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Multicenter Study
. 2014 Mar;20(3):337-44.
doi: 10.1016/j.bbmt.2013.11.025. Epub 2013 Dec 4.

Pulmonary symptoms measured by the national institutes of health lung score predict overall survival, nonrelapse mortality, and patient-reported outcomes in chronic graft-versus-host disease

Jeanne Palmer  1 , Kirsten Williams  2 , Yoshihiro Inamoto  3 , Xiaoyu Chai  3 , Paul J Martin  3 , Linus Santo Tomas  4 , Corey Cutler  5 , Daniel Weisdorf  6 , Brenda F Kurland  7 , Paul A Carpenter  3 , Joseph Pidala  8 , Steven Z Pavletic  9 , William Wood  10 , David Jacobsohn  2 , Sally Arai  11 , Mukta Arora  6 , Madan Jagasia  12 , Georgia B Vogelsang  13 , Stephanie J Lee  3
Affiliations
Multicenter Study

Pulmonary symptoms measured by the national institutes of health lung score predict overall survival, nonrelapse mortality, and patient-reported outcomes in chronic graft-versus-host disease

Jeanne Palmer et al. Biol Blood Marrow Transplant. 2014 Mar.

Abstract

The 2005 National Institutes of Health (NIH) Consensus Conference recommended assessment of lung function in patients with chronic graft-versus-host disease (GVHD) by both pulmonary function tests (PFTs) and assessment of pulmonary symptoms. We tested whether pulmonary measures were associated with nonrelapse mortality (NRM), overall survival (OS), and patient-reported outcomes (PRO). Clinician and patient-reported data were collected serially in a prospective, multicenter, observational study. Available PFT data were abstracted. Cox regression models were fit for outcomes using a time-varying covariate model for lung function measures and adjusting for patient and transplantation characteristics and nonlung chronic GVHD severity. A total of 1591 visits (496 patients) were used in this analysis. The NIH symptom-based lung score was associated with NRM (P = .02), OS (P = .02), patient-reported symptoms (P < .001) and functional status (P < .001). Worsening of NIH symptom-based lung score over time was associated with higher NRM and lower survival. All other measures were not associated with OS or NRM; although, some were associated with patient-reported lung symptoms. In conclusion, the NIH symptom-based lung symptom score of 0 to 3 is associated with NRM, OS, and PRO measures in patients with chronic GVHD. Worsening of the NIH symptom-based lung score was associated with increased mortality.

Keywords: Bronchiolitis obliterans syndrome; Chronic graft-versus-host disease.

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Conflict of interest statement

Conflict-of-interest disclosure

The authors declare no competing financial interests related to this study.

Figures

Figure 1
Figure 1
Kaplan-Meier overall survival and cumulative incidence of non-relapse mortality, according to NIH symptom-based lung score at enrollment
Figure 2
Figure 2
Scatter plot (left) and Bland-Altman plot (right) between hand-held spirometry and FEV1 on PFTs. On the Bland-Altman plot, the mean difference between two measures was centered around zero (solid line), with the 95% limits of agreement shown by dashed lines.
Figure 3
Figure 3
Spaghetti plot of hand-held spirometry FEV1 according to survival status
See this image and copyright information in PMC

Comment in

References

    1. Chien JW, Martin PJ, Flowers ME, Nichols WG, Clark JG. Implications of early airflow decline after myeloablative allogeneic stem cell transplantation. Bone Marrow Transplantation. 2004;33:759–764. - PubMed
    1. Gore EM, Lawton CA, Ash RC, Lipchik RJ. Pulmonary function changes in long-term survivors of bone marrow transplantation. International Journal of Radiation Oncology*Biology*Physics. 1996;36:67–75. - PubMed
    1. Marras TK, Chan CK, Lipton JH, Messner HA, Szalai JP, Laupacis A. Long-term pulmonary function abnormalities and survival after allogeneic marrow transplantation. Bone Marrow Transplant. 2004;33:509–517. - PubMed
    1. Ralph DD, Springmeyer SC, Sullivan KM, Hackman RC, Storb R, Thomas ED. Rapidly progressive air-flow obstruction in marrow transplant recipients. Possible association between obliterative bronchiolitis and chronic graft-versus-host disease. Am Rev Respir Dis. 1984;129:641–644. - PubMed
    1. Sakaida E, Nakaseko C, Harima A, et al. Late-onset noninfectious pulmonary complications after allogeneic stem cell transplantation are significantly associated with chronic graft-versus-host disease and with the graft-versus-leukemia effect. Blood. 2003;102:4236–4242. - PubMed

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