Multidisciplinary Prehabilitation to Boost Outcomes in AML, MDS for Stem Cell Transplant

A new study from the Royal Adelaide Hospital in Australia explores the impact of a multidisciplinary prehabilitation program aimed at reducing deconditioning in patients undergoing allogenic hematopoietic stem cell transplantation (allo-HSCT). This treatment, often used for individuals with acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS), frequently comes with significant morbidity and mortality.

The study, published in BMJ Open,¹ seeks to assess the feasibility, safety, and preliminary efficacy of an 8-week single-group prehabilitation program.1 The program, which enrolled patients aged 18 or older with AML or MDS planning to undergo allo-HSCT, includes a range of interventions such as exercise, nutritional guidance, psychological support, and therapy from a multidisciplinary team of physiotherapists, dietitians, social workers, and occupational therapists. The trial, with a targeted sample size of 20 participants, is running from June 2023 to July 2024.

Although allo-HSCT is potentially curative, deconditioning is a common adverse effect, marked by significant declines in muscle strength, endurance, and overall physical functioning. These declines often lead to extended hospital stays, increased health care costs, and reduced quality of life. The study investigators hope this comprehensive approach, designed to optimize patients' physical function and psychological and psychosocial well-being, will help counteract these negative effects. Adherence, retention, and safety were key metrics, while secondary outcome measures were strength, fall risk, nutritional status, and quality-of-life measures.

"The clinical significance of implementing an intensive prehabilitation intervention in this context lies in its potential to enhance the overall well-being and functional capacity of patients preparing for allo-HSCT," the authors write.

Deconditioning is a common adverse effect of allo-HSCT, although the transplant is potentially curative, marked by significant declines in muscle strength, endurance, and overall physical functioning. | Image Credit: © marikova-stock.adobe.com

The prehabilitation intervention evaluated in this trial includes exercise, nutritional guidance, psychosocial support, and education. Patients participating in the study undergo 2 supervised exercise sessions each week for 8 weeks, focused on resistance and aerobic activities. The regimen is designed to follow international cancer exercise guidelines but is flexible enough to be tailored to each patient's abilities.

In addition to the physical exercise regimen, patients receive face-to-face consultations with dietitians to assess their nutritional status and address any treatment-related adverse effects that might affect their oral intake. Participants receive personalized nutritional advice, including high-protein diets designed to help them minimize weight loss.

The psychosocial aspect of the program includes meeting with social workers and psychologists for education and support. Social workers provide practical support, including guidance on issues such as wills, powers of attorney, advance care directives, and financial support. Between weeks 6 and 8, a single psychoeducation session of 60 to 90 minutes focuses on preparing patients mentally and emotionally for the challenges of stem cell transplantation, covering topics such as mood management, anxiety reduction, and coping skills.

Although previous studies have explored the benefits of exercise interventions during chemotherapy for patients who have AML or MDS, they have largely been limited to exercise-only approaches.^2-4 This trial is among the first to explore a more comprehensive, multidisciplinary prehabilitation strategy before allo-HSCT. "Our research project aims to extend these findings by assessing the impact of multidisciplinary prehabilitation strategies on AML and MDS patients prior to allo-HSCT," the researchers add.

The study is expected to measure not only the physical benefits but also the psychosocial impacts of prehabilitation, evaluating patients' quality of life, anxiety, depression, and ability to cope with the stresses of cancer treatment. "The findings of this study have the potential to contribute significantly to the evolving field of prehabilitation and shape the future care for allo-HSCT patients and potentially other cancer patient populations at RAH," suggest the researchers.

References

1. Naumann K, Singh B, Bushaway S, et al. Investigating the impact of multidisciplinary prehabilitation on deconditioning in patients eligible for haematopoietic allogenic stem cell transplantation: protocol for a feasibility trial. BMJ Open. 2024;14(9):e084372. doi:10.1136/bmjopen-2024-084372

2. Alibhai SMH, Durbano S, Breunis H, et al. A phase II exercise randomized controlled trial for patients with acute myeloid leukemia undergoing induction chemotherapy. Leuk Res. 2015;39(11):1178-1186. doi:10.1016/j.leukres.2015.08.012

3. Schuler MK, Hentschel L, Göbel J, et al. Effects of a home-based exercise program on physical capacity and fatigue in patients with low to intermediate risk myelodysplastic syndrome—a pilot study. Leuk Res. 2016;47:128-135. doi:10.1016/j.leukres.2016.05.022

4. Santa Mina D, Dolan LB, Lipton JH, et al. Exercise before, during, and after hospitalization for allogeneic hematological stem cell transplant: A feasibility randomized controlled trial. J Clin Med. 2020;9(6):1854. doi:10.3390/jcm9061854