Suboptimal long-term physical performance in children and young adults after pediatric allo-SCT

Hovi, Liisa; Kurimo, Marita; Taskinen, Mervi; Vettenranta, J.; Vettenranta, Kim; Saarinen‐Pihkala, Ulla M.

doi:10.1038/bmt.2009.221

Cited by 25 publications

(27 citation statements)

References 25 publications

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“…In line with the report from Hovi et al, 28 we found higher exercise capacity in patients who participated in organized sports. This finding suggests that the children who participate in sports activity may achieve an improved rehabilitation compared with those who are physically less active.…”

Section: Discussionsupporting

confidence: 82%

“…Direct effects of chemotherapy and radiation, as well as indirect effects such as endocrine dysfunction, may contribute to this impairment. 1,28 Growth hormone deficiency was present in 11% of our patients. Although the mean height, weight and BMI z-scores of our patients were close to normal, the range was quite large, and VO 2peak was associated with patient BMI and height z-scores in univariate analyses.…”

Section: Discussionmentioning

confidence: 99%

“…Hovi et al 28 recently documented that reduced physical performance in children and young adults 4-16 years after HSCT was associated with reduced strength, endurance and flexibility of the larger muscle groups. Direct effects of chemotherapy and radiation, as well as indirect effects such as endocrine dysfunction, may contribute to this impairment.…”

Section: Discussionmentioning

confidence: 99%

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Aerobic exercise capacity at long-term follow-up after paediatric allogeneic haematopoietic SCT

Mathiesen

Uhlving

Buchvald

et al. 2014

Bone Marrow Transplant

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Peak oxygen uptake (VO 2peak ), a measure of aerobic exercise capacity, predicts mortality and morbidity in healthy and diseased individuals. Our aim was to determine VO 2peak years after paediatric allogeneic haematopoietic SCT (HSCT) and to identify associations with baseline patient and donor characteristics, transplantation factors, pulmonary function and self-reported sports activity. In this cross-sectional, population-based study, we measured VO 2peak , spirometry and diffusion capacity of the lung (D LCO ) 3-10 years post HSCT. Z-scores were calculated by reference values from healthy subjects. Self-reported hours of sports activity were obtained by interview. We included 63 patients (mean age (range) 14.4 (7-24) years). HSCT patients exhibited lower mean VO 2peak (−1.42 z-score, 95% confidential interval (−1.7; − 1.1)) compared with healthy subjects (Po 0.001). Sixteen patients (25%) had VO 2peak values o − 1.96 z-score. Low VO 2peak was associated with reduced forced expiratory volume in 1 s (R 2 = 0.11, P = 0.009), reduced D LCO /V A (R 2 = 0.09, P = 0.01) and low physical activity (mean VO 2peak z-score inactive group: − 2.1 vs most active group: − 1.1, P = 0.02). No associations between VO 2peak and diagnosis, donor type or GvHD were found. Although causes for reduced VO 2peak may be multiple, our findings stress the need to focus on physical activity post HSCT to prevent lifestyle diseases and improve quality of life. INTRODUCTIONThe population of long-term survivors after allogeneic haematopoietic SCT (HSCT) has increased owing to advances in donor selection and improvements in conditioning regimens and supportive care. Improved survival has increased the focus on late effects and quality of life. 1 HSCT may affect multiple organ systems as a result of the toxicity from chemotherapy, TBI and complications including GvHD and infections. 1 In a recent retrospective study, we documented reduced spirometric values in 34% of paediatric patients more than 18 months from HSCT. 2 However, little is known about the potential consequences of reduced pulmonary function for daily life activities and aerobic exercise capacity.Peak oxygen uptake (VO 2peak ) is a measure of physical capacity, which integrates the responses of the cardiovascular, pulmonary and musculoskeletal systems when faced with physical requirements; 3 thus, VO 2peak allows evaluation of abnormalities, which may not be apparent during rest. 4 As a measure of cardiorespiratory fitness, VO 2peak is a powerful predictor of morbidity and mortality in both healthy and diseased individuals. 5,6 In cancer patients, reduced VO 2peak has been associated with fatigue, which is known to reduce the quality of life, especially in children and young adults for whom physical activities are an essential part of the daily routine. 7 A recent systematic review revealed slightly reduced VO 2peak in survivors of childhood leukaemia compared with healthy controls. 8 Although HSCT has been described as the treatmentvariable most consistently associated with redu...

