[show abstract][hide abstract] ABSTRACT: An allogeneic hematopoietic stem cell transplantation (HSCT) can have profound and lasting adverse effects on a patient's physical and psychological well-being. So far, only few studies have investigated the effectiveness of physical activity over the entire inpatient phase of an allogeneic HSCT.
We performed a randomized controlled study to examine the influence of a controlled moderate exercise program starting parallel to chemotherapeutic conditioning and total body irradiation on the patient's physical and psychological constitution.
Forty-seven patients undergoing an allogeneic HSCT were randomly assigned to an exercise group (EG) or a control group (CG). While the EG took part in an endurance and activity of daily living-training twice a day, the CG received the clinic's standard physiotherapy program once a day.
Significant differences and/or trends in favor of the EG were observed regarding the primary endpoint endurance performance (P=0.002), muscular strength (P=0.022), fatigue (P=0.046), and emotional state (P=0.028) without posing an additional risk for the individual.
The results show that the training program is feasible and seems to have positive influences on physical performance and quality of life in patients undergoing an allogeneic HSCT. However, further studies are necessary to confirm these results.
European Journal Of Haematology 05/2011; 87(2):148-56. · 2.55 Impact Factor
[show abstract][hide abstract] ABSTRACT: A haematopoietic SCT (HSCT) can cause severe side effects, which may have a profound impact on a patient's life both physically and psychologically. Some studies have shown that physical activity has positive effects for inpatients after an HSCT. Therefore, the question arises whether a controlled exercise programme right from the beginning of the conditioning phase could help contribute to a patient's physical and psychological recovery. To evaluate the different effects of specific, moderate physical activities on the physical and psychological condition of HSCT patients we performed a controlled randomized study with 64 inpatients undergoing an allogeneic or autologous HSCT. The patients were randomly assigned to two groups. Although the training group took part in a specific programme of exercise therapy twice a day throughout the entire hospitalization phase, patients in the control group were offered the hospital's standard mobilization programme. The results of this study showed significant differences in favour of the training group regarding strength, endurance, lung function and quality of life. However, further studies are needed to confirm these results.
Bone marrow transplantation 08/2009; 45(2):355-62. · 3.00 Impact Factor
[show abstract][hide abstract] ABSTRACT: The role of unrelated allogeneic stem-cell transplantation in acute lymphoblastic leukemia (ALL) patients is still not clear, and only limited data are available from the literature. We analyzed factors affecting clinical outcome of ALL patients receiving a related or unrelated stem-cell graft from matched donors.
The total study population was 264 adult patients receiving a myeloablative allogeneic stem-cell transplant for ALL at nine bone marrow transplantation centers between 1990 and 2002. Of these, 221 patients receiving a matched related or unrelated graft were analyzed. One hundred forty-eight patients received transplantation in complete remission; 62 patients were in relapse; and 11 patients were refractory to chemotherapy before transplant. Fifty percent of patients received bone marrow, and 50% received peripheral blood stem cell from a human leukocyte antigen-identical related (n = 103), or matched unrelated (n = 118) donor.
Disease-free survival (DFS) at 5 years was 28%, with 76 patients (34%) still alive (2.2 to 103 months post-transplantation), and 145 deceased (65 relapses, transplant-related mortality, 45%). We observed an advantage regarding DFS in favor of patients receiving transplantation during their first complete remission (CR) in comparison with patients receiving transplantation in or after second CR (P =.014) or who relapsed (P <.001). We observed a clear trend toward improved survival in favor of B-lineage ALL patients compared with T-lineage ALL patients (P =.052), and Philadelphia chromosome-positive patients had no poorer outcome than Philadelphia chromosome-negative patients. Total-body irradiation-based conditioning improved DFS in comparison with busulfan (P =.041).
Myeloablative matched related or matched unrelated allogeneic hematopoietic stem-cell transplantation in ALL patients should be performed in first CR.
Journal of Clinical Oncology 07/2004; 22(14):2816-25. · 18.04 Impact Factor
[show abstract][hide abstract] ABSTRACT: According to recent reports, fast engraftment with minimal transplant-related toxicity and mortality (TRT, TRM) can be achieved by using reduced-intensity preparative regimens in allogeneic hematopoietic stem cell transplantation (HSCT). We report our experience with related (39%) and unrelated (61%) HSCT in 44 high risk patients (AML, ALL, CML, CLL) receiving either busulfan/fludarabine or busulfane/fludarabine/ATG or TBI/fludarabine as reduced-intensity preparative regimens. Organ toxicity was minimal with mild mucositis and no major bleeding. Acute GVHD was recorded in 64% of the patients. Twenty-three patients achieved complete remission after transplantation, and complete chimerism was obtained in all patients with stable engraftment (35 patients). Twenty-nine patients died: 15 due to relapse/progression, 14 due to TRM. Survival with median follow-up of 18.5 months was significantly better in patients with matched related transplants compared to patients with other transplants. However, there was no difference between related and unrelated transplants with regard to engraftment, TRM and GVHD. In conclusion, our results in high-risk patients transplanted in CR or with smoldering leukemia from a related donor are encouraging, although a longer follow-up and a larger group of patients is needed in order to evaluate the role of different reduced-intensity preparative regimens in unrelated and related HSCT.
Bone Marrow Transplantation 12/2002; 30(10):651-9. · 3.54 Impact Factor
[show abstract][hide abstract] ABSTRACT: Currently, the most commonly used routes of administration of antiemetics in chemotherapeutic regimens are oral and intravenous. Patient compliance and thus efficacy of conventional drug schedules and formulations are often impaired by difficulties associated with oral or intravenous uptake of the administered chemotherapy. Alternative or new drug delivery systems should overcome these problems by improving patient compliance. Several new drug delivery systems are available and development of these new systems is ongoing, in particular to meet delivery requirements of modern biological therapeutics and the application of gene therapy. However, at the present time, the implementation of new techniques of alternative antiemetic drug administration for chemotherapy-induced emesis is very limited. The challenge for clinical investigations to further develop new delivery systems, in particular for antiemetic therapies, remains.