Cataract-free interval and severity of cataract after total body irradiation and bone marrow transplantation: Influence of treatment parameters

Purpose: To determine prospectively the cataract-free interval (latency tim e) after total body irradiation (TBT) and bone marrow transplantation (BMT) and to assess accurately the final severity of the cataract. Methods and Materials: Ninety-three of the patients who received TBI as a p art of their conditioning regimen for BMT between 1982 and 1995 were follow ed with respect to cataract formation. Included were only patients who had a follow-up period of at least 23 months. TBI was applied in one fraction o f 8 Gy or two fractions of 5 or 6 Gy. Cataract-free period was assessed and in 56 patients, who could be followed until stabilization of the cataract had occurred, final severity of the cataract was determined using a classif ication system. With respect to final severity, two groups were analyzed: s ubclinical low-grade cataract and high-grade cataract. Cataract-free period and final severity were determined with respect to type of transplantation , TBI dose, and posttransplant variables such as graft versus host disease (GVHD) and steroid treatment. Results: Cataract incidence of the analyzed patients was 89%. Median time t o develop a cataract was 58 months for autologous transplanted patients. Fo r allogeneic transplanted patients treated or not treated with steroids, me dian times were 33 and 46 months, respectively. Final severity was not sign ificantly different for autologous or allogeneic patients. In allogeneic pa tients, however, final severity was significantly different for patients wh o had or had not been treated with steroids for GVHD: 93% versus 35% high-g rade cataract, respectively. Final severity was also different for patients receiving 1 x 8 or 2 x 5 Gy TBI, from patients receiving 2 x 6 Gy as condi tioning therapy: 33% versus 79% high-grade cataract, respectively. The grou p of patients receiving 2 x 6 Gy comprised, however, more patients with ste roid treatment for GVHD. So the high percentage of high-grade cataract in t he 2 x 6 Gy group might also have been caused to a significant extent by st eroid treatment. The percentage of patients with high-grade cataract was lo wer in allogeneic transplanted patients without steroid treatment for GVHD than in autologous transplanted patients: 35% versus 48%. An explanation fo r this could be pretransplant therapy containing high-dose steroids. Conclusions: After high-dose-rate TBI in one or two fractions, steroids for GVHD influence latency time of a cataract and are of great importance for the severity the cataract finally attains. Although a cataract will develop in all patients, a clinically important high-grade cataract is relatively infrequent in patients not treated with steroids. Pretransplant therapy mig ht also influence final severity of cataract. (C) 2000 Elsevier Science Inc .