Physical Fitness and Frailty in Males after Allogeneic Hematopoietic Stem Cell Transplantation in Childhood: A Long-Term Follow-Up Study
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Subjects
2.2. Physical Fitness Tests
2.2.1. Dominant Hand-Grip Muscle Strength by Dynamometer
2.2.2. Functional Mobility by Timed Up-and-Go Test
2.2.3. Dynamic Muscular Endurance by Sit-to-Stand Test
2.2.4. Gait Speed Test
2.2.5. Endurance by Two-Minute Walk Test
2.3. Physical Activity Assessment
2.4. Assessment of Frailty
2.4.1. Low Lean Muscle Mass
2.4.2. Low Energy Expenditure
2.4.3. Slowness
2.4.4. Weakness
2.4.5. Exhaustion
2.5. Data Analysis
3. Results
3.1. Participants
3.2. Physical Fitness
3.3. Physical Activity
3.4. Prevalence of Frailty
3.5. Risk Factors Associated with Prefrail to Frail Health
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Characteristic | All HSCT | Pre-Frail and Frail Participants | Non-Frail Participants | p |
---|---|---|---|---|
Survivors | ||||
n = 98 | n = 30 | n = 68 | ||
Age at examination (years) | 28.7 ± 7.3 | 29.5 ± 8.0 | 28.4 ± 7.0 | 0.622 |
18.5–47.0 | 18.7–43.2 | 18.5–47.0 | ||
Time since HSCT (years) | 19.0 ± 7.0 | 19.8 ± 7.9 | 18.6 ± 6.5 | 0.537 |
7.7–34.6 | 8.1–33.4 | 7.7–34.6 | ||
Treatment regimens | ||||
Total body irradiation, n (%) 1 | 72 (73%) | 26 (87%) | 46 (68%) | 0.081 |
Chemotherapy before HSCT, | 66 (67%) | 20 (67%) | 46 (68%) | 1 |
n (%) | ||||
Total CNS radiation dose (cGy) | 1036 ± 929 | 1384 ± 1137 | 842 ± 713 | 0.181 |
0–3600 | 0–3600 | 0–3000 | ||
Total gonadal radiation dose (cGy) | 987 ± 1009 | 1208 ± 1067 | 885 ± 981 | 0.252 |
0–4130 | 0–4130 | 0–3600 | ||
Doxorubicin isoequivalent dose (mg/m2) 2 | 162 ± 167 | 150 ± 187 | 168 ± 158 | 0.412 |
0–750 | 0–750 | 0–517 | ||
Cyclophosphamide equivalent dose (mg/m2) 2 | 6625 ± 4874 | 7175 ± 5028 | 6379 ± 4822 | 0.247 |
0–28,743 | 2600–28,743 | 0–23,461 | ||
Clinical outcomes, n (%) | ||||
Chronic graft-versus-host disease | 28 (29%) | 14 (47%) | 14 (21%) | 0.014 |
Testosterone substitution | 25 (26%) | 9 (30%) | 16 (24%) | 0.616 |
Anti-hypertension medication | 12 (12%) | 5 (17%) | 7 (10%) | 0.504 |
Current smoker | 20 (20%) | 6 (20%) | 14 (21%) | 1 |
Hazardous drinking 3 | 2 (2%) | 2 (7%) | 0 | 0.092 |
Laboratory assessments | ||||
Height (cm) | 171.6 ± 9.8 | 166.5 ± 8.6 | 174.1 ± 9.6 | <0.001 |
143.2–199.0 | 143.2–180.2 | 150.0–199.0 | ||
Testicular volume (ml) 4 | 13.4 ± 7.6 | 10.6 ± 7.0 | 14.7 ± 7.6 | 0.015 |
2.0–27.0 | 2.0–25.0 | 2.0–27.0 | ||
Triglycerides (mmol/L) | 1.9 ± 1.7 | 2.0 ± 1.2 | 1.8 ± 1.9 | 0.07 |
0.4–12.4 | 0.7–5.2 | 0.4–12.4 | ||
Resting heart rate (beats/min) | 73.7 ± 14.3 | 78.9 ± 13.7 | 70.3 ± 13.6 | 0.028 |
45.0–122.3 | 56.0–122.3 | 45.0–110.0 | ||
Diastolic blood pressure (mmHg) | 74.5 ± 11.7 | 75.5 ± 13.3 | 74.1 ± 11.5 | 0.68 |
45.3–125.0 | 52.7–105.0 | 45.3–125.0 | ||
Systolic blood pressure (mmHg) | 127.2 ± 13.3 | 127.0 ± 14.0 | 127.9 ± 13.3 | 0.601 |
102.0–174.0 | 106.0–158.0 | 102.0–174.0 | ||
High-density lipoprotein (mmol/L) | 1.2 ± 0.3 | 1.1 ± 0.3 | 1.2 ± 0.3 | 0.2 |
0.5–2.2 | 0.6–1.9 | 0.5–2.2 | ||
Glycosylated hemoglobin A1c (%) | 6.2 ± 1.4 | 5.9 ± 0.8 | 6.3 ± 1.6 | 0.621 |
4.6–13.6 | 4.6–8.4 | 4.7–13.6 | ||
