title: Prognostic Importance of Pretransplant Functional Capacity After Allogeneic Hematopoietic Cell Transplantation.
abstract: BACKGROUND
  The purpose of this study was to investigate the prognostic importance of functional capacity in patients undergoing allogeneic hematopoietic cell transplantation (HCT) for hematological malignancies.
  
  
  METHODS
  Using a retrospective design, 407 patients completed a 6-minute walk distance (6 MWD) test to assess functional capacity before HCT; 193 (47%) completed a 6 MWD test after hospital discharge. Cox proportional hazards regression was used to estimate the risk of nonrelapse mortality (NRM) and overall survival (OS) according to the 6 MWD category (<400 m vs. ≥ 400 m) and the change in 6 MWD (before HCT to discharge) with or without adjustment for Karnofsky performance status (KPS), age, and other prognostic markers.
  
  
  RESULTS
  Compared with <400 m, the unadjusted hazard ratio for NRM was 0.65 (95% confidence interval, 0.44-0.96) for a 6 MWD ≥ 400 m. A 6 MWD of ≥ 400 m provided incremental information on the prediction of NRM with adjustment for age (p = .032) but not KPS alone (p = .062) or adjustment for other prognostic markers (p = .099). A significant association was found between the 6 MWD and OS (p = .027). A 6 MWD of ≥ 400 m provided incremental information on the prediction of OS with adjustment for age (p = .032) but not for other prognostic markers (p > .05 for all). Patients presenting with a pre-HCT 6 MWD of <400 m and experiencing a decline in 6 MWD had the highest risk of NRM.
  
  
  CONCLUSIONS
  The 6 MWD is a significant univariate predictor of clinical outcomes but did not provide prognostic information beyond that of traditional prognostic markers in HCT.
  
  
  CONCLUSIONS
  The pretransplant 6-minute walk test is a significant univariate predictor of clinical outcomes in hematological patients beyond age but not beyond that of performance status. On this basis, 6-minute walk distance testing should not be considered part of the standard battery of assessments for risk stratification before hematopoietic cell transplantation.
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York, New York, USA Weill Cornell Medical College, Cornell University, New York, New York, USA jonesl3@mskcc.org.
authors.forename: Lee W
authors.initials: LW
authors.lastname: Jones
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York, New York, USA Weill Cornell Medical College, Cornell University, New York, New York, USA.
authors.forename: Sean M
authors.initials: SM
authors.lastname: Devlin
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York, New York, USA Weill Cornell Medical College, Cornell University, New York, New York, USA.
authors.forename: Molly A
authors.initials: MA
authors.lastname: Maloy
authors.affiliation: Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: William A
authors.initials: WA
authors.lastname: Wood
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York, New York, USA Weill Cornell Medical College, Cornell University, New York, New York, USA.
authors.forename: Sharlynn
authors.initials: S
authors.lastname: Tuohy
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York, New York, USA Weill Cornell Medical College, Cornell University, New York, New York, USA.
authors.forename: Noel
authors.initials: N
authors.lastname: Espiritu
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York, New York, USA Weill Cornell Medical College, Cornell University, New York, New York, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Aquino
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York, New York, USA Weill Cornell Medical College, Cornell University, New York, New York, USA.
authors.forename: Tiffany
authors.initials: T
authors.lastname: Kendig
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York, New York, USA Weill Cornell Medical College, Cornell University, New York, New York, USA.
authors.forename: Meghan G
authors.initials: MG
authors.lastname: Michalski
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York, New York, USA Weill Cornell Medical College, Cornell University, New York, New York, USA.
authors.forename: Boglarka
authors.initials: B
authors.lastname: Gyurkocza
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York, New York, USA Weill Cornell Medical College, Cornell University, New York, New York, USA.
authors.forename: Wendy L
authors.initials: WL
authors.lastname: Schaffer
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York, New York, USA Weill Cornell Medical College, Cornell University, New York, New York, USA.
authors.forename: Benzar
authors.initials: B
authors.lastname: Ali
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York, New York, USA Weill Cornell Medical College, Cornell University, New York, New York, USA.
authors.forename: Sergio
authors.initials: S
authors.lastname: Giralt
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York, New York, USA.
authors.forename: Ann A
authors.initials: AA
authors.lastname: Jakubowski
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005081:Exercise Therapy; D005260:Female; D019337:Hematologic Neoplasms / Q000473:pathology / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D016138:Walking
keywords: Cancer; Exercise; Functional capacity; Prognosis; Risk stratification; Survival