Does allogeneic stem cell transplantation in survivors of pediatric leukemia impact regular physical activity, pulmonary function, and exercise capacity?

IF 2.4 Q1 PEDIATRICS
Katharina Ruf, Alaa Badran, Céline Siauw, Imme Haubitz, Paul-Gerhardt Schlegel, Helge Hebestreit, Christoph Härtel, Verena Wiegering
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Abstract

Background: Allogeneic hematopoietic stem cell transplantation (allo-HSCT) has improved survival in high-risk childhood leukemia but is associated with long-term sequelae such as impaired pulmonary function and reduced exercise capacity impacting quality of life.

Methods: A convenience sample of 17 patients after allo-HSCT (HSCT-12 male, age 15.7±6.7 years, time after HSCT 5.3±2.8 years) underwent pulmonary function testing, echocardiography, and an incremental exercise test on a bike. Physical activity and health-related quality of life were assessed by questionnaires (7-day physical activity recall, PEDS-QL). Seventeen healthy age- and gender-matched controls served as control group (CG) for results of pulmonary function and exercise testing.

Results: HSCT showed reduced pulmonary function (HSCT vs. CG: FEV1 90.5±14.0 vs. 108.0±8.7%pred; FVC 88.4±19.3 vs. 107.6±6.9%pred, DLCO 75.3±23.6 vs. 104.9±12.8%pred) and exercise capacity (VO2peak 89±30.8%pred, CG 98±17.5%pred; Wmax 84±21.7%pred, CG 115±22.8%pred), but no relevant cardiac dysfunction and a good quality of life (PEDS-QL mean overall score 83.3±10.7). Differences in peak oxygen uptake between groups were mostly explained by 5 adolescent patients who underwent total body irradiation for conditioning. They showed significantly reduced diffusion capacity and reduced peak oxygen uptake. Patients reported a mean time of inactivity of 777±159min/day, moderate activity of 110±107 min/day, hard activity of 35±36 min/day, and very hard activity of 23±22 min/day. A higher amount of inactivity was associated with a lower peak oxygen uptake (correlation coefficient tau -0.48, p=0.023).

Conclusions: This pilot study shows that although patients after allo-HSCT reported a good quality of life, regular physical activity and exercise capacity are reduced in survivors of stem cell transplantation, especially in adolescents who are treated with total body irradiation for conditioning. Factors hindering regular physical activity need to be identified and exercise counseling should be part of follow-up visits in these patients.

Abstract Image

同种异体干细胞移植对儿童白血病幸存者的常规身体活动、肺功能和运动能力有影响吗?
背景:同种异体造血干细胞移植(Allogeneic hematopoietic stem cell transplantation, alloo - hsct)可提高高危儿童白血病患者的生存率,但也存在长期后遗症,如肺功能受损和运动能力下降,影响生活质量。方法:选取17例同种异体造血干细胞移植后患者(HSCT-12例男性,年龄15.7±6.7岁,HSCT后时间5.3±2.8年)进行肺功能检查、超声心动图检查和自行车增量运动试验。通过问卷(7天体力活动回忆,ped - ql)评估体力活动和健康相关生活质量。17名年龄和性别匹配的健康对照组(CG)作为肺功能和运动测试结果的对照组。结果:HSCT显示肺功能降低(HSCT vs. CG: FEV1 90.5±14.0 vs. 108.0±8.7%;FVC 88.4±19.3 vs. 107.6±6.9%pred, DLCO 75.3±23.6 vs. 104.9±12.8%pred)和运动能力(vo2峰值89±30.8%pred, CG 98±17.5%pred;Wmax 84±21.7%pred, CG 115±22.8%pred),但无相关心功能障碍和良好的生活质量(PEDS-QL平均总评分83.3±10.7)。两组之间的峰值摄氧量差异主要由5名接受全身照射的青少年患者来解释。它们的扩散能力和峰值摄氧量明显降低。患者报告平均不活动时间为777±159min/天,中等活动时间为110±107 min/天,剧烈活动时间为35±36 min/天,剧烈活动时间为23±22 min/天。不活动的时间越长,吸氧峰值越低(相关系数tau -0.48, p=0.023)。结论:这项初步研究表明,尽管同种异体造血干细胞移植后的患者报告了良好的生活质量,但干细胞移植幸存者的常规体力活动和运动能力下降,特别是在接受全身照射治疗的青少年中。需要确定妨碍定期身体活动的因素,并在这些患者的随访中提供运动咨询。
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