National Heart, Lung, and Blood Institute.
Pulmonary Branch, National Heart, Lung, and Blood Institute, and.
Blood Adv. 2022 Jul 26;6(14):4196-4207. doi: 10.1182/bloodadvances.2021006885.
Pulmonary chronic graft-versus-host disease (PcGVHD) is a devastating complication of allogeneic hematopoietic stem cell transplant (HCT). The 2014 National Institutes of Health cGVHD consensus criteria (NIH criteria) only captures bronchiolitis obliterans syndrome (BOS). In this study, we adapted the 2019 International Society for Heart and Lung Transplantation (ISHLT) criteria of chronic lung allograft dysfunction (CLAD) to define novel phenotypes of PcGVHD and compared the performance of this criteria with the NIH criteria to identify patients with high-risk PcGVHD. We reviewed consecutive patients in a cGVHD natural history protocol (#NCT00092235) and adapted the 2019 CLAD criteria (the adapted criteria) to define PcGVHD as post-HCT forced expiratory volume at 1 second < 80% predicted value, with 4 phenotypes: obstructive, restrictive, mixed obstructive/restrictive, and undefined. An independent adjudication committee evaluated subjects for diagnosis and phenotyping. We identified 166 (47.4%) patients who met the adapted criteria, including obstruction (n = 12, 3.4%), restriction (n = 67, 19.1%), mixed obstruction/restriction (n = 47, 13.4%), and undefined (n = 40, 11.4%). In these patients, less than half (n = 78) met the NIH criteria for BOS (NIH+); the rest (n = 88) did not (NIH-). The NIH- subjects showed increased risk of death compared with those without PcGVHD (hazard ratio = 1.88, 95% confidence interval = 1.20-2.95; P = .006) that was similar to NIH+ subjects (P = .678). Our study demonstrated the potential of the adapted criteria in identifying patients with high-risk PcGVHD that have been missed by the NIH criteria. The adapted criteria could become a valuable tool to better phenotype and study lung disease in cGVHD.
肺慢性移植物抗宿主病（PcGVHD）是异基因造血干细胞移植（HCT）的一种破坏性并发症。2014 年美国国立卫生研究院 cGVHD 共识标准（NIH 标准）仅捕获了细支气管炎性闭塞综合征（BOS）。在这项研究中，我们改编了 2019 年国际心肺移植学会（ISHLT）慢性肺移植物功能障碍（CLAD）标准，以定义 PcGVHD 的新型表型，并将该标准与 NIH 标准进行比较，以确定具有高风险 PcGVHD 的患者。我们回顾了一项 cGVHD 自然史研究方案（#NCT00092235）中的连续患者，并改编了 2019 年 CLAD 标准（改编标准），将 PcGVHD 定义为 HCT 后 1 秒用力呼气量（FEV1）低于预测值的 80%，有 4 种表型：阻塞性、限制性、混合性阻塞/限制性和未定义性。一个独立的裁决委员会评估了患者的诊断和表型。我们确定了 166 名（47.4%）符合改编标准的患者，包括阻塞性疾病（n = 12，3.4%）、限制性疾病（n = 67，19.1%）、混合性阻塞/限制性疾病（n = 47，13.4%）和未定义性疾病（n = 40，11.4%）。在这些患者中，不到一半（n = 78）符合 NIH 对 BOS 的标准（NIH+）；其余的（n = 88）不符合（NIH-）。与无 PcGVHD 的患者相比，NIH-患者的死亡风险增加（风险比=1.88，95%置信区间=1.20-2.95；P =.006），与 NIH+患者相似（P =.678）。我们的研究表明，改编标准有可能识别出被 NIH 标准遗漏的高风险 PcGVHD 患者。改编标准可能成为更好地表型和研究 cGVHD 肺部疾病的有价值工具。
