The effect of High Intensity Interval Exercise on Platelet Engraftment in Autologous Bone Marrow Transplantation (BMT)
Abstract
Background: Thrombocytopenia is a frequent complication after hematopoietic stem cell transplantation (HSCT). Although platelet transfusion is the most used treatment for severe thrombocytopenia, it is associated with well-established risks. High-intensity interval exercise (HIIE) results in thrombocytosis. Therefore, this study aimed to reduce thrombocytopenia by increasing platelet count through exercise.
Materials and Methods: Twenty lymphoma and multiple myeloma patients were divided into HIIE and control groups. To determine the maximal exercise capacity, patients in the HIIE group performed a graded exercise test. All patients received granulocyte colony-stimulating factor for 5 days, followed by a HIIE trial. After 5 min warm up at 10 to 20% of peak power, patients in the HIIE group performed an HIIE protocol that included 12 intervals of one-minute work at 100% peak power interspersed by one-minute active rest at 20% of peak power. Patients in the control group were seated for the same duration without any physical activity. Two blood samples were taken before and immediately after the trials and were analyzed for measuring complete blood count.
Results: Platelet count on the day of platelet engraftment in the HIIE group was significantly higher than in the control group (P=0.02). Single-donor platelet transfusion was significantly lower in the HIIE group than in the control group (P=0.05).
Conclusion: Based on the findings of the present study, a short bout of HIIE had a positive effect on platelet engraftment through thrombocytosis and reduced platelet transfusion and its complications, which could be a useful strategy for HSCT patients.
1. Majhail NS, Farnia SH, Carpenter PA, et al. Indications for autologous and allogeneic hematopoietic cell transplantation: guidelines from the American Society for Blood and Marrow Transplantation. Biol Blood Marrow Transplant. 2015; 21(11): 1863–1869.
2. Kim DH, Sohn SK, Baek JH, et al. Clinical significance of platelet count at day+ 60 after allogeneic peripheral blood stem cell transplantation. J Korean Med Sci. 2006;21(1):46-51.
3. Shaw JL, Nielson CM, Park JK, et al. The incidence of thrombocytopenia in adult patients receiving chemotherapy for solid tumors or hematologic malignancies. Eur J Haematol. 2021;106(5):662-72.
4. Izak M, Bussel JB. Management of thrombocytopenia. F1000 Prime Rep. 2014;6:45.
5. Li Y, Guo R, Wang L, et al. G-CSF administration results in thrombocytopenia by inhibiting the differentiation of hematopoietic progenitors into megakaryocytes. Biochem Pharmacol. 2019;169:113624.
6. Trivedi M, Martinez S, Corringham S, et al. Optimal use of G-CSF administration after hematopoietic SCT. Bone Marrow Transplant. 2009;43(12):895-908.
7. Nash RA, Gooley T, Davis C, et al. The problem of thrombocytopenia after hematopoietic stem cell transplantation. Oncologist. 1996;1(6):371-80.
8. Razonable RR, Paya CV, Smith TF. Role of the laboratory in diagnosis and management of cytomegalovirus infection in hematopoietic stem cell and solid-organ transplant recipients. J Clin Microbiol. 2002;40(3):746-52.
9. Morishita S, Nakano J, Fu JB, et al. Physical exercise is safe and feasible in thrombocytopenic patients with hematologic malignancies: a narrative review. Hematology. 2020;25(1):95-100.
10. Schmitz KH, Courneya KS, Matthews C, et al. American college of sports medicine roundtable on exercise guidelines for cancer survivors. Med Sci Sports Exerc. 2010;42(7):1409-26.
11. Zar A, Ahmadi F, Krustrup P, et al. Effect of high-intensity interval exercise in the morning and evening on platelet indices and exercise-induced thrombocytosis. Middle EastJ Rehabil Health Stud. 2020;7(3):e104417.
