Oral Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2024

Preventing Allogeneic Stem Cell Transplant-Related Cardiovascular Dysfunction: The ALLO-Active Trial (#78)

Hayley T Dillon 1 2 , Nicholas J Saner 2 3 , Tegan Ilsley 2 4 , David S Kliman 5 , Steve J Foulkes 2 6 7 , Christian J Brakenridge 2 8 , Andrew Spencer 9 , Sharon Avery 10 , Piet Claus 11 , David W Dunstan 1 2 , Robin M Daly 1 , Steve F Fraser 1 , Neville Owen 2 8 , Brigid M Lynch 2 12 13 , Bronwyn A Kingwell 2 14 , Andre La Gerche 6 11 15 16 , Erin J Howden 2 17
  1. Institute for Physical Activity and Nutrition, Deakin University, Melbourne, VIC, AU
  2. Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
  3. Institute for health and sport, Victoria University, Melbourne, VIC, Australia
  4. Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, AU
  5. Department of Haematology, Royal North Shore Hospital, Sydney, NSW, Australia
  6. Heart, Exercise and Research Trials (HEART) Lab, St Vincent's Institute, Melbourne, VIC, Australia
  7. Faculty of Nursing, University of Alberta, Edmonton, Canada
  8. Centre for Urban Transitions, Swinburne University of Technology, Melbourne, VIC, Australia
  9. Malignant Haematology and Stem Cell Transplantation Service, Alfred Hospital, Melbourne, VIC, Please Select, Australia
  10. Liz Plummer Cancer Care Centre, Cairns and Hinterland Health Service, Cairns, QLD, Australia
  11. Department of Cardiovascular Science, KU Leuven, Leuven, Belgium
  12. Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, VIC, Australia
  13. Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
  14. CSL, Melbourne, VIC, AU
  15. Cardiology Department, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
  16. HEART Lab, Victor Chang Cardiovascular Research Institute, Darlinghurst, NSW, Australia
  17. Baker Department of Cardiometabolic Health, University of Melbourne, Parkville, VIC, Australia

Background and Aim. Allogeneic stem cell transplantation (allo-SCT) is an efficacious treatment for hematological malignancies but can be complicated by cardiac dysfunction and exercise intolerance impacting quality of life and longevity. We conducted a randomized controlled trial testing whether a multi-component activity intervention could attenuate reductions in cardiorespiratory fitness and exercise cardiac function (co-primary end points) in adults undergoing allo-SCT.

Methods. Sixty-two adults scheduled for allo-SCT were randomized to a 4-month Activity program (n=30) or usual care (UC, n=32). Activity comprised a multi-component exercise training (3 days.week-1) and sedentary time reduction (at least 30 minutes.day-1) program and was delivered throughout hospitalization (~4-weeks) and for 12-weeks post-discharge. Physiological assessments conducted pre-admission, and 12-weeks post-discharge included cardiopulmonary exercise testing to quantify peak oxygen uptake (V̇O2peak), exercise cardiac MRI for peak cardiac (CIpeak) and stroke volume (SVIpeak) index, echocardiography-derived left-ventricular ejection fraction and global longitudinal strain, and cardiac biomarkers (troponin-I, B-type natriuretic peptide).

Results. Fifty-two participants (84%) completed follow-up (25 Activity; 27 UC), and median (IQR) Activity adherence was 74% (41-96%). There was a marked decline in VO2peak in UC (-3.4 ml.kg-1.min-1 [95%CI -4.9, -1.8]) that was attenuated with Activity (-0.9 ml.kg-1.min-1 [95%CI -2.5, 0.8]; interaction, p=0.029). Activity preserved exercise cardiac function, with preservation of CIpeak (0.30 L.min-1.m-2, [95%CI -0.34, 0.41]) and SVIpeak (0.6 ml.m-2 [95%CI -1.3, 2.5]), both of which declined with UC (CIpeak: -0.68 L.min-1.m-2, [95%CI -1.3, -0.32]; interaction, p=0.008; SVIpeak: -2.7 ml.m-2 [95%CI -4.6, -0.9]; interaction, p=0.014). There were no treatment effects of Activity on cardiac biomarkers or echocardiography.

Conclusion. Intervening during and following allo-SCT with a multi-component exercise intervention is beneficial for preserving patient’s cardiorespiratory fitness and exercise cardiac function. These results may have important implications for cardiovascular morbidity and mortality following allo-SCT.