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Cataracts after bone marrow transplantation: long-term follow-up of adults treated with fractionated total body irradiation.

Publication ,  Journal Article
Benyunes, MC; Sullivan, KM; Deeg, HJ; Mori, M; Meyer, W; Fisher, L; Bensinger, R; Jack, MK; Hicks, J; Witherspoon, R
Published in: Int J Radiat Oncol Biol Phys
June 15, 1995

PURPOSE: To determine the risk of, and risk factors for, developing cataracts after bone marrow transplantation. METHODS AND MATERIALS: Four hundred and ninety-two adults who underwent bone marrow transplantation in Seattle were followed for 2 to 18 (median, 6) years. Before transplantation, patients received a preparative regimen of chemotherapy plus total body irradiation (TBI) (n = 407) or chemotherapy alone, without TBI (n = 85). TBI was administered in a single dose of 10 Gy (n = 74) or in fractionated doses totaling 12-15.75 Gy (n = 333). The risk of cataracts was determined for groups of patients with respect to the type of preparative regimen received and other pretransplant and posttransplant variables. RESULTS: One hundred and fifty-nine patients (32%) developed cataracts between 0.5 to 11 (median, 2.3) years after transplantation. The probability of cataracts at 11 years after transplantation was 85%, 50%, 34%, and 19% for patients receiving 10 Gy of single-dose TBI, > 12 Gy fractionated TBI, 12 Gy fractionated TBI, and no TBI, respectively (p < 0.0001). Among those developing cataracts, the severity was greater in patients after single-dose TBI (59% probability of surgical extraction) than after > 12 Gy fractionated TBI, 12 Gy fractionated TBI, or no TBI (33%, 22% and 23%, respectively). Patients given corticosteroids after transplant had a higher probability of cataracts (45%) than those without steroids (38%) (p < 0.0001). In a proportional hazards regression model, the variables that were correlated with an increased probability of cataracts were single-dose TBI (relative risk (RR) = 2.46) and steroid therapy (RR = 2.34), while a decreased probability of cataracts was correlated with a nonTBI preparative regimen (RR = 0.41). The yearly hazard of developing cataracts in recipients of single-dose TBI was highest during the third year after transplantation, while in recipients of fractionated TBI, the hazard was distributed among years one through seven. The probability of cataracts in all groups reached a plateau at 7 years after transplantation, after which the development of cataracts was extremely unlikely. CONCLUSION: TBI is the major risk factor for developing cataracts after BMT. Single-dose TBI results in the highest risk of cataracts. However, the risk of cataracts in recipients of fractionated-TBI is significantly higher than in patients who receive no TBI. In addition to TBI, steroid therapy is an independent risk factor for cataracts after BMT.

Duke Scholars

Published In

Int J Radiat Oncol Biol Phys

DOI

ISSN

0360-3016

Publication Date

June 15, 1995

Volume

32

Issue

3

Start / End Page

661 / 670

Location

United States

Related Subject Headings

  • Whole-Body Irradiation
  • Time Factors
  • Steroids
  • Risk Factors
  • Radiotherapy Dosage
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma
  • Oncology & Carcinogenesis
  • Middle Aged
  • Male
  • Humans
 

Citation

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Benyunes, M. C., Sullivan, K. M., Deeg, H. J., Mori, M., Meyer, W., Fisher, L., … Witherspoon, R. (1995). Cataracts after bone marrow transplantation: long-term follow-up of adults treated with fractionated total body irradiation. Int J Radiat Oncol Biol Phys, 32(3), 661–670. https://doi.org/10.1016/0360-3016(94)00392-x
Benyunes, M. C., K. M. Sullivan, H. J. Deeg, M. Mori, W. Meyer, L. Fisher, R. Bensinger, M. K. Jack, J. Hicks, and R. Witherspoon. “Cataracts after bone marrow transplantation: long-term follow-up of adults treated with fractionated total body irradiation.Int J Radiat Oncol Biol Phys 32, no. 3 (June 15, 1995): 661–70. https://doi.org/10.1016/0360-3016(94)00392-x.
Benyunes MC, Sullivan KM, Deeg HJ, Mori M, Meyer W, Fisher L, et al. Cataracts after bone marrow transplantation: long-term follow-up of adults treated with fractionated total body irradiation. Int J Radiat Oncol Biol Phys. 1995 Jun 15;32(3):661–70.
Benyunes, M. C., et al. “Cataracts after bone marrow transplantation: long-term follow-up of adults treated with fractionated total body irradiation.Int J Radiat Oncol Biol Phys, vol. 32, no. 3, June 1995, pp. 661–70. Pubmed, doi:10.1016/0360-3016(94)00392-x.
Benyunes MC, Sullivan KM, Deeg HJ, Mori M, Meyer W, Fisher L, Bensinger R, Jack MK, Hicks J, Witherspoon R. Cataracts after bone marrow transplantation: long-term follow-up of adults treated with fractionated total body irradiation. Int J Radiat Oncol Biol Phys. 1995 Jun 15;32(3):661–670.
Journal cover image

Published In

Int J Radiat Oncol Biol Phys

DOI

ISSN

0360-3016

Publication Date

June 15, 1995

Volume

32

Issue

3

Start / End Page

661 / 670

Location

United States

Related Subject Headings

  • Whole-Body Irradiation
  • Time Factors
  • Steroids
  • Risk Factors
  • Radiotherapy Dosage
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma
  • Oncology & Carcinogenesis
  • Middle Aged
  • Male
  • Humans