Chronic ocular graft-versus-host disease after allogeneic haematopoietic stem cell transplantation in Denmark – factors associated with risks and rates in adults according to conditioning regimen


We investigated risks and hazard rates of developing chronic ocular graft-versus-host disease (oGVHD) in a large nationwide, single centre study by using the criteria proposed by “The International Chronic oGVHD Consensus Group”. This retrospective study included 1407 consecutive adults who underwent allogeneic haematopoietic stem cell transplantation (HSCT). Patients were examined by an ophthalmologist according to the hospital’s guidelines: baseline examination before HSCT, annually up to 5 years after HSCT. The 186 (13%) had dry eye disease before HSCT. The 5-year cumulative incidence of oGVHD was 18% (95% CI: 15–21) after myeloablative (MA) and 35% (95% CI: 30–39) after non-myeloablative conditioning (NMA). Factors associated with the rate of oGVHD were assessed separately according to conditioning regimen by using multiple Cox regression analyses. Factors that increased the rate in the MA group: Malignant disease, Schirmer’s test≤10 mm/5 min before transplantation, use of female donor, matched unrelated donor, peripheral blood as stem cell source, and grade III-IV acute GVHD. Factors that increased the rate in the NMA group: Schirmer’s test≤10 mm/5 min before transplantation and higher recipient age. We recommend a baseline ophthalmological examination before HSCT since many of the patients have signs of dry eyes before transplantation which increased the risk and rate of developing oGVHD.

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Fig. 1: The cumulative incidence curves of ocular cGVHD after HSCT according to conditioning.
Fig. 2: Myeloablative conditioning: cumulative incidence curves of ocular cGVHD according to the five risk factors.
Fig. 3: Non-myeloablative conditioning: cumulative incidence curves of ocular cGVHD according to “Family relation” and “Schirmer’s test before HSCT”.
Fig. 4: Non-myeloablative conditioning: the 5-year cumulative incidence of assumed oGVHD is higher in the group with “DEWS score 1” before transplantation (43%) than the 5-year cumulative incidence of oGVHD in the group with no DED before transplantation (35%) (p = 0.0428).


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We would like to thank the following foundation for financial support to this study: The Danish Cancer Society (grant R108-A7021-14-S31), Fight for Sight Denmark, Synoptik-Fonden, Novo Nordic Foundation (grant NNF15OC0014158) and Dansk Kræftforskningsfond.

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Correspondence to Helene Jeppesen.

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Jeppesen, H., Sengeløv, H., Eriksson, F. et al. Chronic ocular graft-versus-host disease after allogeneic haematopoietic stem cell transplantation in Denmark – factors associated with risks and rates in adults according to conditioning regimen. Bone Marrow Transplant (2020).

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