458 Utility of Grip Strength and 2 Minute Walk Test in Chronic Gvhd Assessment: An Analysis From the Chronic Gvhd Consortium

Track: Contributed Abstracts
Saturday, February 16, 2013, 6:45 PM-7:45 PM
Hall 1 (Salt Palace Convention Center)
Joseph Pidala, MD, MS , Moffitt Cancer Center
Xiaoyu Chai, MS , Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
Paul J Martin, MD , Fred Hutchinson Cancer Research Center, Seattle, WA
Yoshihiro Inamoto, MD, PhD , Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA
Mary E.D. Flowers, MD , Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA
Corey Cutler, MD MPH FRCP(C) , Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
Jeanne Palmer, MD , Department of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI
Daniel J. Weisdorf, MD , Masonic Cancer Center, University of Minnesota, Minneapolis, MN
Steven Z. Pavletic, MD , NCI Experimental Transplantation and Immunology Branch, National Institute of Health NIH, Bethesda, MD
Mukta Arora, MD MS , Hematology, Oncology and Transplant, University of Minnesota, Minneapolis, MN
Sally Arai, MD , Stanford University, Stanford, CA
Stephanie J. Lee, MD, MPH , Clinical Transplant Research, Fred Hutchinson Cancer Research Center, Seattle, WA

Utility of grip strength and 2 minute walk test in chronic GVHD assessment: An analysis from the Chronic GVHD Consortium

Background: Grip strength and 2 minute walk test have been suggested as elements of chronic graft-vs-host disease (GVHD) assessment in clinical trials. Methods: Using all available data (n=584, 1,689 follow-up visits, total of 2,273 visits) from a prospective observational cohort study, we explored the relationship between grip strength and 2 minute walk test and patient-reported outcomes (Lee symptom scale, SF-36 and FACT-BMT quality of life instruments, and Human Activity Profile, or HAP), chronic GVHD severity (NIH global 0-3 score, clinician global 0-3 score, and patient-reported global 0-3 score) and mortality (overall survival (OS) and non-relapse mortality (NRM)) in multivariate analyses adjusted for significant covariates. Results: In multivariate analysis, 2 minute walk test was significantly (p < 0.001) associated with intuitive domains of the Lee Symptom Scale (overall, skin, lung, energy), while grip strength was not. Excepting MCS (mental component score), 2 minute walk test had significant association with all studied SF-36 domain and summary scores (p < 0.001) and FACT summary and domain scores (p < 0.001). Both grip strength and 2 minute walk test had significant association with FACT summary scores and HAP (maximum activity score (MAS), and adjusted activity score (AAS)). In univariate analysis using all visit data, 2 minute walk test had significant association with global chronic GVHD severity, as calculated from organ scores, reported by clinicians, and reported by patients (p < 0.01). Patients with NIH global score of mild or less and moderate achieved on average 20.7 and 15.3 feet, respectively, greater distance covered compared to those with NIH severe chronic GVHD. Conversely, grip strength had no significant association with any of these measures of chronic GVHD. In time-varying multivariate models examining all data and adjusting for significant covariates, 2 minute walk test was significantly associated with both OS and NRM (both p < 0.001), while no association was  found for grip strength. Conclusions: Based on its consistent association with symptom burden, QOL, chronic GVHD severity and mortality, these data support the 2 minute walk test as a useful measure in chronic GVHD assessment.

See more of: Poster Session 2: GVH/GVL
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