Preventing Allogeneic Stem Cell Transplant–Related Cardiovascular Dysfunction: ALLO-Active Trial
Bibliographic record
Abstract
BACKGROUND: Allogeneic stem cell transplantation (allo-SCT) is an efficacious treatment for hematologic malignancies but can be complicated by cardiac dysfunction and exercise intolerance impacting quality of life and longevity. We conducted a randomized controlled trial testing whether a multicomponent activity intervention could attenuate reductions in cardiorespiratory fitness and exercise cardiac function (co-primary end points) in adults undergoing allo-SCT. METHODS: Sixty-two adults scheduled for allo-SCT were randomized to a 4-month activity program (activity; n=30) or usual care (UC; n=32). Activity comprised a multicomponent exercise training (3 days.week -1 ) and sedentary time reduction (≥30 minutes.day -1 ) program and was delivered throughout hospitalization (≈4 weeks) and for 12 weeks after discharge. Physiological assessments conducted before admission and at 12 weeks after discharge included cardiopulmonary exercise testing to quantify peak oxygen uptake ( <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" overflow="scroll"> <mml:mstyle displaystyle="false"> <mml:mrow> <mml:mover accent="true"> <mml:mi mathvariant="normal">V</mml:mi> <mml:mo>˙</mml:mo> </mml:mover> </mml:mrow> <mml:mrow> <mml:msub> <mml:mrow> <mml:mrow> <mml:mi mathvariant="normal">o</mml:mi> </mml:mrow> </mml:mrow> <mml:mrow> <mml:mrow> <mml:mn>2</mml:mn> <mml:mi mathvariant="normal">p</mml:mi> <mml:mi mathvariant="normal">e</mml:mi> <mml:mi mathvariant="normal">a</mml:mi> <mml:mi mathvariant="normal">k</mml:mi> </mml:mrow> </mml:mrow> </mml:msub> </mml:mrow> </mml:mstyle> </mml:math> ), exercise cardiac magnetic resonance imaging for peak cardiac (CI peak ) and stroke volume (SVI peak ) index, echocardiography-derived left ventricular ejection fraction and global longitudinal strain, and cardiac biomarkers (cTn-I [troponin-I] and BNP [B-type natriuretic peptide]). RESULTS: Fifty-two participants (84%) completed follow-up (25 activity and 27 UC); median (interquartile range [IQR]) adherence to the activity program was 74% (41%–96%). There was a marked decline in <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" overflow="scroll"> <mml:mstyle displaystyle="false"> <mml:mrow> <mml:mover accent="true"> <mml:mi mathvariant="normal">V</mml:mi> <mml:mo>˙</mml:mo> </mml:mover> </mml:mrow> <mml:mrow> <mml:msub> <mml:mrow> <mml:mrow> <mml:mi mathvariant="normal">o</mml:mi> </mml:mrow> </mml:mrow> <mml:mrow> <mml:mrow> <mml:mn>2</mml:mn> <mml:mi mathvariant="normal">p</mml:mi> <mml:mi mathvariant="normal">e</mml:mi> <mml:mi mathvariant="normal">a</mml:mi> <mml:mi mathvariant="normal">k</mml:mi> </mml:mrow> </mml:mrow> </mml:msub> </mml:mrow> </mml:mstyle> </mml:math> in the UC program (−3.4 mL‧kg -1 ‧min -1 [95% CI, −4.9 to −1.8]) that was attenuated with activity (−0.9 mL‧kg -1‧ min -1 [95% CI, −2.5 to 0.8]; interaction P =0.029). Activity preserved exercise cardiac function, with preservation of CI peak (0.30 L‧min -1 ‧m -2 [95% CI, −0.34 to 0.41]) and SVI peak (0.6 mL.m -2 [95% CI, −1.3 to 2.5]), both of which declined with UC (CI peak , −0.68 L‧min -1 ‧m -2 [95% CI, –1.3 to −0.32]; interaction P =0.008; SVI peak , −2.7 mL.m -2 [95% CI, −4.6 to −0.9]; interaction P= 0.014). There were no treatment effects of activity on cardiac biomarkers or echocardiographic indices. CONCLUSIONS: Intervening during and after allo-SCT with a multicomponent activity program during and after allo-SCT is beneficial for preserving a patient’s cardiorespiratory fitness and exercise cardiac function. These results may have important implications for cardiovascular morbidity and mortality after allo-SCT. REGISTRATION: URL: https://anzctr.org.au/ ; Unique identifier: ACTRN12619000741189.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".