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. 2023 Jul 26;32(169):220251. doi: 10.1183/16000617.0251-2022

BOX 1.

National Institutes of Health 2015 criteria for chronic graft-versus-host disease of the lung following haematopoietic stem cell transplantation [10], diagnostic criteria for bronchiolitis obliterans syndrome (BOS), BOS stage 0p (BOS 0p) [15] and, as a reference, the International Heart and Lung Transplant Society (ISHLT) BOS grading system used in lung transplantation [11]

BOS:

  1. Forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) <0.7 or <5th percentile of predicted, and

  2. FEV1 <75% of predicted with a decline of ≥10% over <2 years, and

  3. Absence of infection in the respiratory tract, and

  4. One of the following two:
    1. evidence of air trapping on expiratory computed tomography (CT) or small airway thickening or bronchiectasis on high-resolution CT;
    2. evidence of air trapping on pulmonary function tests with a residual volume (RV) >120% of predicted or RV/total lung capacity outside of the 90% confidence interval.
BOS 0p:

  1. A decline in FEV1 of ≥10% of predicted, or

  2. A decline in forced expiratory flow at 25–75% of FVC (FEF25–75) of ≥25% of predicted.

  3. Not otherwise meeting the criteria for BOS.

ISHLT criteria for BOS in lung transplantation: Values represent spirometry % of baseline.

  • BOS 0 – FEV1 >90% and FEF25–75% >75%

  • BOS 0p – FEV1 81–90% and/or FEF25–75% ≤75%

  • BOS 1 – FEV1 66–80%

  • BOS 2 – FEV1 51–65%

  • BOS 3 – FEV1 ≤50%