Effect of Physical Condition on Outcomes in Transplant Patients: A Retrospective Data Analysis

Abstract

Background: Stem cell transplantation is a potential curative procedure for many patients with hematologic malignancies. These patients because of age, comorbid medical conditions, and prior therapies can present in various physical conditions from good performance status to frail, which may affect transplant outcomes. Objective: To assess the relationship of measurable physical conditioning metrics to survival, progression-free survival, relapse rate, and transplant-related morbidity and mortality in the context of our current rehabilitation program. Methods: We conducted a retrospective review of 207 patients who had undergone hematopoietic stem cell transplantation with 6 months of follow-up. Data were collected from their pretransplant rehabilitation evaluation and their 60-day posttransplant evaluation including their Karnofsky Performance Status (KPS) score, Timed Up and Go, pain, fatigue, and distress measurements. Using their KPS score patients were categorized as high performers (KPS ≥80) and low performers (KPS ≤70). Results: Patients experienced significant decreases in pain, fatigue, and distress after transplant. There were no significant differences in overall survival, progression-free survival, relapse rate, or transplant-related mortality between high and low performers. When controlling for transplant type, high performers had half the risk of dying compared with low performers. Conclusions: Our study demonstrated better posttransplant standard measures regardless of initial performance status. Our data suggest that patients with a better pretransplant performance status have better overall survival. One limitation of our study is the exercise program was not supervised and adherence is unknown.

Severely reduced physical performance is already present at the time of admission for stem cell transplantation

“…16 Better pre-HSCT fitness is linked to improved overall survival. 17 Therefore, enhancing pre-HSCT fitness status is recommended, potentially contributing Open access to a better outcome for paediatric patients undergoing HSCT.…”

“…Previous exercise sessions correlate with higher muscle strength values. Open access studies in adult patients undergoing HSCT reveal positive effects of exercise programmes on physical functioning, medical outcomes, with baseline fitness seeming to be protective against mortality, and psychological parameters, [14][15][16] as well as a better overall survival for pre-HSCT fitness status, 17 data in paediatric oncology remain limited. 18 Some studies indicate that exercising with children may be beneficial, safe and feasible.…”