Pre-transplant physical function and sarcopenia assessment in allogeneic stem cell transplant recipients: A cross-sectional analysis from a multidisciplinary program

Abstract

Abstract Introduction Advances in allogeneic stem cell transplantation (alloSCT) have improved survival, yet long-term complications compromise post-transplant outcomes and quality of life. Physical Medicine and Rehabilitation (PM&R) may help preserve strength, prevent sarcopenia and frailty, and improve quality of life, emotional well-being, and potentially survival. Integrating pre-transplant assessment of in-depth physical fitness may aid in better candidate selection and positively influence outcomes. Despite growing interest in functional assessment, data describing the physical status of patients prior to alloSCT are scarce, without established ranges for PM&R scales in this population. A clearer understanding of baseline function may inform risk stratification, optimize selection, and guide supportive care.Objectives To provide a cross-sectional description of PM&R parameters prior to alloSCT in a cohort of recipients at a European transplant center and to broaden understanding of the physical condition in these patients.Materials and Methods We conducted a retrospective, single-center analysis of the pre-alloSCT physical condition within a multidisciplinary interventional project optimizing PM&R support peri-alloSCT (the RehabiliTPH study). One month prior to alloSCT, patients underwent joint assessment by hematology and PM&R using seven validated scales:De Morton Mobility Index (DEMMI): mobility, transfers, static and dynamic balance, walking, and coordination. Raw score: 0-100, higher scores equal better mobility.EuroQol 5-Dimensions (EQ-5D): health-related quality of life. Range: 1-3, higher scores reflect better quality of life.Short Physical Performance Battery (SPPB): evaluates balance (side-by-side, semi-tandem, tandem), 4-meter gait speed and chair. Total score 0-12; scores <10 indicate limited mobility.Visual Analog Scale for Pain (VAS): score: 0-10.Checklist Individual Strength – Fatigue Subscale (CIS): fatigue severity. Nine items, scored on a 7-point Likert scale. Score range: 9–63; scores ≥ 35 indicate severe fatigue.SARC-F sarcopenia score: Range: 0-10; scores ≥ 4 suggest sarcopenia. Direct physical variables included body-mass index (BMI), handgrip strength of dominant arm via dynamometry and linear ultrasound of the rectus femoris muscle (cross-sectional thickness during relaxation and contraction and area during relaxation).Results A total of 80 patients were included, 32 female (40%), with a median age of 62 years (IQR: 50, 67). Median follow-up was 231 days (IQR: 84-406). The most frequent diagnoses were acute myeloid leukemia (41%) and myelodysplastic syndrome (24%). 67% underwent reduced intensity and 33% myeloablative conditioning. 41% percent underwent haploidentical transplants. Median hospital stay was 32 days (IQR: 27-39). 29% patients required ICU during alloSCT admission, and 16 (21%) died during follow-up. Median BMI and weight were within normal values, 25 kg/m2 (IQR: 23-29) and 73 kg (62-83), respectively. In terms of pre-alloSCT functional assessment, patients showed: optimal mobility with a DEMMI score of 100 (IQR: 85-100), preserved QoL overall: EQ-5D 1 (IQR: 1-1), lower-limb performance was preserved, with an overall SPPB score of 12 (IQR: 11-12). Pain was absent, with a VAS of 0 points (IQR: 0-0). We found mild levels of fatigue: CIS 26 (IQR: 18-42), however with 31.8% of patients over 35 points, indicating severe fatigue. Regarding sarcopenia, SARC-F score indicated a normal value of 0 points (IQR: 0-1), and unaltered findings in the ultrasound exam: a cross-sectional thickness of the rectus femoris muscle of 1,18 cm during relaxation (IQR: 1.0-1.5) and 1.62 cm (IQR: 1.3-1.8) during contraction, and an overall area of 3.79 cm2 (IQR: 2.97-5.2). Dynamometry showed a median value of 28 kg (IQR: 20, 33), within the normal range in both men and women.Conclusions Our study provides a snapshot of key PM&R parameters in a pre-alloSCT cohort. Overall, patients demonstrated preserved physical performance and mobility. Fatigue varied from mild to moderate, with a significant proportion of patients scoring for severe fatigue. BMI and weight were within normal limits and no sarcopenia was identified. Fatigue evaluation and ultrasound tests may show potential for pre-transplant stratification. Longitudinal analysis is ongoing to correlate baseline PM&R parameters and alloSCT outcomes as well as the evolution of PM&R parameters throughout alloSCT.