HEMATOLOJİK MALİGNİTENİN MİYELOİD VEYA LENFOİD KÖKENİ SOLUNUM FONKSİYONU, KAS KUVVETİ, EGZERSİZ KAPASİTESİ VE YAŞAM KALİTESİNİ NASIL ETKİLER?

Abstract

Amaç: Allojeneik hematopoetik kök hücre transplantasyonu (AHKHT) boyunca alıcıların kas kuvveti, egzersiz kapasitesi ve yaşam kalitesi kötüleşmesine rağmen, alıcılarda immunofenotipik özelliklere göre solunum fonksiyonları, kas kuvveti, egzersiz kapasitesi ve yaşam kalitesi üzerine etkiler halen bilinmemektedir. Bu yüzden, bu çalışmada miyeloid ve lenfoid maliniteli alıcılar arasında fiziksel bozuklukların ve yaşam kalitesinin retrospektif olarak araştırılması amaçlandı. Yöntem: Yirmi beş miyeloid (42,76±14,72 yıl) ve 22 lenfoid (37,27±14,13 yıl) hematolojik maliniteli alıcılarının (AHKHT sonrası durumu >100 gün) solunum fonksiyonları (FEV1, FVC, PEF, FEV1/FVC ve FEF%25-75), quadriceps kuvveti ve solunum kas kuvveti, egzersiz kapasitesi (artan hızda mekik yürüme testi, AHMYT) ve yaşam kalitesi retrospektif olarak analiz edildi. Sonuçlar: Yaş, cinsiyet, FEV1, FVC, PEF, quadriseps kas kuvveti, yaşam kalitesi puanları ve AHMYT mesafesi (lenfoid: 637,27±211,10 m, miyeloid: 704,00±211,60 m, fark: 66,73 m) gruplar arasında benzerdi (p>0,05). Miyeloid gruba göre lenfoid grubun FEV1/FVC ve FEF%25-75 değerleri istatistiksel olarak daha yüksekti (p<0,05), ve AHMYT mesafesi yüzdesi (etki büyüklüğü d=0.97, güç (1-b)=0.89), maksimum inspiratuar basınç (lenfoid: 106,64±23,99 cmH2O, miyeloid: 121,88±24,40 cmH2O, fark: 15,24 cmH2O) ve maksimum ekspiratuar basınç (lenfoid: 122,55±38,29 cmH2O, miyeloid: 146,72±33,06 cmH2O, fark: 24,18 cmH2O) ise, anlamlı olarak daha düşüktü (p<0,05). Tartışma: Tüm alıcılar egzersiz kapasitesi, alt ekstremite kas kuvveti ve yaşam kalitesi konusunda benzer zayıflatıcı problemlere sahipti. Ancak, lenfoid tip bozukluğu olan alıcılar daha düşük solunum kas kuvveti ve egzersiz kapasitesine sahiptiler. Küçük havayolu obstrüksiyonuysa, miyeloid tip bozukluğu olan alıcılarda daha yaygın olarak gözlenir. Rehabilitasyon programı içeriklerinin hematolojik malinitenin immunofenotipine tipine göre düzenlenmesi ve ayarlanması yaklaşımı üzerinde durulması gereken bir konudur.

Keywords

• Egzersiz Testi
• Hematolojik Neoplazmlar
• Hematopoietik Kök Hücre Transplantasyonu
• Kas Kuvveti
• Yaşam Kalitesi

HOW DOES MYELOID OR LYMPHOID ORIGIN OF HEMATOLOGIC MALIGNANCY AFFECT PULMONARY FUNCTION, MUSCLE STRENGTH, EXERCISE CAPACITY, AND QUALITY OF LIFE?

