Oral Presentation 2025 National Cancer Survivorship Conference

Predictors of Cardiorespiratory Fitness Across the Allogeneic Stem Cell Transplant Care Continuum (#6)

Hayley T Dillon 1 2 , Nicholas J Saner 2 3 , Tegan Ilsley 2 4 , David S Kliman 5 6 , Stephen J Foulkes 7 8 , Andrew Spencer 5 , Sharon Avery 9 , David W Dunstan 1 2 , Robin M Daly 1 , Steve F Fraser 1 , Neville Owen 2 10 , Brigid M Lynch 2 11 12 , Bronwyn A Kingwell 2 13 , Andre La Gerche 7 14 15 16 , Erin J Howden 2 17
  1. Institute for Physical Activity and Nutrition, Deakin University, Melbourne, VIC, AU
  2. Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
  3. Institute for health and sport, Victoria University, Melbourne, VIC, Australia
  4. Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, AU
  5. Malignant Haematology and Stem Cell Transplantation Service, Alfred Hospital, Melbourne, VIC, Please Select, Australia
  6. Department of Haematology, Royal North Shore Hospital, Sydney, NSW, Australia
  7. Heart, Exercise and Research Trials (HEART) Lab, St Vincent's Institute, Melbourne, VIC, Australia
  8. Faculty of Nursing, University of Alberta, Edmonton, Canada
  9. Liz Plummer Cancer Care Centre, Cairns and Hinterland Health Service, Cairns, QLD, Australia
  10. Centre for Urban Transitions, Swinburne University of Technology, Melbourne, VIC, Australia
  11. Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, VIC, Australia
  12. Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
  13. CSL, Melbourne, VIC, AU
  14. Department of Cardiovascular Science, KU Leuven, Leuven, Belgium
  15. Cardiology Department, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
  16. HEART Lab, Victor Chang Cardiovascular Research Institute, Darlinghurst, NSW, Australia
  17. Baker Department of Cardiometabolic Health, University of Melbourne, Parkville, VIC, Australia

Background: Cardiovascular disease (CVD) is a leading cause of morbidity and mortality after allogeneic stem cell transplantation (SCT), yet effective risk stratification and prevention remain hindered by reliance on resting echocardiographic measures of left-ventricular function, which often fail to detect subclinical dysfunction. While evaluating cardiorespiratory fitness (VO2peak) has proven effective in unmasking cardiac dysfunction across the SCT care continuum, its time, cost, and expertise demands may limit widespread clinical adoption, highlighting the need for surrogate predictors. Objective: This study aimed to examine the relationship between VO2peak and echocardiographic measures of cardiac structure, which are established as strong independent predictors of VO2peak in other populations, in adults across the SCT care continuum. Methods: A total of 175 adults (96 SCT candidates, 62 early SCT survivors, 14 long-term SCT survivors) underwent 1) cardiopulmonary exercise testing to quantify VO2peak, and 2) resting echocardiography to quantify body surface area indexed left atrial systolic volume (LAVi), left ventricular mass (LVMi), and left-ventricular end-diastolic volume (LVEDVi). The relationships between VO2peak and candidate measures of resting cardiac structure were assessed using univariate, and multivariate linear regression adjusted for age and sex. Results: VO2peak showed a very weak association with LAVi (R2=0.04; standardised β: -0.19, p=0.13) and LVEDVi (R2=0.04; standardised β: 0.19, p=0.010), but both remained significant independent predictors of VO2peak after adjusting for age and sex (standardised  β: -0.39, p<0.001; standardised  β: 0.34, p<0.001). No significant association was found between VO2peak and LVMi (R2=0.01; standardised β: -0.07, p=0.38). Conclusion: Compared with previous reports in broader populations, LVEDVi,  LAVi and LVMi demonstrated significantly lower predictive ability for VO2peak across the SCT care continuum, making them unreliable surrogate predictors of cardiorespiratory fitness and CVD risk in this population.