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Aerobic exercise capacity at long-term follow-up after paediatric allogeneic haematopoietic SCT

Mathiesen

Uhlving

Buchvald

et al. 2014

Bone Marrow Transplant

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“…Conservative management of joint contractures with physical therapy can improve outcomes in these children (Beredjiklian et al, 1998). In children following stem cell transplant, physical performance, as assessed with objective measures, is impaired in patients with extensive chronic GVHD (Hovi et al, 2010). Using these objective measures, carefully designed studies assessing the impact of physical therapy and exercise programmes on chronic GVHD should be feasible.…”

Section: Ancillary Therapies and Supportive Carementioning

confidence: 99%

Optimal management of chronic graft‐versus‐host disease in children

Jacobsohn

2010

Br J Haematol

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SummaryChronic graft-versus-host disease (GVHD) is a major complication after allogeneic haematopoietic stem cell transplantation (HSCT). Not only is it the major cause of late mortality in HSCT patients, but it also accounts for significant morbidity. Much of the literature on chronic GVHD has focused on adults. Chronic GVHD is of major importance in children, especially since they have years to live following the complications of chronic GVHD and its therapy. The goal is to review incidence, manifestations, and therapies, especially when applicable to the paediatric population.

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“…Limitations in physical function have been reported for childhood HSCT survivors ranging from 7% (clinician report) 13 to 17% (selfreport) 14 and 40-62% from direct measures of cardiopulmonary fitness. 15 Associations between poor physical performance and cGVHD, cardiac conditions, immune suppression, treatment for secondary malignancies 16 and myeloid disease 17 have been found. Reports of psychological functioning are mixed.…”

Section: Introductionmentioning

confidence: 99%

Pediatric allo-SCT for malignant and non-malignant diseases: impact on health-related quality of life outcomes

Oberg

Bender

Morris

et al. 2012

Bone Marrow Transplant

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The objective of this study was prospectively to investigate the health-related quality of life (HRQOL) of 80 pediatric recipients of allo-SCT for malignant and non-malignant diseases. The PedsQL 4.0 was used to assess self-reported physical, emotional and social functioning of children X5 years old once, pre-allo-SCT and on days þ 100, þ 180, þ 365 and þ 730. Emotional and social functioning was stable pre-to-post-allo-SCT and comparable to the normative sample (P40.05), and physical functioning was 17 points lower pre-allo-SCT (Pp0.01) with improved scores equivalent to the norms by day þ 730. Lower physical scores were reflected by 50-54% of children reporting difficulties with movement, strength, pain and fatigue. At baseline, children ages 5-7 reported lower social functioning (Po0.05) and patients with non-malignant disease reported better physical functioning (Po0.05). Emotional functioning in ages 8-12 improved over time (Po0.05). More than 50% of the participants were minority and their HRQOL was similar to non-minority participants. Physical functioning significantly improved for recipients of reduced-toxicity conditioning (Pp0.01), significantly worsened for patients with chronic GVHD (cGVHD; Po0.05), and significantly decreased in recipients of matched-unrelated donor transplant who developed cGVHD (Po0.05). Multidisciplinary efforts are necessary to identify and support pediatric patients' physical needs to improve functional outcomes.

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Suboptimal long-term physical performance in children and young adults after pediatric allo-SCT

Cited by 25 publications

References 25 publications

Aerobic exercise capacity at long-term follow-up after paediatric allogeneic haematopoietic SCT

Aerobic exercise capacity at long-term follow-up after paediatric allogeneic haematopoietic SCT

Optimal management of chronic graft‐versus‐host disease in children

Pediatric allo-SCT for malignant and non-malignant diseases: impact on health-related quality of life outcomes

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