NHANES III equations enhance early detection and mortality prediction of bronchiolitis obliterans syndrome after hematopoietic SCT

K M Williams; O Hnatiuk; S A Mitchell; K Baird; S M Gadalla; S M Steinberg; J Shelhamer; A Carpenter; D Avila; T Taylor; L Grkovic; D Pulanic; L E Comis; B Blacklock-Schuver; R E Gress; S Z Pavletic

doi:10.1038/bmt.2013.222

NHANES III equations enhance early detection and mortality prediction of bronchiolitis obliterans syndrome after hematopoietic SCT

Bone Marrow Transplant. 2014 Apr;49(4):561-6. doi: 10.1038/bmt.2013.222. Epub 2014 Jan 13.

Authors

K M Williams¹, O Hnatiuk², S A Mitchell³, K Baird⁴, S M Gadalla⁵, S M Steinberg⁶, J Shelhamer⁷, A Carpenter⁸, D Avila⁸, T Taylor⁸, L Grkovic⁹, D Pulanic⁹, L E Comis¹⁰, B Blacklock-Schuver⁸, R E Gress⁸, S Z Pavletic⁸

Affiliations

¹ 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.
² Pulmonary, Critical Care and Sleep Medicine Service, Raymond G. Murphy VA Medical Center, Albuquerque, NM, USA.
³ Division of Cancer Control and Population Sciences, Outcomes Research Branch, National Cancer Institute, NIH, Bethesda, MD, USA.
⁴ Pediatric Oncology Branch, National Cancer Institute, NIH, Bethesda, MD, USA.
⁵ Clinical Genetics Branch, DCEG, NCI, Bethesda, MD, USA.
⁶ Biostatistics and Data Management Section, OCD, CCR, NCI, NIH, Bethesda, MD, USA.
⁷ Critical Care Medicine Department, NIH, Bethesda, MD, USA.
⁸ Experimental Transplantation and Immunology Branch, National Cancer Institute, NIH, Bethesda, MD, USA.
⁹ Division of Hematology, Department of Internal Medicine, Clinical Hospital Center Zagreb, Zagreb, Croatia.
¹⁰ Rehabilitation Medicine, NIH, Bethesda, MD, USA.

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.

Publication types

Research Support, N.I.H., Intramural

MeSH terms

Adolescent
Adult
Aged
Bronchiolitis Obliterans / diagnosis*
Bronchiolitis Obliterans / etiology*
Bronchiolitis Obliterans / mortality
Child
Chronic Disease
Cohort Studies
Cross-Sectional Studies
Early Diagnosis
Female
Graft vs Host Disease / etiology
Hematopoietic Stem Cell Transplantation / adverse effects*
Hematopoietic Stem Cell Transplantation / methods*
Humans
Male
Middle Aged
Respiratory Function Tests
Transplantation, Homologous
Treatment Outcome
Young Adult

Grants and funding

Z99 CA999999/Intramural NIH HHS/United States