Exercise and nutrition in hematologic malignancies: translational evidence and emerging interventions

Patients with hematologic malignancies, including leukemia, lymphoma, and multiple myeloma, are living longer because of advances in treatment. Nonetheless, these treatments often lead to toxicities, affecting patients' quality of life (QoL). Although lifestyle interventions, such as exercise and nutrition, have shown benefits by reducing cancer risk and improving outcomes in solid tumors, their application in hematologic malignancies remains underexplored. This narrative review examines the current evidence on the role of exercise and nutrition across the hematologic malignancy continuum, highlighting potential benefits and research gaps. Epidemiological studies suggest that physical activity and plant-based diets reduce the risk of developing hematologic malignancies, but interventional studies are lacking. During treatment, exercise interventions, which have been most extensively studied in the hematopoietic stem cell transplantation setting, are associated with improvements in physical function, fatigue, and QoL, whereas evidence for structured nutritional interventions is less robust and has largely focused on optimizing nutritional status and reducing treatment-related complications. Emerging translational and preclinical studies, including rodent and microfluidic models, provide mechanistic insights into how exercise and diet may influence disease progression through immune regulation, systemic inflammation, and modulation of the gut microbiome. Collectively, the heterogeneity in study design, populations, and outcome measures limits definitive conclusions. Well-designed, disease-specific randomized trials are needed to define safe and effective exercise and nutritional strategies across the hematologic malignancy continuum. Integrating lifestyle-based supportive care approaches has the potential to improve functional outcomes and long-term survivorship among patients with hematologic malignancies.