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.

Palmer J, Williams K, Inamoto Y, Chai X, Martin PJ, Tomas LS, Cutler C, Weisdorf D, Kurland BF, Carpenter PA, Pidala J, Pavletic SZ, Wood W, Jacobsohn D, Arai S, Arora M, Jagasia M, Vogelsang GB, Lee SJ
Biol Blood Marrow Transplant. 2014 20 (3): 337-44

PMID: 24315845 · PMCID: PMC3973401 · DOI:10.1016/j.bbmt.2013.11.025

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.

Copyright © 2014 American Society for Blood and Marrow Transplantation. All rights reserved.

MeSH Terms (22)

Adolescent Adult Child Child, Preschool Chronic Disease Female Graft vs Host Disease Hematologic Neoplasms Hematopoietic Stem Cell Transplantation Humans Lung Male National Institutes of Health (U.S.) Patient Outcome Assessment Proportional Hazards Models Prospective Studies Research Design Respiratory Function Tests Severity of Illness Index Survival Analysis Transplantation, Homologous United States

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