PREVALENCE OF OCULAR DISORDERS IN MULTIPLE MYELOMA
(Abstract release date: 05/19/16)
EHA Library. Pennisi M. 06/09/16; 134872; PB1972
Dr. Martina Pennisi
Contributions
Contributions
Abstract
Abstract: PB1972
Type: Publication Only
Background
Overall survival of multiple myeloma (MM) patients has increased significantly due to the availability of new drugs. However, since MM is an incurable disease, patients are exposed to repeated lines of therapy with different agents. It is therefore increasingly important to monitor the long-term side-effects of treatments. In the present study we focused on ocular disorders.
Aims
Assessing the prevalence of ocular disorders in patients treated or in follow-up for MM.
Methods
87 symptomatic MM patients were enrolled in a prospective protocol which consisted in a complete ophtalmologic evaluation. Best corrected visual acuity (BCVA) was assessed; lens opacities were classified according to the LOCS III score; intraocular pressure was measured and was considered pathological if > 21 mmHg; Schirmer test was pathological if <15 mm. Binary logistic regression analysis (univariate and multivariate) were conducted to relate ocular disorders to age, comorbidities (diabetes, hypertension, smoking, autoimmunity) and MM variables (time from diagnosis to last treatment and to ocular evaluation, cumulative dose of dexamethasone, exposure to lenalidomide, thalidomide, bortezomib and melphalan, previous autologous or allogeneic transplantation and graft-versus-host-disease).
Results
Median age was 63 years. Median number of previous lines of treatement was 2 (range 1-10). Median time from diagnosis to ophtalmologic evaluation was 37 months (range 2-160). Median cumulative dose of dexamethasone was 1600 mg (range 80-8480). Inadequate visual acuity was found in 35/71 pts (49%); severe visual loss (< 20/40) was found in 13/71 pts (15%), 10 of which had pre-existing ocular history of lazy eye, myopia, pseudophakia, vitrectomy, retinitis pigmentosa and trauma. No relation was found with cumulative steroid dose, duration or type of treatment. Instead, age and history of hypertension resulted to be independent risk factors for visual impairment, also in multivariate analysis (age OR: 4.6 p=0.004; hypertension OR: 2.8 p=0.05). Retinal disorders (11%) were related to age and hypertension in multivariate analysis. Fifty percent of patients (44/87) had lens opacities of any grade: cataract was observed in 6/87 pts (7%), and in all cases was posterior subcapsular cataract LOCS III >/= 2; moderate lens opacities were observed in 32% pts (28/87), while 23% showed nuclear or concomitant nuclear/cortical opacities (LOCS III = 2-3) and 9% posterior subcapsular opacities (LOCS III = 1). Lens opacities related with age > 63 years (OR: 4.0 p=0.009) and time from diagnosis > 37 months (OR: 2.6 p=0.05) in multivariate analysis. No association was found with cumulative steroid dose or other drugs exposure. Only 1 patient showed elevated intraocular pressure. Inadequate tears production was observed in 52% pts (45/87), but no statistically association with treatments or comorbidities was observed.
Conclusion
Our study shows a high prevalence of visual impairment and early lens opacities in MM patients. We observed a higher prevalence of posterior subcapsular cataract compared to other cataract subtypes, unlike in the healthy population, probably due to the chronic systemic steroids exposure. A high prevalence of inadequate tear production was observed, as well. Interestingly, no significant increase in intraocular pressure was noticed, possibly because of chronic but pulse administration of steroids. Patients with hypertension show an increased risk of retinal disorders. We recommend an adequate ophthalmologist follow-up in treated MM patients.
Session topic: E-poster
Keyword(s): Myeloma, Side effects, Treatment
Type: Publication Only
Background
Overall survival of multiple myeloma (MM) patients has increased significantly due to the availability of new drugs. However, since MM is an incurable disease, patients are exposed to repeated lines of therapy with different agents. It is therefore increasingly important to monitor the long-term side-effects of treatments. In the present study we focused on ocular disorders.
Aims
Assessing the prevalence of ocular disorders in patients treated or in follow-up for MM.
Methods
87 symptomatic MM patients were enrolled in a prospective protocol which consisted in a complete ophtalmologic evaluation. Best corrected visual acuity (BCVA) was assessed; lens opacities were classified according to the LOCS III score; intraocular pressure was measured and was considered pathological if > 21 mmHg; Schirmer test was pathological if <15 mm. Binary logistic regression analysis (univariate and multivariate) were conducted to relate ocular disorders to age, comorbidities (diabetes, hypertension, smoking, autoimmunity) and MM variables (time from diagnosis to last treatment and to ocular evaluation, cumulative dose of dexamethasone, exposure to lenalidomide, thalidomide, bortezomib and melphalan, previous autologous or allogeneic transplantation and graft-versus-host-disease).
