The Role of Physical Therapy Across the Transplant Trajectory in Allogeneic Hematopoietic Stem Cell Transplantation, A Systematic Review and Clinical Framework.
Houssem Ben Jemia, Rebecca Catterina, Marialaura Calonghi et al.
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In 30 seconds
This systematic review assessed randomized trials of rehabilitation and exercise in adults undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT), across pre-, peri- and post-transplant phases. Ten trials included 537 participants, of whom 405 completed the studies. Pre-transplant respiratory training improved respiratory muscle strength and six-minute walk distance in small trials; supervised exercise during hospitalization attenuated declines in aerobic capacity and muscle strength. Post-transplant programmes were feasible and generally safe, but functional and patient-reported benefits were modest and adherence-dependent. Evidence certainty was low to very low, and no trial was powered to assess survival or other major transplant outcomes.
Key findings
- Ten randomized controlled trials included 537 participants, with 405 completing the studies.
- Pre-transplant respiratory training improved respiratory muscle strength and six-minute walk distance in small trials, with mixed spirometric effects.
- During hospitalization, supervised multimodal exercise attenuated declines in aerobic capacity and muscle strength versus standard care.
- Overall, 70% of trials were at high risk of bias; GRADE certainty ranged from low to very low, particularly for whole-body vibration and patient-reported outcomes.
Why it matters
Physical deconditioning and impaired pulmonary function are relevant concerns across allo-HSCT, and the review organizes rehabilitation evidence by transplant phase. The findings suggest that structured rehabilitation may help preserve function, while highlighting uncertainty about the size and durability of benefits. No included trial established an effect on survival, transplant-related mortality or graft-versus-host disease.
What to keep in mind
The evidence came from small, mostly single-center trials; 70% were at high risk of bias, and certainty was low to very low. Older adults were underrepresented, and no trial was powered for major transplant-related outcomes.