Effect of the severity of acute graft-versus-host disease on physical function after allogeneic hematopoietic stem cell transplantation

Abstract

The purpose of this study was to retrospectively investigate the effect of the severity of acute graft-versus-host disease (acute GVHD) on physical function after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Methods 76 patients were included as subjects of this study. Severity of acute GVHD was classified according to the method defined by Grucksberg. To evaluate physical function, the knee extensor strength and six-minute walk distance (6MWD) were performed. Results Among these patients, 54% developed acute GVHD; of these 32%, 54%, and 15% of patients had Grade I, Grade II, and Grade III-IV GVHD, respectively. In the Grade I-II groups, mild acute GVHD following allo-HSCT, resulted in a gradual decline in physical function, which improved at discharge. However, in cases of severe acute GVHD, physical function deteriorated, implementation of rehabilitation became difficult, and the decline in physical function persisted even at discharge. Conclusion These results indicate that severe acute GVHD negatively affects physical function leading to longer hospital days because of inadequate rehabilitation interventions.

Pre-transplant Rehabilitation to Decrease the Post-transplant Length of Stay for Hematological Malignancy Patients Undergoing Allo-HSCT

“…The mean duration of pre-transplant rehabilitation in this study was 10.8 days, which is consistent with previous studies in Japan that initiated pre-transplant rehabilitation 1–4 weeks before transplantation. 19 , 20 , 21 ) However, this period is longer than that reported in previous studies in some other countries (mean: 6–7 days). 2 , 10 ) Such differences between Japan and other countries could be influenced by differences in the respective medical systems.…”

Burden and Needs of Patients with Severe GvHD from the Supportive and Palliative Care Perspective—A Literature Review

“…With regard to physical function, a significant decrease of this parameter was shown in patients with aGvHD of all severity grades in a retrospective study by Hamada et al However, compared to less severely affected patients, patients with severe aGvHD (15% of 76 study participants) had a longer time to recovery, which resulted in longer hospitalization. At discharge, physical functions in these patients were not fully restored, which was examined by measuring the knee extensor strength and performance of a 6-min walk test [ 32 ].…”

“…The literature findings suggest that patients with more severe GvHD suffer from worse physical functioning [ 10 , 32 , 35 , 38 ] and show a more impaired QoL as compared to those with less severe forms of GvHD [ 10 , 38 , 44 , 45 , 46 ]. With regard to physical symptoms, it was not possible to gather sufficient data to show if specific symptoms were especially burdensome in the severe forms of GvHD and if so, which ones those were.…”

Screening supportive care needs, compliance with exercise program, quality of life, and anxiety level during the COVID-19 pandemic in individuals treated with hematopoietic stem cell transplantation

“…Since unique challenges may have been experienced by individuals treated with HSCT, we aimed to screen this population in the present study. On the other hand, we excluded patients diagnosed with GVHD since it causes severe physical and functional limitations as a result of joint/fascia manifestations, contractures, pain, and gastrointestinal symptoms [18,31]. In addition to the disease-related problems, treatment of GVHD includes glucocorticoid treatment which reduces muscle strength and functional capacity [32].…”

“…Exclusion criteria were (1) patients not available by phone, (2) staying in the hospital when we called, (3) not willing to participate, (4) not being able to cooperate, (5) having a serious chronic disease other than cancer, and (6) being infected with COVID-19. Since graft-versus-host-disease (GVHD) causes unique problems that suppress physical, psychological, and/or cognitive functions [17][18][19], patients diagnosed with GVHD were also excluded to ensure a homogenous study sample. The Hacettepe University Ethical Committee approved the present study (GO 20/611).…”