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2023-11-27T21:00:13.000Z

The impact of physical activity on functional performance in multiple myeloma

Nov 27, 2023
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Learning objective: After reading this article, learners will be able to recall the influence of physical activity on functional and immunological outcomes in patients with multiple myeloma.

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As treatments for multiple myeloma (MM) improve, patients are experiencing longer remissions. As a result, patients are expressing more interest in returning to activities of daily life, including physical activity (PA), sports, and hobbies. However, MM-associated bone disease has led to reluctance among physicians to recommend PA for MM patients due to the risk of new fractures that could impact frailty status.1

At the 20th International Myeloma Society (IMS) Annual Meeting, Hillengass presented findings on the impact of PA on functional performance and quality of life in patients with MM. The Multiple Myeloma Hub is pleased to summarize this presentation here.

Study design1

Over 6 months, 42 patients from a single center were given a choice of participating one of the following cohorts:

  • Resistance (strength) training cohort, consisting of twice weekly supervised sessions; or
  • Walking cohort, prompted remotely through a fitness tracker to achieve 150–300 active minutes per week.

Throughout this intervention period, and for a further 6 months following study conclusion, patients were assessed for changes in:

  • Functional status
  • Immune cell subsets
  • Quality of life

Patient characteristics1

This study aimed to assess the feasibility of PA as an intervention; therefore, the patients selected were primarily fit or intermediate-fit and were classified as having non-active disease. Baseline characteristics are outlined in Table 1.

Table 1. Baseline characteristics*

Characteristic, % (unless otherwise specified)

Strength
(n = 24)

Walking
(n = 18)

p value

Mean age (years)

63.9

62.2

0.52

Mean body mass index (kg/m2)

30.9

29.5

0.49

Sex

              Female

58.3

66.7

0.58

              Male

41.7

33.3

ECOG, baseline

              0 fully active

70.8

50

0.26

             1 restricted in strenuous activity

29.2

44.4

Disease status

              Active disease

4.2

16.7

0.17

              Non-active disease

95.8

83.3

Timepoints

              Baseline

100.0

94.4

0.36

              3-month

83.3

66.7

              6-month

79.2

66.7

              3-months post-intervention

75.0

61.1

              6-months post-intervention

79.2

61.1

ECOG, Eastern Cooperative Oncology Group performance status.
*Adapted from Hillengass.1

Results

Functional status prior to and following the intervention period was determined using five assessments, outlined in Figure 1, to replicate the activities of daily living.

Figure 1. Assessments for functional status* 

AM-PAC, activity measure for post-acute care.
*Adapted from Hillengass.1

In both cohorts, a significant improvement was observed in the activity measure for post-acute care (AM-PAC) form and the timed up-and-go test, with these results largely maintained at follow-up. However, in the sit-to-stand test, improvements observed over the trial period slowly decreased to baseline after the intervention ended.

T-cell exhaustion2

The ratio of exhausted to non-exhausted T-cells was lower at the end of the intervention period in all subsets. Changes in programmed cell death protein 1 and/or T-cell immunoreceptor with Ig and ITIM domain exhaustion markers are outlined in Table 3, with significant changes highlighted in bold.

Table 3. Ratio of exhausted to non-exhausted T cells*

Ratio, median

Baseline

Final

p value

CD4+

PD-1+ or TIGIT+

1.33

1.15

0.14

PD-1+

1.18

0.92

0.17

TIGIT+

0.71

0.57

0.04

TIGIT+ and PD-1+

0.48

0.41

0.10

CD8+

PD-1+ or TIGIT+

2.36

2.13

0.09

PD-1+

1.81

1.48

0.06

TIGIT+

1.91

1.67

0.18

TIGIT+ and PD-1+

1.25

1.01

0.17

PD-1, programmed cell death protein 1; TIGIT, T-cell immunoreceptor with Ig and ITIM domains.
*Adapted from Joseph, et al.2

Safety1

  • There were no intervention-related Grade ≥3 adverse events.
  • Adverse events were primarily musculoskeletal.
  • There were no new fractures.

Conclusion

Physical activity in patients with MM is largely safe and had a positive impact on immunological and functional outcomes. There was also a benefit to quality of life and facilitation of patients returning to activities of daily living. A risk remains to patients in respect of musculoskeletal injury and potential subsequent impacts on frailty status. However, with trained supervision to maximize safety, PA offers a feasible intervention to improve the functional status of patients with MM.

  1. Hillengass J. Physical activity interventions to improve functional performance in patients with multiple myeloma. Oral abstract #38. International Myeloma Society Annual Meeting 2023; Sep 27, 2023; Athens, GR.
  2. Joseph J. T cell exhaustion markers in multiple myeloma patients before and after physical activity intervention. American Society of Clinical Oncology Annual Meeting 2023; Jun 2-6; Chicago, US.

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