Abstract

Purpose: Although recipients’ muscle strength, exercise capacity and quality of life (QOL) may deteriorate during allogeneic hematopoietic stem cell transplantation (AHSCT), impacts on pulmonary function, muscle strength, exercise capacity, and QOL are still unknown in recipients based on immunophenotypes. Therefore, this study aimed to investigate retrospectively physical impairments and QOL between recipients with myeloid and lymphoid malignancies. Methods: Pulmonary function (FEV1, FVC, PEF, FEV1/FVC, and FEF25-75%), quadriceps and respiratory muscle strength, exercise capacity (incremental shuttle walk test, ISWT), and QOL of 25 recipients with myeloid (42.76±14.72 years) and 22 recipients with lymphoid (37.27±14.13 years) hematologic malignancies (>100 days post-AHSCT status) were analyzed retrospectively. Results: Age, gender, FEV1, FVC, PEF, quadriceps strength, QOL scores, and ISWT distance (lymphoid: 637.27±211.1 m, myeloid: 704±211.6 m, difference: 66.73 m) were similar between the groups (p>0.05). Lymphoid group’s FEV1/FVC and FEF25-75% values were statistically higher, and the percentage of ISWT distance (effect size d=0.97, power (1-b)=0.89), maximum inspiratory pressure (lymphoid: 106.64±23.99 cmH2O, myeloid: 121.88±24.4 cmH2O, difference: 15.24 cmH2O) and maximum expiratory pressure (lymphoid: 122.55±38.29 cmH2O, myeloid: 146.72±33.06 cmH2O, difference: 24.18 cmH2O) were significantly lower than the myeloid group (p<0.05). Conclusion: All recipients had common debilitating problems on exercise capacity, lower extremity strength, and QOL. However, recipients with lymphoid type disorder had more reduced respiratory muscle strength and exercise capacity. Small airway obstruction was more commonly observed respiratory dysfunction in recipients with myeloid type disorder. Modifying and adjusting contents of rehabilitation programs according to immunophenotype of hematologic malignancy should be considered in further study.

Keywords

• Exercise test
• Hematopoietic stem cell transplantation
• Muscle strength
• hematological neoplasms
• quality of life

References

1. REFERENCES1. Paul KL. Rehabilitation and exercise considerations in hematologic malignancies. Am J Phys Med Rehabil. 2011;90(5):88-94.
2. 2. Bergenthal N, Will A, Streckmann F, Wolkewitz K-D, Monsef I, Engert A, et al. Aerobic physical exercise for adult patients with haematological malignancies. Cochrane Database Syst Rev. 2014;(11):CD009075.
3. 3. Steinberg A, Asher A, Bailey C, Fu JB. The role of physical rehabilitation in stem cell transplantation patients. Support Care Cancer. 2015;23(8):2447-60.
4. 4. Barğı G, Boşnak Güçlü M, Türköz Sucak AG. Differences in pulmonary and extra-pulmonary characteristics in severely versus non-severely fatigued recipients of allogeneic hematopoietic stem cell transplantation: a cross-sectional, comparative study. Hematology. 2019;24(1):112-22.
5. 5. Kovalszki A, Schumaker G, Klein A, Terrin N, White A. Reduced respiratory and skeletal muscle strength in survivors of sibling or unrelated donor hematopoietic stem cell transplantation. Bone Marrow Transplant. 2008;41(11):965-9.
6. 6. Quanjer PH, Tammeling GJ, Cotes JE, Pedersen OF, Peslin R, Yernault JC. Lung volumes and forced ventilatory flows. Eur Respir J. 1993;6(16):5-40.
7. 7. No authors listed. Lung function testing: selection of reference values and interpretative strategies. American Thoracic Society. Am Rev Respir Dis. 1991;144(5):1202-18.
8. 8. Soubani AO, Miller KB, Hassoun PM. Pulmonary complications of bone marrow transplantation. Chest. 1996;109(4):1066-77.

