Abstract: |
Background. The purpose of this study was to investigate the prognostic importance of functional capacity in patients undergoing allogeneic hematopoietic cell transplantation (HCT) for hematological malignancies. Patients and Methods. Using a retrospective design, 407 patients completed a 6-minute walk distance (6MWD) test to assess functional capacity before HCT; 193 (47%) completed a 6MWD test after hospital discharge. Cox proportional hazards regression was used to estimate the risk of nonrelapse mortality (NRM) and overall survival (OS) according to the 6MWD category (<400 m vs. ≥400 m) and the change in 6MWD (before HCT to discharge) with or without adjustment for Karnofsky performance status (KPS), age, and other prognostic markers. Results. Compared with <400 m, the unadjusted hazard ratio for NRM was 0.65 (95% confidence interval, 0.44-0.96) for a 6MWD ≥400 m. A 6MWD of ≥400 m provided incremental information on the prediction of NRM with adjustment for age (p =.032) but not KPS alone (p =.062) or adjustment for other prognostic markers (p =.099). A significant association was found between the 6MWD and OS (p =.027). A 6MWD of ≥400 m provided incremental information on the prediction of OS with adjustment for age (p =.032) but not for other prognostic markers (p >.05 for all). Patients presenting with a pre-HCT 6MWD of,400 m and experiencing a decline in 6MWD had the highest risk of NRM. Conclusion. The 6MWD is a significant univariate predictor of clinical outcomes but did not provide prognostic information beyond that of traditional prognostic markers in HCT. © AlphaMed Press 2015. |