Long-term recovery of quality of life and physical function over three years in adult survivors of acute myeloid leukemia after intensive chemotherapy.

We previously described impairments in quality of life (QOL) and physical function among acute myeloid leukemia (AML) survivors between diagnosis and 1 year. The aim of the current study is to describe and compare to normative data QOL and physical function recovery over 3 years from diagnosis and treatment with intensive chemotherapy (IC). At assessments done at baseline (pre-IC) and at 11 time points over 3 years, QOL, fatigue, and 3 physical performance measures (PPMs; grip strength, 6-min walk test (6MWT), and timed chair stands) were collected. Long-term recovery was defined by reaching scores within the minimum clinically important difference of normative data. Global QOL recovery was seen in 79% at 1 year, 75% at 2 years, and 86% at 3 years. At 3 years, the QLQ-C30 subscales with the greatest recovery were physical and emotional functioning. For FACT-fatigue, recovery was seen in 68% at 1 year and 77% at 3 years. Recovery on PPMs was poorer on average, with only 17% on the 6MWT and 42% in grip strength returning to normal at 3 years. The vast majority of AML survivors after IC achieve recovery in QOL and fatigue by three years. However, recovery in physical performance remained blunted.

The importance of meaningful activity in people living with acute myeloid leukemia.

PURPOSE: The symptom burden of acute myeloid leukemia (AML) and its treatment can accelerate physical deconditioning and impair mobility and quality of life. In the present study, we explore the subjective experience of functional capacity in people living with AML. METHODS: A secondary qualitative analysis was performed on a subset of interviews (n = 21) obtained from an observational cohort study of people with acute leukemia. Conventional content analysis was employed to identify key themes and concepts. RESULTS: Participants valued their physical function to the extent that it was required to pursue personally meaningful activities and interests. We identified Meaningful Activity as an overarching goal of participants. Three interrelated themes captured the obstacles participants reported facing when attempting to realize this goal: Compromised Body, Threatened Identity, and Shrinking World. Adaptation was common across themes, representing the strategies employed to overcome such challenges. Themes were consistent across participants, despite the variability in disease states at the time of the interview. CONCLUSIONS: Dynamic interactions between physical, psychological, and environmental factors affect the pursuit and achievement of meaningful activity among people living with AML. It may be important to consider personal incentives when designing interventions for physical rehabilitation in this patient population.

Perceived Benefits and Barriers to Exercise for Recently Treated Adults With Acute Leukemia

PURPOSE/OBJECTIVES: To explore perceived exercise benefits and barriers in adults with acute leukemia who recently completed an inpatient exercise intervention during induction therapy.
. RESEARCH APPROACH: Descriptive, exploratory design using semistructured interviews.
. SETTING: Inpatient hematology/oncology unit at North Carolina Cancer Hospital in Chapel Hill.
. PARTICIPANTS: 6 adults with acute leukemia aged 35-67 years.
. METHODOLOGIC APPROACH: Content analyses of semistructured interviews that were conducted with each participant prior to hospital discharge.
. FINDINGS: Most participants were not meeting the recommended physical activity levels of 150 minutes of moderate-intensity exercise per week before their diagnosis. Patients were highly pleased with the exercise intervention and the overall program. Common barriers to exercise were anxiety and aches and pains.
. INTERPRETATION: Overall, participants experienced physical and psychological benefits with the exercise intervention with no adverse events from exercising regularly during induction chemotherapy. Referrals for cancer rehabilitation management will lead to prolonged recovery benefits.
. IMPLICATIONS FOR NURSING: Findings inform the nurses' role in encouraging and supporting adults with acute leukemia to exercise and be physically active during their hospitalization. Nurses should also be responsible for assisting patients with physical function activities to increase mobility and enhance overall health-related quality of life.

Efficacy of Exercise Interventions in Patients with Acute Leukemia: A Meta-Analysis.

BACKGROUND: Decreased physical performance and impaired physiological and psychological fitness have been reported in patients with acute leukemia (AL). We performed a meta-analysis to assess the efficacy of exercise in patients with AL. METHODS: In this meta-analysis, the electronic databases MEDLINE, Embase, Cochrane, Web of Science, SPORTDiscus, CINAHL and PEDro were searched through November 2015. Three authors participated in the study selection, data extraction and quality assessment. The instrument used for quality assessment was derived from the Cochrane Handbook for Systematic Reviews of Interventions. Analyses were performed according to the recommendations of The Cochrane Collaboration using Review Manager 5.3. RESULTS: Nine trials (8 randomized controlled trials and 1 quasi-experimental design trial) with 314 AL participants were included in this meta-analysis. The pooled standardized mean differences between the exercise and control groups were 0.45 (95% confidence interval (CI): 0.09 to 0.80, P value = 0.01, P for heterogeneity = 0.23, I2 = 28%) for cardiorespiratory fitness and 0.67 (95% CI: 0.28 to 1.06, P value = 0.0007, P for heterogeneity = 0.14, I2 = 43%) for muscle strength. Based on the data for fatigue, anxiety, and depression, there were no significant differences in these parameters between the exercise and control groups. CONCLUSIONS: Exercise has beneficial effects on cardiorespiratory fitness, muscle strength and functional mobility; however, no significant improvements in fatigue, anxiety, depression or quality of life were observed. Further large-scale randomized trials are needed to assess the safety, feasibility and efficacy of exercise programs for AL patients.

Self-reported fertility in long-term survivors of acute myeloid leukemia.

