Despite the potential clinical implications, no previous study has addressed the role of respiratory muscle strength in pre-BMT evaluation. White et al should be congratulated for initiating the work on respiratory muscle strength and expanding the available literature on exercise capacity. Muscle weakness and decreased exercise capacity could be related to the underlying disease, nutritional status, metabolic abnormalities, critical illness, anemia, chemotherapy, corticosteroid use, radiation therapy, and GVHD.24–29 Respiratory and skeletal muscle weakness has the potential to lead to ventilatory insufficiency following transplant and to increase the associated morbidity and mortality. Identification of modifiable risk factors that predispose BMT recipients to muscle weakness has clinical importance. However, White et al were not able to identify such risk factors, probably due to the small size of the study. For the same reason, their study did not have adequate power to assess the impact of muscle weakness on survival. White et al used the “burden of chemotherapy,” defined as the number of drugs multiplied by the number of cycles administered, to quantify the amount of chemotherapy patients received. This is an attractive concept, especially for a study with small sample size. However, lumping together all chemotherapeutic agents with qualitatively different effects on muscle strength can obscure the results and lead to wrong conclusions.