, JP
Prentice, HG
Tichelli, A
Schattenberg, A
Boogaerts, MA
Ernst, P
Della Volpe, A
Goldstone, AH
Jouet, JP
Verdonck, LF
Locasciulli, A
Rio, B
Ozsahin, M
Gorin, NC
机构
[1] Hop Tenon, Serv Oncol Radiotherapie, F-75970 Paris 20, France
[2] European Grp Blood Marrow Transplantat, Acute Leukemia Working Party, London, England
[3] European Grp Blood Marrow Transplantat, Acute Leukemia Working Party, Basel, Switzerland
[4] European Grp Blood Marrow Transplantat, Acute Leukemia Working Party, Nijmegen, Netherlands
[5] European Grp Blood Marrow Transplantat, Acute Leukemia Working Party, Paris, France
[6] European Grp Blood Marrow Transplantat, Acute Leukemia Working Party, Lille, France
[7] European Grp Blood Marrow Transplantat, Acute Leukemia Working Party, Louvain, Belgium
[8] European Grp Blood Marrow Transplantat, Acute Leukemia Working Party, Riyadh, Saudi Arabia
[9] European Grp Blood Marrow Transplantat, Acute Leukemia Working Party, Milan, Italy
[10] European Grp Blood Marrow Transplantat, Acute Leukemia Working Party, Utrecht, Netherlands
[11] European Grp Blood Marrow Transplantat, Acute Leukemia Working Party, Monza, Italy
[12] European Grp Blood Marrow Transplantat, Acute Leukemia Working Party, Lausanne, Switzerland
来源
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS | 1998年 / 41卷 / 03期
关键词
cataract; posterior capsular opacification; total body irradiation (TBI); fractionation; dose rate; bone marrow transplantation (BMT); heparin;
D O I
10.1016/S0360-3016(98)00077-7
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Purpose: Advances in bone marrow transplantation (BMT) have consistently improved long-term survival. Therefore, evaluation of late complications such as cataracts is of paramount importance. Methods and Materials: We analyzed data of 2149 patients from the EBMT registry. A cohort of 1063 patients were evaluable for survival and ophthalmologic status after transplant for acute leukemia (AL) in first or second complete remission. Conditioning therapy included either single-dose total body irradiation (STBI) or fractionated TBI (FTBI) grouped in different dose rates (low: LDR less than or equal to 0.04 Gy/min; high: HDR > 0.04 Gy/min). Results: The overall 10-year estimated cataract incidence (ECI) was 50%. It was 60% in the STBI group, 43% in the FTBI group less than or equal to 6 fractions, and 7% in the FTBI group > 6 fractions (p < 10(-4)). It was significantly lower (30%) in the LDR than in the HDR groups (59%;p < 10(-4)). Patients receiving heparin for veno-occlusive disease prophylaxis had fewer cataracts than those who did not (10-year ECI: 33% vs. 53%, respectively; p = 0.04). The 10-year ECI was 65% in the allogeneic vs. 46% in the autologous BMT patients (p = 0.0018). Factors independently associated with an increased risk of cataract were an older age (> 23 years), higher dose rate (> 0.04 Gy/min), allogeneic BMT, and steroid administration (> 100 days). The use of FTBI was associated with a decreased risk of cataract. Heparin administration was a protective factor in patients receiving STBI. In terms of cataract surgery, the unfavorable factors for requiring surgery were: age > 23 yr, STBI, dose rate > 0.04 Gy/min, chronic graft-vs.-host disease (cGvHD), and absence of heparin administration. Among the patients who required cataract surgery (111 out of 257), secondary posterior capsular opacification was observed in 15.7%. Conclusion: High dose rate and STBI are the main risk factors for cataract development and the need for surgery,and the administration of heparin has a protective role in cataractogenesis. (C) 1998 Elsevier Science Inc.
引用
收藏
页码:659 / 668
页数:10
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