Oral Presentation Clinical Oncology Society of Australia 2014 Annual Scientific Meeting

Positive Change for Life – Preliminary results of a 12 month lifestyle intervention program on metabolic syndrome risk factors in haemopoeitic stem cell transplant survivors (#62)

Elizabeth Viner Smith 1 , Audrey C Tierney 1 2 , Helen McLauchlan 3 , Sharon Avery 3
  1. Department of Nutrition and Dietetics, Alfred Health, Melbourne, Victoria, Australia
  2. Department of Dietetics and Human Nutrition, La Trobe University, Melbourne, Victoria, Australia
  3. Malignant Haematology and Stem Cell Transplantation Service, Alfred Health, Melbourne, Victoria, Australia

Aim: Haemopoeitic Stem Cell Transplant (HSCT) survivors are at increased risk of developing late effects, including those associated with metabolic syndrome1. The risk of developing type 2 diabetes mellitus and atherosclerotic cardiovascular disease increases significantly with the presence of obesity, hyperglycaemia, dyslipidemia or hypertension1. Studies in solid tumour survivors identified nutrition and/or physical activity interventions can potentially reduce treatment side-effects2. Little evidence exists for such programs in HSCT survivors. This study aimed to determine the benefit of a 12 month lifestyle intervention program on reducing the number and/or severity of metabolic syndrome components in HSCT survivors. 

Method: HSCT survivors ≥2 years post autologous or allogeneic transplantation were recruited from July 2012 to July 2013. Program implementation included baseline and 12 month medical reviews, individualised physiotherapist devised exercise programs and nutrition counselling based on the previously described COACH model3. Outcomes were measured at baseline and 12 months.

Results: 53 survivors (53% female), median age 47.8 (range, 24.6-67.6) years, participated. Median time since transplantation (autologous or allogeneic) was 5.1 (range, 1.8-15.4) years. Mean baseline weight was 81.8 (±16.0) kilograms reducing to 78.2 (±15.1) kilograms at 12 months (p<0.001). Waist circumference decreased from a mean of 98.0 (±13.5) centimetres to 94.8 (±12.5) centimetres (p<0.001). Median fasting glucose levels changed from 4.8 (25-75th percentile, 4.5-5.2) mmol/L to 5.0 (25-75th percentile, 4.5-5.3) mmol/L (p=0.06). Median fasting HDL levels were 1.4mmol/L at baseline (25-75th percentile, 1.2-1.6) and 12 months (25-75th percentile, 1.2-1.7) (p=0.02). While a decrease in mean systolic blood pressure was non-significant (129±16mmHg to 127±15mmHg) (p=0.70), 47% of participants reduced their systolic blood pressure by ≥4mmHg. Median diastolic blood pressure levels increased from 80 (25-75th percentile, 73-86) mmHg to 83 (25-75th percentile, 71-85) mmHg (p=0.16).

Conclusion: Results indicate lifestyle related intervention programs are effective in reducing risk factors associated with metabolic syndrome in HSCT survivors.

  1. Baker KS, Armenian S, Bhatia S. Long-term consequences of hematopoietic stem cell transplantation: current state of the science. Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation 2010; 16(1 Suppl): S90-96.
  2. Hung Y-C, Bauer JD, Horsely P, Coll J, Bashford J, Isenring, EA. Telephone-delivered nutrition and exercise counselling after auto-SCT: a pilot, randomised controlled trial. Bone Marrow Transplantation 2014; 49, 786-792.
  3. Vale MJ, Jelinek MV, Grigg LE, Newman, RW. Coaching patients On Achieving Cardiovascular Health (COACH). Archives of Internal Medicine 2003; 163 (22), 2775-83.