Physical Impairments in Allogeneic-HSCT
Condition: Stem Cell Transplantation
Study type: Observational

Summary: 
      Pulmonary functions, exercise capacity and muscle strength deteriorate in survived
      hematopoietic stem cell transplantation (HSCT) recipients due to toxic effects of
      chemotherapy, radiotherapy, conditioning regimens and/or corticosteroid use before HSCT,
      prolonged stay of recipients in rooms with laminar airflow and strict infection control rules
      during process of HSCT. There are also limited numbers of studies demonstrated pulmonary
      function abnormalities, decreased maximal exercise capacity, respiratory and peripheral
      muscle weakness in recipients. Current study was planned since no study compared pulmonary
      functions, maximal exercise capacity, respiratory and peripheral muscle strength between
      recipients and healthy individuals in the literature.
    

Detailed description: 
      Treatments of hematologic malignancies consist of chemotherapy, radiotherapy, surgery,
      medical treatment, supportive care and/or hematopoietic stem cell transplantation (HSCT)
      which is resulted in early or late adverse effects on body systems, tissues and organs.
      Physical deconditioning is also observed in patients with hematologic malignancies because of
      reasons such as neurotoxic and pulmonary toxic effects of long term these anticancer
      treatments, immobilization, recommendation of resting and avoiding intense exercise,
      nutrition problems, severe anemia and thrombocytopenia etc. For these reasons, normal
      physical activities may not be kept on by patients which induces decreased physical
      performance.

      The HSCT provides longer survival with standard treatments for patients with hematological
      malignancies while it increases risk of HSCT-related toxicity, complications and even
      mortality. Infectious and non-infectious pulmonary complications occur in about 60% of HSCT
      recipients and intensive-care unit support is also required in one-third of recipients for
      these reasons. Restrictive lung disease prior to allogeneic HSCT is related to early
      respiratory failure, non-relapse mortality and respiratory muscle weakness in post
      transplantation period. Therefore pulmonary restriction is considered as a risk factor for
      complications or failure of HSCT. Moreover it is known that carbon monoxide diffusing
      capacity of lungs which is the most common abnormality seen in pulmonary function test,
      respiratory muscle strength and functional exercise capacity are reduced in the majority of
      patients before HSCT. In addition to muscle weakness and decreased exercise capacity at prior
      to HSCT, patients experience more reduction in both inspiratory and expiratory muscles and
      exercise capacity after HSCT. Unfortunately, exercise capacity and peripheral muscle strength
      are decreased in HSCT recipients in spite of doing regular and planned exercise during acute
      process of HSCT. The average reduction in functional exercise capacity of recipients is 48 m.
      As shown in the literature, limited number of study has used evaluation of maximal exercise
      capacity with Modified-Incremental Shuttle Walk Test (ISWT) in HSCT patients and recipients.
      On the other hand, it has been reported that ISWT is a reliable test and has no adverse event
      or side effects for HSCT recipients in these studies, as well. Despite the fact that there is
      no negative feedback related to using of this test in recipients, no study comprehensively
      demonstrated influence of HSCT on maximal exercise capacity.

      Impairments in pulmonary functions, respiratory muscle strength and maximal exercise capacity
      have been demonstrated in limited number of studies. Moreover, there is no study compared
      pulmonary functions, respiratory muscle strength and maximal exercise capacity between HSCT
      recipients and healthy individuals. Therefore investigators aimed to compare aforementioned
      outcomes between recipients and healthy individuals.
    

Observational model: Case-Control
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        66 recipients underwent allogeneic HSCT who were at minimum 100 days status
        post-transplantation compared with 50 healthy individuals.

        All recipients transplanted at the Bone Marrow Transplantation Unit of University Faculty
        of Medicine. All measurements were done by a physiotherapist at Cardiopulmonary Unit of
        University Faculty of Health Science Department of Physiotherapy and Rehabilitation.
        Demographic and clinical characteristics of all participants were recorded. Study was
        planned as retrospective, cross sectional and approved by the local Ethics Committee.
        Informed consent was obtained from all individual participants included in the study.
      
Keywords: stem cell transplantation; Pulmonary Functions; muscle strength; exercise capacity