Determinants of cardiorespiratory fitness in very long-term survivors of allogeneic hematopoietic stem cell transplantat
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ORIGINAL ARTICLE
Determinants of cardiorespiratory fitness in very long-term survivors of allogeneic hematopoietic stem cell transplantation: a national cohort study Ole Henrik Myrdal 1,2 & Phoi Phoi Diep 2,3,4 & Ellen Ruud 2,3 & Lorentz Brinch 5 & Richard John Massey 2,6 & Elisabeth Edvardsen 7,8 & Johny Kongerud 1,2 & May B. Lund 1,2 & Liv Ingunn Sikkeland 1,2 Received: 12 May 2020 / Accepted: 20 July 2020 # The Author(s) 2020
Abstract Purpose Survivors of allogeneic hematopoietic stem cell transplantation (allo-HSCT) are at risk for cardiopulmonary adverse events. Data on long-term effects on cardiorespiratory fitness are limited. To address the gap in knowledge, we aimed to determine peak oxygen uptake (V̇ O2peak) and identify associations between cardiorespiratory fitness and clinical characteristics, self-reported physical activity, cardiac, and pulmonary function. Methods In a nationwide, single-center cross-sectional study, 90 survivors [aged median (range) 35 (17–54) years, 56% females] were examined, 17 (6–26) years after allo-HSCT. Myeloablative conditioning comprised busulfan/cyclophosphamide or cyclophosphamide only. Methods included pulmonary function tests, echocardiography, and cardiopulmonary exercise test. Results Chronic graft-versus-host disease (cGVHD) was found in 31% of the subjects, of whom 40% had bronchiolitis obliterans syndrome (BOS). Seventy-one percent of the survivors did not meet WHO recommendations for physical activity and 42% were overweight. Reduced gas diffusion (DLCO) and systolic ventricular dysfunction (LVEF) were found in 44% and 31%, respectively. For the group, mean (95% CI), V̇ O2peak was 36.4 (34.7–38.0) mL/min/kg [89 (85–93)% of predicted]. V̇ O2peak was low at 43%. Cardiopulmonary factors and deconditioning were equally common limitations for exercise. In a multiple linear regression model, low V̇ O2peak was associated with low DLCO, low LVEF, BOS, overweight, and inactivity. Conclusion Half of the survivors had reduced cardiorespiratory fitness median 17 years after allo-HSCT. Cardiopulmonary factors and deconditioning were equally common limitations to exercise. We encourage long-term cardiopulmonary monitoring of allo-HSCT survivors and targeted advice on modifiable lifestyle factors. Keywords Allogeneic hematopoietic stem cell transplantation . Long-term follow-up . Cardiorespiratory fitness . Cardiac function . Pulmonary function Notation of prior abstract presentation: Parts of the results were presented at the ERS (European Respiratory Society) Annual Congress in Madrid, September 2019. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00520-020-05644-1) contains supplementary material, which is available to authorized users. * Ole Henrik Myrdal [email protected] 1
Department of Respiratory Medicine, Oslo University Hospital, Rikshospitalet, Box 4950 Nydalen, 0424 Oslo, Norway
2
Institute of Clinical Medicine, University of Oslo, Oslo, Norway
3
Department of Pediatric Oncology and Haematology, Oslo University Ho
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