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

Hand grip strength (HGS) and 2 minute walk test (2MWT) have been proposed as elements of chronic graft-vs-host disease (GVHD) assessment in clinical trials. Using all available data (n=584 enrollment visits, 1,689 follow-up visits, total of 2,273 visits) from a prospective observational cohort study, we explored the relationship between HGS and 2MWT and patient-reported measures (Lee symptom scale, SF-36 and FACT-BMT quality of life instruments, and Human Activity Profile, or HAP), chronic GVHD global severity (NIH global 0–3 score, clinician global 0–3 score, and patient-reported global 0–3 score), calculated and clinician-reported chronic GVHD response, and mortality (overall survival (OS), non-relapse mortality (NRM), and failure-free survival (FFS)) in multivariable analyses adjusted for significant covariates. 2MWT was significantly associated with intuitive domains of the Lee Symptom Scale (overall, skin, lung, energy), SF-36 domain and summary scores, FACT summary and domain scores, and HAP scores (all p < 0.001). Fewer associations were detected with the HGS. The 2MWT and HGS both had significant association with global chronic GVHD severity. In multivariable analysis, 2MWT was significantly associated with OS, NRM, and FFS, while no association was found for HGS. 2MWT and HGS were not sensitive to NIH or clinician-reported response. Based on independent association with mortality, these data support the importance of the 2MWT for identification of high-risk chronic GVHD patients. However, change in 2MWT is not sensitive to chronic GVHD response, limiting its usefulness in clinical trials.