oGVHD After Bone Marrow Transplantation: a Territory-wide Cohort
Ocular Graft-Versus-Host-Disease After Allogeneic Haematopoietic Stem Cell Transplantation: A Territory-Wide Prospective Cohort
Allogeneic Haematopoietic stem cell transplantation (HSCT) is an effective treatment for all array of blood or blood-producing organ disorders. Graft-versus-host-disease (GVHD) occurs as a result of an overactive immunological system against normal host tissues. It can happen in the liver, skin, mucosal surface of the eye, gastrointestinal tract, and genitalia.
Ocular GVHD occurs in 30-70% of patients after HSCT. It mainly affects the ocular surface, including the conjunctiva and cornea. In severe cases, multiple clinical manifestations can lead to painful non-healing corneal ulcers, secondary infections, and visual loss.
oGVHD can be debilitating and severely impact patients' quality of life. However, there are no widely accepted guidelines available for prevention and management.
In collaboration with the Department of Haematology of Queen Mary Hospital, the investigators set out to establish a territory-wide cohort of patients receiving HSCT. Primarily, the investigators aim to establish the population-based epidemiology of oGVHD and understand the natural history and the long-term ophthalmic outcomes of oGVHD via this study.
Přehled studie
Postavení
Detailní popis
Allogeneic haematopoietic stem cell transplantation (HSCT) is an effective treatment for all array of haematological disorders. Graft-versus-host-disease (GVHD) occurs as a result of an overactive systemic immunological response against normal host tissues, in particular the liver, skin, mucosal surface of the eye, gastrointestinal tract, and genitalia.
Ocular graft-versus-host-disease (oGVHD) occurs in 30-70% patients after allogeneic HSCT. It mainly affects the ocular surface, and pathologically it is characterized by decreased conjunctival goblet cell density, increased conjunctival squamous metaplasia, and infiltration of tissues with inflammatory cells. Common clinical manifestations include keratoconjunctivitis sicca, marginal keratitis, conjunctivitis, and conjunctival scarring, and anterior uveitis. In severe cases, these can lead to painful non-healing corneal ulcers, secondary infections, and visual loss. Risk factors for oGVHD reported in the literature included non- Caucasian race, male recipient from female donor, more extensive and severe systemic involvement, pre-existing diabetes mellitus, and use of anti-thymocyte globulin.
oGVHD can be debilitating and severely impact patients' quality of life. Although common and significant, currently there are no widely accepted guidelines available for prophylaxis and management.
The Haemopoietic Stem Cell Transplantation Centre at Queen Mary Hospital is the only quaternary referral centre for adults in Hong Kong since 1990 and now it serves over 100 patients per year. In collaboration with the Department of Haematology of QMH, the investigators set out to establish a territory-wide cohort of patients receiving allogeneic HSCT to fill the current knowledge gaps.
Typ studie
Zápis (Očekávaný)
Kontakty a umístění
Studijní kontakt
- Jméno: Allie Lee
- Telefonní číslo: +852 39621405
- E-mail: aleeni@hku.hk
Studijní záloha kontaktů
- Jméno: Alex HS Kan
- E-mail: alexkhs@connect.hku.hk
Studijní místa
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Hong Kong, Hongkong
- Nábor
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong
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Vrchní vyšetřovatel:
- Allie Lee
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Kritéria účasti
Kritéria způsobilosti
Věk způsobilý ke studiu
Přijímá zdravé dobrovolníky
Pohlaví způsobilá ke studiu
Metoda odběru vzorků
Studijní populace
Popis
Inclusion Criteria:
- Patient aged 18 or above
- Underwent allogeneic HSCT in QMH in the two-year recruitment period
Exclusion Criteria:
- Underwent autologous HSCT
- Patient unable to attend follow-up visits
Family Control Subjects The research team will invite an accompanying family member to be the family control. Microbiome and tear samples will be collected for comparison. The sample collection schedule is the same as the corresponding post-HSCT case.
Studijní plán
Jak je studie koncipována?
Detaily designu
Kohorty a intervence
Skupina / kohorta |
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Post-Haematopoietic Stem Cell Transplantation (Post-HSCT) patients
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Family Control Subjects
The research team will invite an accompanying family member to be the family control.
Microbiome and tear samples will be collected for comparison.
The sample collection schedule is the same as the corresponding post-HSCT case.
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Co je měření studie?
Primární výstupní opatření
Měření výsledku |
Popis opatření |
Časové okno |
|---|---|---|
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Population-based epidemiology of oGVHD after allogeneic HSCT
Časové okno: 5 years, starting from the baseline visit
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Incidence of oGVHD at 3 months, 6 months, 9 months, 12 months, 18 months, 24 months, 36 months, 48 months, and 60 months following allogeneic HSCT (according to ?
criteria)
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5 years, starting from the baseline visit
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Sekundární výstupní opatření
Měření výsledku |
Popis opatření |
Časové okno |
|---|---|---|
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Longitudinal change in OSDI scores
Časové okno: 5 years, starting from the baseline visit
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Change in OSDI scores post-BMT over the 5-year study period will be evaluated.
