Versão HTML básica
347
Functional evaluation indicates physical losses after hematopoietic stem cell transplantation
Rev Bras Hematol Hemoter. 2012;34(5):345-51
Table 2 - Functional outcomes in Phase 1 for allogeneic and autologous hematopoietic stem
cell transplantation (n= 44)
Outcomes
Type of HSCT
p-value*
Allogeneic
(n= 21)
Autologous
(n= 23)
Age (years) - median (range)
45 (25-65)
24 (24-67)
0.22
Gender (male) - n
11 (52)
9 (39)
0.54
Weight (kg) - median (range)
66.4 (35-121)
67.3 (43-113)
0.96
BMI (kg/m
2
) - median (range)
24.9 (15.8-35.9)
24.6 (18.9-44.4)
0.84
Hemoglobin (g/dL) - median (range)
10.1 (7.0-14.8)
11.4 (6.9-15-2)
0.20
2MWT (meters) - median (range)
178 (113-224)
178 (107-224)
0.98
SaO
2
Before 2MWT (%) - median (range)
98 (93-100)
99 (94-100)
0.92
After 2MWT (%) - median (range)
98 (91-100)
97 (91-100)
0.44
Heart rate
Before 2MWT (bpm) - median (range)
87 (63-131)
79 (57-112)
0.18
After 2MWT (bpm) - median (range)
116 (73-152)
102 (69-143)
0.15
Borg score
Before 2MWT, median (range)
0 (0-3)
0 (0-5)
0.66
After 2MWT, median (range)
3 (0-10)
2 (0-8)
0.12
Schober’s test (cm) - median (range)
6 (2-10)
6 (2-9)
0.68
Grip Strength
Right hand (kg) - median (range)
30.3 (14.7-55)
33.3 (19.0-56)
0.61
Left hand (kg) - median (range)
28.0 (14.0-47)
32.0 (16.0-49)
0.62
MAS - median (range)
53 (21-91)
56 (26-84)
0.15
ASS - median (range)
41 (-13-91)
48 (-1-82)
0.31
* p-value from independent-samples test;
HSCT: hematopoietic stem cell transplantation; BMI: body mass index; 2MWT: 2-minute walking test; SaO
2
:
oxygen saturation; bpm: beats per minute; MAS: maximum activity scale; AAS: adapted activity scale.
Thirty-three of 44 (75%) patients performed evaluations in
Phase 1 (before) and Phase 2 (after HSCT). Eleven (25%) patients
did not complete the Phase 2 evaluations as nine died and two
were excluded due to physical and clinical impairment. Figure
1 shows the flowchart of patients’ distribution for phase 1 and
phase 2. The Phase 1 functional evaluation of patients who died
after HSCT and thus did not perform the Phase 2 evaluation, was
not statistically different compared with those who performed
both evaluations.
Figure 1 - Flowchart showing patient distribution before and after HSCT
50 patients
Pre HSCT
44 patients HSCT
6 (12%):
no HSCT
• 3 died
• 2 refused
• 1 excluded
15
(46%) allogenic
18
(54%) autologous
11 (25%):
no evaluation
• 9 died
• 2 excluded
21
(48%) allogenic
23
(52%) autologous
33 patients
Post HSCT
The Phase 1 functional evaluation was compared between
allogeneic and autologous HSCT patients and the functional
status was statistically similar (Table 2).
For the 33 patients who performed both evaluations, 18
patients underwent autologous and 15 underwent allogeneic
HSCT. When the transplant outcomes were analyzed for
patients who performed both Phase 1 and Phase 2 functional
evaluations, the median length of total parenteral nutrition
(TPN), the length of antibiotic therapy, and time to neutrophil
and platelet engraftment were longer in the allogeneic HSCT
group, resulting in a longer hospital stay. The transplant
outcomes are presented in Table 3.
Functional outcomes comparing Phase 1 and Phase 2
evaluations
The median time in days from the Phase 1 evaluation to
HSCT was 26 days (range: 7-188) and from HSCT to Phase 2
evaluation was 41 days (range: 17-187). The expectation was to
evaluate patients until 60 days after HSCT and only three patients
exceeded this timeframe.
Of the patients who performed both evaluations, there were
significantly lower values in Phase 2 for weight and BMI (p-value
< 0.0001), 2MWT (p-value = 0.004), ST (p-value < 0.0001), GS
for both right and left hands (p-value = 0.004 and < 0.0001,
respectively), MAS and AAS (p-value < 0.0001 for both) and
higher values for HR before 2MWT (p-value = 0.01) and SaO
2