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

Öz

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.

Anahtar Kelimeler

• 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

Kaynakça

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