400 Section - Cumulative corticosteroid dose is associated with impaired sit-to-stand ability after hematopoietic stem cell transplantation

Corticosteroid therapy is widely used for the management of graft-versus-host disease (GVHD) after hematopoietic stem cell transplantation (HSCT). However, corticosteroid-induced muscle atrophy impairs sit-to-stand ability. This study aimed to identify factors associated with decline in sit-to-stand ability before and after HSCT.

Design:

This prospective study included 80 HSCT patients. Baseline data were age, sex, and Eastern Cooperative Oncology Group Performance Status (ECOG-PS). Transplant-related variables included conditioning intensity, acute GVHD grade, and cumulative corticosteroid dose during hospitalization (prednisolone-equivalent per body weight). Nutritional status was assessed with the Geriatric Nutritional Risk Index. Physical function was measured using the 30-second chair stand test (CS-30) before HSCT and on day 45 after HSCT, and the rate of change was calculated. Isometric knee extension strength (per body weight) and skeletal muscle mass index (via bioelectrical impedance analysis) were also measured. Multiple regression analysis was performed to identify factors associated with CS-30 change. The duration of preserved sit-to-stand ability was compared between low- and high-dose corticosteroid groups using log-rank tests and Cox proportional hazards models.

Results:

The median age was 52 years; 46% were female. The median cumulative corticosteroid dose was 37.2 mg/kg. In multiple regression analysis, higher corticosteroid dose was the only factor significantly associated with greater decline in CS-30 performance (β = –0.38; p < 0.01; R² = 0.24). The duration of preserved sit-to-stand ability was significantly shorter in the high-dose group (p < 0.01, log-rank). After adjusting for age, sex, ECOG-PS, knee strength, skeletal muscle mass, and acute GVHD grade, cumulative corticosteroid dose remained an independent predictor of reduced sit-to-stand ability (HR = 1.01; 95% CI = 1.00–1.00; p = 0.03, Cox).

Conclusion:

In HSCT patients, cumulative corticosteroid dose was the primary factor influencing decline in sit-to-stand ability. Higher steroid exposure may accelerate loss of sit-to-stand function.