9. 9. American Thoracic Society/European Respiratory Society. ATS/ERS Statement on respiratory muscle testing. Am J Respir Crit Care Med. 2002;166(4):518-624.
10. 10. Evans JA, Whitelaw WA. The assessment of maximal respiratory mouth pressures in adults. Respir Care. 2009;54(10):1348-59.
11. 11. Kyroussis D, Polkey M, Hughes P, Fleming T, Wood C, Mills G, et al. Abdominal muscle strength measured by gastric pressure during maximal cough. Thorax. 1996;51(3):A45.
12. 12. Gosselink R, De Vos J, Van Den Heuvel S, Segers J, Decramer M, Kwakkel G. Impact of inspiratory muscle training in patients with COPD: what is the evidence? Eur Respir J. 2011;37(2):416-25.
13. 13. Bohannon RW. Reference values for extremity muscle strength obtained by hand-held dynamometry from adults aged 20 to 79 years. Arch Phys Med Rehabil. 1997;78(1):26-32.
14. 14. Knols RH, Aufdemkampe G, De Bruin ED, Uebelhart D, Aaronson NK. Hand-held dynamometry in patients with haematological malignancies: measurement error in the clinical assessment of knee extension strength. BMC Musculoskelet Disord. 2009;10:31.
15. 15. Probst VS, Hernandes NA, Teixeira DC, Felcar JM, Mesquita RB, Gonçalves CG, et al. Reference values for the incremental shuttle walking test. Respir Med. 2012;106(2):243-8.
16. 16. Singh SJ, Jones P, Evans R, Morgan M. Minimum clinically important improvement for the incremental shuttle walking test. Thorax. 2008;63(9):775-7.
17. 17. Armutlu K, Korkmaz NC, Keser I, Sumbuloglu V, Akbiyik DI, Guney Z, et al. The validity and reliability of the Fatigue Severity Scale in Turkish multiple sclerosis patients. Int J Rehabil Res. 2007;30(1):81-5.
18. 18. Krupp LB, LaRocca NG, Muir-Nash J, Steinberg AD. The fatigue severity scale: application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol. 1989;46(10):1121-3.
19. 19. Stone P, Hardy J, Huddart R, A'hern R, Richards M. Fatigue in patients with prostate cancer receiving hormone therapy. Eur J Cancer. 2000;36(9):1134-41.
20. 20. Cankurtaran E, Ozalp E, Soygur H, Ozer S, Akbiyik D, Bottomley A. Understanding the reliability and validity of the EORTC QLQ‐C30 in Turkish cancer patients. Eur J Cancer Care Engl). 2008;17(1):98-104.
21. 21. Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst. 1993;85(5):365-76.
22. 22. Fayers PM, Aaronson NK, Bjordal K, Grønvold M, Curran D, Bottomley A. EORTC QLQ-C30 scoring manual. 2001.
23. 23. Osoba D, Rodrigues G, Myles J, Zee B, Pater J. Interpreting the significance of changes in health-related quality-of-life scores. J Clin Oncol. 1998;16(1):139-44.
24. 24. Faul F, Erdfelder E, Lang A-G, Buchner A. G* Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39(2):175-91.
25. 25. Smith-Turchyn J, Richardson J. A systematic review on the use of exercise interventions for individuals with myeloid leukemia. Support Care Cancer. 2015;23(8):2435-46.
26. 26. White AC, Terrin N, Miller KB, Ryan HF. Impaired respiratory and skeletal muscle strength in patients prior to hematopoietic stem-cell transplantation. Chest. 2005;128(1):145-52.
27. 27. Morishita S, Kaida K, Tanaka T, Itani Y, Ikegame K, Okada M, et al. Prevalence of sarcopenia and relevance of body composition, physiological function, fatigue, and health-related quality of life in patients before allogeneic hematopoietic stem cell transplantation. Support Care Cancer. 2012;20(12):3161-8.
28. 28. Danaher EH, Ferrans C, Verlen E, Ravandi F, van Besien K, Gelms J, et al. Fatigue and physical activity in patients undergoing hematopoietic stem cell transplant. Oncol Nurs Forum. 2006;33(3):614-24.
29. 29. Morishita S, Kaida K, Yamauchi S, Sota K, Ishii S, Ikegame K, et al. Relationship between corticosteroid dose and declines in physical function among allogeneic hematopoietic stem cell transplantation patients. Support Care Cancer. 2013;21(8):2161-9.
30. 30. Ren G, Zhang J, Li M, Yi S, Xie J, Zhang H, et al. Protein blend ingestion before allogeneic stem cell transplantation improves protein-energy malnutrition in patients with leukemia. Nutr Res. 2017;46:68-77.
31. 31. Wakasugi T, Morishita S, Kaida K, Itani Y, Kodama N, Ikegame K, et al. Impaired skeletal muscle oxygenation following allogeneic hematopoietic stem cell transplantation is associated with exercise capacity. Support Care Cancer. 2018;26(7):2149-60.
32. 32. Burmeister DW, Smith EH, Cristel RT, McKay SD, Shi H, Arthur GL, et al. The expression of RUNDC3B is associated with promoter methylation in lymphoid malignancies. Hematol Oncol. 2017;35(1):25-33.
33. 33. Taylor KH, Pena-Hernandez KE, Davis JW, Arthur GL, Duff DJ, Shi H, et al. Large-scale CpG methylation analysis identifies novel candidate genes and reveals methylation hotspots in acute lymphoblastic leukemia. Cancer Res. 2007;67(6):2617-25.
34. 34. Wang MX, Wang H-Y, Zhao X, Srilatha N, Zheng D, Shi H, et al. Molecular detection of B-cell neoplasms by specific DNA methylation biomarkers. Int J Clin Exp Pathol. 2010;3(3):265-79.
35. 35. Raguz S, De Bella MT, Slade MJ, Higgins CF, Coombes RC, Yagüe E. Expression of RPIP9 (Rap2 interacting protein 9) is activated in breast carcinoma and correlates with a poor prognosis. Int J Cancer. 2005;117(6):934-41.