Article
Open Access Article

Effects of Exercise in Combination With Epoetin Alfa During High-Dose Chemotherapy and Autologous Peripheral Blood Stem Cell Transplantation for Multiple Myeloma

Elizabeth Ann Coleman

Sharon Coon

Robert L. Kennedy

Kimberly Lockhart

Carol B. Stewart

Elias J. Anaissie

Bart Barlogie

peripheral blood stem cell transplantation, exercise
ONF 2008, 35(3), E53-E61. DOI: 10.1188/08.ONF.E53-E61

Purpose/Objectives: To determine the effect of aerobic and strength resistance training and epoetin alfa (EPO) therapy on transfusions, stem cell collections, transplantation recovery, and multiple myeloma treatment response.

Design: Randomized clinical trial.

Setting: A myeloma research and therapy center in the south central United States.

Sample: 135 patients with multiple myeloma, 120 evaluable.

Methods: Random assignment to exercise or usual care groups. All patients received EPO based on an algorithm. Aerobic capacity, using the six-minute walk test, was assessed prior to induction chemotherapy, prior to stem cell mobilization, and following stem cell collection for all patients and before and after transplantation for patients continuing in the study. Data analysis included analysis of variance to compare other outcome variables by groups.

Main Research Variables: Number of red blood cell and platelet transfusions during transplantation, number of attempts at and total number of days of stem cell collection, time to recovery after transplantation, and response to intensive therapy for multiple myeloma.

Findings: Recovery and treatment response were not significantly different between groups after transplantation. The exercise group had significantly fewer red blood cell transfusions and fewer attempts at stem cell collection. Serious adverse events were similar in each group.

Conclusions: Exercise with prophylactic EPO therapy reduces the number of RBC transfusions and attempts at stem cell collection for patients receiving intensive treatment for multiple myeloma.

Implications for Nursing: Exercise is safe and has many physiologic benefits for patients receiving multiple myeloma treatment.

