Determinants of cardiorespiratory fitness in very long-term survivors of allogeneic hematopoietic stem cell transplantation: a national cohort study

Abstract

Purpose Survivors of allogeneic hematopoietic stem cell transplantation (allo-HSCT) are at risk for cardiopulmonary adverse events. Data on long-term effects on cardiorespiratory fitness are limited. To address the gap in knowledge, we aimed to determine peak oxygen uptake (V̇O2peak) and identify associations between cardiorespiratory fitness and clinical characteristics, self-reported physical activity, cardiac, and pulmonary function. Methods In a nationwide, single-center cross-sectional study, 90 survivors [aged median (range) 35 (17–54) years, 56% females] were examined, 17 (6–26) years after allo-HSCT. Myeloablative conditioning comprised busulfan/cyclophosphamide or cyclophosphamide only. Methods included pulmonary function tests, echocardiography, and cardiopulmonary exercise test. Results Chronic graft-versus-host disease (cGVHD) was found in 31% of the subjects, of whom 40% had bronchiolitis obliterans syndrome (BOS). Seventy-one percent of the survivors did not meet WHO recommendations for physical activity and 42% were overweight. Reduced gas diffusion (DLCO) and systolic ventricular dysfunction (LVEF) were found in 44% and 31%, respectively. For the group, mean (95% CI), V̇O2peak was 36.4 (34.7–38.0) mL/min/kg [89 (85–93)% of predicted]. V̇O2peak was low at 43%. Cardiopulmonary factors and deconditioning were equally common limitations for exercise. In a multiple linear regression model, low V̇O2peak was associated with low DLCO, low LVEF, BOS, overweight, and inactivity. Conclusion Half of the survivors had reduced cardiorespiratory fitness median 17 years after allo-HSCT. Cardiopulmonary factors and deconditioning were equally common limitations to exercise. We encourage long-term cardiopulmonary monitoring of allo-HSCT survivors and targeted advice on modifiable lifestyle factors.

Oral chronic GVHD after allogeneic stem cell transplantation without total body irradiation performed at a young age

“…All the 20 LTSs who had LPL changes also had other distinctive signs and symptoms of oral cGVHD (Table 1 ). In addition to these 20 LTSs with LPL changes, six (6.5%) had one or more distinctive signs and symptoms of oral cGVHD in addition to definite cGVHD in another organ, five with ocular affection and one with both ocular and skin affection [ 21 , 22 ]. Hence, they also fulfilled the diagnostic criteria of oral cGVHD (Tables 1 , 2 ).…”

“…Our cross-sectional, non-comparative clinical study was part of a large, national multidisciplinary Norwegian Allo Survivorship study (AlloSS-young), investigating health impairments in young survivors after allo-HCT [ 21 , 22 ]. The study included subjects with leukemia, lymphoma, benign hematological diseases, immunodeficiencies, or metabolic diseases treated with allo-HCT at Oslo University Hospital, during the period April 1974 to August 2009 [ 21 , 22 ].…”

“…Our cross-sectional, non-comparative clinical study was part of a large, national multidisciplinary Norwegian Allo Survivorship study (AlloSS-young), investigating health impairments in young survivors after allo-HCT [ 21 , 22 ]. The study included subjects with leukemia, lymphoma, benign hematological diseases, immunodeficiencies, or metabolic diseases treated with allo-HCT at Oslo University Hospital, during the period April 1974 to August 2009 [ 21 , 22 ]. Eligibility criteria for inclusion were (1) all patients alive and older than 16 years at study start, August 1, 2014; (2) all patients were aged < 30 years at transplantation; (3) minimum time since allo-HCT was 5 years.…”

“…In addition, subjects without oral LPL changes but with one or more distinctive signs or symptoms, xerostomia, mucoceles, mucosal atrophy, ulcers, and pseudomembranes, in combination with a definite diagnosis of cGVHD in another organ, were also regarded as oral cGVHD cases [ 4 ]. Information regarding cGVHD in another organ was based on multidisciplinary examinations performed during the study [ 21 , 22 ]. A 4-point (0–3) clinical scoring system was used to grade the severity of oral cGVHD; 0 = no symptoms, 1 = mild symptoms with no limiting oral intake, 2 = moderate symptoms with partial limitation of oral intake, 3 = severe symptoms with major limitation of oral intake [ 4 ].…”

Late-Onset, Noninfectious Pulmonary Complications following Allogeneic Hematopoietic Stem Cell Transplantation: A Nationwide Cohort Study of Long-Term Survivors

“…Hence, little is known of LONIPCs in adult allo-HSCT survivors with observation periods exceeding 1 decade. The present study was carried out within the context of a large and comprehensive project investigating health conditions in young, very long-term survivors of allo-HSCT [18][19][20][21]. All survivors were examined with both HRCT and pulmonary function tests.…”