Naslov
NIH lung score components are associated with clinical outcomes, Bronchiolitis obliterans syndrome and survival in chronic GvHD

Autori
Grkovic, L. ; Pulanic, D. ; Steinberg, S.M. ; Williams, K.M. ; Baird, K. ; Mitchell, S.A. ; Cowen, E.W. ; Datiles, M.B. ; Aria, D. ; Bassim, C. ; Joe, G. ; Comis, L. ; Baruffaldi, J. ; Zhang, D. ; Sportes, C. ; Fowler, D.H. ; Hakim, F. ; Gress, R.E. ; Pavletic, S.Z.

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, znanstveni

Izvornik
Bone marrow transplantation / - , 2012, S61-S61

Skup
38th Annual Meeting of the European Group for Blood and Marrow Transplantation

Mjesto i datum
Ženeva, Švicarska, 01.04.2012. - 04.04.2012

Vrsta sudjelovanja
Poster

Vrsta recenzije
Međunarodna recenzija

Ključne riječi
chronic graft versus host disease; severity; lung score

Sažetak
Objectives: NIH chronic GVHD (cGVHD) consensus project proposed NIH lung score (NIHLs) 0-3 as a measure of cGVHD severity (BBMT 2005 ; 11:945). NIHLs is composed of 3 components: respiratory symptoms (RS), FEV1 and lung function score (LFS) devised from DLCO and FEV1. The final NIHLs (0-3) is determined by maximum of individual components. The goal of this study was to evaluate associations of NIHLs components and clinical outcomes. Methods: 211 cGVHD patients (pts), median age 48y (18-70), enrolled 2004-2011 into the NCI natural history study, with median follow-up for survivors of 36 months. Pts received 3 (0– 9) prior systemic therapies (PST). 66% had severe and 32% moderate NIH global cGVHD severity ; median 5 (1-8) organs were involved. 42% had mild, 26% moderate and 10% severe NIHLs. 46 pts had bronchiolitis obliterans syndrome (BOS) by modifi ed NIH criteria (BBMT 2010 ; 16:S106). Measures were obtained at study entry: NIHLs, SF36 (PCS, MCS), Lee symptom scale (total and breathing), HAP (MAS, AAS), walk velocity, grip strength, cGVHD activity, intensity of immunosuppression, number of PST, cGVHD severity by clinician and patient (0-10). Results: FEV1 and LFS were weakly to moderately correlated with 8-9 outcome measures (|r| >0.30) ; DLCO with grip strength, AAS and walk velocity (|r| >0.30), and increasing RS and NIHLs was associated with 11 and 12 outcomes respectively (p<0.05 ; most p<0.01). Since BOS is a manifestation of lung cGVHD we analyzed components of NIHLs relative to BOS. 91% of pts without BOS can be predicted on the basis of RS alone (symptom score<2) while only 56% with BOS could be correctly identified using only RS. 89% pts without BOS as well as 89% with BOS could be predicted on the basis of FEV1< 59% alone. 63% with and 64% without BOS can be correctly classified by DLCO alone ; 80% without BOS could be correctly predicted on the basis of the NIHLs alone as could 93% with BOS (NIHLs≥2). Overall 3yr survival (OS) was 76.2%. In univariate analysis worse RS (p<0.0001), lower FEV1 (p=0.007), DLCO (p=0.002), higher LFS (p=0.002) and NIHLs (p<0.0001) were associated with worse OS. In multivariable analyses only NIHLs retained an association with OS. OS at 3y: 81% (95%CI 73- 86%) vs. 31% (95%CI 14-55%) for NIHLs 0-2 vs. 3 respectively. Conclusion: Most components of the NIHLs are associated with important clinical outcomes. Severe NIHLs is predictive of clinical BOS and poor survival. These data support the validity of NIHLs in pts with cGVHD.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

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