Physiotherapy in Stem Cell Transplantation

Original Editor - User Name

Top Contributors - Nnenna Nina Chigbo  

Introduction

Stem cells are special progenitor cells in the body that can regenerate into different types of cells. Stem cell transplantation is defined as the intravenous infusion of cells harvested either from the patient or from a donor. This is referred to as autologous or allogeneic stem cell transplantation. It can also be termed syngeneic stem cell transplantation if the donor is the patient's twin. This type eliminates the concerns for chronic graft versus host disease. The primary aim is to augment dysfunctional bone marrow cells. The cells can be collected from bone marrow, peripheral blood, or umbilical cord blood to replace damaged or aberrant stem cells in a patient. It can be used for both malignant and non- malignant disease. Examples include but not limited to :

• severe aplastic anaemia
• leukaemia
• lymphoma
• multiple myeloma
• sickle cell anaemia
• thalassaemia
• severe combined immunodeficiency (SCID)
• Hurler syndrome

The Process

A stem cell transplant has 5 main stages . 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

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

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
• 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.

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

Resources

• British Bone Marrow Registry
• NHS Blood and Transplant
• Anthony Nolan