Jump to content

Physiotherapy in Stem Cell Transplantation

Original Editor - Nnenna Nina Chigbo Top Contributors - Nnenna Nina Chigbo and Lucinda hampton

Top Contributors - Nnenna Nina Chigbo and Lucinda hampton  

Introduction

Stem cells are special progenitor cells in the body that can regenerate into different types of cells. it is now a major part of regenerative medicine.

Stem cells can:

  1. Turn into different cell types
  2. Help with immune system issues
  3. Treat blood cancers

The two main types of stem cells are: Embryonic stem cells (ESCs) and; Adult stem cells (ASCs). ESCs: Can become any cell in the body but also raise ethical concerns. Other stem cell sources include: Induced pluripotent stem cells (iPSCs); Adult stem cells (ASCs), including: Mesenchymal stem cells, neural stem cells and hematopoietic stem cells (HSCs). These other sources are being studied more due to fewer ethical issues.[1]

Stem Cell Transplantation is defined as infusion of cells harvested from the patient or a donor

Types

  1. Autologous: Cells from the patient
  2. Allogeneic: Cells from a donor
  3. Syngeneic: Cells from the patient's twin • Eliminates concerns for chronic graft versus host disease

Primary Aim

To augment dysfunctional bone marrow cells.

Autologous stem cell transplant

Uses

For both malignant and non-malignant diseases

Examples of Conditions Treated:

Note: This list is not exhaustive and includes examples of conditions treated with autologous stem cell transplant[2]

The Process

Allogeneic stem cell transplant

A stem cell transplant has 5 main stages [3]. These are:

  1. Tests and examinations
  2. Harvesting/collecting the cells for transplant
  3. Conditioning – The patients are given high dose chemotherapy or whole body irradiation to reduce the burden of cancer cells in the body before transplantation.
  4. Transplanting the stem cells.
  5. Recovery – this the period the body begins to regenerate cells and the body accepts and functions with the new cells

Complications

  • Graft versus host disease (GvHD)
  • Reduced number of blood cells – haemoglobin, white blood cells, platelets and neutrophils are reduced to critical points that can lead to iron deficiency anaemia, excessive bleeding or bruising, and an increased risk of infections
  • Chemotherapy side effects – including sickness, tiredness/fatigue, hair loss and infertility [4]

Physiotherapy intervention

Need - evidence shows that transplant patients decondition during long stay elective admissions. It also can be postulated that physical activity can help patients remain functional and be better equipped to handle side effects of the therapy of which fatigue and decrease in mobility are very common

The aim of physiotherapy for patients undergoing stem cell transplant will be :

  • Early identification of rehabilitation needs eg pre-existing neurological, respiratory or musculoskeletal conditions
  • Physical activity promotion for long stay elective admissions
  • Structured physiotherapy intervention to reduce length of hospital stay
  • Early referral to other specialties eg occupational therapy
  • Programmed re-integration into society and return to work if applicable [5][6]

Suggested protocol for physiotherapy intervention:

  • Pre-habilitation which should be done a couple of weeks before the transplant. The essence is to aid recovery from previous chemotherapy and radiotherapy and prepare the body for the anticipated deconditioning after cell transplant [7][8]
  • Initial contact during in-patient admission including subjective, objective assessment, analysis of findings and a therapy plan including discharge planning and return to work
  • Routine check in within the minimum of 14 days admission or according to hospital policy
  • Final check to clear patients for discharge and re-integration into society

The initial assessment will provide baseline functional assessment for the therapist to compare with during the admission. A brief assessment of movement and function as well as cardiopulmonary fitness will give a fair baseline to monitor throughout the admission. [6]

Some basic tests include:

  • Balance assessment for stable transfers
  • Sit to stand test
  • Timed unsupported stand
  • Gross muscle power for all four limbs
  • Need for assistive devices for falls prevention
  • Pain assessment
  • Functional assessment using the Karnofsky Performance Scale[9]

Resources

References

  1. ↑ Raghav PK. Improving stem cell transplantation delivery using computational modelling. Frontiers in Immunology. 2025 Mar 10;16:1579353.Available:https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2025.1579353/full (accessed 14.8.2025)
  2. ↑ Sakuru R, Bollu PC Hurler Syndrome. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532261/ accessed on 9/12/2023
  3. ↑ National Health Service (2022). Stem Cell Transplant-what happens. Available from https://www.nhs.uk/conditions/stem-cell-transplant/what-happens/ (retrieved 3/12/2023) [1]
  4. ↑ Cancer Research UK. Stem cell transplant/complications. Available from https://www.cancerresearchuk.org/about-cancer/treatment/bone-marrow-stem-cell-transplants/side-effects (Retrieved 3/12/2023) [2]
  5. ↑ Mohammed J, Aljurf M, Althumayri A, Almansour M, Alghamdi A, Hamidieh AA et al.  Physical therapy pathway and protocol for patients undergoing hematopoietic stem cell transplantation: Recommendations from The Eastern Mediterranean Blood and Marrow Transplantation (EMBMT) Group. Hematology/oncology and stem cell therapy. 2019;'12(3):127–132.
  6. ↑ 6.0 6.1 Mohammed J, Smith SR., Burns L, Basak G, Aljurf M, Savani BN et al.  Role of Physical Therapy before and after Hematopoietic Stem Cell Transplantation: White Paper Report. Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation. 2019;'25(6):e191–e198.
  7. ↑ Steinberg A, Asher A, Bailey C, Fu JB. The role of physical rehabilitation in stem cell transplantation patients. Support Care Cancer. 2015; 23(8):2447-60.
  8. ↑ 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 Jan;29(1):359-367.
  9. ↑ National Palliative Care Research Center. Karnofsky Performance Scale. Available from http://www.npcrc.org/files/news/karnofsky_performance_scale.pdf (retrieved on 3/12/2023) [3]
Retrieved from "https://www.physio-pedia.com/w/index.php?title=Physiotherapy_in_Stem_Cell_Transplantation&oldid=371293"