12. Licker M, Karenovics W, Diaper J, et al. Short-term preoperative high-intensity interval training in patients awaiting lung cancer surgery: a randomized controlled trial. J Thorac Oncol. 2017;12(2):323-33.
13. Ahmadizad S, Nouri-Habashi A, Rahmani H, et al. Platelet activation and function in response to high intensity interval exercise and moderate continuous exercise in CABG and PCI patients. Clin Hemorheol Microcirc. 2016;64(4):911-919.
14. Ahmadizad S, Rahmani H, Khosravi N, et al. Acute responses of platelet count and ADP-induced platelet aggregation to different high intensity interval exercise modes. Clin Hemorheol Microcirc. 2020;75(4):467-474.
15. Tschakert G, Kroepfl JM, Mueller A, et al. Acute physiological responses to short-and long-stage high-intensity interval exercise in cardiac rehabilitation: a pilot study. J Sports Sci Med. 2016;15(1):80-91.
16. Großek A, Elter T, Oberste M, et al. Feasibility and suitability of a graded exercise test in patients with aggressive hemato-oncological disease. Support Care Cancer. 2021;29(8):4859-4866.
17. Saba F, Soleimani M, Atashi A, et al. The role of the nervous system in hematopoietic stem cell mobilization. Lab Hematol. 2013;19(3):8-16.
18. Alcaina PS. Platelet transfusion: And update on challenges and outcomes. J Blood Med. 2020;11:19-26.
19. Emmons R, Niemiro GM, De Lisio M. Exercise as an adjuvant therapy for hematopoietic stem cell mobilization. Stem Cells Int. 2016;2016:7131359.
20. Roshandel E, Kaviani S, Hajifathali A, et al. Pre-transplant thrombocytopenia predicts engraftment time and blood products requirement in allogeneic hematopoietic stem cell transplantation patients. Transfus Apher Sci. 2020;59(4):102810.
21. Li Y, Guo R, Wang L, et al. G-CSF administration results in thrombocytopenia by inhibiting the differentiation of hematopoietic progenitors into megakaryocytes. Biochem Pharmacol. 2019;169:113624.
22. El-Sayed MS, El-Sayed Ali Z, Ahmadizad S. Exercise and training effects on blood haemostasis in health and disease. Sports Med. 2004;34(3):181-200.
23. Wang J, Zhou P, Han Y, et al. Platelet transfusion for cancer secondary thrombocytopenia: platelet and cancer cell interaction. Transl Oncol. 2021;14(4):101022.
24. Mina A, Platanias LC. Increasing megakaryopoiesis without promoting the malignant clone in myeloid malignancies. Leuk Lymphoma. 2020;61(10):2289-91.
25. Emmons R, Niemiro GM, Owolabi O, et al. Acute exercise mobilizes hematopoietic stem and progenitor cells and alters the mesenchymal stromal cell secretome. J Appl Physiol. 2016;120(6):624-32.
26. Fortunel NO, Hatzfeld A, Hatzfeld JA. Transforming growth factor-β: pleiotropic role in the regulation of hematopoiesis. Blood. 2000;96(6):2022-36.
27. Baria MR, Miller MM, Borchers J, et al. High Intensity Interval Exercise Increases Platelet and Transforming Growth Factor‐β Yield in Platelet‐Rich Plasma. PM R. 2020;12(12):1244-1250.
28. Guo T, Wang X, Qu Y, et al. Megakaryopoiesis and platelet production: insight into hematopoietic stem cell proliferation and differentiation. Stem Cell Investig. 2015;2:3.
29. Stakiw J, Bowman M, Hegadorn C, et al. The effect of exercise on von Willebrand factor and ADAMTS‐13 in individuals with type 1 and type 2B von Willebrand disease. J Thromb Haemost. 2008;6(1):90-6.
30. Devin JL, Hill MM, Mourtzakis M, et al. Acute high intensity interval exercise reduces colon cancer cell growth. J Physiol. 2019;597(8):2177-2184.
