Table 2.

2014 National Institutes of Health Chronic GVHD Consensus Diagnostic Criteria for BOS after Hematopoietic Cell Transplant

In the presence of a distinctive manifestation of chronic GVHD, the clinical diagnosis of BOS is sufficient to establish the diagnosis of chronic GVHD for the purposes of enrollment in clinical trials when all of the following criteria are met:
1.FEV1/vital capacity ratio <0.7 or the fifth percentile of predicted	A. Vital capacity includes FVC or slow vital capacity, whichever is greater
	B. The fifth percentile of predicted is the lower limit of 90% CI
	C. For pediatric or elderly patients, use the lower limits of normal, defined according to NHANES III calculations
2.FEV1 <75% of predicted with ⩾10% decline over <2 yr; FEV1 should not correct to >75% of predicted with albuterol, and the absolute decrease for corrected values should still remain at ⩾10% over 2 yr	—
3.Absence of infection in the respiratory tract documented with investigations directed by clinical symptoms such as chest radiographs, CT, or microbiologic cultures (sinus aspiration, upper respiratory tract viral screen, sputum culture, BAL)	—
4.One of the two supporting features of BOS	A. Evidence of air trapping by expiratory CT or small airway thickening or bronchiectasis by high-resolution chest CT
	B. Evidence of air trapping by PFTs: residual volume >120% of predicted or residual volume/TLC ratio increased beyond the 90% CI

Definition of abbreviations: BOS = bronchiolitis obliterans syndrome; CI = confidence interval; CT = computed tomography; GVHD = graft-versus-host disease; NHANES = National Health and Nutrition Examination Survey; PFT = pulmonary function test.

Adapted with permission from Jagasia and coworkers (6).