‘To treat or not to treat’: raising awareness on the effects of graft versus host disease drugs on musculoskeletal system

Mohammed, Jaleel; Akomolafe, Tola; Aljurf, Mahmoud; Savani, Bipin N.; Hashmi, Shahrukh K.

doi:10.1038/s41409-018-0095-7

Cited by 4 publications

(3 citation statements)

References 28 publications

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“…The loss of muscle mass in cancer patients is often multifactorial, resulting from undernutrition, low physical activity, comorbid health conditions (eg, gonadal dysfunction, growth hormone deficiency), chronic inflammation, or treatmentrelated myopathy (eg, systemic corticosteroids) (10,30,31). It is important to note that an overwhelming majority of patients who underwent allogeneic HCT in our cohort likely received systemic chemotherapy for disease control prior to HCT, representing a heavily pretreated population.…”

Section: Discussionmentioning

confidence: 99%

Impact of Sarcopenia on Adverse Outcomes After Allogeneic Hematopoietic Cell Transplantation

Armenian¹,

Xiao²,

Teh³

et al. 2019

JNCI: Journal of the National Cancer Institute

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Background High intensity treatments such as hematopoietic cell transplantation (HCT) can be curative for patients with hematologic malignancies, but this needs to be balanced by the high risk of nonrelapse mortality (NRM) during the first 2 years after HCT. Sarcopenia (low muscle mass) is associated with physical disability and premature mortality in individuals with nonmalignant diseases and may be a predictor of NRM and poor overall survival in patients undergoing HCT. Methods This was a retrospective cohort study of 859 patients with acute leukemia or myelodysplastic syndrome who underwent a first HCT as adults (≥18 years) between 2007 and 2014. Sarcopenia was assessed from pre-HCT abdominal computed tomography scans. Two-year cumulative incidence of NRM was calculated, with relapse/progression considered as a competing risk event. Fine-Gray subdistribution hazard ratio estimates and 95% confidence intervals (CI) were obtained and adjusted for relevant covariates. Kaplan-Meier method was used to examine overall survival. All statistical tests were two-sided. Results Median age at HCT was 51 years (range = 18–74 years); 52.5% had a high [≥3] HCT-comorbidity index; 33.7% had sarcopenia pre-HCT. Sarcopenia was an independent predictor of higher NRM risk (hazard ratio = 1.58, 95% CI = 1.16 to 2.16) compared with patients who were not. The 2-year incidence of NRM approached 30% in patients with sarcopenia and high (≥3) HCT-comorbidity index. Patients with sarcopenia had on average a longer hospitalization (37.2 days vs 31.5 days, P < .001) and inferior overall survival at 2 years (55.2%, 95% CI = 49.5% to 61.0% vs 66.9%, 95% CI = 63.0% to 70.8%, P < .001). Conclusions Sarcopenia is an important and independent predictor of survival after HCT, with potential additional downstream impacts on health-economic outcomes. This information can be used to facilitate treatment decisions prior to HCT and guide interventions to decrease the risk of treatment-related complications after HCT.

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Section: Discussionmentioning

confidence: 99%

Impact of Sarcopenia on Adverse Outcomes After Allogeneic Hematopoietic Cell Transplantation

Armenian¹,

Xiao²,

Teh³

et al. 2019

JNCI: Journal of the National Cancer Institute

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“…The majority of patients develop some level of MSK and cardiovascular complications post-HSCT (Armenian et al , 2017; Majhail et al , 2012; Mohammed et al , 2018a; Bar et al , 2020). Some patients may suffer from these complications for several decades, meaning that they have a significant impact on their health-related QoL.…”

Section: Discussionmentioning

confidence: 99%

Should healthcare organisations offer ongoing rehabilitation services for patients undergoing haematopoietic cell transplant? A narrative review

Mohammed

Kabir

Bakhsh

et al. 2021

IJHG

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PurposeHematopoietic stem cell transplant (HSCT) patients can suffer from long-term transplant-related complications that affect their quality of life and daily activities. This study, a narrative review, aims to report the impact of HCT complications, the benefits of rehabilitation intervention, the need for long-term care and highlights the research gap in clinical trials involving rehabilitation.Design/methodology/approachA comprehensive search strategy was performed on several databases to look for relevant articles published from 1998 to 2018. Articles published in English with the following terms were used: hematopoietic stem cell transplant, chronic graft-versus-host disease, rehabilitation, exercise, physical therapy, occupational therapy. A patient/population, intervention, comparison, and outcomes (PICO) framework was employed to ensure that the search strategies were structured and precise. Study year, design, outcome, intervention, sample demographics, setting and study results were extracted.FindingsOf the 1,411 records identified, 51 studies underwent title/abstract screening for appropriateness, 30 were reviewed in full, and 19 studies were included in the review. The review found that, for the majority of patients who underwent HSCT and developed treatment-related complications, rehabilitation exercises had a positive impact on their overall quality of life. However, exercise prescription in this patient group has not always reflected the scientific approach; there is a lack of high-quality clinical trials in general. The review also highlights the need to educate healthcare policymakers and insurance companies responsible for rationing services to recognise the importance of offering long-term follow-up care for this patient group, including rehabilitation services.Practical implicationsA large number of HSCT patients require long-term follow-up from a multidisciplinary team, including rehabilitation specialists. It is important for healthcare policymakers and insurance companies to recognise this need and take the necessary steps to ensure that HSCT patients receive adequate long-term care. This paper also highlights the urgent need for high-quality rehabilitation trials to demonstrate the feasibility and importance of rehabilitation teams.Originality/valueHealthcare policymakers and insurance companies need to recognise that transplant patients need ongoing physiotherapy for early identification of any functional impairments and appropriate timely intervention.

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“…La fisioterapia es el pilar del tratamiento de apoyo de la fascitis (84,136137) , especialmente las modalidades térmicas, estiramientos, movilización articular y drenaje linfático, y deben iniciarse lo antes posible con el fin de prevenir o resolver las contracturas articulares. Los ejercicios de fortalecimiento son controvertidos, al igual que la terapia quirúrgica de articulaciones afectadas (138) . Además, es necesario tener precaución con la fisioterapia o el drenaje linfático en la etapa edematosa aguda de la fascitis, ya que los procesos inflamatorios pueden aumentar por irritación mecánica.…”

Section: V13 Tratamiento Del Eicrc Fenotipo Escleróticounclassified

Afectación musculoesquelética y del tejido conectivo en pacientes sometidos a trasplante alogénico de progenitores hematopoyéticos con enfermedad injerto contra receptor crónica: caracterización clínica y biológica

Hidalgo Calleja

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‘To treat or not to treat’: raising awareness on the effects of graft versus host disease drugs on musculoskeletal system

Cited by 4 publications

References 28 publications

Impact of Sarcopenia on Adverse Outcomes After Allogeneic Hematopoietic Cell Transplantation

Impact of Sarcopenia on Adverse Outcomes After Allogeneic Hematopoietic Cell Transplantation

Should healthcare organisations offer ongoing rehabilitation services for patients undergoing haematopoietic cell transplant? A narrative review

Afectación musculoesquelética y del tejido conectivo en pacientes sometidos a trasplante alogénico de progenitores hematopoyéticos con enfermedad injerto contra receptor crónica: caracterización clínica y biológica

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