The Impact of a Physical Activity Intervention Can be Accurately Assessed By Smart Watches in Patients Completing Autologous Stem Cell Transplantation for Lymphoma or Multiple Myeloma: Results of a Feasibility Study
Authors: Ip Andrew , Churnetski Michael C , Calzada Oscar , Chang Andres , Liu Yuan , Bumpers Nassoma , Leeson Deborah , Mahar Ernestine , Hesaroieh Iraj , Crain Maria , Nooka Ajay K , Koff Jean L. , Hofmeister Craig C , Gupta Vikas A. , Allen Pamela , Lechowicz Mary Jo , Kaufman Jonathan L , Blum Kristie A. , Lonial Sagar , Langston Amelia , Waller Edmund K. , Flowers Christopher R , Cohen Jonathon B. 
Published: October 2019

Abstract
Background: Based on cohort studies and a limited number of prospective studies, physical activity (PA) can improve quality of life (QoL) in non-Hodgkin lymphoma (NHL), multiple myeloma (MM), and patients (pts) undergoing autologous stem cell transplant (ASCT). There are also data to suggest that survival (Pophali et al, ASH 2017) is improved with increased PA in NHL pts. After ASCT, it is known that QoL and physical function will decrease. PA has been linked to improved QoL outcomes for pts undergoing ASCT. Recently, evidence shows fitness trackers can help monitor and improve adherence to PA in cancer pts. We aim to study the feasibility of a PA intervention in NHL/MM patients undergoing ASCT and to assess the use of smart watches in this setting to monitor PA.
Methods: We included MM and NHL pts undergoing ASCT. Key inclusion criteria included ECOG < 2 and ability to complete a 6 minute walk test (6MWT). Pts were asked to adhere to a PA program of 150 minutes a week on a stationary bicycle or by walking, recording data in a diary and by wearing a smart watch provided to them. Data were collected from date of hospitalization to discharge, with research staff checking on pts at least twice a week to ensure adequate data collection and adherence. Feasibility of the intervention was assessed by average weekly minutes of PA performed by self-report. Validation of moderate intensity PA was attempted by heart rate (HR) monitoring (goal 40% of HR reserve) by the smart watch. QoL was assessed from FACT-lymphoma and FACT-MM surveys prior to transplant and around day 30 post ASCT. Clinical outcomes measured include time to neutrophil engraftment (≥0.5 10E3/mcL) and physical function (6MWT). Survey scores and 6MWT distances were compared using Wilcoxson rank sum tests. Historical controls at Emory matched for age, disease status, conditioning, stem cells infused, and use of stimulating factor were used to compare median time to neutrophil engraftment.
Results: Since April 2018, 10 pts have enrolled and completed the PA intervention. Median age was 62, 70% were males, 40% had NHL, 50% were African American, and 50% were Caucasian. All pts were chemotherapy sensitive at time of transplant. Conditioning regimens included BEAM (30%), Melphalan (60%) and Busulfan/cyclophosphamide/etoposide (10%). Granulocyte colony stimulating factor was used in 60% of pts. Median follow up was 22 days.
Six of 9 (67%) patients were able to adhere to a PA regimen while hospitalized by self-report, with one patient having incomplete PA data. Eight of ten patients wore their watch regularly for HR analysis. Six of these eight patients (75%) consistently reached HR goal during their PA. Of the 6 patients who met PA goal by self-report, 4 (67%) consistently met HR goals during PA (sample data, figure 1). QoL scores measured by FACT-lymphoma and FACT-MM showed no significant decrease in total score from pre-intervention to post-discharge follow up (median score difference -2.5 points, p-value=0.72, table 1). Individual sections of FACT surveys showed no significant differences except emotional well-being (median score difference, -3 points, p=0.008, table 1). Physical function by 6MWT decreased by a median of 97 meters (pre-test median of 435 meters, post-test median of 333.5 meters, p-value=0.016, table 1). Compared to 20 historical controls, median time to engraftment was similar (12 days vs 12.5 days).
