SALT LAKE CITY — Endurance limitations appeared significantly associated with greater length of inpatient admission and death during admission for hematopoietic stem cell transplantation, according to study results presented at the BMT Tandem Meetings.
Thus, a formal physical performance assessment could better evaluate a patient’s endurance and physical reserve, improving patient selection and prognostication.
Measures of risk assessment commonly used to predict HSCT outcomes include the validated hematopoietic cell transplantation-specific comorbidity index (HCT-CI) and Karnofsky performance score.
“These indices focus on a patient’s comorbidities and physical functioning,” Shabnam Rehman, MD, clinical fellow with the department of medicine at Roswell Park Comprehensive Cancer Center, told HemOnc Today. “Comorbidities alone do not define the true biological age/functional status of a patient, and Karnofsky performance score can be a subjective measure. Therefore, we assessed whether more objective tests assessed by physical therapists could predict physical functioning and biologic age/functional status better than HCT-CI and Karnofsky performance score.”
Rehman and colleagues evaluated how the results of a comprehensive physical performance status prior to transplant — in addition to HCT-CI and Karnofsky performance status — were associated with day 100 transplant-related mortality, OS, length of inpatient admission, death during admission, readmission and need for rehabilitation after discharge.
The analysis included 349 adults who underwent a first allogeneic HSCT between 2010 and 2016.
One of two dedicated physical therapists conducted a physical performance assessment — which included 25 step-ups per side, unassisted sit-to-stands from an 18-inch chair in 30 seconds, weight-bearing ability, need for assistance with ambulation, motor strength in all four extremities, sensory or coordination impairment, self-reported pain, and time to recovery of heart rate and oxygen saturation to pre-exercise levels — for all patients 4 weeks prior to HSCT.
Length of inpatient admission — defined as duration of hospitalization from inpatient admission, including for receipt of conditioning regimen and hematopoietic cell infusion, to first post-HSCT discharge — appeared significantly associated with donor type ( 30 days vs. < 30 days; P = .009; 60 days vs. < 60 days; P = .02), as well as regular ( 30 days vs. < 30 days, P = .05; 60 days vs. < 60 days, P = .02) and age-adjusted ( 30 days vs. < 30 days, P = .04) HCT-CI.
Death during first admission also appeared linked to donor type (P < .0001), and regular (P = .0004) and age-adjusted (P = .03) HCT-CI.
Patients who self-reported pain experienced significantly shorter OS (P = .04).
Endurance limitations appeared linked to length of admission of 60 days or longer vs. shorter than 60 days (P = .02) and death during HSCT admission (P = .03).
Also, heart rate recovery within 3 minutes of exercise was associated with length of admission ( 30 days vs. < 30 days; P = .03; 60 days vs. < 60 days; P = .02), whereas oxygen saturation recovery was linked to day 100 nonrelapse mortality.
Researchers observed shorter survival among patients unable to perform more than 10 sit-to-stands in 30 seconds (P = .01) and those who needed assistance with ambulation.
“Surprisingly, age was not associated with any of the novel outcomes or objective measures of physical performance,” Rehman said. “We found that HCT-CI risk scoring predicts outcome, and that objective tests assessed by the physical therapists — such as the number of sit-to stands in 30 seconds and the ability to perform 25 step-ups — were equally prognostic. These quantitative measures are prognostic of novel short-term outcomes of length of stay, inpatient mortality during transplant admission and disability.”
The association with limitations on endurance tests and shorter OS persisted when researchers stratified results for the age-adjusted HCT-CI group.
“These physical performance assessments are part of the routine pretransplant workup at our institution,” Rehman said. “We hope that bone marrow transplantation centers may find these tests to be useful in determining a patient’s level of physical reserve and fitness for HSCT, and in predicting short-term outcomes and disability. We are developing a validated risk score incorporating endurance tests in conjunction with the HCT-CI that could be used by other transplant centers.”
The results of these study “should be tested, replicated and validated in a larger population before any generalized conclusions can be drawn from our approach,” study author Theresa Hahn, PhD, professor of oncology in the department of medicine at Roswell Park Comprehensive Cancer Center, told HemOnc Today. “These findings should be tested, for example, in pediatric patients, patients receiving autologous HSCT and in a broader and more ethnically diverse patient base.” – by Alexandra Todak
Rehman S, et al. abstract 19. Presented at: BMT Tandem Meetings; Feb. 21-25, 2018; Salt Lake City.
Sorror ML, et al. J Clin Oncol. 2007;25:4246-4254.
Disclosures: The authors report no relevant financial disclosures.