Purpose: The objective of this study is to characterize biochemical and physiologic factors that contribute to changes in patient fitness, body composition, and quality of life (QoL) during hematopoietic stem cell transplantation (HCT).
Background: Though HCT can cure subsets of patients with hematologic malignancies, it carries a high risk of short- and long-term toxicity. Prior work has shown that following both autologous and allogeneic HCT, most patients suffer impairment in QoL for many months after transplant. Efforts to date have inconsistently demonstrated benefit in addressing parameters of nutrition, physical activity, and metabolism.
Methods: This prospective pilot study of 60 patients at VA Puget Sound Marrow Transplant Unit with hematologic malignancy will incorporate multidisciplinary evaluation by endocrinology, nutrition, gastroenterology, and oncology specialties. Assessments before and periodically after HCT include objective measures of fitness by 6-minue walk test, resting energy expenditure, maximum oxygen consumption, handgrip and other muscle group strength, and stair climbing power; body composition by bio-impedance and dual-energy X-ray absorptiometry scans; anabolic and catabolic factors such as insulin growth factor-1, growth hormone, and free and weakly bound testosterone; biochemical markers of inflammatory milieu; and validated questionnaires of nutrition, functional status, and QoL.
Results: The protocol opened to accrual in March 2017. To date, 12 patients have enrolled in study, and posttransplant evaluations (approximately 30 days after transplantation, median = 36) have been performed on 4. Early findings suggest relatively preserved body weight and composition but trends toward decreased QoL and fitness, particularly in aerobic capacity, handgrip strength, and total lower body fitness. Updated findings will be presented at the Association of VA Hematology/Oncology Conference.
Implications: With improving survival outcomes following HCT for hematologic malignancies due to advances in therapeutics and supportive care, increased attention will be directed at optimizing patient-centered quality outcomes. Understanding of the biochemical and physiologic factors underlying these outcomes may lead to refinements in prognostic models and present targets for risk mitigation interventions in the peri-transplant period.
