Lung Complications Measured by Simple Questionnaire Predict Survival in Chronic Graft-vs-Host Disease
A simple questionnaire that rates breathing difficulties on a scale of 0 to 3 may be able to predict survival in patients with chronic graft-vs-host disease, according to a study by Palmer et al published in Biology of Blood and Marrow Transplantation.
Although a poor National Institutes of Health (NIH) symptom-based lung score was associated with increased mortality, detecting lung involvement early means that patients can begin treatments to reduce or manage symptoms, said senior study author Stephanie Lee, MD, MPH, of Fred Hutchinson Cancer Research Center and the University of Washington School of Medicine. “It’s a warning,” said Dr. Lee. “It puts us on notice to be more careful and attentive.”
Chronic graft-vs-host disease most often involves the skin and mouth, but almost any other organ system can be involved. The likelihood of developing chronic graft-vs-host disease is around 30% to 50%, she said. Of those patients who do develop it, about 15% to 20% will have lung involvement. The first line of treatment for chronic chronic graft-vs-host disease is immunosuppression.
In 2005, the NIH recommended assessment of lung function in patients with chronic graft-vs-host disease using both pulmonary function tests and an assessment of symptoms.
Study Details
The current study found that shortness of breath is associated with a higher risk of death overall and of nonrelapse mortality, and that worsening symptoms over time were associated with increased mortality. Researchers analyzed a total of 1,591 visits by 496 patients in multiple treatment centers.
The investigators found that as a screening test, the simple questionnaire outperformed other lung function tests, which the study investigators called encouraging.
“The questionnaire turned out to be the most predictive,” Dr. Lee said. “It’s just a question, therefore easy to do and cost-effective. No special equipment is involved.”
The NIH symptom-based lung score asks about breathing difficulties and assigns the following numbers: 0 for no symptoms, 1 for shortness of breath with stairs, 2 for shortness of breath on flat ground, and 3 for shortness of breath at rest or requiring oxygen.
A score of 3 (shortness of breath at rest or requiring oxygen) was associated with higher mortality. But, the study pointed out, even patients with an NIH symptom-based lung score of 1 (shortness of breath with stairs) had a worse outcome than those with a score of 0.
Importance of Early Detection
Dr. Lee noted that the results may serve as as a way to notice problems earlier and start treatment sooner. If a patient scores poorly on the questionnaire, their doctor would most likely follow up with other tests, such as a CT scan, to determine the cause; although chronic graft-vs-host disease should always be suspected following a transplant, it is not the cause of every problem.
A poor score can also serve as a reminder to make sure the patient has had a pneumonia vaccination and is taking other precautions, Dr. Lee said.
Jeanne Palmer, MD, of the Medical College of Wisconsin, is the corresponding author of the Biology of Blood and Marrow Transplantation article.
The study was funded by the National Institutes of Health.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
