Autologous stem cell transplantation improves cardiopulmonary exercise testing outcomes in systemic sclerosis patients

Abstract

Objectives Autologous hematopoietic stem cell transplantation (AHSCT) is a disease-modifying treatment for patients with severe systemic sclerosis (SSc). Here, we aimed at assessing cardiopulmonary function outcomes of SSc patients after AHSCT. Patients and Methods Twenty-seven SSc adult patients treated with AHSCT were included in this retrospective study. Most had the diffuse cutaneous subset (93%) and pulmonary involvement (85%). Before and 12 months after AHSCT, patients underwent cardiopulmonary exercise testing (CPET), transthoracic echocardiography, pulmonary function test with diffusing capacity for carbon monoxide (DLCO), six-minute walk test (6MWT), and quality of life evaluations. Results After AHSCT, the peak VO2 increased from 954 to 1029 ml/min (p = 0.02), the percentage of predicted peak VO2 increased from 48.9 to 53.5 meters (p = 0.01), and the distance measured by the 6MWT increased from 445 to 502 meters (p = 0.01), respectively, compared to baseline. Improvements in peak VO2 correlated positively with improvements in 6MWT distance, and negatively with a decrease in resting heart rate. At baseline, patients with DLCO >70% had higher peak VO2 values than those with DLCO <70% (p = 0.04), but after AHSCT all patients improved VO2 values, regardless of baseline DLCO levels. Increases in VO2 levels after AHSCT positively correlated with increases in the physical component scores of the Short Form (SF)-36 quality of life questionnaire (r = 0.70; p = 0.0003). Conclusion AHSCT improves the aerobic capacity of SSc patients probably reflecting combined increments in lungs, skeletal muscle and cardiac function.