Jump to a section

    References

    Ahmadizad, S., El-Sayed, M. S., & Maclaren, D. P. (2006). Responses of platelet activation and function to a single bout of resistance exercise and recovery. Clinical Hemorheology and Microcirculation, 35(1-2), 159-168.
    Aldemir, H., & Kilic, N. (2005). The effect of time of day and exercise on platelet functions and platelet-neutrophil aggregates in healthy male subjects. Molecular and Cellular Biochemistry, 280(1-2), 119-124.
    American College of Sports Medicine. (2001). Perceived exertion. Retrieved October 10, 2007, from http://www.acsm.org/AM/Template.cfm?Section=Search&section=20014&template=/CM/ContentDisplay.cfm&ContentFileID=307
    Bailes, J. S. (2007). Communication to M. O. Leavitt. Retrieved October 10, 2007, from http://www.esafacts.org/ASCO.pdf
    Barlogie, B. (2001). High-dose therapy and innovative approaches to treatment of multiple myeloma. Seminars in Hematology, 38(2, Suppl. 3), 21-27.
    Barlogie, B., & Beck, T. (1993). Recombinant human erythropoietin and the anemia of multiple myeloma. Stem Cells, 11(2), 88-94.
    Borg, G. (1998). Perceived exertion (Borg rating of perceived exertion scale). Retrieved October 10, 2007, from http://www.cdc.gov/nccdphp/dnpa/physical/measuring/perceived_exertion.htm
    Courneya, K. S., & Friedenreich, C. M. (1999). Physical exercise and quality of life following cancer diagnosis: A literature review. Annals of Behavioral Medicine, 21(2), 171-179.
    Drouin, J. S., Young, T. J., Beeler, J., Byrne, K., Birk, T. J., Hryniuk, W. M., et al. (2006). Random control clinical trial on the effects of aerobic exercise training on erythrocyte levels during radiation treatment for breast cancer. Cancer, 107(10), 2490-2495.
    Engert, A. (2005). Recombinant human erythropoietin in oncology: Current status and further developments. Annals of Oncology, 16(10), 1584-1595.
    Faul, F., Erdfelder, E., Lang, A. G., & Buchner, A. (2007). GPower 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods, 39(2), 175-191.
    Galvao, D. A., & Newton, R. U. (2005). Review of exercise intervention studies in cancer patients. Journal of Clinical Oncology, 23(4), 899-909.
    Hamilton, D. M., & Haennel, R. G. (2000). Validity and reliability of the 6-minute walk test in a cardiac rehabilitation population. Journal of Cardiopulmonary Rehabilitation and Prevention, 20(3), 156-164.
    Henry, D. H. (2005). Epoetin alfa for the treatment of cancer- and chemotherapy-related anaemia: Product review and update. Expert Opinion on Pharmacotherapy, 6(2), 295-310.
    Knight, K., Wade, S., & Balducci, L. (2004). Prevalence and outcomes of anemia in cancer: A systematic review of the literature. American Journal of Medicine, 116(Suppl. 7A), 11S-26S.
    Knols, R., Aaronson, N. K., Uebelhart, D., Fransen, J., & Aufdemkampe, G. (2005). Physical exercise in cancer patients during and after medical treatment: A systematic review of randomized and controlled clinical trials. Journal of Clinical Oncology, 23(16), 3830-3842.
    Li, N., He, S., Blomback, M., & Hjemdahl, P. (2007). Platelet activity, coagulation, and fibrinolysis during exercise in healthy males: Effects of thrombin inhibition by argatroban and enoxaparin. Arteriosclerosis, Thrombosis, and Vascular Biology, 27(2), 407-413.
    Monreal, M., Munoz, F. J., Rosa, V., Romero, C., Roman, P., Di Micco, P., et al. (2006). Upper extremity DVT in oncological patients: Analysis of risk factors. Data from the RIETE registry. Experimental Oncology, 28(3), 245-247.
    Multiple Myeloma Research Foundation. (2002). Myeloma treatments. Retrieved January 24, 2006, from http://www.multiplemyeloma.org/treatments/3.07.02.asp
    Naess, I. A., Christiansen, S. C., Romundstad, P., Cannegieter, S. C., Rosendaal, F. R., & Hammerstrom, J. (2007). Incidence and mortality of venous thrombosis: A population-based study. Journal of Thrombosis and Haemostasis, 5(4), 692-699.
    National Cancer Institute. (2007). Common terminology criteria for adverse events. Retrieved October 10, 2007, from http://ctep.cancer.gov/forms/CTCAEv3.pdf
    Oldervoll, L. M., Kaasa, S., Hjermstad, M. J., Lund, J. A., & Loge, J. H. (2004). Physical exercise results in the improved subjective well-being of a few or is effective rehabilitation for all cancer patients? European Journal of Cancer, 40(7), 951-962.
    Ortho Biotech Products. (2005). Procrit® (epoetin alfa) prescribing information [Package insert]. Ortho Biotech Products, L. P.
    Purrough, S., Jacques, L., Ciccanti, M., Long, K., Koller, E., & Feinglass, S. (2007). Decision memo for erythropoiesis stimulating agents (ESAs) for non-renal disease indications. Retrieved October 10, 2007, from http://www.cms.hhs.gov/determinationprocess/downloads/id203d.pdf
    Schmitz, K. H., Holtzman, J., Courneya, K. S., Masse, L. C., Duval, S., & Kane, R. (2005). Controlled physical activity trials in cancer survivors: A systematic review and meta-analysis. Cancer Epidemiology, Biomarkers and Prevention, 14(7), 1588-1595.
    Schnell, F. M. (2007). Communications to S. E. Phurrough. Retrieved October 10, 2007, from http://www.legislink.com/site/DocServer/COA_ESA_Commentary_6-8-07.pdf
    Sports Coach. (1997). Borg scale. Retrieved October 10, 2007, from http://www.brianmac.co.uk/borgscale.htm
    Steensma, D. P., & Loprinzi, C. L. (2005). Erythropoietin use in cancer patients: A matter of life and death? Journal of Clinical Oncology, 23(25), 5865-5868.
    Stevinson, C., Lawlor, D. A., & Fox, K. R. (2004). Exercise interventions for cancer patients: Systematic review of controlled trials. Cancer Causes and Control, 15(10), 1035-1056.
    Stricker, C. T., Drake, D., Hoyer, K. A., & Mock, V. (2004). Evidence-based practice for fatigue management in adults with cancer: Exercise as an intervention. Oncology Nursing Forum, 31(5), 963-976.
    Strong, A., Karavatas, S., & Reicherter, E. A. (2006). Recommended exercise protocol to decrease cancer-related fatigue and muscle wasting in patients with multiple myeloma. Topics in Geriatric Rehabilitation, 22(2), 172-186.
    U. S. Food and Drug Administration. (2007). FDA public health advisory: Erythropoiesis-stimulating agents (ESAs). Retrieved October 10, 2007, from http://www.fda.gov/CDER/Drug/advisory/RHE2007.htm
    Zangari, M., Barlogie, B., Thertulien, R., Jacobson, J., Eddleman, P., Fink, L., et al. (2003). Thalidomide and deep vein thrombosis in multiple myeloma: Risk factors and effect on survival. Clinical Lymphoma, 4(1), 32-35.
    Zangari, M., Siegel, E., Barlogie, B., Anaissie, E., Saghafifar, F., Fassas, A., et al. (2002). Thrombogenic activity of doxorubicin in myeloma patients receiving thalidomide: Implications for therapy. Blood, 100(4), 1168-1171.