Simple, cost-effective questionnaire outperforms other tests in spotting lung involvement
A simple questionnaire that rates breathing difficulties on a scale of 0 to 3 predicts survival in chronic graft-vs.-host disease, according to a study published in the March issue of Biology of Blood and Marrow Transplantation.
Stephanie Lee, M.D., M.P.H., research director of Fred Hutchinson Cancer Research Center’s Long-Term Follow-Up Program, member of the Clinical Research Division at Fred Hutch and professor of oncology at the University of Washington School of Medicine. Photo by Suong Che / SCCA
And although a poor score means a higher risk of death, asking a simple question that can spot lung involvement early means that patients can begin treatments to reduce or manage symptoms, said senior author Stephanie Lee, M.D., M.P.H., research director of Fred Hutchinson Cancer Research Center’s Long-Term Follow-Up Program, member of the Clinical Research Division at Fred Hutch and professor of oncology at the University of Washington School of Medicine.
“It’s a warning,” said Lee, senior author of the study. “It puts us on notice to be more careful and attentive.”
GVHD is an immune reaction that occurs in some patients who have received bone marrow or blood cell transplants using donor cells. In GVHD, the transplanted cells — which will become the patient’s new immune system — attack the patient’s own cells as they would a foreign object or infection. GVHD can be either acute or chronic; severe, uncontrolled cases can be fatal.
Chronic GVHD most often involves the skin and mouth, but almost any other organ system can be involved. The likelihood of developing chronic GVHD is around 30 to 50 percent, said Lee. Of those who do develop it, about 15 to 20 percent will have lung involvement.
In 2005, the National Institutes of Health recommended assessment of lung function in patients with chronic GVHD using both pulmonary function tests — machines that measure air flow — and an assessment of symptoms.
The newly published 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.
One of the study’s findings was both surprising and encouraging: As a screening test, the simple questionnaire outperformed other tests, which the study called encouraging.
“The questionnaire turned out to be the most predictive,” 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.
Not surprisingly, 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.
Again, Lee saw the result as a way to notice problems earlier and start treatment sooner.
The patient’s doctor would most likely follow up a poor score with other tests, such as a CT scan, to determine the cause; although chronic GVHD should always be suspected following a transplant, it is not the cause of every problem. The first line of treatment for chronic GVHD is medicines that suppress the immune system.
A poor score can also serve as a reminder to make sure the patient has had a pneumonia vaccination and is taking other precautions, Lee said.
The Fred Hutch Long-Term Follow-Up program is a lifelong monitoring and care program for bone marrow and stem cell transplant survivors.
The National Institutes of Health funded the research, which also involved researchers at the Medical College of Wisconsin, Children’s National Medical Center, Dana-Farber Cancer Institute, University of Minnesota, University of Pittsburgh, Moffitt Cancer Center, the National Institues of Health, Lineberger Comprehensive Cancer Center, Stanford University, Vanderbilt University and Johns Hopkins Hospital.
Editor’s note: This news release was written by Fred Hutch staff writer/editor Mary Engel. To obtain a copy of the Biology of Blood and Marrow Transplantation paper, 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, or to arrange an interview with senior author Stephanie Lee, M.D., M.P.H., contact Kristen Woodward, email@example.com or 206-667-2210.
# # #
At Fred Hutchinson Cancer Research Center, home to three Nobel laureates, interdisciplinary teams of world-renowned scientists seek new and innovative ways to prevent, diagnose and treat cancer, HIV/AIDS and other life-threatening diseases. Fred Hutch’s pioneering work in bone marrow transplantation led to the development of immunotherapy, which harnesses the power of the immune system to treat cancer with minimal side effects. An independent, nonprofit research institute based in Seattle, Fred Hutch houses the nation’s first and largest cancer prevention research program, as well as the clinical coordinating center of the Women’s Health Initiative and the international headquarters of the HIV Vaccine Trials Network. Private contributions are essential for enabling Fred Hutch scientists to explore novel research opportunities that lead to important medical breakthroughs. For more information visit www.fredhutch.org or follow Fred Hutch on Facebook, Twitter or YouTube.
Kristen Woodward | EurekAlert!
Real-time imaging of lung lesions during surgery helps localize tumors and improve precision
30.07.2015 | American Association for Thoracic Surgery
Experimental MERS vaccine shows promise in animal studies
29.07.2015 | NIH/National Institute of Allergy and Infectious Diseases
Using ultracold atoms trapped in light crystals, scientists from the MPQ, LMU, and the Weizmann Institute observe a novel state of matter that never thermalizes.
What happens if one mixes cold and hot water? After some initial dynamics, one is left with lukewarm water—the system has thermalized to a new thermal...
Physicists from Regensburg and Marburg, Germany have succeeded in taking a slow-motion movie of speeding electrons in a solid driven by a strong light wave. In the process, they have unraveled a novel quantum phenomenon, which will be reported in the forthcoming edition of Nature.
The advent of ever faster electronics featuring clock rates up to the multiple-gigahertz range has revolutionized our day-to-day life. Researchers and...
Researchers have developed an ultrafast light-emitting device that can flip on and off 90 billion times a second and could form the basis of optical computing.
Joint BioEnergy Institute study identifies bacterial protein that is key to protecting rice against bacterial blight
A bacterial signal that when recognized by rice plants enables the plants to resist a devastating blight disease has been identified by a multi-national team...
Researchers in the Cockrell School of Engineering at The University of Texas at Austin are one step closer to delivering smart windows with a new level of energy efficiency, engineering materials that allow windows to reveal light without transferring heat and, conversely, to block light while allowing heat transmission, as described in two new research papers.
By allowing indoor occupants to more precisely control the energy and sunlight passing through a window, the new materials could significantly reduce costs for...
23.07.2015 | Event News
10.07.2015 | Event News
25.06.2015 | Event News
31.07.2015 | Trade Fair News
31.07.2015 | Transportation and Logistics
31.07.2015 | Physics and Astronomy