Long-term, drug-free remission of sympathetic ophthalmia with high-dose, short-term chlorambucil therapy.

Abstract

OBJECTIVE:

To evaluate the safety and effectiveness of short-term, high-dose chlorambucil therapy in achieving long-term, drug-free remission in the treatment of sympathetic ophthalmia (SO).

DESIGN:

Retrospective case series.

PARTICIPANTS:

Sixteen patients with SO treated with high-dose, short-term chlorambucil therapy between 1970 and 2010.

METHODS:

Descriptive and bivariate analyses were used to characterize disease and outcomes.

MAIN OUTCOME MEASURES:

Months of disease-free remission, prevalence rate of relapse, and prevalence of serious treatment-related adverse events.

RESULTS:

Sixteen patients with SO treated with short-term, high-dose chlorambucil were identified. Patients were treated with chlorambucil for a median of 14.0 weeks (mean, 14.5 weeks; range, 12.0-19.0 weeks). Median follow-up was 98.5 months (mean, 139.1 months; range, 48-441 months) from initiation of chlorambucil therapy. Control of inflammation was achieved in 100% of patients. Thirteen patients (81.3%) maintained vision of 20/40 or better in the sympathizing eye. Four patients (25%) relapsed after a median of 83 months (mean, 131 months) after cessation of systemic therapy. Seventy-five percent of relapses were controlled with topical therapy only. Conjunctival Kaposi's sarcoma developed in 1 patient. No patient demonstrated systemic malignancy.

CONCLUSIONS:

Short-term, high-dose chlorambucil therapy provides sustained periods of drug-free remission. With median follow-up of more than 8 years (mean, 11.6 years; range, 4-37 years), there was a low rate of recurrence and minimal long-term serious health consequences or adverse events. Because SO may be a lifelong condition and because chlorambucil therapy may offer long-term, drug-free remission, this treatment may be worth considering early in the decision-making process for severe sight-threatening disease.

• Authors: Sarju S Patel, Emilio M Dodds, Laura V Echandi, Cristobal A Couto, Ariel Schlaen, Howard H Tessler, Debra A Goldstein
• Journal: Ophthalmology (Ophthalmology) Vol. 121 Issue 2 Pg. 596-602 (Feb 2014) ISSN: 1549-4713 [Electronic] United States
• PMID: 24572676 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2014 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Chemical References

• Antineoplastic Agents, Alkylating
• Chlorambucil

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Antineoplastic Agents, Alkylating (administration & dosage, adverse effects)
• Child
• Chlorambucil (administration & dosage, adverse effects)
• Female
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Ophthalmia, Sympathetic (drug therapy, physiopathology)
• Remission Induction
• Retrospective Studies
• Treatment Outcome
• Visual Acuity (physiology)
• Young Adult