Conclusion: Our findings support the feasibility of studying an inpatient PA intervention for ASCT pts using traditional and novel methods. Nearly 70% of pts who participated were successful in adhering to a PA regimen of 150 minutes of exercise. Ongoing assessment by research staff to encourage pts to adhere to prescribed exercise, as well as use of a smart watch to validate PA by HR data was feasible. QoL results are consistent with prior PA studies in ASCT pts, with no significant decrease in overall QoL by day +30. Additional analyses from this study, including a flow-based panel to measure the impact of PA on immune reconstitution post ASCT, will be presented at the meeting. We plan to utilize the findings from this feasibility study to construct a randomized study of PA in ASCT assessing QoL as a primary outcome.

Disclosures
Calzada: Seattle Genetics: Research Funding. Nooka:Janssen pharmaceuticals: Consultancy, Membership on an entity's Board of Directors or advisory committees; Takeda: Consultancy, Membership on an entity's Board of Directors or advisory committees; GSK: Consultancy, Membership on an entity's Board of Directors or advisory committees; Celgene: Consultancy, Membership on an entity's Board of Directors or advisory committees; Adaptive technologies: Consultancy, Membership on an entity's Board of Directors or advisory committees; Spectrum Pharmaceuticals: Consultancy, Membership on an entity's Board of Directors or advisory committees; BMS: Consultancy, Membership on an entity's Board of Directors or advisory committees; Amgen: Consultancy, Membership on an entity's Board of Directors or advisory committees. Hofmeister:Bristol-Myers Squibb: Research Funding; Adaptive biotechnologies: Membership on an entity's Board of Directors or advisory committees; Oncopeptides: Membership on an entity's Board of Directors or advisory committees; Celgene: Membership on an entity's Board of Directors or advisory committees, Research Funding; Janssen: Membership on an entity's Board of Directors or advisory committees. Allen:Merck: Research Funding; Bayer: Consultancy. Kaufman:Karyopharm: Other: data monitoring committee; Abbvie: Consultancy; Janssen: Consultancy; BMS: Consultancy; Roche: Consultancy. Blum:Morphosys: Research Funding; Seattle Genetics: Research Funding; Celgene: Research Funding; Novartis: Research Funding. Lonial:Amgen: Research Funding. Waller:Cambium Medical Technologies: Consultancy, Equity Ownership; Pharmacyclics: Other: Travel Expenses, EHA, Research Funding; Novartis Pharmaceuticals Corporation: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Celldex: Research Funding; Kalytera: Consultancy. Flowers:Celgene: Research Funding; Millennium/Takeda: Research Funding; TG Therapeutics: Research Funding; Acerta: Research Funding; Pharmacyclics/ Janssen: Consultancy; Eastern Cooperative Oncology Group: Research Funding; V Foundation: Research Funding; Denovo Biopharma: Consultancy; Spectrum: Consultancy; Abbvie: Consultancy, Research Funding; OptumRx: Consultancy; Abbvie: Research Funding; Gilead: Research Funding; Karyopharm: Consultancy; BeiGene: Research Funding; Bayer: Consultancy; Janssen Pharmaceutical: Research Funding; Gilead: Consultancy; Genentech/Roche: Research Funding; Pharmacyclics: Research Funding; National Cancer Institute: Research Funding; Burroughs Wellcome Fund: Research Funding; Genentech/Roche: Consultancy. Cohen:Bristol-Myers Squibb: Research Funding; AbbVie: Consultancy, Membership on an entity's Board of Directors or advisory committees; Bristol-Myers Squibb: Research Funding; Celgene: Consultancy, Membership on an entity's Board of Directors or advisory committees; BioInvent: Consultancy; Celgene: Consultancy, Membership on an entity's Board of Directors or advisory committees; Seattle Genetics: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Infinity Pharmaceuticals: Consultancy, Membership on an entity's Board of Directors or advisory committees; Janssen: Research Funding; Infinity Pharmaceuticals: Consultancy, Membership on an entity's Board of Directors or advisory committees; AbbVie: Consultancy, Membership on an entity's Board of Directors or advisory committees; Millennium: Consultancy, Membership on an entity's Board of Directors or advisory committees; Janssen: Research Funding; Novartis: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Pharmacyclics: Consultancy, Membership on an entity's Board of Directors or advisory committees; Millennium: Consultancy, Membership on an entity's Board of Directors or advisory committees; Takeda: Research Funding; Novartis: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; BioInvent: Consultancy; Pharmacyclics: Consultancy, Membership on an entity's Board of Directors or advisory committees; Seattle Genetics: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Takeda: Research Funding.