Faculty Collaboration Database

Assessing physical function in transplantation and CAR-T recipients: expert recommendations from the survivorship, aging and biobehavioral special interest groups of ASTCT. Transplant Cell Ther 2025 Oct;31(10):742-755

Date

06/23/2025

Pubmed ID

40545000

Pubmed Central ID

PMC13189036

DOI

10.1016/j.jtct.2025.06.017

Scopus ID

2-s2.0-105010897985 (requires institutional sign-in at Scopus site)   2 Citations

Abstract

The past few decades have witnessed significant advancements in stem cell transplantation and cell therapy (TCT). This has allowed their expanded use in older patients and those with comorbidities with favorable outcomes. However, these procedures carry significant risks, such as graft-versus-host disease, infection, cytokine release syndrome, and immune effector cell-associated neurotoxicity. Therefore, physical function assessment is crucial to assess patient fitness and potential optimization before and after TCT. The existence of diverse assessment tools makes implementation, comparison, and sharing knowledge among centers difficult. This paper proposes a tiered approach aiming to harmonize physical assessment in the TCT. This allows healthcare facilities to prioritize recommended assessments based on their current capabilities and resources. TCT patients should receive comprehensive physical assessments pre- and post-TCT using a combination of both patient-reported and objective measures. For patient-reported measures, the Patient-Reported Outcomes Measurement Information System should be considered. For objective measures, we recommend considering a physical performance assessment (eg, gait speed) or muscle strength assessment (eg, hand grip), if feasible. Albumin and C reactive protein are also informative in predicting the risk of nonrelapse mortality. Other composite tools, questionnaire libraries, biomarkers, imaging, and wearables can be added according to research and clinical needs. A care workflow needs to be in place in case any impairment is found during the evaluation with goals of increasing physiologic reserve and mitigating stressors. This tiered approach will increase awareness and adoption of these tools and hence improve patient care, facilitate data sharing, and enhance collaboration in this field.

Author List

Farhan S, Kennedy VE, Espinoza-Gutarra MR, Lust H, Bobillo MSO, Lin AY, Olin RL, Lin RJ, Rentscher KE, Taylor MR, Mohanraj L, Wood WA, Murthy HS, Ahmed N, Dueck AC, Phelan R, Kelly DL, Yuen C, Munshi PN, Schoemans H, Hamilton BK, Lee C, Sung AD

Authors

Rachel A. Phelan MD, MPH Professor in the Pediatrics department at Medical College of Wisconsin
Kelly E. Rentscher PhD Assistant Professor in the Psychiatry and Behavioral Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aging
Graft vs Host Disease
Humans
Immunotherapy, Adoptive
Stem Cell Transplantation
Survivorship