Results
Median age was 63 years. Median number of previous lines of treatement was 2 (range 1-10). Median time from diagnosis to ophtalmologic evaluation was 37 months (range 2-160). Median cumulative dose of dexamethasone was 1600 mg (range 80-8480). Inadequate visual acuity was found in 35/71 pts (49%); severe visual loss (< 20/40) was found in 13/71 pts (15%), 10 of which had pre-existing ocular history of lazy eye, myopia, pseudophakia, vitrectomy, retinitis pigmentosa and trauma. No relation was found with cumulative steroid dose, duration or type of treatment. Instead, age and history of hypertension resulted to be independent risk factors for visual impairment, also in multivariate analysis (age OR: 4.6 p=0.004; hypertension OR: 2.8 p=0.05). Retinal disorders (11%) were related to age and hypertension in multivariate analysis. Fifty percent of patients (44/87) had lens opacities of any grade: cataract was observed in 6/87 pts (7%), and in all cases was posterior subcapsular cataract LOCS III >/= 2; moderate lens opacities were observed in 32% pts (28/87), while 23% showed nuclear or concomitant nuclear/cortical opacities (LOCS III = 2-3) and 9% posterior subcapsular opacities (LOCS III = 1). Lens opacities related with age > 63 years (OR: 4.0 p=0.009) and time from diagnosis > 37 months (OR: 2.6 p=0.05) in multivariate analysis. No association was found with cumulative steroid dose or other drugs exposure. Only 1 patient showed elevated intraocular pressure. Inadequate tears production was observed in 52% pts (45/87), but no statistically association with treatments or comorbidities was observed.
Conclusion
Our study shows a high prevalence of visual impairment and early lens opacities in MM patients. We observed a higher prevalence of posterior subcapsular cataract compared to other cataract subtypes, unlike in the healthy population, probably due to the chronic systemic steroids exposure. A high prevalence of inadequate tear production was observed, as well. Interestingly, no significant increase in intraocular pressure was noticed, possibly because of chronic but pulse administration of steroids. Patients with hypertension show an increased risk of retinal disorders. We recommend an adequate ophthalmologist follow-up in treated MM patients.
Session topic: E-poster
Keyword(s): Myeloma, Side effects, Treatment
Abstract: PB1972
Type: Publication Only
Background
Overall survival of multiple myeloma (MM) patients has increased significantly due to the availability of new drugs. However, since MM is an incurable disease, patients are exposed to repeated lines of therapy with different agents. It is therefore increasingly important to monitor the long-term side-effects of treatments. In the present study we focused on ocular disorders.
Aims
Assessing the prevalence of ocular disorders in patients treated or in follow-up for MM.
Methods
87 symptomatic MM patients were enrolled in a prospective protocol which consisted in a complete ophtalmologic evaluation. Best corrected visual acuity (BCVA) was assessed; lens opacities were classified according to the LOCS III score; intraocular pressure was measured and was considered pathological if > 21 mmHg; Schirmer test was pathological if <15 mm. Binary logistic regression analysis (univariate and multivariate) were conducted to relate ocular disorders to age, comorbidities (diabetes, hypertension, smoking, autoimmunity) and MM variables (time from diagnosis to last treatment and to ocular evaluation, cumulative dose of dexamethasone, exposure to lenalidomide, thalidomide, bortezomib and melphalan, previous autologous or allogeneic transplantation and graft-versus-host-disease).
Results
Median age was 63 years. Median number of previous lines of treatement was 2 (range 1-10). Median time from diagnosis to ophtalmologic evaluation was 37 months (range 2-160). Median cumulative dose of dexamethasone was 1600 mg (range 80-8480). Inadequate visual acuity was found in 35/71 pts (49%); severe visual loss (< 20/40) was found in 13/71 pts (15%), 10 of which had pre-existing ocular history of lazy eye, myopia, pseudophakia, vitrectomy, retinitis pigmentosa and trauma. No relation was found with cumulative steroid dose, duration or type of treatment. Instead, age and history of hypertension resulted to be independent risk factors for visual impairment, also in multivariate analysis (age OR: 4.6 p=0.004; hypertension OR: 2.8 p=0.05). Retinal disorders (11%) were related to age and hypertension in multivariate analysis. Fifty percent of patients (44/87) had lens opacities of any grade: cataract was observed in 6/87 pts (7%), and in all cases was posterior subcapsular cataract LOCS III >/= 2; moderate lens opacities were observed in 32% pts (28/87), while 23% showed nuclear or concomitant nuclear/cortical opacities (LOCS III = 2-3) and 9% posterior subcapsular opacities (LOCS III = 1). Lens opacities related with age > 63 years (OR: 4.0 p=0.009) and time from diagnosis > 37 months (OR: 2.6 p=0.05) in multivariate analysis. No association was found with cumulative steroid dose or other drugs exposure. Only 1 patient showed elevated intraocular pressure. Inadequate tears production was observed in 52% pts (45/87), but no statistically association with treatments or comorbidities was observed.
