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Cataracts after autologous bone marrow transplantation in children
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology, Oncology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ophthalmology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ophthalmology. (Per Söderberg)
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2000 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 89, no 7, 814-819 p.Article in journal (Refereed) Published
Abstract [en]

We recorded the incidence and degree of posterior subcapsular cataract (PSC) in 29 children who had undergone autologous (n = 28) or syngeneic (n = 1) bone marrow transplantation (BMT) due to haematologic or lymphoid malignancy. Conditioning prior to transplantation consisted either of a combination of chemotherapy and total body irradiation (TBI) (n = 21) or of chemotherapy only (n = 8). TBI was given in one fraction of 7.5 Gy. Nine patients had received previous cranial irradiation. The patients were followed for 4-10 y (median 8y) after transplantation. Of 29 patients, 22 developed PSC, all within 4 y after BMT. With the exception of one patient who developed unilateral PSC, all had received TBI. Conversely, 100% of those who received TBI developed PSC. In this group (+TBI), eight patients (38%) developed significant PSC, defined as best corrected visual acuity < 0.8 in either eye. Six patients (10 eyes) have since needed surgical repair consisting of extracapsular cataract extraction and intraocular lens implantation. There was no clear relationship between previous cranial irradiation and cataract development, nor any other obvious baseline differences between those in the +TBI group who developed significant PSC and those who did not. Although effects of previous therapy cannot be ruled out, TBI appears to be the main cause of PSC in this group of patients. Twelve patients in the +TBI group had well-preserved visual acuity throughout the study, reflecting a slow progression of PSC. This compares favourably with previous reports of allogeneic BMT, possibly owing to less need for corticosteroids after autologous BMT.

We conclude that the incidence of PSC was high after autologous BMT where the conditioning regimen included total body irradiation.

Place, publisher, year, edition, pages
2000. Vol. 89, no 7, 814-819 p.
Keyword [en]
Autologous, bone marrow transplantation, cataract, children, long-term follow-up
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-90956DOI: 10.1111/j.1651-2227.2000.tb00390.xOAI: oai:DiVA.org:uu-90956DiVA: diva2:163497
Available from: 2003-10-30 Created: 2003-10-30 Last updated: 2017-01-25Bibliographically approved
In thesis
1. Late Effects After Autologous Bone Marrow Transplantation in Childhood
Open this publication in new window or tab >>Late Effects After Autologous Bone Marrow Transplantation in Childhood
2003 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Fifty children with hematologic malignancies have been treated with autologous BMT in Uppsala. The aim was to describe late effects in this group with special reference to cataracts, reduced final height, and to hepatic, renal, and pulmonary late effects.

Cataracts: All patients who received TBI in their conditioning developed posterior subcapsular cataract after BMT. A few patients with visual impairment affecting daily life needed cataract surgery, whereas the visual acuity was well preserved in most of the other patients.

Final height: There was a decrease in final height relative both to height at BMT and to target height. This decrease was significant both in those who had received TBI only and in those who had been given cranial irradiation. Cranial irradiation, young age at BMT, and short duration of GH treatment were predictors of height loss.

Hepatic function: Hepatic function was well preserved over a period of 10 years after BMT. TBI did not appear to be a risk factor for hepatic impairment.

Renal function: Six months after BMT there was a decrease in renal function in patients who had received TBI. It then recovered, albeit incompletely, and stabilized. After the first year there was little change over a period of 10 years after BMT. TBI appeared to be the most important risk factor for the development of chronic renal impairment in a number of patients. Nephrotoxic antibiotics may have contributed.

Pulmonary function: Six months after BMT there was a decrease in pulmonary function in those who received TBI. It then recovered and stabilized at the pretransplant level. After the first year there was little change over a period of 10 years after BMT. TBI appeared to be the most important risk factor for restrictive pulmonary disease in a number of patients whereas chemotherapy might also have been of importance for impaired gas exchange.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2003. 63 p.
Series
Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 0282-7476 ; 1293
Keyword
Pediatrics, bone marrow transplantation, children, follow-up, cataracts, final height, pubertal development, hepatic function, renal function, pulmonary function, Pediatrik
National Category
Pediatrics
Identifiers
urn:nbn:se:uu:diva-3673 (URN)91-554-5767-3 (ISBN)
Public defence
2003-11-21, Rosénsalen, Akademiska barnsjukhuset, 751 85 Uppsala, 09:15
Opponent
Supervisors
Available from: 2003-10-30 Created: 2003-10-30Bibliographically approved

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Frisk, PerHagberg, HansSöderberg, PerLönnerholm, Gudmar

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