Lean mass (kg) | 48.1 ± 10.6 | 40.4 ± 7.8 | 51.3 ± 10.2 | <0.001 |
19.7–82.6 | 20.0–54.9 | 31.1–82.6 | ||
Fat mass (%) | 28.3 ± 7.9 | 32.2 ± 7.8 | 26.5 ± 7.4 | <0.001 |
7.7–45.5 | 7.7–45.5 | 10.5–44.6 |
Disease and Treatment Characteristics, n (%) | All HSCT |
---|---|
Survivors, n = 98 | |
Diagnoses | |
Malignancies | 74 (75.5) |
Acute lymphoblastic leukemia | 45 (45.9) |
Acute myeloid leukemia | 9 (9.2) |
Other malignant disease | 20 (20.4) |
Benign diseases | 24 (24.5) |
Severe aplastic anemia | 13 (13.3) |
Immune deficiency syndromes | 6 (6.1) |
Histiocytic disorders | 2 (2.0) |
Inherited abnormalities of erythrocyte function | 3 (3.1) |
High dose treatment with allogeneic HSCT | |
Donor | |
Sibling | 47 (48.0) |
Related | 8 (8.2) |
Unrelated donor | 43 (43.9) |
Stem cell source | |
Bone marrow | 91 (92.9) |
Peripheral blood | 4 (4.1) |
Umbilical cord blood | 3 (3.1) |
Conditioning regimens | |
TBI based conditioning | 72 (73) |
TBI + Cyclophosphamide | 47 (48) |
TBI + ARAC: Sytarabine | 15 (15) |
TBI + Other | 10 (10) |
Non-TBI based conditioning | 26 (27) |
Busulfan + Cyclophosphamide | 11 (11) |
Cyclophosphamide | 8 (8) |
Other | 7 (7) |
Acute graft-versus-host disease | 69 (70.4) |
Grade I | 21 (21.4) |
Grade II | 29 (29.6) |
Grade III | 16 (16.3) |
Grade IV | 3 (3.1) |
Late effects | |
Previous growth hormone therapy | 26 (26.5) |
Therapy for diabetes mellitus | 8 (1) |
Raw Score | Z-Score 1 | ||||
---|---|---|---|---|---|
Test (Unit) | Median | Range | Median | Range | p2 |
Physical Fitness | |||||
Dominant hand grip-strength (kg) | 48 | 20–83 | −0.7 | −4.3–3.9 | <0.001 |
Timed up-and-go (s) | 7.6 | 4.3–14.2 | 0.7 | −4.5–6.1 | <0.001 |
Sit-to-stand (repetitions) | 33 | 10–78 | −1.5 | −3.5–2.5 | <0.001 |
Gait Speed (m/s) | 0.8 | 0.4–1.5 | 0.11 | −2.7–5.8 | 0.549 |
Two-minute walk test (m) | 217.3 | 98.9–288.8 | 0.5 | −3.4–2.9 | <0.001 |
Physical activity | |||||
MET-minutes 3 | 2620.0 | 0–51,240.0 | - | - | - |
MET-minutes < 600 min, n (%) | 12 (12.2%) | - | - | - |
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Suominen, A.; Haavisto, A.; Mathiesen, S.; Mejdahl Nielsen, M.; Lähteenmäki, P.M.; Sørensen, K.; Ifversen, M.; Mølgaard, C.; Juul, A.; Müller, K.; et al. Physical Fitness and Frailty in Males after Allogeneic Hematopoietic Stem Cell Transplantation in Childhood: A Long-Term Follow-Up Study. Cancers 2022, 14, 3310. https://doi.org/10.3390/cancers14143310
Suominen A, Haavisto A, Mathiesen S, Mejdahl Nielsen M, Lähteenmäki PM, Sørensen K, Ifversen M, Mølgaard C, Juul A, Müller K, et al. Physical Fitness and Frailty in Males after Allogeneic Hematopoietic Stem Cell Transplantation in Childhood: A Long-Term Follow-Up Study. Cancers. 2022; 14(14):3310. https://doi.org/10.3390/cancers14143310
Chicago/Turabian StyleSuominen, Anu, Anu Haavisto, Sidsel Mathiesen, Malene Mejdahl Nielsen, Päivi M. Lähteenmäki, Kaspar Sørensen, Marianne Ifversen, Christian Mølgaard, Anders Juul, Klaus Müller, and et al. 2022. "Physical Fitness and Frailty in Males after Allogeneic Hematopoietic Stem Cell Transplantation in Childhood: A Long-Term Follow-Up Study" Cancers 14, no. 14: 3310. https://doi.org/10.3390/cancers14143310