Conclusion
Our study shows a high prevalence of visual impairment and early lens opacities in MM patients. We observed a higher prevalence of posterior subcapsular cataract compared to other cataract subtypes, unlike in the healthy population, probably due to the chronic systemic steroids exposure. A high prevalence of inadequate tear production was observed, as well. Interestingly, no significant increase in intraocular pressure was noticed, possibly because of chronic but pulse administration of steroids. Patients with hypertension show an increased risk of retinal disorders. We recommend an adequate ophthalmologist follow-up in treated MM patients.
Session topic: E-poster
Keyword(s): Myeloma, Side effects, Treatment
Type: Publication Only
Background
Overall survival of multiple myeloma (MM) patients has increased significantly due to the availability of new drugs. However, since MM is an incurable disease, patients are exposed to repeated lines of therapy with different agents. It is therefore increasingly important to monitor the long-term side-effects of treatments. In the present study we focused on ocular disorders.
Aims
Assessing the prevalence of ocular disorders in patients treated or in follow-up for MM.
Methods
87 symptomatic MM patients were enrolled in a prospective protocol which consisted in a complete ophtalmologic evaluation. Best corrected visual acuity (BCVA) was assessed; lens opacities were classified according to the LOCS III score; intraocular pressure was measured and was considered pathological if > 21 mmHg; Schirmer test was pathological if <15 mm. Binary logistic regression analysis (univariate and multivariate) were conducted to relate ocular disorders to age, comorbidities (diabetes, hypertension, smoking, autoimmunity) and MM variables (time from diagnosis to last treatment and to ocular evaluation, cumulative dose of dexamethasone, exposure to lenalidomide, thalidomide, bortezomib and melphalan, previous autologous or allogeneic transplantation and graft-versus-host-disease).
Results
Median age was 63 years. Median number of previous lines of treatement was 2 (range 1-10). Median time from diagnosis to ophtalmologic evaluation was 37 months (range 2-160). Median cumulative dose of dexamethasone was 1600 mg (range 80-8480). Inadequate visual acuity was found in 35/71 pts (49%); severe visual loss (< 20/40) was found in 13/71 pts (15%), 10 of which had pre-existing ocular history of lazy eye, myopia, pseudophakia, vitrectomy, retinitis pigmentosa and trauma. No relation was found with cumulative steroid dose, duration or type of treatment. Instead, age and history of hypertension resulted to be independent risk factors for visual impairment, also in multivariate analysis (age OR: 4.6 p=0.004; hypertension OR: 2.8 p=0.05). Retinal disorders (11%) were related to age and hypertension in multivariate analysis. Fifty percent of patients (44/87) had lens opacities of any grade: cataract was observed in 6/87 pts (7%), and in all cases was posterior subcapsular cataract LOCS III >/= 2; moderate lens opacities were observed in 32% pts (28/87), while 23% showed nuclear or concomitant nuclear/cortical opacities (LOCS III = 2-3) and 9% posterior subcapsular opacities (LOCS III = 1). Lens opacities related with age > 63 years (OR: 4.0 p=0.009) and time from diagnosis > 37 months (OR: 2.6 p=0.05) in multivariate analysis. No association was found with cumulative steroid dose or other drugs exposure. Only 1 patient showed elevated intraocular pressure. Inadequate tears production was observed in 52% pts (45/87), but no statistically association with treatments or comorbidities was observed.
Conclusion
Our study shows a high prevalence of visual impairment and early lens opacities in MM patients. We observed a higher prevalence of posterior subcapsular cataract compared to other cataract subtypes, unlike in the healthy population, probably due to the chronic systemic steroids exposure. A high prevalence of inadequate tear production was observed, as well. Interestingly, no significant increase in intraocular pressure was noticed, possibly because of chronic but pulse administration of steroids. Patients with hypertension show an increased risk of retinal disorders. We recommend an adequate ophthalmologist follow-up in treated MM patients.
Session topic: E-poster
Keyword(s): Myeloma, Side effects, Treatment
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