Geriatric Research, Education and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, United States of America.
University of Washington Department of Medicine, Division of Gerontology and Geriatric Medicine, Seattle, Washington, United States of America.
PLoS One. 2024 May 10;19(5):e0302970. doi: 10.1371/journal.pone.0302970. eCollection 2024.
Hematopoietic stem cell transplantation is a common life-saving treatment for hematologic malignancies, though can lead to long-term functional impairment, fatigue, muscle atrophy, with decreased quality of life. Although traditional exercise has helped reduce these effects, it is inconsistently recommended and infrequently maintained, and most patients remain sedentary during and after treatment. There is need for alternative rehabilitation strategies, like neuromuscular electrical stimulation, that may be more amenable to the capabilities of hematopoietic stem cell transplant recipients. Patients receiving autologous HCT are being enroled in a randomized controlled trial with 1:1 (neuromuscular electrical stimulation:sham) design stratified by diagnosis and sex. Physical function, body composition, quality of life, and fatigue are assessed prior to hematopoietic stem cell transplant (prior to initiating preparatory treatment) and 24±5 days post hematopoietic stem cell transplant (Follow-up 1); physical function and quality of life are also assessed 6-months post hematopoietic stem cell transplant (Follow-up 2). The primary outcome is between-group difference in the 6-minute walk test change scores (Follow-up 1-Pre-transplant; final enrolment goal N = 23/group). We hypothesize that 1) neuromuscular electrical stimulation will attenuate hematopoietic stem cell transplant-induced adverse effects on physical function, muscle mass, quality of life, and fatigue compared to sham at Follow-up 1, and 2) Pre-transplant physical function will significantly predict fatigue and quality of life at Follow-up 2. We will also describe feasibility and acceptability of neuromuscular electrical stimulation during hematopoietic stem cell transplant. This proposal will improve rehabilitative patient care and quality of life by determining efficacy and feasibility of a currently underutilized therapeutic strategy aimed at maintaining daily function and reducing the impact of a potent and widely used cancer treatment. This trial is registered with clinicaltrials.gov (NCT04364256).
造血干细胞移植是治疗血液系统恶性肿瘤的常用救命疗法，但可导致长期的功能损害、疲劳、肌肉萎缩，生活质量下降。尽管传统运动有助于减轻这些影响，但它的推荐并不一致，也很少被维持，而且大多数患者在治疗期间和治疗后仍然久坐不动。需要替代康复策略，如神经肌肉电刺激，这可能更适合造血干细胞移植受者的能力。正在接受自体造血干细胞移植的患者正在参加一项随机对照试验，采用 1:1（神经肌肉电刺激：假）设计，按诊断和性别分层。在造血干细胞移植前（开始准备治疗前）和造血干细胞移植后 24±5 天（随访 1）评估身体功能、身体成分、生活质量和疲劳；在造血干细胞移植后 6 个月（随访 2）评估身体功能和生活质量。主要结局是 6 分钟步行试验变化评分的组间差异（随访 1-移植前；最终入组目标 N=23/组）。我们假设 1）与假刺激相比，神经肌肉电刺激将在随访 1 时减轻造血干细胞移植引起的身体功能、肌肉质量、生活质量和疲劳的不良影响，以及 2）移植前的身体功能将显著预测随访 2 时的疲劳和生活质量。我们还将描述造血干细胞移植期间神经肌肉电刺激的可行性和可接受性。通过确定目前未充分利用的治疗策略的疗效和可行性，该研究旨在维持日常功能并减少强大且广泛使用的癌症治疗的影响，从而改善康复患者的护理和生活质量。该试验已在 clinicaltrials.gov（NCT04364256）注册。
