Effects of Exercise in Combination With Epoetin Alfa During High-Dose Chemotherapy and Autologous Peripheral Blood Stem Cell Transplantation for Multiple Myeloma

Abstract

Purpose/Objectives-To determine the effect of aerobic and strength resistance training and epoetin alfa (EPO) therapy on transfusions, stem cell collections, transplantation recovery, and multiple myeloma treatment response. Design-Randomized clinical trial.Setting-A myeloma research and therapy center in the south central United States.Sample-135 patients with multiple myeloma, 120 evaluable.Methods-Random assignment to exercise or usual care groups. All patients received EPO based on an algorithm. Aerobic capacity, using the six-minute walk test, was assessed prior to induction chemotherapy, prior to stem cell mobilization, and following stem cell collection for all patients and before and after transplantation for patients continuing in the study. Data analysis included analysis of variance to compare other outcome variables by groups.Main Research Variables-Number of red blood cell and platelet transfusions during transplantation, number of attempts at and total number of days of stem cell collection, time to recovery after transplantation, and response to intensive therapy for multiple myeloma.Findings-Recovery and treatment response were not significantly different between groups after transplantation. The exercise group had significantly fewer red blood cell transfusions and fewer attempts at stem cell collection. Serious adverse events were similar in each group.Conclusions-Exercise with prophylactic EPO therapy reduces the number of RBC transfusions and attempts at stem cell collection for patients receiving intensive treatment for multiple myeloma.Implications for Nursing-Exercise is safe and has many physiologic benefits for patients receiving multiple myeloma treatment. Key Points • Exercise in combination with epoetin alfa therapy reduced the number of transfusions and the number of attempts at stem cell collection while improving aerobic capacity.• Patients receiving chemotherapy and autologous peripheral blood stem cell transplantation can exercise safely.• Nurses should use exercise as an intervention to reduce the need for transfusions and improve stem cell collection.At least 60% of patients with multiple myeloma are anemic (hemoglobin less than 12 g/dl) at diagnosis (Multiple Myeloma Research Foundation, 2002), and almost all become anemic during treatment, often requiring red blood cell (RBC) transfusions (Knight, Wade, & Balducci, 2004). Epoetin alfa (EPO) increases hemoglobin levels and reduces the need for RBC transfusions in diverse groups of patients with cancer-related anemia (Henry, 2005), particularly patients with multiple myeloma receiving chemotherapy treatment (Barlogie & Beck, 1993).Evidence supports the benefit of exercise in managing fatigue during and after treatment for patients with breast cancer and other solid tumors (Courneya & Friedenreich, 1999;Galvao & Newton, 2005 (Drouin et al., 2006) suggest that exercise increases hemoglobin levels. Women receiving radiation treatment for breast cancer (N = 20) were randomly assigned to aerobic exercise or to placebo stretc...

Exercise in adult and pediatric hematological cancer survivors: an intervention review

“…Only two included a large population sample (nX100). 39,40 Nine studies (comprising 13 publications) were of high quality. 39,40,[52][53][54][58][59][60][61][62][63][64][65] Several exercise interventions for HSCT survivors took place during hospitalization 56,58,63 or started during hospitalization and continued after release, 40,57,[59][60][61][62]64 whereas others were performed only in the outpatient or homebased setting.…”

“…39,40,[52][53][54][58][59][60][61][62][63][64][65] Several exercise interventions for HSCT survivors took place during hospitalization 56,58,63 or started during hospitalization and continued after release, 40,57,[59][60][61][62]64 whereas others were performed only in the outpatient or homebased setting. 39,[52][53][54][55]65,66 Many interventions were aerobic and successfully increased functional capacity or at least offset the loss of functional capacity associated with HSCT. 40,52,55,57,61,66 Not surprisingly, there is substantial interest in the ability of physical activity interventions to change blood markers in HSCT patients, with inconclusive results to date.…”

“…We located 17 publications from 13 studies, 39,40,52-66 8 of which 39,40,53,54,56,[63][64][65] were RCTs. Only two included a large population sample (nX100).…”

“…Liu et al 33 recently performed a systematic review on exercise interventions conducted in hematological cancer patients, including studies published up to September 2007. This area of research is growing considerably and several intervention studies in adult/children survivors of hematological cancer have been recently published in adults [34][35][36][37][38][39][40] and in children 28,[41][42][43][44][45][46][47] that were not included in the review by Liu et al 33 Here, we summarize the intervention data related to all the possible effects of physical activity on adult and pediatric hematological cancer survivors. The information is also detailed extensively in Supplementary Material.…”

Efficacy of exercise training in SCT patients-who benefits most?

“…7 Since this review, six new randomized controlled trials have been published, supporting these findings; some studies showed strong effects for body composition as well as weaker but promising effects for cardiorespiratory fitness, fatigue, muscle strength, physical functioning and quality of life. [8][9][10][11][12][13] Nevertheless, many questions remain unanswered regarding exercise interventions in HCT patients. Additional evidence is required to determine the optimal exercise recommendation, with respect to amount, type, intensity and time point for intervention.…”