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 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 non-relapse 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 transplant characteristics and non-lung 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=0.02), overall survival (p=0.02), patient-reported symptoms (p<0.001) and functional status (p<0.001). 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 0–3 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.

How I treat bronchiolitis obliterans syndrome after hematopoietic stem cell transplantation

“…[1][2][3] Lung cGVHD or bronchiolitis obliterans syndrome (BOS) results from immune attack of the small airways, leading to fibrotic occlusion and subsequent obliteration. BOS is often an asymptomatic, insidious disease occurring within the first 2 years of HCT with other manifestations of cGVHD.…”

Predictors of survival, nonrelapse mortality, and failure-free survival in patients treated for chronic graft-versus-host disease

“…In analysis of individual organ systems, this scoring system has been predictive of meaningful end points such as OS and NRM. [19][20][21][22][23][24] However, when imputed into a calculated composite response, measures have had variable correlation with clinician-reported response and survival outcomes. Although 1 study demonstrated good correlation between response calculated per the 2005 NIH consensus criteria and clinician-reported response, and a survival advantage to those patients who had a favorable response (partial response [PR] or better) at 6 months, this study had a small number of patients evaluated.…”

Emerging uses of patient generated health data in clinical research

“…In another study, a symptombased lung score predicted overall survival and nonrelapse mortality in stem cell transplant recipients with chronic graft versus host disease (Palmer et al, 2014). Based on the prognostic signal seen to date in diverse cancer settings from infrequently collected HRQOL and symptom data, it is conceivable that PGHD streams of frequent, longitudinal symptom, HRQOL, functional status, and physical activity data may provide important prognostic and perhaps predictive information at multiple time points for patients on therapeutic clinical trials.…”