Cardiopulmonary exercise testing prior to myeloablative allo-SCT: a feasibility study

Area of Science:

• Hematology
• Pulmonology
• Cardiology
• Exercise Physiology

Background:

• Allogeneic stem cell transplant (allo-SCT) is a high-risk procedure.
• Pre-transplant assessment of cardiopulmonary reserve is crucial for patient management.
• Current risk stratification methods may not fully capture cardiopulmonary risks.

Purpose of the Study:

• To evaluate the safety and feasibility of symptom-limited cardiopulmonary exercise testing (CPET) before allo-SCT.
• To determine the prognostic value of CPET-derived measures for outcomes after allo-SCT.

Main Methods:

• Prospective study of 21 patients with hematologic malignancies undergoing allo-SCT.
• Symptom-limited CPET performed pre-transplant, assessing peak oxygen consumption (VO2peak) and ventilatory threshold (VT).
• Adverse events, test completion rates, and CPET metrics were recorded.

Main Results:

• CPET was safe and feasible, with 95% of patients achieving peak test criteria and no serious adverse events.
• Patients exhibited significantly reduced VO2peak compared to healthy controls.
• Lower VO2peak and VT were associated with poorer overall survival (OS), increased pulmonary toxicity, and non-relapse mortality (NRM).

Conclusions:

• CPET is a safe and feasible pre-transplant evaluation for patients undergoing allo-SCT.
• Patients undergoing allo-SCT often present with significant cardiopulmonary function impairment.
• CPET-derived metrics offer valuable prognostic information, potentially enhancing risk stratification beyond conventional assessments.