title: NHANES III equations enhance early detection and mortality prediction of bronchiolitis obliterans syndrome after hematopoietic SCT.
abstract: Bronchiolitis obliterans syndrome (BOS) is a serious complication of chronic GVHD (cGVHD) following HSCT (hematopoietic SCT). The clinical diagnosis of BOS is based on pulmonary function test (PFT) abnormalities including: FEV1<75% predicted and obstructive FEV1/VC ratio, calculated using reference equations. We sought to determine if the frequency of clinical diagnoses and severity of BOS would be altered by using the recommended NHANES III vs older equations (Morris/Goldman/Bates, MGB) in 166 cGVHD patients, median age 48 (range: 12-67). We found that NHANES III equations significantly increased the prevalence of BOS, with an additional 11% (18/166) meeting diagnostic criteria by revealing low FEV1 (<75%) (P<0.0001), and six additional patients by obstructive ratio (vs MBG). Collectively, this led to an increase of BOS incidence from 17 (29/166) to 29% (41/166). For patients with severe BOS, (FEV1<35%), NHANES III equations correctly predicted death 71.4% vs 50% using MGB. In conclusion, the use of NHANES III equations markedly increases the proportion of cases meeting diagnostic criteria for BOS and improves prediction of survival.
authors.affiliation: 1] Experimental Transplantation and Immunology Branch, National Cancer Institute, NIH, Bethesda, MD, USA [2] Division of Blood and Marrow Transplantation, Center for Cancer and Blood Disorders, Children's National Medical Center, The George Washington University Medical Center, Washington, DC, USA.
authors.forename: K M
authors.initials: KM
authors.lastname: Williams
authors.affiliation: Pulmonary, Critical Care and Sleep Medicine Service, Raymond G. Murphy VA Medical Center, Albuquerque, NM, USA.
authors.forename: O
authors.initials: O
authors.lastname: Hnatiuk
authors.affiliation: Division of Cancer Control and Population Sciences, Outcomes Research Branch, National Cancer Institute, NIH, Bethesda, MD, USA.
authors.forename: S A
authors.initials: SA
authors.lastname: Mitchell
authors.affiliation: Pediatric Oncology Branch, National Cancer Institute, NIH, Bethesda, MD, USA.
authors.forename: K
authors.initials: K
authors.lastname: Baird
authors.affiliation: Clinical Genetics Branch, DCEG, NCI, Bethesda, MD, USA.
authors.forename: S M
authors.initials: SM
authors.lastname: Gadalla
authors.affiliation: Biostatistics and Data Management Section, OCD, CCR, NCI, NIH, Bethesda, MD, USA.
authors.forename: S M
authors.initials: SM
authors.lastname: Steinberg
authors.affiliation: Critical Care Medicine Department, NIH, Bethesda, MD, USA.
authors.forename: J
authors.initials: J
authors.lastname: Shelhamer
authors.affiliation: Experimental Transplantation and Immunology Branch, National Cancer Institute, NIH, Bethesda, MD, USA.
authors.forename: A
authors.initials: A
authors.lastname: Carpenter
authors.affiliation: Experimental Transplantation and Immunology Branch, National Cancer Institute, NIH, Bethesda, MD, USA.
authors.forename: D
authors.initials: D
authors.lastname: Avila
authors.affiliation: Experimental Transplantation and Immunology Branch, National Cancer Institute, NIH, Bethesda, MD, USA.
authors.forename: T
authors.initials: T
authors.lastname: Taylor
authors.affiliation: Division of Hematology, Department of Internal Medicine, Clinical Hospital Center Zagreb, Zagreb, Croatia.
authors.forename: L
authors.initials: L
authors.lastname: Grkovic
authors.affiliation: Division of Hematology, Department of Internal Medicine, Clinical Hospital Center Zagreb, Zagreb, Croatia.
authors.forename: D
authors.initials: D
authors.lastname: Pulanic
authors.affiliation: Rehabilitation Medicine, NIH, Bethesda, MD, USA.
authors.forename: L E
authors.initials: LE
authors.lastname: Comis
authors.affiliation: Experimental Transplantation and Immunology Branch, National Cancer Institute, NIH, Bethesda, MD, USA.
authors.forename: B
authors.initials: B
authors.lastname: Blacklock-Schuver
authors.affiliation: Experimental Transplantation and Immunology Branch, National Cancer Institute, NIH, Bethesda, MD, USA.
authors.forename: R E
authors.initials: RE
authors.lastname: Gress
authors.affiliation: Experimental Transplantation and Immunology Branch, National Cancer Institute, NIH, Bethesda, MD, USA.
authors.forename: S Z
authors.initials: SZ
authors.lastname: Pavletic
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001989:Bronchiolitis Obliterans / Q000175:diagnosis* / Q000209:etiology* / Q000401:mortality; D002648:Child; D002908:Chronic Disease; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D042241:Early Diagnosis; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012129:Respiratory Function Tests; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult