title: 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.
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.
authors: Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin. Electronic address: palmer.jeanne@mayo.edu.
authors: Jeanne
authors: J
authors: Palmer
authors: Division of Blood and Marrow Transplantation, Children's National Medical Center, Center for Cancer and Blood Disorders, Washington, District of Columbia.
authors: Kirsten
authors: K
authors: Williams
authors: Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors: Yoshihiro
authors: Y
authors: Inamoto
authors: Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors: Xiaoyu
authors: X
authors: Chai
authors: Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors: Paul J
authors: PJ
authors: Martin
authors: Pulmonary Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors: Linus Santo
authors: LS
authors: Tomas
authors: Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts.
authors: Corey
authors: C
authors: Cutler
authors: Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota.
authors: Daniel
authors: D
authors: Weisdorf
authors: Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors: Brenda F
authors: BF
authors: Kurland
authors: Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors: Paul A
authors: PA
authors: Carpenter
authors: Blood and Marrow Transplantation, Moffitt Cancer Center, Tampa, Florida.
authors: Joseph
authors: J
authors: Pidala
authors: National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
authors: Steven Z
authors: SZ
authors: Pavletic
authors: Linenberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors: William
authors: W
authors: Wood
authors: Division of Blood and Marrow Transplantation, Children's National Medical Center, Center for Cancer and Blood Disorders, Washington, District of Columbia.
authors: David
authors: D
authors: Jacobsohn
authors: Division of Blood and Marrow Transplantation, Stanford University Medical Center, Stanford, California.
authors: Sally
authors: S
authors: Arai
authors: Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota.
authors: Mukta
authors: M
authors: Arora
authors: Hematology and Stem Cell Transplant Program, Vanderbilt University Medical Center, Nashville, Tennessee.
authors: Madan
authors: M
authors: Jagasia
authors: Oncology, Johns Hopkins Hospital, Baltimore, Maryland.
authors: Georgia B
authors: GB
authors: Vogelsang
authors: Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors: Stephanie J
authors: SJ
authors: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D005260:Female; D006086:Graft vs Host Disease / Q000276:immunology / Q000401:mortality / Q000503:physiopathology*; D019337:Hematologic Neoplasms / Q000276:immunology / Q000473:pathology / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008168:Lung / Q000276:immunology / Q000503:physiopathology*; D008297:Male; D009316:National Institutes of Health (U.S.); D063868:Patient Outcome Assessment; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012107:Research Design; D012129:Respiratory Function Tests; D012720:Severity of Illness Index; D016019:Survival Analysis; D014184:Transplantation, Homologous; D014481:United States
keywords: Bronchiolitis obliterans syndrome; Chronic graft-versus-host disease