Systemic Immunosuppressant Cessation/Tapering Linked to MGD Progression Post-HSCT.

PURPOSE: To observe the longitudinal changes in meibomian gland structure and function in patients after allogeneic hematopoietic stem cell transplantation (allo-HSCT) and to investigate the potential associated factors.

DESIGN

Single-center retrospective clinical cohort study.

PARTICIPANTS

Sixty-eight patients after allo-HSCT, including 48 patients (92 eyes) with and 20 patients (40 eyes) without chronic ocular graft-versus-host disease (coGVHD).

METHODS

Medical records were retrospectively reviewed. Data collected included demographic characteristics, medical history, ocular surface disease index questionnaire, corneal fluorescein staining, bulbar conjunctival injection, Schirmer's test, noninvasive break-up time, lid margin abnormalities, meibum quality scores, and meibomian gland area ratio (MGAR). Follow-up data were compared. A generalized estimating equation was used to analyze the associated factors.

MAIN OUTCOME MEASURES: Change in MGAR.

RESULTS

All patients were followed up for 22.9 ± 10.7 months since first visit (coGVHD group vs non-coGVHD group = 23.6 ± 10.8 months vs 21.3 ± 10.5 months, P = .441). Compared with baseline, the severity of coGVHD at the last follow-up visit improved (International Chronic Ocular Graft-versus-Host Disease [ICCGVHD] score: 7.3 ± 2.3 vs 8.5 ± 1.7, P < .001), but no significant change in MGAR (51.7% ± 14.8% vs 52.6% ± 14.8%, P = .341). Specifically, MGAR remained stable in 59 eyes (64.1%), deteriorated in 14 eyes (15.2%), and improved in 19 eyes (20.7%). In the non-coGVHD group, while ICCGVHD scores remained stable compared to baseline, MGAR showed a decrease at the final follow-up (70.2 ± 11.0% vs 73.5 ± 10.0%, P = .001). Cessation or tapering of systemic immunosuppressants was associated with MGAR worsening in both the coGHVD group (odds ratio [OR]: 4.60, 95% confidence interval [CI]: 1.24-17.00) and the non-coGHVD group (OR: 2.48, 95%CI: 1.14-5.40). Further subgroup analysis revealed that in coGVHD patients, the subgroup with cessation or tapering of systemic immunosuppressants showed a significant worsening in meibum quality (8.4 ± 5.3 vs 5.9 ± 4.6, P = .005).

CONCLUSIONS

Improvement in coGVHD is not necessarily accompanied by improvement in Meibomian gland dysfunction (MGD). Cessation or tapering of systemic immunosuppressants was associated with the progression of MGD after allo-HSCT.