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Maximal cardiopulmonary exercise testing in childhood acute lymphoblastic leukemia survivors exposed to chemotherapy

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Abstract

Purpose

The purpose of this study was to demonstrate if childhood acute lymphoblastic leukemia (ALL) survivors exposed to chemotherapy (i.e., doxorubicin) are able to achieve a safe maximal cardiopulmonary exercise test (CPET).

Methods

A total of 250 childhood ALL survivors were eligible to undergo a CPET on ergocycle. Analyses were performed in 216 survivors and stratified in regard to their prognostic risk groups: 99 survivors (55 males and 44 females) at standard risk and 117 survivors (56 males and 61 females) at high risk.

Results

Results showed that 100% (n = 216) of survivors completed a maximal CPET confirmed by the achievement of two out of three of the following criteria: 197 survivors (91.2%) reached a peak RER value of ≥ 1.15, 197 survivors (91.2%) reached a RPE score > 7, and 210 survivors (97.2%) reached a maximal heart rate ≥ 85% of the predicted value. Linear regression analysis showed a significant association between the survivors’ cumulative dose of doxorubicin and their VO2 peak measured. Two non-fatal adverse events were observed and reported at the end of the maximal CPET, while non-fatal adverse events were reported in 5 survivors during the recovery period. None of these events resulted in a long-term complication.

Conclusion

Childhood ALL survivors with prior exposure to chemotherapy can achieve a safe maximal CPET. They were able of achieving a maximal exercise test without being limited by symptoms, potential overprotection, or musculoskeletal issues. Thus, it should be the norm to realize a CPET prior a physical activity program to propose an optimal prescription. This study provides important information regarding the maximal physiological parameters that childhood ALL survivors are able to reach and have important clinical implications in the exercise and oncology field for this population of survivors.

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Acknowledgments

We appreciate the assistance of Ariane Levesque (McGill University) for her review of the article in the English language.

Funding

This work was supported by the Institute of Cancer Research (ICR) of the Canadian Institutes of Health Research (CIHR), in collaboration with C17 Council, Canadian Cancer Society (CCS), Cancer Research Society (CRS), Garron Family Cancer Centre at the Hospital for Sick Children, Ontario Institute for Cancer Research (OICR), and Pediatric Oncology Group of Ontario (POGO). This research was also supported in part by PhD study grants from the Canadian Research Data Centre Network and the Quebec inter-University Centre for Social Statistics, Cole Foundation, Fonds de Recherche du Québec – Santé (FRQS), Sainte-Justine University Hospital Center Foundation and Foundation of Stars. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Authors and Affiliations

  1. Laboratory of Pathophysiology of EXercise (LPEX), School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, University of Montreal, CEPSUM, 2100, boulevard Édouard Montpetit, Montréal, QC, H3C 3J7, Canada

    Maxime Caru, Valerie Lemay & Daniel Curnier

  2. Sainte-Justine University Health Center, Research Center, Montreal, Canada

    Maxime Caru, Caroline Laverdière, Valerie Lemay, Simon Drouin, Laurence Bertout, Maja Krajinovic, Gregor Andelfinger, Daniel Sinnett & Daniel Curnier

  3. Laboratoire EA 4430 – Clinique Psychanalyse Developpement (CliPsyD), Department of Psychology, University of Paris Nanterre, Nanterre, France

    Maxime Caru

  4. Department of Pediatrics, University of Montreal, Montreal, Canada

    Caroline Laverdière, Maja Krajinovic, Gregor Andelfinger & Daniel Sinnett

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  1. Maxime Caru
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Corresponding author

Correspondence to Maxime Caru.

Ethics declarations

Written informed consent was obtained from every patient or parent/legal guardian. The PETALE study was conducted in accordance with the Declaration of Helsinki, and the protocol was approved by the Ethics Review Committee of SJUHC (2013-3607).

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The authors declare that they have no competing interests.

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Caru, M., Laverdière, C., Lemay, V. et al. Maximal cardiopulmonary exercise testing in childhood acute lymphoblastic leukemia survivors exposed to chemotherapy. Support Care Cancer 29, 987–996 (2021). https://doi.org/10.1007/s00520-020-05582-y

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