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Pulmonary Physiology |

Pulmonary Rehabilitation (PR) Improves Exercise Tolerance and Quality of Life Among Allogeneic Hematopoietic Stem Cell Transplant (HSCT) Recipients With Late-Onset Noninfectious Pulmonary Complications (LONIPCs)

Vickie Shannon*, MD
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University of Texas at MD Anderson Cancer Center, Houston, TX


Chest. 2012;142(4_MeetingAbstracts):791A. doi:10.1378/chest.1390103
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Abstract

SESSION TYPE: Physiology/PFTs/ Rehabilitation II

PRESENTED ON: Monday, October 22, 2012 at 11:15 AM - 12:30 PM

PURPOSE: The study aim is to examine the impact of a 12-week, outpatient, multidisciplinary PR program on cardiopulmonary and quality of life (QOL) endponts among symptomatic patients with LONIPCs following allogeneic HSCT.

METHODS: Patients with LONIPCs following allogeneic HSCT who were referred to the outpatient PR clinic for management of chronic shortness of breath and fatigue were retrospectively identified from an institutional database. Those patients who completed the PR program between September 2006 and December 2010 were included in the study. Assessments of exercise performance, pulmonary function, dyspnea and fatigue were performed at baseline and used to develop the individualized, 12-week PR program. PR program strategies included thrice weekly high intensity (60 to 80% of maximal work rate) muscle strength training and aerobic exercises along with weekly educational sessions. Repeat assessments were performed immediately following PR completion, and at 3 and 12 months post PR.

RESULTS: Among the 251 HSCT recipients with LONIPCs following HSCT that were referred to PR, 173 (69%) completed the 12 week program and were included in the study. LONIPCs were diagnosed based on strict pathologic, radiologic and clinical criteria, and included bronchiolitis obliterans syncrome (91%), bronchiolitis obliterans with organizing pneumonia (5%), and idiopathic pneumonia (3%). The mean age was 38 years. Two patients reported pretransplant tobacco use, however no history of chronic lung disease prior to transplantation was recorded. All patients showed significant improvements in maximal exercise tolerance, as evidenced by a mean 97-meter improvement in 6MWD (P <0.005) and a mean 0.34 L/min increase in maximal oxygen uptake (P < 0.001) immediately following PR. Symptoms scores for perceived breathlessness and fatigue fell on average by a 4.9 and 3.7, respectively, following program completion (P < 0.001). Improvements tended to diminish at 3 and 12 months follow-up, but remained significantly better than pre-PR values.

CONCLUSIONS: Pulmonary rehabilitation improves exercise tolerance and subjective symtoms of dyspnea and fatigue among HSCT recipients with LONIPCs.

CLINICAL IMPLICATIONS: Exercise intolerance, dyspnea and fatigue are debilitating symptoms that profoundly impact quality of life among patients with LONIPCs following HSCT. Therapeutic options are limited. PR may represent an important adjunctive treatment strategy among this group of patients.

DISCLOSURE: The following authors have nothing to disclose: Vickie Shannon

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University of Texas at MD Anderson Cancer Center, Houston, TX

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