Effects of exercise in combination with Epoetin Alfa during high-dose chemotherapy and autologous peripheral blood stem cell transplantation for multiple myeloma

Purpose/Objectives: To determine the effect of aerobic and strength resistance training and epoetin alfa (EPO) therapy on transfusions, stem cell collections, transplantation recovery, and multiple myeloma treatment response. Design: Randomized clinical trial. Setting: A myeloma research and therapy center in the south central United States. Sample: 135 patients with multiple myeloma, 120 evaluable. Methods: Random assignment to exercise or usual care groups. All patients received EPO based on an algorithm. Aerobic capacity, using the six-minute walk test, was assessed prior to induction chemotherapy, prior to stem cell mobilization, and following stem cell collection for all patients and before and after transplantation for patients continuing in the study. Data analysis included analysis of variance to compare other outcome variables by groups. Main Research Variables: Number of red blood cell and platelet transfusions during transplantation, number of attempts at and total number of days of stem cell collection, time to recovery after transplantation, and response to intensive therapy for multiple myeloma. Findings: Recovery and treatment response were not significantly different between groups after transplantation. The exercise group had significantly fewer red blood cell transfusions and fewer attempts at stem cell collection. Serious adverse events were similar in each group. Conclusions: Exercise with prophylactic EPO therapy reduces the number of RBC transfusions and attempts at stem cell collection for patients receiving intensive treatment for multiple myeloma. Implications for Nursing: Exercise is safe and has many physiologic benefits for patients receiving multiple myeloma treatment.