Acute myeloid leukemia (AML) survival rates in younger patients have improved considerably since the 1970s. In order to evaluate the impact of AML and its treatment on fertility and family situation in adult long-term survivors, we used the Swedish population-based registries to identify 161 adult patients diagnosed with AML within the Leukemia Group of Middle Sweden (LGMS) 1973-2003, who survived for more than 5 years and were alive in 2010. Ninety-eight patients (61 %) completed a questionnaire including items on reproductive concerns, family situation, and infertility-related distress. After excluding women >45 years and/or postmenopausal women and men >55 years, 22 women and 38 men were included in the final analysis. Nine of the women (41 %) tried to conceive after treatment, but only three succeeded. Five (83 %) of the unwillingly childless women reported "a moderate" or "a lot" of distress caused by this. Among men in the same age group, all six who wanted children after treatment succeeded. None of the men 46-55 years old cryopreserved their sperm or tried to father a child. Among patients who wanted children after AML treatment, 46 % of the women and 40 % of the younger men reported that they were not, or not fully, informed about fertility-related issues. In contrast, among men 46-55 years, none reported they would have wanted more information. Infertility among young female AML survivors thus remains an important clinical issue, and there is a need for improved clinical counseling and education in this area.

Patient Activation through Counseling and Exercise--Acute Leukemia (PACE-AL)--a randomized controlled trial.

BACKGROUND: Patients with acute leukemia experience a substantial symptom burden and are at risk of developing infections throughout the course of repeated cycles of intensive chemotherapy. Physical activity in recent years has been a strategy for rehabilitation in cancer patients to remedy disease and treatment related symptoms and side effects. To date, there are no clinical practice exercise guidelines for patients with acute leukemia undergoing induction and consolidation chemotherapy. A randomized controlled trial is needed to determine if patients with acute leukemia can benefit by a structured and supervised counseling and exercise program. METHODS/DESIGN: This paper presents the study protocol: Patient Activation through Counseling and Exercise--Acute Leukemia (PACE-AL) trial, a two center, randomized controlled trial of 70 patients with acute leukemia (35 patients/study arm) following induction chemotherapy in the outpatient setting. Eligible patients will be randomized to usual care or to the 12 week exercise and counseling program. The intervention includes 3 hours + 30 minutes per week of supervised and structured aerobic training (moderate to high intensity 70-80%) on an ergometer cycle, strength exercises using hand weights and relaxation exercise. Individual health counseling sessions include a self directed home walk program with a step counter. The primary endpoint is functional performance/exercise capacity (6 minute walk distance). The secondary endpoints are submaximal VO2 max test, sit to stand and bicep curl test, physical activity levels, patient reported outcomes (quality of life, anxiety and depression, symptom prevalence, intensity and interference). Evaluation of clinical outcomes will be explored including incidence of infection, hospitalization days, body mass index, time to recurrence and survival. Qualitative exploration of patients' health behavior and experiences. DISCUSSION: PACE-AL will provide evidence of the effect of exercise and health promotion counseling on functional and physical capacity, the symptom burden and quality of life in patients with acute leukemia during out patient management. The results will inform clinical practice exercise guidelines and rehabilitation programs for patients undergoing treatment for acute leukemia. Optimizing the treatment and care pathway may ease the transition for patients from illness to the resumption of everyday activities. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01404520.

Estimation of the prevalence of Fanconi anemia among patients with de novo acute myelogenous leukemia who have poor recovery from chemotherapy.

We speculated that some individuals with de novo acute myelogenous leukemia (AML) may have undiagnosed Fanconi Anemia (FA). Data from patients enrolled on AML protocol CCG-2961, published FA cohort studies, SEER, and Bayes rule were used to estimate the probability of FA among all newly diagnosed AML cases, and among those who had no or delayed recovery of the absolute neutrophil count following initial chemotherapy. We determined that the probability of undiagnosed FA in patients in a treatment trial for newly diagnosed patients was around 0.18%, and around 0.83% in the subset who had poor marrow recovery. We suggest that FA or other inherited bone marrow failure syndromes be considered prior to treatment, or certainly among those with poor recovery.

Enfermedad de injerto contra huésped. Presentación atípica / Graft versus host disease, a typical presentation

La enfermedad de injerto contra huésped(EICH) es la complicación más grave del trasplante de precursores hematopoyéticos alogénico y se puede presentar de forma aguda o crónica. La EICH aguda ocurre en el 40-70% de los pacientes y es causa de muerte en más del 20 %. La forma crónica aparece en un 20-50 % de los supervivientes a largo plazo.Presentamos el caso de un paciente con antecedente personal de leucemia mieloblástica aguda que había requerido trasplante de precursores hematopoyéticos alogénico de un hermano HLA compatible y presentó una EICH de presentación atípica como sinovitis de flexores de carpo y síndrome doloroso regional complejo asociado

Graft versus host disease (GVHD), which can occur in acute or chronic form, is the most serious complication of allogeneic hematopoietic stem cell transplantation(HSCT). The acute GVHD occurs in 40 % to 70 % of the patients and is the first cause of death in about 20 %. The chronic type occurs in 20 % to 50 % of long-term survivors.We present the case of a patient with acute myeloblasticleukemia who received allogeneic HSCT from his HLA-identical brother, and presented atypical GVHD with carpal flexor synovitis associated with complex regional pain syndrome

[Phases in the rehabilitation of male and female bone marrow transplant patients]. / Phasen der Rehabilitation knochenmarktransplantierter Patienten und Patientinnen.

Teamwork is essential when investigating the long-term adoption of such medical intervention that are highly demanding on patients, physicians and nursing staff. Bone marrow transplantation represent such an intervention for a series of well defined hematological diseases. The contribution demonstrates the multiple perspective approach of the Ulm team. A case report illustrates the multiplicity of clinical issues. The state of research allows the sketching of a process model on rehabilitation.