Feasibility and safety of exercise training and nutritional support prior to haematopoietic stem cell transplantation in patients with haematologic malignancies

Abstract

Background Prehabilitation with regular exercise and nutritional care for patients undergoing surgeries for malignant disease was recently introduced to increase physiologic reserve prior to the procedure, accelerate recovery and improve outcomes. This study aimed to investigate the feasibility and safety of combined exercise training and nutritional support in patients with haematologic malignancies prior to haematopoietic stem cell transplantation (HSCT). Methods In this single-arm pilot study, 34 HSCT candidates were enrolled at least two weeks before admission for the procedure. Patients performed aerobic exercises at least 4 days per week for 20–30 min and strength exercises 3 days per week for 10–20 min. They received daily supplements of whey protein (0.3–0.4 g/kg body weight) and oral nutritional supplements if needed. The primary endpoints were feasibility (acceptability > 75%, attrition < 20%, adherence > 66%) and safety. The secondary endpoints were fat-free mass (FFM), muscle strength, physical performance and health-related quality of life (HRQoL) at HSCT. Results The rate of acceptability, attrition and adherence to aerobic exercise, strength exercise and protein supplement consumption was 82.4, 17.8, 71, 78 and 80%, respectively. No severe adverse events were reported. Twenty-eight patients participated in the study for a median of 6.0 weeks (range, 2–14). They performed aerobic exercises 4.5 days per week for 132 min per week and strength exercises 3.0 times per week. Patients consumed 20.7 g of extra protein daily. At the end of the programme, we recorded increases of 1.1 kg in FFM (p = 0.011), 50 m in walking distance in the 6-min walking test (6MWT) (p < 0.001), 3.3 repetitions in the 30-s chair-stand test (30sCST) score (p < 0.001) and 2.6 kg in handgrip strength (p = 0.006). The EORTC QLQ-C30 scores improved by 8.6 (p < 0.006) for global health status, 8.3 (p = 0.009) for emotional functioning, and 12.1 (p = 0.014) for social functioning. There was less fatigue, nausea and insomnia (p < 0.05). Conclusions Our study shows that a multimodal intervention programme with partially supervised exercise training combined with nutritional support prior to HSCT is feasible and safe. Patients showed improvements in FFM, physical performance and HRQoL. Additional research is needed to assess the possible positive effects of such interventions.

A Scoping Review on Outcomes and Outcome Measurement Instruments in Rehabilitative Interventions for Patients with Haematological Malignancies Treated with Allogeneic Stem Cell Transplantation

“…Of these, we assessed n = 195 for eligibility based on the full text. A total of n = 39 studies of the following types met the inclusion criteria [ 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 ]: n = 24 randomized clinical trials, n = 9 pilot studies, and n = 6 feasibility studies ( Table 1 ). In these 39 studies, n = 84 different outcomes were used 227 times and were measured using n = 125 different instruments ( Table 2 ).…”

“…In these 39 studies, n = 84 different outcomes were used 227 times and were measured using n = 125 different instruments (Table 2). Adherence [16] Adverse Events [16] Program completion from 50% of the patients [17] Recruitment [16] Feasibility Pilot Study [17] Hospital [17] Exercise [16,17] Santa mina et al Feasibility [18][19][20] Pilot Study [21,25] Hospital [18][19][20] Outpatient post [21] Outpatient pre [25] Electric Muscle Stimulation [18] Healing touch [19] Inspiratory muscle training [20] Home based aerobic exercise [6] Exercise Training and Nutritional Support [25] Bewarder et al Attrition [20,21,25,27] Feasibility [20] Pilot Study [21,25] Hospital [20] Outpatient post [21] Outpatient pre [25] Inspiratory muscle training [20] Home based aerobic exercise [21] Exercise Training and Nutritional Support [25] De almeida et al Retention [19,22] Feasibility [19,22] Hospital [19] Outpatient post [22] Healing touch…”

“…Acceptability [21,25] Pilot Study [21,25] Outpatient post [21] Outpatient pre [25] Home based aerobic exercise [21] Exercise Training and Nutritional Support [25] Wilson Pilot Study [24] Outpatient post [24] Positive Psychology Intervention [24] Amonoo et al, 2020…”

“…The Graham and Longman QoL Questionnaire [42] RCT [42] Outpatient post [42] Exercise Relaxation Information [ RCT [41] Pilot [25] Feasibility [27] Outpatient post [41] Outpatient pre [25] Outpatient physical exercise [ FACT-BMT [23,47] RCT [23,47] Hospital [23,47] Exergaming [23] Multidirectional Walking [ Feasibility [43] Outpatient post [43] Mindfulness based Intervention [43] Grossman et al, 2015 SF36 [21,23] Pilot Study [21] Outpatient post [21] Home based aerobic exercise [ Clinician administered PTSD Scale for DSM IV [48] RCT [48] Outpatient post [48] Cognitive Behavioural Therapy [48] DuHamel et al, PCL-C [45,48] RCT [45,48] Hospital [45] Palliative Care [45] El Jawahri et al, 2017…”

Weight Loss Intervention before Cord Blood Transplantation in an Obese Patient with Acute Myeloid Leukemia: A Case Study

“…Rehabilitation for patients undergoing HSCT is generally aimed at preventing the deterioration of physical function and improving the quality of life. 15 ) A recent study 16 ) reported the feasibility and safety of combined exercise training and nutritional support before HSCT in patients with hematologic malignancies. The present case suggested that combined exercise training and nutritional support aimed at weight loss could be feasible and safe in patients with hematologic malignancies.…”