31. van Haren IE, Staal JB, Potting CM, et al. Physical exercise prior to hematopoietic stem cell transplantation: a feasibility study. Physiother Theory Pract. 2018;34(10):747-756.
32. Van Staveren S, Ten Haaf T, Klöpping M, et al. Multi-dimensional flow cytometry analysis reveals increasing changes in the systemic neutrophil compartment during seven consecutive days of endurance exercise. PLoS One. 2018;13(10):e0206175.
33. Su SH, Jen CJ, Chen HI. NO signaling in exercise training-induced anti-apoptotic effects in human neutrophils. Biochem Biophys Res Commun. 2011;405(1):58-63.
2. Kim DH, Sohn SK, Baek JH, et al. Clinical significance of platelet count at day+ 60 after allogeneic peripheral blood stem cell transplantation. J Korean Med Sci. 2006;21(1):46-51.
3. Shaw JL, Nielson CM, Park JK, et al. The incidence of thrombocytopenia in adult patients receiving chemotherapy for solid tumors or hematologic malignancies. Eur J Haematol. 2021;106(5):662-72.
4. Izak M, Bussel JB. Management of thrombocytopenia. F1000 Prime Rep. 2014;6:45.
5. Li Y, Guo R, Wang L, et al. G-CSF administration results in thrombocytopenia by inhibiting the differentiation of hematopoietic progenitors into megakaryocytes. Biochem Pharmacol. 2019;169:113624.
6. Trivedi M, Martinez S, Corringham S, et al. Optimal use of G-CSF administration after hematopoietic SCT. Bone Marrow Transplant. 2009;43(12):895-908.
7. Nash RA, Gooley T, Davis C, et al. The problem of thrombocytopenia after hematopoietic stem cell transplantation. Oncologist. 1996;1(6):371-80.
8. Razonable RR, Paya CV, Smith TF. Role of the laboratory in diagnosis and management of cytomegalovirus infection in hematopoietic stem cell and solid-organ transplant recipients. J Clin Microbiol. 2002;40(3):746-52.
9. Morishita S, Nakano J, Fu JB, et al. Physical exercise is safe and feasible in thrombocytopenic patients with hematologic malignancies: a narrative review. Hematology. 2020;25(1):95-100.
10. Schmitz KH, Courneya KS, Matthews C, et al. American college of sports medicine roundtable on exercise guidelines for cancer survivors. Med Sci Sports Exerc. 2010;42(7):1409-26.
11. Zar A, Ahmadi F, Krustrup P, et al. Effect of high-intensity interval exercise in the morning and evening on platelet indices and exercise-induced thrombocytosis. Middle EastJ Rehabil Health Stud. 2020;7(3):e104417.
12. Licker M, Karenovics W, Diaper J, et al. Short-term preoperative high-intensity interval training in patients awaiting lung cancer surgery: a randomized controlled trial. J Thorac Oncol. 2017;12(2):323-33.
13. Ahmadizad S, Nouri-Habashi A, Rahmani H, et al. Platelet activation and function in response to high intensity interval exercise and moderate continuous exercise in CABG and PCI patients. Clin Hemorheol Microcirc. 2016;64(4):911-919.
14. Ahmadizad S, Rahmani H, Khosravi N, et al. Acute responses of platelet count and ADP-induced platelet aggregation to different high intensity interval exercise modes. Clin Hemorheol Microcirc. 2020;75(4):467-474.
15. Tschakert G, Kroepfl JM, Mueller A, et al. Acute physiological responses to short-and long-stage high-intensity interval exercise in cardiac rehabilitation: a pilot study. J Sports Sci Med. 2016;15(1):80-91.
16. Großek A, Elter T, Oberste M, et al. Feasibility and suitability of a graded exercise test in patients with aggressive hemato-oncological disease. Support Care Cancer. 2021;29(8):4859-4866.
17. Saba F, Soleimani M, Atashi A, et al. The role of the nervous system in hematopoietic stem cell mobilization. Lab Hematol. 2013;19(3):8-16.
