Journal Article

Rationale and design of APOLLO: a personalized rehAbilitation PrOgram in aLLOgeneic bone marrow transplantation

Wu, Cynthia, Skow, Rachel J., McMurtry, Thomas, Hamilton, Marlene, Haykowsky, Mark J., Greiner, Justin G., Thompson, Richard B., Pituskin, Edith, Lieuw, Elena, Tandon, Puneeta, Zhu, Nancy, Bates, Janet E., Foulkes, Stephen, Gyenes, Gabor T., Prado, Carla M., Wang, Peng, Paterson, Ian, Taparia, Minakshi, Meyer, Tara, Lamoureux, Daena, McNeely, Margaret L., Comfort-Riddle, Tiffany, Kruger, Calvin, Brandwein, Joseph, Sawler, Daniel

2025

Overview

Background Hematopoietic stem cell transplantation (HSCT) is a common therapy for many hematologic malignancies. While advances in transplant practice have improved cancer-specific outcomes, multiple and debilitating long term physical and psychologic effects remain. Patients undergoing allogeneic bone marrow transplantation (allo-BMT) are often critically ill at initial diagnosis and with necessary sequential treatments become increasingly frail and deconditioned. Despite modern treatment regimens and support, cardiovascular disease remains a leading cause of non-relapse mortality among allo-BMT survivors. Well-established multi-disciplinary care models such as cardiac rehabilitation offer holistic care including exercise training, nursing support, physical/occupational therapy, psychosocial support and nutritional education. HSCT patients may be excluded from conventional outpatient physical rehabilitation programs due to prolonged pancytopenia and frequent hospital admissions. In Canada, dedicated cancer-specific rehabilitation programs are available only at major tertiary academic centers. Methods The primary aim of this study will evaluate the feasibility and acceptability of a multimodal care navigation (nursing, exercise, nutrition) intervention with content delivery facilitated by a supportive care web-based ‘app’ extending from diagnosis to 1 year in the allogeneic bone marrow transplant population. Adult patients scheduled for allo-BMT will receive support from exercise specialist, nursing support and dietician expertise alongside a supportive care ‘app’ with additional in-person or virtual cardiac rehabilitation support. Discussion To our knowledge, no research team is taking such a holistic, multidisciplinary approach to address the debilitating physiologic and psychological consequences of allo-BMT. We expect the findings to inform the optimal timing and patient preferences to develop studies examining risk-specific, individualized interventions (including exercise, pharmacotherapy, combination treatments) to reduce or prevent symptoms and dysfunction. We expect this innovative program to identify ways to benefit innumerable patients with hematologic and other malignancies. Ultimately, we hope to transform supportive care in hematopoietic stem cell transplantation. Trial Registration Clinicaltrials.gov ID: NCT05579678.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Adult / Allogeneic bone marrow transplant / Allografts / Biomedical and Life Sciences / Biomedicine / Blood cancer / Body composition / Bone cancer / Bone marrow / Bone marrow transplantation / Bone Marrow Transplantation - adverse effects / Bone Marrow Transplantation - methods / Bone Marrow Transplantation - rehabilitation / Cancer Research / Cancer therapies / Cardiac rehabilitation / Cardiovascular diseases / Chemotherapy / Chronic illnesses / Deconditioning / Diagnosis / Drug therapy / Exercise / Feasibility studies / Fitness training programs / Health Promotion and Disease Prevention / Hematologic Neoplasms - rehabilitation / Hematologic Neoplasms - therapy / Hematopoietic Stem Cell Transplantation / Hematopoietic stem cells / Humans / Intervention / Long bone / Magnetic resonance imaging / Malignancy / Malnutrition / Medical innovations / Medical research / Medical treatment / Medicine, Experimental / Medicine/Public Health / Methods / Mortality / MRI / Nursing / Nutrition / Nutritional status / Oncology / Pancytopenia / Patients / Physical fitness / Physical therapy / Physical training / Physiological aspects / Precision Medicine - methods / Preferences / Proteins / Quality of life / Rehabilitation / Sarcopenia / Stem cell transplantation / Study Protocol / Surgical Oncology / Transplantation / Transplantation, Homologous