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Objective and subjective physical function in allogeneic hematopoietic stem cell transplant recipients

Bone Marrow Transplantation volume 56, pages 2897–2903 (2021)Cite this article

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Abstract

We conducted a prospective study of adult allogeneic hematopoietic cell transplantation (HCT) recipients to assess pre- and post-HCT physical function. Baseline measurements included a wrist actigraphy, a 6 min walk test (6MWT), an international physical activity questionnaire (IPAQ), and a Functional Assessment of Cancer Therapy-Bone Marrow Transplant (FACT-BMT) as well as serial post-HCT assessments of 6MWT, IPAQ, and FACT-BMT. Forty-seven patients were evaluable for functionality assessments, with a median follow-up of 54.5 months for surviving recipients. No patients demonstrated vigorous or very vigorous activity at any time during monitoring by wrist actigraphy; patients spent a median of 6 h daily sedentary. Self-reported activity via the IPAQ showed 36%, 43%, and 21% of subjects reporting light, moderate, and vigorous activity prior to HCT, respectively. Post-HCT 6MWTs on day +30 demonstrated the greatest association with subsequent survival and non-relapse mortality. A decline in 6MWT distance over time also demonstrated worsened overall survival. This study shows the feasibility of fitness assessments and the ability to risk stratify for subsequent mortality, particularly using the 6MWT on the day +30 single time point assessment and change scores from baseline to day +30 post HCT. These pilot findings suggest important targets for future study.

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Fig. 1: Observed and Predicted 6-min walk test.
Fig. 2: Overall survival according to 6 min walk test values at baseline and serial time points post-hematopoietic stem cell transplant.
Fig. 3: None-relapse mortality (NRM) according to distance walked on 6MWT at baseline and serial post-HCT assessments.
Fig. 4: Overall survival according to change in 6 min walk test from baseline to serial post-hematopoietic stem cell transplant time points.

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Acknowledgements

The authors wish to thank all the patients and their families as well as all physicians, nurses, medical providers, and data managers for their contribution to this study. The authors of this manuscript certify that they comply with the ethical guidelines for authorship and publishing in the Journal of Bone Marrow Transplantation. This work has been supported in part by the Biostatistics and Bioinformatics Shared Resource at the H. Lee Moffitt Cancer Center & Research Institute, an NCI designated Comprehensive Cancer Center (P30-CA076292). Editorial assistance was provided by the Moffitt Cancer Center’s Office of Scientific Writing by Dr Paul Fletcher & Daley Drucker. No compensation was given beyond their regular salaries.

Funding

We acknowledge the following funding support: H. Lee Moffitt Cancer Center BMT-CI Foundation Grant (to AM), Moffitt Cancer Center Support Grant P30-CA076292.

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Authors and Affiliations

  1. Blood and Marrow Transplantation and Cellular Immunotherapy, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA

    Asmita Mishra, Joseph Pidala, Frederick L. Locke, Taiga Nishihori, Lia Perez & Claudio Anasetti

  2. Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA

    Ram Thapa & Xuefeng Wang

  3. Department of Medicine, University of Minnesota, Minneapolis, MN, USA

    Brian C. Betts

  4. Moffitt Malignant Hematology and Cellular Therapy at Memorial Healthcare System, Pembroke Pines, FL, USA

    Hugo Fernandez

  5. Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA

    Heather Jim

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Contributions

AM, CA, and HJ were involved with conceptualization and methodology. RT and XW contributed to the formal analysis. AM and JP contributed to the writing of the original draft and all remaining authors contributed to the draft revisions

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Correspondence to Asmita Mishra.

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Competing interests

AM receives grant funding from Novartis. BCB is a co-inventor for provisional patents related to the use of the CD83 CAR T cells (WO2019165156), JAK inhibitors (WO2017058950A1), and STAT3 inhibitors (WO2015120436A2) in GVHD prevention and treatment; BCB nor his institution(s) have received payment related to claims described in the patents. HF is on the advisory boards for Incyte and Jazz and speakers bureau for Sanofi. FLL is a scientific advisor for Kite/Gilead, Novartis, BMS/Celgene, Allogene, Wugen, Calibr, and GammaDelta Therapeutics, is a consultant for Cellular BioMedicine Group Inc., and has institutional patents for Survivin Dendritic Cell Vaccine; improving CAR T Cell Therapy. TN receives research support to the institution (not to the individual) from Novartis and Karyopharm. HJ consulted for RedHill BioPharma, Janssen Scientific Affairs, and Merck. The other authors declare no competing interests.

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Mishra, A., Pidala, J., Thapa, R. et al. Objective and subjective physical function in allogeneic hematopoietic stem cell transplant recipients. Bone Marrow Transplant 56, 2897–2903 (2021). https://doi.org/10.1038/s41409-021-01428-1

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