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Scientific Comments
Rev Bras Hematol Hemoter. 2012;34(5):323-33
Importance of functional evaluation after hematopoietic cell transplantation
Substantial advances in hematopoietic stem cell transplantation (HSCT) have been
accomplished in the last three decades
(1)
. For example, reductions in early mortality by 60%
and in overall mortality by 41% have been achieved in patients transplanted in Seattle after
the introduction of high intensity conditioning between 2003 and 2007 compared to the 1993
to 1997 period
(2)
. According to the Center for International Blood and Marrow Transplant
Research (CIBMTR), several thousands of long-termHSCT recipients are surviving worldwide
from diseases considered fatal before transplantation. Nonetheless, HSCT can result in several
complications resulting in impaired quality of life (QoL). Determinants of overall benefits
of HSCT therefore are not limited to the eradication of the original disease and improved
survival, but also to impairment of QoL with an impact on functional performance. As a
matter of fact, several studies of QoL that evaluated mental and physical function, domestic
and vocational role function and family and social interaction have reported impairments in
functional performance in both autologous and allogeneic HSCT recipients
(3-5)
.
In this issue of the
Revista Brasileira de Hematologia e Hemoterapia
, Souza et al. describe
the evaluation of functional performance before and after myeloablative conditioning HSCT in
patients transplanted in one center in Brazil
(6)
. Evaluation of functional performance included
gait performance, grip strength, spine mobility and function role in daily activities using the
Human Activity Profile (HAP) questionnaire. A significant decline in functional performance
was found in both autologous and allogeneic HSCT recipients, including in the two-minute
walk test (gait performance), grip strength of both hands, spine mobility (Schober test) and
daily activities using the maximum and adapted activity score of the HAP. These findings are
consistent with studies of North American HSCT populations
(3-5)
. To the best of my knowledge,
this is the first prospective study evaluating functional performance in a Brazilian HSCT
population. Decline in functional performance depends on several factors including the presence
of chronic graft-versus-host disease
(5)
, but the decline in functional performance can improve 5
years after HSCT
(3,4)
. Findings of the current study need to be considered as preliminary because
of the small population studied and the relative short follow up. A larger population and longer
follow up are needed to confirm the current study findings, and to determine if the decline in
functional capacity will improve or result in further performance limitations over time.
The study of Souza et al. demonstrates the feasibility of conducting a prospective study of
functional performance in recipients of HSCT in Brazil
(6)
. Moreover, it creates an opportunity
to conduct larger studies to evaluate risk factors for poor functional performance in transplant
recipients in Brazil and to design future intervention studies aimed at improving functional
capacity and performance after HSCT.
References
1. Horowitz MM. Uses and growth of hematopoietic cell transplantation. In: Thomas ED, Blume KG, Forman
SJ, eds. Hematopoietic Cell Transplantation. 2
nd
ed. Malden, Mass: Blackwell Science; 1999:12-18.
2. Gooley TA, Chien JW, Pergam SA, Hingorani S, Sorror ML, Boeckh M, et al. Reduced mortality after
allogeneic hematopoietic cell transplantation. N Engl J Med
.
2010;363(22):2091-101. Comment in: N Engl
J Med. 2010;363(22):2158-9.
3. Syrjala KL, Langer SL, Abrams JR, Storer B, Sanders JE, Flowers ME
,
et al. Recovery and long-term function
after hematopoietic cell transplantation for leukemia or lymphoma. JAMA. 2004;291(19):2335–43.
4. Syrjala KL, Langer SL, Abrams JR, Storer BE, Martin PJ. Late effects of hematopoietic cell transplantation
among 10-year adult survivors compared with case-matched controls. J Clin Oncol 2005;23(27):6596–606.
5. Mitchell SA, Leidy NK, Mooney KH, Dudley WN, Beck SL, LaStayo PC, et al. Determinants of functional
performance in longterm survivors of allogeneic hematopoietic stem cell transplantation with chronic graft
-
versus
-
host disease (cGVHD). Bone Marrow Transplant
.
2010; 45(4):762
-
9.
6. Souza CV, Miranda EC, Garcia Jr C, Aranha FJ, Souza CA, Vigorito AC
.
Functional evaluation indicates
physical losses after hematopoietic stem cell transplantation. Rev Bras Hematol Hemoter. 2012;34(5): 345-51
Mary Evelyn Dantas Flowers
Fred Hutchinson Cancer Research Center
and the University of Washington, Seattle,
WA, USA
Conflict-of-interest disclosure:
The author declares no competing financial
interest
Submitted: 9/23/2012
Accepted: 9/27/2012
Corresponding author:
Mary Evelyn Dantas Flowers
Fred Hutchinson Cancer Research Center D5-
290, P.O. Box 19024
98109-1024 Seattle, WA
Phone: 206-667-5191
mflowers@fhcrc.org
www.rbhh.org or www.scielo.br/rbhh
DOI: 10.5581/1516-8484.20120084
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