Klinik der okulären Graft-versus-Host Disease

Zusammenfassung

Hintergrund: Bei der okulären Graft-versus-Host Disease (GvHD) handelt es sich überwiegend um eine inflammatorische Augenoberflächenerkrankung nach allogener hämatopoetischer Stammzelltransplantation (HSCT), deren Inzidenz derzeit zunimmt. Methoden: Überblick über klinische Zeichen der okulären GvHD. Ergebnisse: Die chronische okuläre GvHD als schwere Augenoberflächenerkrankung stellt oft ein langfristiges Problem nach allogener HSCT dar. Sie führt nicht nur zu einer reduzierten Lebensqualität durch ausgeprägte Beschwerden, sondern kann die Sehfähigkeit herabsetzen und zur Erblindung durch korneale Komplikationen führen. Patienten mit chronischer okulärer GvHD sind aufgrund der ausgeprägten Benetzungsstörung und der häufig persistierenden Entzündungsaktivität oft therapierefraktär. Schlussfolgerung: Eine multimodale und interdisziplinäre Therapie – unter Einbeziehung der behandelnden Kollegen der Hämatoonkologie – ist für die Behandlung von GvHD-Patienten essenziell.

Abstract

Background: Ocular graft-versus-host disease (GvHD) is mainly an inflammatory ocular surface disorder after allogeneic hematopoetic stem cell transplantation (HSCT) with increasing incidence. Methods: We present an overview on clinical signs of ocular GvHD. Results: Ocular chronic GvHD representing a severe ocular surface disease is a long-term problem after allogeneic HSCT. It is not only associated with reduced quality of life because of dry eye symptoms but can also impair visual acuity and lead to blindness due to corneal complications. Patients with ocular GvHD are often resistant to therapy because of the severe dry eye disease and persistent inflammatory activity. Conclusion: A multimodal and interdisciplinary therapy – in cooperation with the colleagues from haematology and oncology is important for the treatment of patients with ocular GvHD.

Schlüsselwörter

Kornea - Bindehaut - Lider - GVHD - HSCT - graft-versus-host disease

Key words

conjunctiva - cornea - lids - GVHD - HSCT - graft-versus-host disease

• Literatur

• 1 Ferrara JL, Deeg HJ. Graft-versus-host disease. N Engl J Med 1991; 324: 667-674
• 2 Ferrara JL, Levine JE, Reddy P et al. Graft-versus-host disease. Lancet 2009; 373: 1550-1561
• 3 Baird K, Pavletic SZ. Chronic graft versus host disease. Curr Opin Hematol 2006; 13: 426-435
• 4 Filipovich AH, Weisdorf D, Pavletic S et al. National Institutes of Health consensus development project on criteria for clinical trials in chronic graft-versus-host disease: I. Diagnosis and staging working group report. Biol Blood Marrow Transplant 2005; 11: 945-956
• 5 Filipovich AH. Diagnosis and manifestations of chronic graft-versus-host disease. Best Pract Res Clin Haematol 2008; 21: 251-257
• 6 Wolff D, Bertz H, Greinix H et al. The treatment of chronic graft-versus-host disease: consensus recommendations of experts from Germany, Austria and Switzerland. Dtsch Arztebl Int 2011; 108: 732-740
• 7 Lee SJ, Vogelsang G, Flowers ME. Chronic graft versus-host disease. Biol Blood Marrow Transplant 2003; 9: 215-233
• 8 Kim SK, Smith JA, Dunn JP. Chronic Ocular Graft versus Host Disease. In: Vogelsang GB, Pavletic SZ, eds. Chronic Graft Versus Host Disease: Interdisciplinary Management. New York: Cambridge University Press; 2009: 199-206
• 9 Shikari H, Amparo F, Saboo U et al. Onset of ocular graft-versus-host disease symptoms after allogeneic hematopoietic stem cell transplantation. Cornea 2015; 34: 243-247
• 10 Ogawa Y, Shimmura S, Kawakita T et al. Epithelial mesenchymal transition in human ocular chronic graft-versus-host disease. Am J Pathol 2009; 175: 2372-2381
• 11 Rojas B, Cuhna R, Zafrakis P et al. Cell populations and adhesion molecules expression in conjunctiva before and after bone marrow transplantation. Exp Eye Res 2005; 81: 313-325
• 12 Westekemper H, Meller S, Citak S et al. Differential chemokine expression in chronic GVHD of the conjunctiva. Bone Marrow Transplant 2010; 45: 1340-1346
• 13 Kim SK. Update on ocular graft versus host disease. Curr Opin Ophthalmol 2006; 17: 344-348
• 14 Ogawa Y, Kuwana M. Dry eye as a major complication associated with chronic graft-versus-host disease after hematopoietic stem cell transplantation. Cornea 2003; 22 (7 Suppl.) S19-S27
• 15 Hessen M, Akpek EK. Ocular graft-versus-host disease. Curr Opin Allergy Clin Immunol 2012; 2: 540-547
• 16 Anderson GA, Regillo C. Ocular manifestations of graft versus host disease. Curr Opin Ophthalmol 2004; 15: 503-507
• 17 Wang Y, Ogawa Y, Dogru M et al. Baseline profiles of ocular surface and tear dynamics after allogeneic hematopoietic stem cell transplantation in patients with or without chronic GVHD-related dry eye. Bone Marrow Transplant 2010; 45: 1077-1083
• 18 Dietrich-Ntoukas T, Cursiefen C, Westekemper H et al. Diagnosis and treatment of ocular chronic graft-versus-host disease: report from the German-Austrian-Swiss Consensus Conference on Clinical Practice in chronic GVHD. Cornea 2012; 31: 299-310
• 19 Jagasia MH, Greinix HT, Arora M et al. National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: I. The 2014 Diagnosis and Staging Working Group Report. Biol Blood Marrow Transplant 2015; 21: 389-401
• 20 Ogawa Y, Kim SK, Dana R et al. International Chronic Ocular Graft-vs-Host-Disease (GVHD) Consensus Group: proposed diagnostic criteria for chronic GVHD (Part I). Sci Rep 2013; 3: 3419
• 21 Moon SJ, Mieler WF. Retinal complications of bone marrow and solid organ transplantation. Curr Opin Ophthalmol 2003; 14: 433-442
• 22 Tichelli A, Gratwohl A, Egger T et al. Cataract formation after bone marrow transplantation. Ann Intern Med 1993; 119: 1175-1180
• 23 Najima Y, Kakihana K, Ohashi K et al. Incidence, risk factors, and clinical outcomes of cataracts following hematopoietic stem cell transplantation. Am J Hematol 2011; 86: 508-510
• 24 Stevenson W, Shikari H, Saboo US et al. Bilateral corneal ulceration in ocular graft-versus-host disease. Clin Ophthalmol 2013; 7: 2153-2158