Preparing for allogeneic hematopoietic stem cell transplant: a multidisciplinary prehabilitation intervention is safe, feasible and demonstrates preliminary efficacy in acute myeloid leukemia and myelodysplastic syndromes.

BACKGROUND

A multidisciplinary prehabilitation approach may help to counter the negative physical, psychological and social impacts experienced during an allogeneic hematopoietic stem cell transplant (allo-HSCT) among Acute Myeloid Leukaemia (AML) and Myelodysplastic Syndrome (MDS) patients.

Objective

This study investigated the feasibility, safety and preliminary efficacy of multidisciplinary prehabilitation in adults offered allo-HSCT.

METHODS

This single-group pilot study recruited patients (≥ 18 years) with AML or MDS scheduled for allo-HSCT between June 2023 and July 2024. The intervention integrated exercise physiology, physiotherapy, dietetics, occupational therapy, psychology, and social work. Feasibility outcomes included uptake, retention, adherence, and acceptability. Safety was evaluated by monitoring adverse events. Preliminary efficacy was assessed across functional (30-s sit-to-stand, grip strength, 2-min step test, Timed Up and Go), nutritional (PG-SGA), and patient-reported outcomes (EORTC QLQ-C30, HADS, NCCN Distress Thermometer).

RESULTS

Of 27 patients approached, 19 (70.4%) enrolled; one withdrew due to medical deterioration. Eleven participants completed the full 8 weeks, and seven completed 3–7 weeks before transplant. Adherence was high (79.3%), and acceptability was positive across disciplines. No deaths or serious (grade ≥ 3) adverse events occurred. Four intervention-related adverse events were observed (three mild, one moderate), and 34 sessions were cancelled for safety reasons (haemodynamic abnormalities or cytopenias). Preliminary efficacy analyses showed moderate effect size improvements in lower body strength (sit-to-stand, d = 0.49), mobility (Timed Up and Go, d = 0.63), aerobic capacity (2-min step test, d = 0.60), and nutritional status (PG-SGA, d = 0.41). Small-to-moderate effects were observed for several QOL domains, with improvements in constipation but increases in nausea, dyspnoea, and financial concerns.

CONCLUSION

Based on this study’s favourable safety, feasibility and preliminary efficacy results, future, larger-scale research is warranted to evaluate the efficacy of multidisciplinary prehabilitation more rigorously in this setting. The preliminary efficacy results provided by this study may be helpful to inform sample size calculations. TRIAL REGISTRATION: The trial was registered with the Australian New Zealand Clinical Trials Registry (ANZCTR) on 17 January 2023 (ID: ACTRN12623000052639).