Higher exercise tolerance early after allogeneic hematopoietic stem cell transplantation is the predictive marker for higher probability of later social reintegration

Abstract

As the proportion of long-term survivors after allogeneic hematopoietic stem cell transplantation (allo-HSCT) is on the rise, it is essential to consider the significance of quality of life (QOL), including reintegration with society (returning to school or work). This retrospective cohort study aims to illustrate the precise epidemiology of social reintegration later after allo-HSCT and determine its predictive indicators. We enrolled 56 patients, and 40 patients (71%) attained social reintegration at 2 years post-HSCT. Reintegration failure markedly correlated with an inferior performance status and concurrent chronic graft-versus-host disease. In non-reintegrated patients, the physical function at discharge measured by the 6-min walking distance (6MWD) was markedly decreased. On the multivariate risk analyses, sex (female; odds ratio (OR) 0.07; 95% confidence interval (CI) 0.01–0.54; p = 0.01), HCT-CI (≥ 2; OR 0.10; 95% CI 0.01–0.84; p = 0.03), and change in 6MWD (per 5% increase; OR 1.47; 95% CI 1.01–2.13; p = 0.04) were significant predictors of later social reintegration. This study suggests that a multidisciplinary strategy including rehabilitation is essential, especially in patients with poor predictive markers at an early phase, and we should consider suitable rehabilitation programs to prevent a decline in exercise tolerance and improve social reintegration and overall QOL in patients after allo-HSCT.

Effect of rehabilitation in patients undergoing hematopoietic stem cell transplantation

“…Patients with high physical function may be able to return to work earlier. 27 , 54) On the other hand, GvHD and steroid administration are associated with factors that delay recovery of physical function after transplantation. 53) In long-term survivors, patients with higher physical function after discharge from the hospital also tend to have a better QOL.…”

Effects of early post-transplant belt electrode skeletal muscle electrical stimulation therapy on an allogeneic hematopoietic stem cell transplant recipient: A case study

“…The present case was managed according to the rehabilitation protocol for allo-HSCT at our hospital. 6 In short, patients received 5 rehabilitation sessions per week, which included stretching, resistance training, walking, cycling, and stair climbing. In addition, the hospital met the standards of clean management (ISO standard, class 8) , and rehabilitation could be performed in the ward even in the early neutropenic phase post transplantation.…”

Prolonged gut microbial alterations in post‐transplant survivors of allogeneic haematopoietic stem cell transplantation

“…The decreased diversity has also been associated with increased risks for acute graft‐versus‐host disease (aGVHD) and aGVHD‐related mortality 15 . Patients are generally discharged within 1 to 3 months after allo‐HSCT and gradually return to the same lifestyle as healthy individuals 16,17 . A study that investigated gut microbial alterations both pre and post transplantation found that the decrease in microbial diversity observed after transplantation persists for up to 1 year after transplantation 18 .…”

“…15 Patients are generally discharged within 1 to 3 months after allo-HSCT and gradually return to the same lifestyle as healthy individuals. 16,17 A study that investigated gut microbial alterations both pre and post transplantation found that the decrease in microbial diversity observed after transplantation persists for up to 1 year after transplantation. 18 However, whether long-term alterations in the gut microbiota persist for more than a year remains unexplored.…”