Pretransplant Functional Status as a Predictor of Outcomes in Multiple Myeloma
Key Points
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Objective pretransplant functional assessments provide prognostic information beyond age and ECOG performance status in multiple myeloma.
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Inability to perform sit-to-stands or maintain balance was associated with higher mortality and longer hospital stays after autologous stem cell transplantation.
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Identifying functional deficits pretransplant may allow for targeted prehabilitation to improve posttransplant outcomes.
Pretransplant Functional Assessment in Multiple Myeloma
At the 2025 ASH Annual Meeting, Sawyer Bawek, DO, of Roswell Park Comprehensive Cancer Center, presented a poster examining the role of pretransplant functional status in patients undergoing autologous stem cell transplantation for multiple myeloma. Dr. Bawek collaborated with colleagues at Roswell Park Comprehensive Cancer Center—Megan Herr, PhD, and Jens Hillengass, MD, PhD—to evaluate whether objective physical function measures could better predict outcomes than traditional assessments such as age or ECOG performance status alone. He sat down with Rahul Gosain, MD, MBA, of Wilmot Cancer Institute, to discuss the poster presentation.
Historically, transplant eligibility has relied heavily on clinician-assessed performance status. Dr. Bawek and colleagues’ work sought to expand this framework by incorporating standardized physical therapy–based assessments performed routinely prior to transplantation. These evaluations included balance testing, strength assessments, mobility tests, and sit-to-stand exercises.
Study Design and Functional Metrics Evaluated
The analysis included patients with multiple myeloma who underwent autologous stem cell transplantation at Roswell Park Comprehensive Cancer Center. All patients completed a formal pretransplant physical therapy evaluation. Functional measures assessed included the ability to complete repeated sit-to-stands, balance, strength testing, and timed up-and-go assessments.
The study identified several functional deficits strongly associated with adverse outcomes. Patients unable to complete at least 10 sit-to-stands in 30 seconds experienced a 47% higher mortality rate at 5 years following transplant. Additionally, an inability to maintain balance on the right foot for 6 seconds was associated with a longer inpatient length of stay. Left-sided balance was also assessed but did not reach statistical significance.
Clinical Implications and Opportunities for Intervention
Dr. Bawek emphasized that these findings are highly actionable. Physical therapy strategies, including targeted strength training before transplant, may improve functional status and potentially mitigate risks associated with prolonged hospitalization or inferior long-term outcomes. Incorporating objective functional assessments into routine transplant evaluation could support more individualized decision-making and optimize outcomes for patients undergoing autologous transplantation for multiple myeloma.