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自体干细胞移植后急性恶病质的评估

Assessing Cachexia Acutely after Autologous Stem Cell Transplant.

作者信息

Anderson Lindsey J, Yin Chelsea, Burciaga Raul, Lee Jonathan, Crabtree Stephanie, Migula Dorota, Geiss-Wessel Kelsey, Liu Haiming M, Graf Solomon A, Chauncey Thomas R, Garcia Jose M

机构信息

Geriatric Research, Education and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, 98108 WA, USA.

Bone Marrow Transplant Unit, Veterans Affairs Puget Sound Health Care System, Seattle, 98108 WA, USA.

出版信息

Cancers (Basel). 2019 Sep 4;11(9):1300. doi: 10.3390/cancers11091300.

Abstract

Autologous hematopoietic stem cell transplantation (AHCT) is an accepted strategy for various hematologic malignancies that can lead to functional impairment, fatigue, muscle wasting, and reduced quality of life (QOL). In cancer cachexia, these symptoms are associated with inflammation, hypermetabolism, and decreased anabolic hormones. The relative significance of these factors soon after AHCT setting is unclear. The purpose of this study was to characterize the acute effects of AHCT on physical function, body composition, QOL, energy expenditure, cytokines, and testosterone. Outcomes were assessed before (PRE) and 30 ± 10 days after (FU) AHCT in patients with multiple myeloma ( = 15) and non-Hodgkin lymphoma ( = 6). Six-minute walk test (6MWT; = 0.014), lean mass ( = 0.002), and fat mass ( = 0.02) decreased; nausea and fatigue increased at FU (both = 0.039). Recent weight change and steroid exposure were predictors of reduced aerobic capacity ( < 0.001). There were no significant changes in interleukin (IL)-1β, IL-6, tumor necrosis factor (TNF), energy expenditure, or bioavailable testosterone. Alterations in cytokines, energy expenditure, and testosterone were not associated with functional impairment acutely following AHCT. Recent history of weight loss and steroid exposure were predictors of worse physical function after AHCT, suggesting that targeting nutritional status and myopathy may be viable strategies to mitigate these effects.

摘要

自体造血干细胞移植(AHCT)是治疗多种血液系统恶性肿瘤的一种公认策略,这些疾病可导致功能障碍、疲劳、肌肉萎缩和生活质量(QOL)下降。在癌症恶病质中,这些症状与炎症、代谢亢进和合成代谢激素减少有关。AHCT后不久这些因素的相对重要性尚不清楚。本研究的目的是描述AHCT对身体功能、身体成分、生活质量、能量消耗、细胞因子和睾酮的急性影响。对15例多发性骨髓瘤患者和6例非霍奇金淋巴瘤患者在AHCT前(PRE)和AHCT后30±10天(FU)进行了结果评估。六分钟步行试验(6MWT;P = 0.014)、去脂体重(P = 0.002)和脂肪量(P = 0.02)下降;FU时恶心和疲劳增加(两者P = 0.039)。近期体重变化和类固醇暴露是有氧运动能力下降的预测因素(P < 0.001)。白细胞介素(IL)-1β、IL-6、肿瘤坏死因子(TNF)、能量消耗或生物可利用睾酮无显著变化。AHCT后短期内细胞因子、能量消耗和睾酮的变化与功能障碍无关。近期体重减轻史和类固醇暴露是AHCT后身体功能较差的预测因素,这表明针对营养状况和肌病可能是减轻这些影响的可行策略。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7059/6769803/2bd5e397e954/cancers-11-01300-g001.jpg

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