18. Alcaina PS. Platelet transfusion: And update on challenges and outcomes. J Blood Med. 2020;11:19-26.
19. Emmons R, Niemiro GM, De Lisio M. Exercise as an adjuvant therapy for hematopoietic stem cell mobilization. Stem Cells Int. 2016;2016:7131359.
20. Roshandel E, Kaviani S, Hajifathali A, et al. Pre-transplant thrombocytopenia predicts engraftment time and blood products requirement in allogeneic hematopoietic stem cell transplantation patients. Transfus Apher Sci. 2020;59(4):102810.
21. Li Y, Guo R, Wang L, et al. G-CSF administration results in thrombocytopenia by inhibiting the differentiation of hematopoietic progenitors into megakaryocytes. Biochem Pharmacol. 2019;169:113624.
22. El-Sayed MS, El-Sayed Ali Z, Ahmadizad S. Exercise and training effects on blood haemostasis in health and disease. Sports Med. 2004;34(3):181-200.
23. Wang J, Zhou P, Han Y, et al. Platelet transfusion for cancer secondary thrombocytopenia: platelet and cancer cell interaction. Transl Oncol. 2021;14(4):101022.
24. Mina A, Platanias LC. Increasing megakaryopoiesis without promoting the malignant clone in myeloid malignancies. Leuk Lymphoma. 2020;61(10):2289-91.
25. Emmons R, Niemiro GM, Owolabi O, et al. Acute exercise mobilizes hematopoietic stem and progenitor cells and alters the mesenchymal stromal cell secretome. J Appl Physiol. 2016;120(6):624-32.
26. Fortunel NO, Hatzfeld A, Hatzfeld JA. Transforming growth factor-β: pleiotropic role in the regulation of hematopoiesis. Blood. 2000;96(6):2022-36.
27. Baria MR, Miller MM, Borchers J, et al. High Intensity Interval Exercise Increases Platelet and Transforming Growth Factor‐β Yield in Platelet‐Rich Plasma. PM R. 2020;12(12):1244-1250.
28. Guo T, Wang X, Qu Y, et al. Megakaryopoiesis and platelet production: insight into hematopoietic stem cell proliferation and differentiation. Stem Cell Investig. 2015;2:3.
29. Stakiw J, Bowman M, Hegadorn C, et al. The effect of exercise on von Willebrand factor and ADAMTS‐13 in individuals with type 1 and type 2B von Willebrand disease. J Thromb Haemost. 2008;6(1):90-6.
30. Devin JL, Hill MM, Mourtzakis M, et al. Acute high intensity interval exercise reduces colon cancer cell growth. J Physiol. 2019;597(8):2177-2184.
31. van Haren IE, Staal JB, Potting CM, et al. Physical exercise prior to hematopoietic stem cell transplantation: a feasibility study. Physiother Theory Pract. 2018;34(10):747-756.
32. Van Staveren S, Ten Haaf T, Klöpping M, et al. Multi-dimensional flow cytometry analysis reveals increasing changes in the systemic neutrophil compartment during seven consecutive days of endurance exercise. PLoS One. 2018;13(10):e0206175.
33. Su SH, Jen CJ, Chen HI. NO signaling in exercise training-induced anti-apoptotic effects in human neutrophils. Biochem Biophys Res Commun. 2011;405(1):58-63.
| Files | ||
| Issue | Vol 18 No 3 (2024) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijhoscr.v18i3.16104 | |
| Keywords | ||
| Hematopoietic stem cell transplantation (HSCT) Autologous transplantation Thrombocytosis Thrombocytopenia Platelet transfusion | ||
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How to Cite
1.
Zarekar T, Hajifathali A, Ahmadizad S. The effect of High Intensity Interval Exercise on Platelet Engraftment in Autologous Bone Marrow Transplantation (BMT). Int J Hematol Oncol Stem Cell Res. 2024;18(3):240-248.
