An Exploratory Study on Physical Function in Stem Cell Transplant Patients Undergoing Corticosteroid Treatment for Acute Graft-Versus-Host-Disease.

Acute graft-versus-host disease (aGVHD) after allogeneic hematopoietic stem cell transplant (SCT) is treated with corticosteroids, placing patients at risk for steroid myopathy. In this single-arm cohort study, 23 patients who were started on high-dose corticosteroids for aGVHD underwent a series of functional tests (baseline, Day 14, 28, 56): six-minute walk test (6MWT), hip flexors (HF) and knee extensors (KE) strength via dynamometry, five times sit-to-stand (5xSTS), Brooke scale for myopathy, modified Adult Myopathy Assessment Tool (AMAT), and manual muscle testing (MMT). Participants were prescribed home exercises including walking and resistance exercises, with low adherence. Fifteen (63%) participants were male and median (range) age 60 (36-70) years old. Median (range) corticosteroid duration and cumulative equivalent methylprednisolone dose were 66 (22-165) days and 3625 (1020-11720) milligrams, respectively. At Day 14, there was a significant decline in 5xSTS (P=.0132), KE (P=.0182), and MMT (P=.0466). Functional tests negatively-associated with cumulative corticosteroid dose included: 6MWT distance (P=.0103), HF strength (P=.0262), KE strength (P=.0369), manual muscle testing strength (P=.0319). 5xSTS was positively associated with corticosteroid dose (P=.0003). In conclusion, SCT patients receiving high-dose corticosteroids for aGVHD are at risk for weakness detected as early as Day 14. Increasing adherence to exercise may mitigate these changes.