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Post-transplant Events

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

Bone Marrow Transplantation volume 49, pages 561–566 (2014)Cite this article

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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.

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Acknowledgements

We acknowledge Dr David Jacobsohn for his thorough review of this manuscript. National Institutes of Health intramural funds supported this research.

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Authors and Affiliations

  1. Experimental Transplantation and Immunology Branch, National Cancer Institute, NIH, Bethesda, MD, USA

    K M Williams, A Carpenter, D Avila, T Taylor, B Blacklock-Schuver, R E Gress & S Z Pavletic

  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

    K M Williams

  3. Pulmonary, Critical Care and Sleep Medicine Service, Raymond G. Murphy VA Medical Center, Albuquerque, NM, USA

    O Hnatiuk

  4. Division of Cancer Control and Population Sciences, Outcomes Research Branch, National Cancer Institute, NIH, Bethesda, MD, USA

    S A Mitchell

  5. Pediatric Oncology Branch, National Cancer Institute, NIH, Bethesda, MD, USA

    K Baird

  6. Clinical Genetics Branch, DCEG, NCI, Bethesda, MD, USA

    S M Gadalla

  7. Biostatistics and Data Management Section, OCD, CCR, NCI, NIH, Bethesda, MD, USA

    S M Steinberg

  8. Critical Care Medicine Department, NIH, Bethesda, MD, USA

    J Shelhamer

  9. Division of Hematology, Department of Internal Medicine, Clinical Hospital Center Zagreb, Zagreb, Croatia

    L Grkovic & D Pulanic

  10. Rehabilitation Medicine, NIH, Bethesda, MD, USA

    L E Comis

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  1. K M Williams
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Correspondence to K M Williams.

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Williams, K., Hnatiuk, O., Mitchell, S. et al. NHANES III equations enhance early detection and mortality prediction of bronchiolitis obliterans syndrome after hematopoietic SCT. Bone Marrow Transplant 49, 561–566 (2014). https://doi.org/10.1038/bmt.2013.222

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  • DOI: https://doi.org/10.1038/bmt.2013.222

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