Rehabilitation following bone marrow transplantation

Bone marrow transplantation and stem cell transplantation are increasingly used to treat hematologic malignancies and some solid tumors. The treatment entails bone marrow-ablative therapies and intensive medical support to su stain the patient through pancytopenia and other complications of the disea se, transplantation process, or drug side effects. Patients who develop gra ft-versus-host disease are the most difficult subset of transplant recipien ts to manage. Most transplant recipients perform at normal or near-normal f unctional levels at the inception of the transplantation process but are at high risk for developing functional deficits as a result of cumulative imp airments. These impairments arise from their disease, their prior cancer tr eatment, transplant induction, graft-versus-host disease, immobility, infec tion, steroid-related side effects, and other sequelae of transplantation. Preventive and preemptive rehabilitation interventions can minimize functio nal loss and facilitate recovery, but the transplantation team must be sens itive to and regularly assess for early functional declines in these patien ts. The physiatrist and the other members of the rehabilitation team must b e thoroughly acquainted with the unique needs and challenges of the bone ma rrow transplantation population in order to design and modify treatment pro grams effectively and safely. Outcome research has shown that some patients have continued limitations in function despite successful transplantation. Few evidence-based data are available that addresses factors correlating w ith poor functional outcomes other than graft-versus-host disease. However, this disease has not been investigated utilizing objective functional inst ruments. Future research should more clearly elucidate the functional impac t of allogeneic and autologous transplants by using standardized physical p erformance measures as well as thorough function-based symptotology questio nnaires. (C) 2001 American Cancer Society.