Impaired physiological function and health-related QOL in patients before hematopoietic stem-cell transplantation

Morishita, Shinichiro; Kaida, Katsuji; Ikegame, Kazuhiro; Yoshihara, Satoshi; Taniguchi, Kyoko; Okada, Masaya; Kodama, Norihiko; Ogawa, Hiroyasu; Domen, Kazuhisa

doi:10.1007/s00520-011-1156-2

Cited by 79 publications

(50 citation statements)

References 42 publications

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“…12,13 Functional capacity impairments in patients with chronic GVHD have also been shown to mediate adverse changes in post-HCT functional performance associated with symptom burden. 31 There are limited data regarding 6MW in HCT, 32 and no data that we are aware of that explore the feasibility or prognostic value of cardiopulmonary testing in patients planning to undergo HCT. Muffly et al 33 recently reported on the use of a comprehensive geriatric assessment before allogeneic transplant, which incorporated a 'Frailty Index' that included walk speed and grip strength.…”

Section: Discussionmentioning

confidence: 99%

Cardiopulmonary fitness in patients undergoing hematopoietic SCT: a pilot study

Wood

Deal

Reeve

et al. 2013

Bone Marrow Transplant

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Hematopoietic cell transplantation (HCT) is a life-saving treatment for patients with high-risk hematological malignancies. Prognostic measures to determine fitness for HCT are needed to inform decision-making and interventions. VO 2peak is obtained by measuring gas exchange during cycle ergometry and has not been studied as a prognostic factor in HCT. Thirty-two autologous and allogeneic HCT patients underwent VO 2peak and 6 Minute Walk (6MW) testing before HCT, and provided weekly symptom and health-related quality of life (HRQOL) assessments before HCT and concluding at Day 100. Twenty-nine patients completed pre-HCT testing. Pre-HCT VO 2peak was positively correlated with pre-HCT 6MW (r ¼ 0.65, Po0.001) and negatively correlated with number of chemotherapy regimens and months of chemotherapy. Patients with lower VO 2peak reported higher symptom burden and inferior HRQOL at baseline and during early post-HCT period. Patients with pre-HCT VO 2peak o16 mL/kg/min had higher risk of mortality post HCT (entire cohort: hazard ratio (HR) 9.1 (1.75-47.0), P ¼ 0.01; allogeneic HCT patients only: HR 6.70 (1.29-34.75), P ¼ 0.02) and more hospitalized days before Day 100 (entire cohort: median 33 vs 19, P ¼ 0.003; allogeneic HCT patients only: median 33 vs 21, P ¼ 0.004). VO 2peak pre-HCT is feasible and might predict symptom severity, HRQOL and mortality. Additional studies are warranted. Keywords: cardiopulmonary fitness; symptoms; health-related quality of life; hematopoietic SCT INTRODUCTIONFor patients with life-threatening hematological diseases, hematopoietic cell transplantation (HCT) offers the possibility of extended survival relative to standard conventional treatments. 1 The benefits of HCT are counterbalanced by the risk of treatmentrelated toxicity. Prognostic measures are needed to inform clinician and patient decision-making and to limit treatmentrelated risk. Direct cardiopulmonary fitness assessments such as VO 2peak are now available but have not yet been studied.Myeloablative allogeneic HCT has been associated with a 30-40% risk of treatment-related mortality (TRM). 2 Reduced intensity conditioning HCT is offered to older individuals and patients with comorbid illness, but this technique is still associated with a 20-30% risk of TRM. 3 Autologous HCT in older patients has been associated with a TRM risk exceeding 10%. 4 Subsets of patients after all types of transplants experience late health-related quality of life (HRQOL) deficits and functional impairment; 5 this effect is variable with other subgroups experiencing preserved patient-reported outcomes (PROs), relative to normative values. 6 Investigators and clinicians have attempted to determine who is 'fit' for transplant to inform pre-HCT counseling, selection of suitable HCT candidates and identification of vulnerable HCT recipients at risk for treatment-related complications. 7 Age remains the most commonly used surrogate variable for HCT

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Section: Discussionmentioning

confidence: 99%

Cardiopulmonary fitness in patients undergoing hematopoietic SCT: a pilot study

Wood

Deal

Reeve

et al. 2013

Bone Marrow Transplant

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“…1 Before allo-HCT, patients' physical performance is already affected due to the disease itself and prior treatment. 2,3 Physical inactivity, resulting from long hospitalization and side effects or complications, leads to an additional loss of physical performance. A recent review shows that patients after HCT are likely to have long-term difficulties with physical functioning, fatigue, distress and psychological well-being.…”

Section: Introductionmentioning

confidence: 99%

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

Wiskemann

Kuehl

Dreger

et al. 2013

Bone Marrow Transplant

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Patients undergoing allo-HCT often experience a substantial loss in physical performance. We have recently published the general effectiveness of an exercise intervention in 105 allo-HCT patients on physical performance and psychosocial well-being. However, predictor variables for differentiated treatment response remained unclear. To determine the impact of basic physical performance on treatment response, we assessed muscle strength and endurance performance at four assessment points before and after allo-HCT. The exercise group started training 2 weeks before admission and ended 6-8 weeks after discharge. Comparing initially fit with unfit classified patients, the fit patients lost 31% of the strength of the knee-extensors, whereas the unfit patients lost only 1% (Po0.05). For endurance capacity, fit patients lost 4% of their walking capability, whereas unfit patients gained 13% (Po0.05). The individual percent change was statistically different at the 0.05 level in all measures of physical performance. Individual training response in allo-HCT patients strongly depends on the initial physical performance level. Unfit patients can be trained safely and may benefit more from this exercise intervention than fit patients. This result is of major clinical relevance and should encourage hematologists to promote exercise even more in impaired/unfit allo-HCT patients.

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“…Given its intensity and potential short and long term complications, there are significant risks of physical and psychological morbidity following treatment [1]. Several studies have identified that the side effects of an alloBMT can be long term and include physical impairments such as muscle weakness and reduced endurance; persistent symptoms such as fatigue; and poor health-related quality of life (HRQoL) [2,3]. Whilst the side effects observed in allogeneic and autologous BMT are similar, those experienced following an alloBMT are more numerous and severe due to prolonged hospital length of stay and greater risk of debilitating long-term complications such as graftversus-host-disease [1,4].…”

Section: Letter To Editormentioning

confidence: 99%

“…Firstly, patients present to BMT with reduced muscle strength, exercise capacity and HRQoL when compared to the healthy population [3]. The ability therefore to maximise their health status before the insult of treatment is preferred.…”

Section: Letter To Editormentioning

confidence: 99%