Optic disc and retinal microvasculopathy after high-dose chemotherapy and autologous hematopoietic progenitor cell support

The purpose of this study was to prospectively evaluate the retinal and opt ic nerve changes in patients undergoing high-dose chemotherapy (HDC) follow ed by autologous hematopoietic progenitor cell support (AHPCS), One hundred and forty patients undergoing HDC and AHPCS underwent extensive pre- and p ost-transplant ophthalmologic evaluations for development of retinal microv ascular complications. One hundred and ten patients received high-dose cycl ophosphamide, cisplatin and BCNU; thirty received identical doses of cyclop hosphamide and cisplatin, but received paclitaxel instead of BCNU, Thirty-f our patients (24%) had retinal findings of either cotton wool spots (CWS) ( n = 20) or retinal hemorrhages (n = 18) during follow-up, which ranged from 1 to 12 months. Ten (7%) of these patients, all of whom received BCNU, sho wed ocular toxicity characterized by CWS 1 to 4 months post transplant (n = 10); optic disc edema (n = 3); and variable vision loss associated with th e onset of BCNU-induced pulmonary toxicity, Retinal and optic disc microvas cular complications may occur after high-dose chemotherapy followed by AHPC S, The association of ischemic retinal lesions and/or optic disc edema with BCNU-induced pulmonary toxicity and the lack of ocular toxicity in patient s that did not receive BCNU may suggest that BCNU is the etiologic agent.