Differences in pulmonary and extra-pulmonary characteristics in severely versus non-severely fatigued recipients of allogeneic hematopoietic stem cell transplantation: a cross-sectional, comparative study

Inpatient Rehabilitation of Hematopoietic Stem Cell Transplant Patients: Managing Challenging Impairments and Medical Fragility

ABSTRACT

Hematopoietic stem cell transplants play an important role in the treatment of cancer, particularly hematologic malignancies. These patients can encounter functional impairments unique to hematopoietic stem cell transplant, including deconditioning, cancer-related fatigue, steroid myopathy, graft versus host disease, and capillary leak syndrome. Medical fragility and increased risk of infection may make rehabilitation challenging on the acute care and postacute care settings. Patients admitted to acute inpatient rehabilitation experience a high rate of transfer to the primary acute service and high rate of mortality after transfer back. Physical medicine and rehabilitation physicians can use a number of strategies to mitigate these patients' risk of medical complications including evidence-based predictive models to assist with postacute rehabilitation triage, physiatry-led consult-based rehabilitation, and oncology hospitalist comanagement on inpatient rehabilitation.

Rehabilitation after Allogeneic Haematopoietic Stem Cell Transplantation: A Special Challenge

Simple Summary

After undergoing an allogeneic haematopoietic stem cell transplantation (alloHCT), patients need intensive physiological and psychological rehabilitation. This should start immediately after discharge from the transplant ward as in- or outpatient rehabilitation. The rehabilitation centres should be qualified and experienced because this patient group exhibits problems that differ from those of patients who have undergone oncological therapies or autologous HCT. An experienced multidisciplinary team in close consultation with the primary transplantation centre should perform the rehabilitation therapy. This review will show the special challenges of these patients according to different timepoints after HCT. Because there is so little data available, personal experience and general guidelines on patient care after alloHCT are presented.

Abstract

The general population is getting older and suffer more haematological malignancies despite being physically fit. These malignancies are mainly only curable via an alloHCT, and they are now carried out more frequently. Patients benefit from intensive rehabilitation earlier and may need it repeatedly in cases of severe side effects (e.g., graft-versus-host disease). They can suffer many problems that other cancer patients do not experience, such as severe infections, continued immunosuppression, nutritional restrictions, acute or chronic GvHD, or organ impairments (e.g., lung, eyes). They may also encounter various associated psychological problems, e.g., feeling like a chimera. Rehabilitation centres willing to care for patients after alloHCT should have an experienced multidisciplinary team and should work in close co-operation with the primary transplant centre.