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Cancer Resources > Cancer News > 2005 > August

Muscle strength impaired prior to undergoing HSCT

Last Updated: 2005-08-01 15:01:49 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Respiratory and skeletal muscle strength and exercise capacity are impaired in a significant proportion of patients prior to undergoing hematopoietic stem-cell transplantation (HSCT), according to a report in the July issue of Chest.

Pulmonary complications affect up to 60% of patients undergoing HSCT, the authors explain, but whether impaired strength prior to HSCT contributes to these complications has not been carefully studied.

Dr. Alexander C. White and colleagues from Tufts-New England Medical Center, Boston, measured respiratory and skeletal muscle function and submaximal exercise capacity in 56 patients prior to undergoing HSCT to determine if changes in muscle function influenced survival after transplant.

Measures of respiratory muscle strength (maximum inspiratory and expiratory pressures) were significantly below the predicted values prior to HSCT, the authors report. Nearly half (46%) of the patients had maximal voluntary ventilation values below 80% of predicted.

Forty percent of the patients tested had grip strength below 80% predicted, the results indicate, and 58% of the patients tested had less than 80% predicted results for the 6-minute walk test.

Survival was unrelated to any measures of muscle strength, the 6-minute walk test distance, or calculated burden of chemotherapy, the researchers note.

"These data demonstrate either respiratory or skeletal muscle weakness in a significant percentage of patients just prior to starting the preparative regimen for HSCT," the authors conclude. "Rehabilitation programs or novel drug treatments targeting patients identified to be at risk of progressive muscle weakness may help reduce morbidity following an allogeneic HSCT."

"In our institution, we measure pretransplant spirometry and diffusing capacity for carbon dioxide (DLCO) in all bone marrow transplant recipients and lung volumes in those with abnormal spirometry or DLCO," writes Dr. Bekele Afessa from Mayo Clinic College of Medicine, Rochester, Minnesota in a related commentary.

"We use these measurements to identify patients at risk for posttransplant complications, but pretransplant pulmonary abnormalities should not be used for determining eligibility for bone marrow transplant."

"Although we know that pulmonary function abnormalities can be used to identify bone marrow transplant recipients at risk for pulmonary complications," Dr. Afessa adds, "the use of these findings for initiating early preventative and therapeutic plans needs further investigation."

Chest 2005;128:8-10,145-152.

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