Morales Javier S, González Vicent Marta, Valenzuela Pedro L, Castillo-García Adrián, Santana-Sosa Elena, Lassaletta Alvaro, Santos-Lozano Alejandro, Fiuza-Luces Carmen, Lucia Alejandro
Faculty of Sport Sciences, Universidad Europea de Madrid, 28041 Madrid, Spain.
Pediatric Hematology and Oncology Department, Hospital Infantil Universitario Niño Jesús, 28041 Madrid, Spain.
Cancers (Basel). 2020 Oct 17;12(10):3020. doi: 10.3390/cancers12103020.
We assessed the clinical effects of a supervised exercise (aerobic + resistance) intervention performed during inpatient hospitalization for pediatric hematopoietic stem cell transplantation (HSCT). Patients were placed in an exercise ( = 65 (47 and 18 with allogeneic (allo-) and autologous (auto-) HSCT, respectively)) or a control ( = 53 (39 and 14)) group. Exercise interventions were performed in isolated hospital patient rooms. Patients were followed-up from the beginning of the conditioning phase up to 6 years. We assessed survival, risk of graft-versus-host disease (GvHD) or graft failure (primary outcomes), and engraftment kinetics, supportive care, toxicity profile, and immune reconstitution for auto-HSCT and allo-HSCT. The exercise intervention was safe and did not affect the risk of mortality, acute/chronic GvHD, or graft failure (all > 0.05). No between-group differences ( > 0.05) were found for the remainder of clinical endpoints, except for a reduced number of total and viral infections in the exercise group after allo-HSCT (unadjusted = 0.005 for both total and viral infections, and adjusted = 0.023 and 0.083, respectively). In conclusion, exercise performed during inpatient hospitalization for pediatric HSCT is safe and well tolerated during both auto and allo-HSCT and tends to decrease the risk of infection after allo-HSCT. These findings provide additional support to the notion that a multidisciplinary approach (i.e., including the work of exercise specialists) is suitable in the management of children undergoing HSCT. Further studies are needed to determine whether applying a different training stimulus (notably, higher exercise intensities) exerts positive effects on HSCT prognosis in these patients.
我们评估了在小儿造血干细胞移植（HSCT）住院期间进行的有监督的运动干预（有氧运动+抗阻运动）的临床效果。将患者分为运动组（n = 65，其中异基因（allo-）和自体（auto-）HSCT分别为47例和18例）或对照组（n = 53，其中39例和14例）。运动干预在医院隔离病房进行。对患者从预处理阶段开始随访至6年。我们评估了生存情况、移植物抗宿主病（GvHD）或移植物失败的风险（主要结局），以及自体HSCT和异基因HSCT的植入动力学、支持治疗、毒性特征和免疫重建情况。运动干预是安全的，且不影响死亡率、急性/慢性GvHD或移植物失败的风险（所有P>0.05）。除异基因HSCT后运动组的总感染和病毒感染数量减少外（总感染和病毒感染的未调整P均为0.005，调整后P分别为0.023和0.083），其余临床终点在组间未发现差异（P>0.05）。总之，小儿HSCT住院期间进行的运动在自体和异基因HSCT过程中都是安全且耐受性良好的，并且倾向于降低异基因HSCT后的感染风险。这些发现为多学科方法（即包括运动专家的工作）适用于管理接受HSCT的儿童这一观点提供了额外支持。需要进一步研究以确定应用不同的训练刺激（特别是更高的运动强度）是否对这些患者的HSCT预后产生积极影响。
