RETINOPATHY AND OPTIC NEUROPATHY IN BONE-MARROW TRANSPLANTATION FOR BREAST-CANCER

Purpose: To characterize the ocular toxicity of a bone marrow transpla nt regimen that does not include total body or focal head irradiation. Methods: Nine patients with advanced breast cancer were referred for visual symptoms after high-dose chemotherapy with cisplatin, cyclophos phamide, and carmustine and autologous bone marrow transplantation wit hout total body irradiation or local head irradiation. Results: Sympto ms consistent with optic neuropathy and retinopathy developed in five patients. Retinopathy alone developed in three patients and optic neur opathy alone developed in one. Retinal abnormalities included cotton-w ool spots, intraretinal hemorrhages, and macular exudate. Optic nerve findings included disc swelling and subsequent palter. Symptoms and si gns associated with retinopathy were generally reversible, whereas tho se associated with optic neuropathy often were permanent. Retinopathy and/or optic neuropathy developed in all of the patients from 1 to 5 m onths after bone marrow transplantation. Resolution or stabilization o f findings was observed 2-4 months after presentation. Two patients wi th optic neuropathy showed progression of field and acuity loss after 4 months. When compared with control subjects, the exposure of patient s to cyclophosphamide and carmustine was no different. However, cispla tin exposure was 1.2-fold higher in patients with ocular toxicity comp ared with control subjects. Conclusions: Optic neuropathy and retinopa thy are presumed to arise from the administration of a high-dose chemo therapy regimen. As techniques in supportive care improve, long-term a dverse effects of these therapies now are becoming apparent.