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, 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
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.
Conflict of interest statement
Conflict of Interest: The authors declare no conflict of interest.
Figures
![Figure 1](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/5562366/bin/nihms895742f1.jpg)
![Figure 2](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/5562366/bin/nihms895742f2.jpg)
Figure 3
Severity of patients who ‘newly’…
Figure 3
Severity of patients who ‘newly’ met BOS diagnostic criteria using NHANES III equations.…
Figure 4
Mortality of BOS patients with…
Figure 4
Mortality of BOS patients with respect to severity by FEV1% predicted. On the…
- Factors associated with bronchiolitis obliterans syndrome and chronic graft-versus-host disease after allogeneic hematopoietic cell transplantation.Gazourian L, Rogers AJ, Ibanga R, Weinhouse GL, Pinto-Plata V, Ritz J, Soiffer RJ, Antin JH, Washko GR, Baron RM, Ho VT. Gazourian L, et al. Am J Hematol. 2014 Apr;89(4):404-9. doi: 10.1002/ajh.23656. Epub 2014 Feb 21. Am J Hematol. 2014. PMID: 24375545 Free PMC article.
- Prognostic role of FEV1 for survival in bronchiolitis obliterans syndrome after allogeneic hematopoietic stem cell transplantation.Ahn JH, Jo KW, Song JW, Shim TS, Lee SW, Lee JS, Kim DY, Lee JH, Lee JH, Choi Y, Lee KH. Ahn JH, et al. Clin Transplant. 2015 Dec;29(12):1133-9. doi: 10.1111/ctr.12638. Epub 2015 Oct 30. Clin Transplant. 2015. PMID: 26383085
- Bronchiolitis obliterans syndrome epidemiology after allogeneic hematopoietic cell transplantation.Au BK, Au MA, Chien JW. Au BK, et al. Biol Blood Marrow Transplant. 2011 Jul;17(7):1072-8. doi: 10.1016/j.bbmt.2010.11.018. Epub 2010 Nov 30. Biol Blood Marrow Transplant. 2011. PMID: 21126596 Free PMC article.
- Time to explore preventive and novel therapies for bronchiolitis obliterans syndrome after allogeneic hematopoietic stem cell transplantation.Sengsayadeth SM, Srivastava S, Jagasia M, Savani BN. Sengsayadeth SM, et al. Biol Blood Marrow Transplant. 2012 Oct;18(10):1479-87. doi: 10.1016/j.bbmt.2012.03.008. Epub 2012 Mar 24. Biol Blood Marrow Transplant. 2012. PMID: 22449611 Review.
- Bronchiolitis obliterans syndrome after allogeneic hematopoietic stem cell transplantation-an increasingly recognized manifestation of chronic graft-versus-host disease.Chien JW, Duncan S, Williams KM, Pavletic SZ. Chien JW, et al. Biol Blood Marrow Transplant. 2010 Jan;16(1 Suppl):S106-14. doi: 10.1016/j.bbmt.2009.11.002. Epub 2009 Nov 5. Biol Blood Marrow Transplant. 2010. PMID: 19896545 Free PMC article. Review.
- Prospective Phase II Trial of Montelukast to Treat Bronchiolitis Obliterans Syndrome after Hematopoietic Cell Transplantation and Investigation into Bronchiolitis Obliterans Syndrome Pathogenesis.Williams KM, Pavletic SZ, Lee SJ, Martin PJ, Farthing DE, Hakim FT, Rose J, Manning-Geist BL, Gea-Banacloche JC, Comis LE, Cowen EW, Justus DG, Baird K, Cheng GS, Avila D, Steinberg SM, Mitchell SA, Gress RE. Williams KM, et al. Transplant Cell Ther. 2022 May;28(5):264.e1-264.e9. doi: 10.1016/j.jtct.2022.01.021. Epub 2022 Feb 1. Transplant Cell Ther. 2022. PMID: 35114411 Clinical Trial.
- How I treat bronchiolitis obliterans syndrome after hematopoietic stem cell transplantation.Williams KM. Williams KM. Blood. 2017 Jan 26;129(4):448-455. doi: 10.1182/blood-2016-08-693507. Epub 2016 Nov 16. Blood. 2017. PMID: 27856461 Free PMC article. Review.
- MSC therapy attenuates obliterative bronchiolitis after murine bone marrow transplant.Raza K, Larsen T, Samaratunga N, Price AP, Meyer C, Matson A, Ehrhardt MJ, Fogas S, Tolar J, Hertz MI, Panoskaltsis-Mortari A. Raza K, et al. PLoS One. 2014 Oct 1;9(10):e109034. doi: 10.1371/journal.pone.0109034. eCollection 2014. PLoS One. 2014. PMID: 25272285 Free PMC article.
- Research Support, N.I.H., Intramural
- 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
- Full Text Sources
- Other Literature Sources
- Medical
![Figure 3](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/5562366/bin/nihms895742f3.jpg)
Figure 4
Mortality of BOS patients with…
Figure 4
Mortality of BOS patients with respect to severity by FEV1% predicted. On the…
![Figure 4](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/5562366/bin/nihms895742f4.jpg)
Source: PubMed