Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2025 Jan 28;25(1):163.
doi: 10.1186/s12885-025-13502-8.

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

Edith Pituskin  1   2 , Stephen Foulkes  3   4 , Rachel J Skow  3 , Thomas McMurtry  3 , Calvin Kruger  3   5 , Janet E Bates  3 , Daena Lamoureux  3 , Joseph Brandwein  6 , Elena Lieuw  6 , Cynthia Wu  6 , Nancy Zhu  6 , Peng Wang  6 , Daniel Sawler  6 , Minakshi Taparia  6 , Marlene Hamilton  6 , Tiffany Comfort-Riddle  5 , Tara Meyer  5 , Gabor T Gyenes  5   6 , Ian Paterson  7 , Carla M Prado  8 , Mark J Haykowsky  3 , Justin G Greiner  9   10 , Margaret L McNeely  11   12 , Puneeta Tandon  13 , Richard B Thompson  9   10
Affiliations
Observational Study

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

Edith Pituskin et al. BMC Cancer. .

Abstract

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.

Keywords: Allogeneic bone marrow transplant; Cardiac rehabilitation; Cardiovascular diseases; Cardiovascular risk factors; Deconditioning; MRI; Malnutrition; Sarcopenia.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was reviewed and approved by the Health Research Ethics Board of Alberta (HREBA) – Cancer Committee, Ethics ID#: HREBA.CC-22-0164. Written informed consent is provided by all study participants. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Deterioration of skeletal muscle (reduction in size and myosteatosis) after chemotherapy exposure is associated with reduced cardiorespiratory fitness (VO2peak)13
Fig. 2
Fig. 2
Study Flow Diagram
See this image and copyright information in PMC

References

    1. Alizadehasl A, Ghadimi N, Hosseinifard H, Roudini K, Emami AH, Ghavamzadeh A, et al. Cardiovascular diseases in patients after hematopoietic stem cell transplantation: systematic review and Meta-analysis. Curr Res Transl Med. 2023;71(1):103363. - PubMed
    1. Mounier N, Anthony S, Busson R, Thieblemont C, Ribrag V, Tilly H, et al. Long-term fatigue in survivors of non-hodgkin lymphoma: the Lymphoma Study Association SIMONAL cross-sectional study. Cancer. 2019;125(13):2291–9. - PubMed
    1. Armenian SH, Sun CL, Vase T, Ness KK, Blum E, Francisco L, et al. Cardiovascular risk factors in hematopoietic cell transplantation survivors: role in development of subsequent cardiovascular disease. Blood. 2012;120(23):4505–12. - PMC - PubMed
    1. Arranto CA, Burkard T, Leuppi-Taegtmeyer AB, Gerull S, Passweg JR, Pfister O, et al. Prevalence of untreated and uncontrolled cardiovascular risk factors in survivors of allogeneic cell transplantation. Bone Marrow Transpl. 2021;56(1):167–74. - PubMed
    1. Limbach M, Kuehl R, Dreger P, Luft T, Rosenberger F, Kleindienst N, et al. Influencing factors of cardiorespiratory fitness in allogeneic stem cell transplant candidates prior to transplantation. Support Care Cancer. 2021;29(1):359–67. - PMC - PubMed

Publication types

MeSH terms

Associated data