Stage-related changes in functional capacity in Hodgkin’s disease: assessment by cardiopulmonary exercise testing before initiation of treatment

Abstract

Our aim was to examine indices of cardiorespiratory capacity at rest and during exercise before initiation of therapy for Hodgkin’s disease. We prospectively studied 24 patients divided into two groups according to the disease stage. Group 1 included eight patients in stage IA and four in stage IIA; group 2 included four patients in stage IIB, six in stage III, and two in stage IV. All patients underwent detailed cardiopulmonary evaluations at rest using electrocardiogram, echocardiogram, spirometry, and measurement of pulmonary diffusing capacity (DLCO), and during exercise using a cardiopulmonary exercise test. Groups 1 and 2 were similar with respect to sex distribution (eight women and four men in each), mean age (35±36 vs37±4.6 years), body mass index, and hemoglobin concentration (12.7±0.2 vs 12.1±0.3 g l⁻¹). All patients had a normal cardiovascular status. All patients in group 1 had normal cardiorespiratory measurements at rest and during exercise. Forced vital capacity was significantly lower in group 2 (84.8±2.7% predicted) than in group 1 (105±3%, P<0.0001), without abnormalities in DLCO or in resting and exercise oxygen diffusion. Likewise, percentage predicted $V_{{{\text{O}}_{{2\max }} }}$ (65±4 vs 97±6, P<0.0002), oxygen pulse at peak exercise (0.12±0.01 vs 0.17±0.01, P<0.001), and ${\Delta V_{{{\text{O}}_{{\text{2}}} }} } \mathord{\left/ {\vphantom {{\Delta V_{{{\text{O}}_{{\text{2}}} }} } {\Delta {\text{W}}}}} \right. \kern-\nulldelimiterspace} {\Delta {\text{W}}}$ slope (8.4±0.3 vs 10.2±0.4, P<0.003) were significantly lower in group 2 than in group 1. Functional capacity during exercise was markedly reduced in patients suffering from Hodgkin’s disease in advanced stages. This loss of exercise capacity appeared mainly related to a peripheral disorder.