BACKGROUND Allogeneic stem cell transplantation (allo-SCT) is an efficacious treatment for hematologic 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 multicomponent 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 multicomponent exercise training (3 days/week) and sedentary time reduction (≥30 min/day) program and was delivered throughout hospitalization (≈4 weeks) and for 12 weeks after discharge. Physiological assessments conducted before admission and at 12 weeks after discharge included cardiopulmonary exercise testing to quantify peak oxygen uptake ([Formula: see text]), exercise cardiac magnetic resonance imaging for peak cardiac volume (CIpeak) and stroke volume (SVIpeak) index, echocardiography-derived left ventricular ejection fraction and global longitudinal strain, and cardiac biomarkers (cTn-I [troponin-I] and BNP [B-type natriuretic peptide]). RESULTS Fifty-two participants (84%) completed follow-up (25 activity and 27 UC); median (interquartile range [IQR]) adherence to the activity program was 74% (41-96%). There was a marked decline in [Formula: see text] in the UC program (-3.4 mL‧kg-1‧min-1 [95% CI, -4.9 to -1.8]) that was attenuated with activity (-0.9 mL‧kg-1‧min-1 [95% CI, -2.5 to 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 to 0.41]) and SVIpeak (0.6 mL/m2 [95% CI, -1.3 to 2.5]), both of which declined with UC (CIpeak, -0.68 L‧min-1‧m-2 [95% CI, -1.3 to -0.32]; interaction P=0.008; SVIpeak, -2.7 mL/m2 [95% CI, -4.6 to -0.9]; interaction P=0.014). There were no treatment effects of activity on cardiac biomarkers or echocardiographic indices. CONCLUSIONS Multicomponent activity intervention during and after allo-SCT is beneficial for preserving patient cardiorespiratory fitness and exercise cardiac function. These results may have important implications for cardiovascular morbidity and mortality after allo-SCT. REGISTRATION URL: https://anzctr.org.au/; Unique identifier: ACTRN12619000741189.

中文翻译：

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预防同种异体干细胞移植相关心血管功能障碍：ALLO-Active 试验。


背景 同种异体干细胞移植 （allo-SCT） 是血液系统恶性肿瘤的有效治疗方法，但可能因心功能障碍和运动不耐受而复杂化，从而影响生活质量和寿命。我们进行了一项随机对照试验，测试多组分活动干预是否可以减轻接受 allo-SCT 的成人心肺健康和运动心脏功能 （共同主要终点） 的降低。方法 62 例计划接受同种异体 SCT 的成年人被随机分配到为期 4 个月的活动计划 （n=30） 或常规护理 （UC;n=32）。活动包括多组分运动训练 （3 天/周） 和久坐时间减少 （≥30 分钟/天） 计划，并在整个住院期间 （≈4 周） 和出院后 12 周内进行。入院前和出院后 12 周进行的生理评估包括量化峰值摄氧量的心肺运动试验（[公式：见正文]）、运动心脏磁共振成像的峰值心容量 （CIpeak） 和每搏输出量 （SVIpeak） 指数、超声心动图衍生的左心室射血分数和整体纵向应变，以及心脏生物标志物（cTn-I [肌钙蛋白-I] 和 BNP [B 型利钠肽]）。结果 52 名参与者 （84%） 完成了随访 （25 项活动和 27 名 UC）;对活动计划的中位 （四分位距 [IQR] ） 依从性为 74% （41-96%）。UC 计划 [公式：见正文] （-3.4 mL‧kg-1‧min-1 [95% CI，-4.9 至 -1.8]） 显著下降，并随活动而减弱 （-0.9 mL‧kg-1‧min-1 [95% CI，-2.5 至 0.8];交互作用 P=0.029）。活动保留了运动心脏功能，保留了 CIpeak （0.30 L‧min-1‧m-2 [95% CI，-0.34 至 0.41]）和 SVIpeak （0.6 mL/m2 [95% CI，-1.3 至 2.5]），两者均随 UC 而下降 （CIpeak，-0.68 L‧min-1‧m-2 [95% CI，-1.3 至 -0.32];交互作用 P=0.008;SVIpeak，-2.7 mL/m2 [95% CI，-4.6 至 -0.9];交互作用 P=0.014）。活动对心脏生物标志物或超声心动图指标没有治疗影响。结论 allo-SCT 期间和之后的多组分活动干预有利于保持患者的心肺健康和运动心脏功能。这些结果可能对 allo-SCT 后的心血管发病率和死亡率具有重要意义。注册 URL：https://anzctr.org.au/;唯一标识符：ACTRN12619000741189。