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Updated: Dec 5, 2025
Competitive Transplants to Evaluate Hematopoietic Stem Cell Fitness
Published on: August 31, 2016
Tailored Exercise during Hematopoietic Stem Cell Transplantation Hospitalization in Children with Cancer: A
Javier S Morales1, Marta González Vicent2, Pedro L Valenzuela3
1Faculty of Sport Sciences, Universidad Europea de Madrid, 28041 Madrid, Spain.
Insights
Supervised exercise during pediatric stem cell transplant is safe and well-tolerated. While not impacting survival or transplant outcomes, it may reduce infection risk in allogeneic transplant patients.
Area of Science:
- Pediatric Hematology/Oncology
- Transplantation Medicine
- Rehabilitation and Exercise Science
Background:
- Hematopoietic stem cell transplantation (HSCT) is a critical treatment for pediatric cancers and other diseases.
- Inpatient hospitalization during HSCT requires intensive supportive care and can lead to significant physical deconditioning.
- The role of exercise interventions during pediatric HSCT remains an area requiring further investigation.
Purpose of the Study:
- To evaluate the clinical effects and safety of a supervised exercise program during inpatient pediatric HSCT.
- To assess the impact of exercise on survival, graft-versus-host disease (GvHD), graft failure, and other clinical endpoints.
- To explore potential benefits on infection rates and immune reconstitution following HSCT.
Main Methods:
- A prospective study involving pediatric patients undergoing autologous (auto-) or allogeneic (allo-) HSCT.
- Patients were randomized into either a supervised exercise group (aerobic + resistance) or a control group.
- Exercise was conducted in isolated hospital rooms; outcomes were assessed from conditioning through up to 6 years post-transplant.
Main Results:
- The exercise intervention was found to be safe and well-tolerated in both auto- and allo-HSCT patients.
- No significant differences were observed between exercise and control groups for mortality, GvHD, or graft failure (p > 0.05).
- A statistically significant reduction in total and viral infections was noted in the exercise group post-allo-HSCT (adjusted p = 0.023 for total infections).
Conclusions:
- Supervised exercise during pediatric HSCT is a safe and feasible intervention.
- Exercise does not negatively impact primary HSCT outcomes like survival or GvHD.
- The intervention shows a trend towards decreasing infection risk, particularly viral infections, after allogeneic HSCT, supporting a multidisciplinary approach.
Abstract:
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 (n = 65 (47 and 18 with allogeneic (allo-) and autologous (auto-) HSCT, respectively)) or a control (n = 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 p > 0.05). No between-group differences (p > 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 p = 0.005 for both total and viral infections, and adjusted p = 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.
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