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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.
Over 6 months, 42 patients from a single center were given a choice of participating one of the following cohorts:
Throughout this intervention period, and for a further 6 months following study conclusion, patients were assessed for changes in:
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 |
Walking |
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. |
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.
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. |
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.
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