OSDI scores are calculated from a Chinese-validated OSDI questionnaire.
They assess oGVHD-induced dry eye disease symptom severity and their burden on the patients' quality of life.
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5 years, starting from the baseline visit
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Serial changes in the anatomy, function & quantity of Meibomian gland
Časové okno: 5 years, starting from the baseline visit
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Since Meibomian gland dysfunction is one of the main clinical features of oGVHD, anatomical, functional and quantitative changes of Meibomian gland will be examined.
Parameters associated with Meibomian gland anatomy and quantity include its level of obstruction and dropout, which can be observed from Meibographs taken with the Keratography 5M and LipiView devices.
With the help of the ImageJ software, these parameters will be graded according to the () criteria.
Degree of Meibomian gland atrophy indicates the functionality of the Meibomian gland thus the degree of Meibomian gland dysfunction.
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5 years, starting from the baseline visit
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Prevalence of ocular surface disease pre-BMT
Časové okno: 5 years, starting from the baseline visit
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(Purpose).
The presence of ocular surface disease will be confirmed through a comprehensive eye examination (visual acuity, intraocular pressure, slit-lamp and fundus examination), Pentacam, specular microscopy (corneal cell density), and tear assessment (tear breakup time (TBUT), fluorescein staining pattern, non-anaesthetic Schirmer's test).
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5 years, starting from the baseline visit
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Compositional and density changes in ocular surface microbiome over time
Časové okno: 5 years, starting from the baseline visit
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Changes in diversity and density of microbial colonies on the ocular surface are hypothesised to be involved in oGVHD pathogenesis, and hence are investigated.
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5 years, starting from the baseline visit
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Proteomics of tear secretions
Časové okno: 5 years, starting from the baseline visit
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oGVHD is an ocular complication arisen from the infiltration of inflammatory cells.
The presence, type and quantity of inflammatory markers implied in oGVHD pathogenesis will be confirmed through proteomic analysis.
Tear matrix metalloproteinase-9 (MMP-9) will be the main inflammatory marker investigated.
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5 years, starting from the baseline visit
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Spolupracovníci a vyšetřovatelé
Sponzor
Vyšetřovatelé
- Vrchní vyšetřovatel: Allie Lee, The University of Hong Kong
Publikace a užitečné odkazy
Obecné publikace
- Arai S, Jagasia M, Storer B, Chai X, Pidala J, Cutler C, Arora M, Weisdorf DJ, Flowers ME, Martin PJ, Palmer J, Jacobsohn D, Pavletic SZ, Vogelsang GB, Lee SJ. Global and organ-specific chronic graft-versus-host disease severity according to the 2005 NIH Consensus Criteria. Blood. 2011 Oct 13;118(15):4242-9. doi: 10.1182/blood-2011-03-344390. Epub 2011 Jul 26.
- Zeiser R, Blazar BR. Pathophysiology of Chronic Graft-versus-Host Disease and Therapeutic Targets. N Engl J Med. 2017 Dec 28;377(26):2565-2579. doi: 10.1056/NEJMra1703472. No abstract available.
- Aronni S, Cortes M, Sacchetti M, Lambiase A, Micera A, Sgrulletta R, Bonini S. Upregulation of ICAM-1 expression in the conjunctiva of patients with chronic graft-versus-host disease. Eur J Ophthalmol. 2006 Jan-Feb;16(1):17-23. doi: 10.1177/112067210601600104.
- Kim SK. Ocular graft vs. host disease. Ocul Surf. 2005 Oct;3(4 Suppl):S177-9. doi: 10.1016/s1542-0124(12)70250-1.
- Wang JC, Teichman JC, Mustafa M, O'Donnell H, Broady R, Yeung SN. Risk factors for the development of ocular graft-versus-host disease (GVHD) dry eye syndrome in patients with chronic GVHD. Br J Ophthalmol. 2015 Nov;99(11):1514-8. doi: 10.1136/bjophthalmol-2014-306438. Epub 2015 May 6.
- Ogawa Y, Kim SK, Dana R, Clayton J, Jain S, Rosenblatt MI, Perez VL, Shikari H, Riemens A, Tsubota K. International Chronic Ocular Graft-vs-Host-Disease (GVHD) Consensus Group: proposed diagnostic criteria for chronic GVHD (Part I). Sci Rep. 2013 Dec 5;3:3419. doi: 10.1038/srep03419.
- Na KS, Yoo YS, Mok JW, Lee JW, Joo CK. Incidence and risk factors for ocular GVHD after allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant. 2015 Nov;50(11):1459-64. doi: 10.1038/bmt.2015.187. Epub 2015 Aug 24.
- Tabbara KF, Al-Ghamdi A, Al-Mohareb F, Ayas M, Chaudhri N, Al-Sharif F, Al-Zahrani H, Mohammed SY, Nassar A, Aljurf M. Ocular findings after allogeneic hematopoietic stem cell transplantation. Ophthalmology. 2009 Sep;116(9):1624-9. doi: 10.1016/j.ophtha.2009.04.054.
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