Ocular Surface Inflammation and Dry Eye Symptoms at Day 100 Post-Transplantation Are Not Predictive Factors for The Development of Chronic Graft Versus Host Disease
Arianna Tovar1,2,3, Elyana Locatelli1,2,3, Ankit M Shah1, Karla Mones4, Pepita Jean4, Krishna V Komanduri5, Trent P Wang5,
1University of Miami Miller School of Medicine, Miami, Florida; 2Bascom Palmer Eye Institute, Miami, Florida; 3Miami Veterans Affairs Medical Center, Miami, Florida; 4Adult Stem Cell Transplant Program, Division of Transplantation & Cellular Therapy, University of Miami Hospital and Clinics, Sylvester Comprehensive Cancer Center, Miami, Florida; 5Division of Transplantation & Cellular Therapy, University of Miami Hospital and Clinics, Sylvester Comprehensive Cancer Center, Miami, Florida
Purpose: Chronic Graft-Versus-Host Disease (cGVHD) is a significant cause of morbidity and mortality among post-allogeneic hematopoietic stem cell transplant (HCT) patients. Approximately 50% of patients that undergo HCT end up developing cGVHD. Few prognostic biomarkers exist to identify patients at risk for developing cGVHD. The purpose of our study was to determine if early assessment of Matrix Metalloproteinase-9 (MMP-9) and Dry Eye Questionnaire-5 (DEQ-5) had prognostic utility for the development of cGVHD and/or severe dry eye (DE) symptoms.
Methods: Participants underwent baseline InflammaDry and DEQ-5 screening on day 100 post-transplant (D+100). Patients were subsequently followed via DEQ-5 results at 6-, 9-, and 12-months post-transplant. The development of cGVHD was determined by chart review.
Results: The mean age of the study population was 54 years, 64% were female, 16% self-identified as white and 68% as Hispanic. Overall, 28% (n=7) of patients developed cGVHD over a mean follow up of 128 ± 63 days (range 45-216 days). At D+100, 32% (n=8) of patients had a positive MMP-9 in at least one eye and 20% (n=5) had a DEQ-5 ≥6. However, neither the presence of a positive MMP-9 nor a DEQ-5 score ≥6 at D+100 predicted the development of cGVHD (MMP-9: hazard ratio (HR) 1.53, p = 0.58, 95% confidence interval (CI): 0.34 – 6.85; DEQ-5 ≥6: HR 1.00, p = 1.00, 95% CI: 0.12 – 8.32). Additionally, neither of these measurements predicted the development of severe DE symptoms (DEQ-5 ≥12) over time (MMP-9: HR 1.77, p=0.58, 95% CI: 0.24-12.89; DEQ-5 >6: HR 0.03, p = 0.49, 95% CI: 0.00 – 889.93). Moreover, DEQ-5 scores tended to increase over time, irrespective of cGVHD development, but most patients (86%, n=6) who developed cGVHD did not show this pattern.
Conclusions: Within our small study population, DEQ-5 and MMP-9 assessment at D+100 did not predict the development of cGVHD or severe DE symptoms.
Support: Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Clinical Sciences R&D (CSRD) I01 CX002015 (Galor) and Biomedical Laboratory R&D (BLRD) Service I01 BX004893 (Galor), Department of Defense Gulf War Illness Research Program (GWIRP) W81XWH-20-1-0579 (Galor) and Vision Research Program (VRP) W81XWH-20-1-0820 (Galor), National Eye Institute R01EY026174 (Galor) and R61EY032468 (Galor), NIH Center Core Grant P30EY014801 (institutional) and Research to Prevent Blindness Unrestricted Grant GR004596 (institutional). Trent P. Wang is a K12 Scholar supported by the National Cancer Institute of the National Institutes of Health under Award Number K12CA226330. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.