SEATTLE — Autologous hematopoietic stem cell transplantation (AHCT) is an accepted strategy for various hematologic malignancies but can lead to functional impairment, fatigue, muscle wasting, and reduced quality of life, according to a new study.

A report in the journal Cancers (Basel) pointed out that, in cancer cachexia, the symptoms are associated with inflammation, hypermetabolism, and decreased anabolic hormones.1

VA Puget Sound Health Care System and University of Washington researchers noted, “The relative significance of these factors soon after AHCT setting is unclear.” In response, they conducted a study to characterize the acute effects of AHCT on physical function, body composition, QOL, energy expenditure, cytokines, and testosterone.

The study team assessed outcomes before (PRE) and 30 ± 10 days after (FU) AHCT in 15 patients with multiple myeloma and six with non-Hodgkin lymphoma. Researchers noted that the six-minute walk test (6MWT; p = 0.014), lean mass (p = 0.002), and fat mass (p = 0.02) decreased. The trial also showed that nausea and fatigue increased at FU (both p = 0.039). Determined to be predictors of recent weight change and steroid exposure was predictors of reduced aerobic capacity (p < 0.001).

No significant changes in interleukin (IL)-1β, IL-6, tumor necrosis factor (TNF), energy expenditure, or bioavailable testosterone were detected.

The researchers also concluded that alterations in cytokines, energy expenditure, and testosterone were not associated with functional impairment acutely following AHCT. They suggested, however, that recent history of weight loss and steroid exposure were predictors of worse physical function after AHCT, advising that targeting nutritional status and myopathy might help mitigate those effects.

“In this study we showed that AHCT in patients with multiple myeloma and non-Hodgkin lymphoma caused decrement in physical function in parallel with reduced lean and fat mass, and increased patient-reported fatigue one month after AHCT,” the authors explained. “Autologous HCT did not induce significant changes in energy expenditure, inflammatory cytokines, or bioavailable testosterone levels. Even though decline in physical function and quality of life have been previously reported after HCT, the mechanisms underlying these changes are not completely understood. In the setting of non-transplant therapy of malignancy, elevated energy expenditure, inflammation, and low testosterone are associated with cachexia and functional impairment, though their relative contribution in the HCT setting is unclear.

“To our knowledge, this was the first study to report the impact of AHCT on a battery of objective physical function assessments in combination with energy expenditure, inflammatory cytokines, testosterone, and patient-reported QOL outcomes following AHCT. This was also the first assessment of the impact of AHCT on physical function and QOL in U.S. veterans, a population with a higher comorbidity burden and increased risk for hematologic malignancies than the general population.”

  1. Anderson LJ, Yin C, Burciaga R, et al. Assessing Cachexia Acutely after Autologous Stem Cell Transplant. Cancers (Basel). 2019;11(9):1300. Published 2019 Sep 4. doi:10.3390/cancers11091300