Assessing Cachexia Acutely after Autologous Stem Cell Transplant

Abstract

Autologous hematopoietic stem cell transplantation (AHCT) is an accepted strategy for various hematologic malignancies that can lead to functional impairment, fatigue, muscle wasting, and reduced quality of life (QOL). In cancer cachexia, these symptoms are associated with inflammation, hypermetabolism, and decreased anabolic hormones. The relative significance of these factors soon after AHCT setting is unclear. The purpose of this study was to characterize the acute effects of AHCT on physical function, body composition, QOL, energy expenditure, cytokines, and testosterone. Outcomes were assessed before (PRE) and 30 ± 10 days after (FU) AHCT in patients with multiple myeloma (n = 15) and non-Hodgkin lymphoma (n = 6). Six-minute walk test (6MWT; p = 0.014), lean mass (p = 0.002), and fat mass (p = 0.02) decreased; nausea and fatigue increased at FU (both p = 0.039). Recent weight change and steroid exposure were predictors of reduced aerobic capacity (p < 0.001). There were no significant changes in interleukin (IL)-1β, IL-6, tumor necrosis factor (TNF), energy expenditure, or bioavailable testosterone. Alterations in cytokines, energy expenditure, and testosterone were not associated with functional impairment acutely following AHCT. Recent history of weight loss and steroid exposure were predictors of worse physical function after AHCT, suggesting that targeting nutritional status and myopathy may be viable strategies to mitigate these effects.

Androgens and estrogens predict sexual function after autologous hematopoietic stem cell transplant in men

“…We measured FM by dual‐energy X‐ray absorptiometry and circulating cytokines (IL‐6, IL‐1β, and TNF) from plasma samples. Whole‐body FM significantly decreased from PRE to MONTH1 (–0.90 [–1.65, –0.15] kg; p = 0.02) as we previously reported in this cohort 25 . Body mass index did not significantly change from PRE to MONTH1 (–0.8 [–2.2, 0.5] kg/m 2 ; p = 0.23).…”

“…Whole-body FM significantly decreased from PRE to MONTH1 (-0.90 [-1.65, -0.15] kg; p = 0.02) as we previously reported in this cohort. 25…”

Growth hormone secretagogue receptor‐1a mediates ghrelin's effects on attenuating tumour‐induced loss of muscle strength but not muscle mass

“… 50 However, the relationship between these parameters is likely to be non‐linear, where the loss of function may occur later in some cases but earlier in others and accelerate faster than the loss of muscle mass. 51 , 52 Also, the post‐intervention recovery of muscle mass may happen sooner than the recovery of muscle function. 51 This could potentially explain why several phase III clinical trials using GHSR‐1a agonists or other anabolic agents such as selective androgen receptor modulators failed to improve muscle function in spite of increasing muscle mass, 17 , 53 , 54 In the current study, we show that, in the absence of GHSR‐1a, ghrelin partly attenuates muscle atrophy but not the decrease in grip strength induced by LLC tumour implantation.…”

Using Wearable Inertial Sensors to Assess Mobility of Patients With Hematologic Cancer and Associations With Chemotherapy-Related Symptoms Before Autologous Hematopoietic Stem Cell Transplant: Cross-sectional Study

“…Central nervous system disturbances owing to certain chemotherapies can affect cognition and movement, causing a sequela of symptoms comprising nausea and pain [73]. Chemotherapy can cause vestibular toxicity, resulting in nausea that intensifies over the transplant phase [74,75], which could directly or indirectly affect gait and balance [76]. Chronic pain is prevalent among survivors of hematologic cancer [77], has been associated with gait deficits in older adults [78], and is a significant risk factor for falls in survivors of cancer [79].…”