Cardiopulmonary exercise testing prior to myeloablative allo-SCT: A feasibility study Journal Article

Authors: Kelsey, C. R.; Scott, J. M.; Lane, A.; Schwitzer, E.; West, M. J.; Thomas, S.; Herndon, J. E. 2nd; Michalski, M. G.; Horwitz, M. E.; Hennig, T.; Jones, L. W.
Article Title: Cardiopulmonary exercise testing prior to myeloablative allo-SCT: A feasibility study
Abstract: The feasibility of symptom-limited cardiopulmonary exercise testing (CPET) prior to allo-SCT was assessed in addition to the prognostic value of CPET-derived measures. CPET was performed prospectively on 21 patients with hematologic malignancies, with assessments of peak (for example, peak oxygen consumption, VO2peak) and submaximal (for example, ventilatory threshold (VT)) measures of cardiopulmonary function. No serious adverse events were observed during CPET procedures, with 95% of patients achieving criteria for a peak test. Mean VO2peak was 24.7 ± 6.4 mL kg-1 min-1 (range: 10.9-35.5), equivalent to 29% ± 17% below that of age-matched healthy controls. All patients proceeded with the conditioning regimen followed by allo-SCT. Median follow-up was 25 months. During this period, 11 (52.4%) patients died (n = 6, relapsed disease; n = 5, non-relapse mortality (NRM)); 9 patients (43%) developed pulmonary toxicity. In univariate analyses, both peak and submaximal markers of cardiopulmonary function were predictors of OS, pulmonary toxicity and NRM. For OS, the HR for VO2peak and VT were 0.89 (95% CI, 0.8-0.99, P = 0.04) and 0.84 (95% CI, 0.71-0.98, P = 0.03), respectively. In conclusion, CPET is safe and feasible prior to allo-SCT. Patients have marked impairments in cardiopulmonary function prior to allo-SCT. CPET-derived metrics may complement conventional measures to improve risk stratification. © 2014 Macmillan Publishers Limited All rights reserved.
Keywords: adult; clinical article; controlled study; middle aged; young adult; overall survival; fludarabine; mortality; drug megadose; outcome assessment; controlled clinical trial; lung toxicity; etoposide; cyclophosphamide; melphalan; hematopoietic stem cell transplantation; graft failure; hematologic malignancy; myeloablative conditioning; whole body radiation; feasibility study; pilot study; feasibility studies; transplantation conditioning; recurrent disease; allogeneic hematopoietic stem cell transplantation; clinical effectiveness; immunosuppressive treatment; exercise test; cardiopulmonary exercise test; oxygen consumption; heart atrium fibrillation; beta adrenergic receptor blocking agent; functional status; predictive value; chemoradiotherapy; multiple organ failure; sinus tachycardia; cardiovascular parameters; systemic mycosis; procedures; survival prediction; respiratory arrest; humans; prognosis; human; male; female; priority journal; article; ventilatory threshold; six minute walk testing
Journal Title: Bone Marrow Transplantation
Volume: 49
Issue: 10
ISSN: 0268-3369
Publisher: Nature Publishing Group  
Date Published: 2014-10-01
Start Page: 1330
End Page: 1336
Language: English
DOI: 10.1038/bmt.2014.159
PUBMED: 25068429
PROVIDER: scopus
PMCID: PMC4516174
Notes: Export Date: 4 May 2015 -- Source: Scopus
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MSK Authors
  1. Lee Winston Jones
    133 Jones