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NHANES III Equations for PFT Interpretation Significantly Alter the Number of BOS Diagnoses After Hematopoietic Stem Cell Transplantation (HSCT) FREE TO VIEW

Kirsten M. Williams, MD; Steven Z. Pavletic, MD; Seth M. Steinberg, PhD; Ashley Carpenter, RN; Daniele Avila, RN; Sandra Mitchell, PhD; Kristin Baird, MD; Niveen Atlam; Bazetta Blacklock-Schuver, RN; Ronald E. Gress, MD; Oleh Hnatiuk, MD
Author and Funding Information

NIH/National Cancer Institute/ETIB, Bethesda, MD

Chest. 2010;138(4_MeetingAbstracts):815A. doi:10.1378/chest.10542
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PURPOSE: Bronchiolitis obliterans syndrome (BOS) is a rare, deadly manifestation of chronic graft-versus-host disease (cGVHD) following HSCT. Because of the morbidity associated with biopsy, clinical criteria are proposed for diagnosis. This definition includes pulmonary function test (PFT) parameters: FEV1<75% predicted, FEV1/VC<0.7, and RV or RV/TLC>120% predicted (JAMA2009;302:306). This BOS diagnosis may depend on the reference equation used. Although NHANES III is the recommended standard, other equations are commonly used. Purpose: To determine the effect of using NHANES III reference vs. older equations, on the number of patients clinically diagnosed with BOS.

METHODS: 166 consecutive standardized PFT interpretations using both NHANES III and our institution’ s previous reference equations (Morris/Goldman/Bates-MGB) were compared with respect to FEV1% predicted and FEV1/FVC. The resulting 4 classification groups were assessed for degree of agreement using McNemar’ s exact test for paired categorical data. Mortality was determined using clinical records and SSDI.

RESULTS: Assessing only FEV1% predicted, 11% (18/166) of patients were classified as normal by MGB(>75%) and abnormal by NHANES III(<75%) while 0/166 were classified as abnormal by MGB(>75%) and normal by NHANES III(<75%) (p< 0.0001). Evaluating only FEV1/FVC ratios, 95% (157/166) were concordant by confidence interval. One ratio was abnormal by MGB, but normal by NHANES III, and therefore excluded from a diagnosis of BOS using NHANES III. The discordant ratios were divided evenly between > 0.7 (n=4) and < 0.7 (n=5) (p=1.00). Using the proposed amended PFT definition of BOS and the NHANES III classification, 6 additional patients (17%) would have been diagnosed with BOS, and one would have been removed from the BOS cohort. For 33/35 BOS patients with > 1 year follow-up, this changed mortality rates from 6/24 (25%) (MBG) to 4/22 (18%) (NHANES III) for mild/moderate disease; severe BOS (FEV1<35%) mortality was 6/7 (86%, MGB) and 8/9 (89%, NHANES III).

CONCLUSION: Using NHANES III reference equations significantly increased the number of subjects in our cohort with a clinical diagnosis of BOS.

CLINICAL IMPLICATIONS: These data may have implications for incidence and survival prediction.

DISCLOSURE: Kirsten Williams, No Financial Disclosure Information; No Product/Research Disclosure Information

08:00 AM - 09:15 AM




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