Acceptance and Commitment Therapy May Improve Physical Function after Allogeneic Hematopoietic Stem Cell Transplant

Introduction Allogeneic hematopoietic stem cell transplant (HCT) has the potential to cure patients with hematologic malignancies and other diseases, but there is significant risk of treatment-related morbidity and mortality. Targeted interventions to reduce vulnerabilities before, during, and after HCT could therefore improve treatment tolerance and outcomes. Acceptance and Commitment Therapy (ACT) is an evidence-based cognitive behavioral therapy that improves human functioning and adaptability by increasing psychological flexibility. Among HCT patients, increased psychologic flexibility may help patients adapt behaviors to improve or maintain physical activity. Objectives In the phase I clinical trial, ACTIVATE, we aimed to assess the preliminary efficacy of ACT at improving physical functioning and other outcomes 30 and 90 days after HCT. Methods At a single center, we recruited patients ≥18 years old receiving HCT to participate in up to six sessions of ACT between transplant days -30 and +90. We selected three matched controls for each study patient who received an allogeneic transplant at the same center within five years. Matching was based on disease, conditioning regimen intensity, age, and gender. All patients were evaluated in various domains of physical function, cognitive function, mental health, diet, and nutrition, which is standard of care for the transplant center. Clinical outcomes were obtained from the electronic medical record. Results A total of 12 patients receiving ACT underwent HCT, and 36 patients were selected as matched controls. There were no significant differences in baseline patient demographics or clinical baseline measures between the two groups, as seen in table 1. The primary outcome measured was the mean change from baseline in the 6 minute walk test (6MWT) distance at 30 and 90 days after HCT. The mean change in 6MWT at 30 days was +33 m and -45 m for the ACT and control patients, respectively (p value = 0.039). The mean change at 90 days was +18 m and -19 m for the ACT and control patients, respectively (p value = 0.352). As seen in table 2, there were no statistically significant differences between the groups in change from baseline at 30 or 90 days in clinical outcomes, patient reported quality of life, nutritional outcomes, or depression screening scores. Conclusion ACT may be an effective intervention for improving physical functioning for patients undergoing HCT. This phase 1 clinical trial demonstrated a statistically significant mean change in 6MWT distance from baseline at 30 days and a non-statistically significant change at 90 days compared to matched controls. These findings support pursuing future randomized studies to better assess associations of ACT on adaptability and resilience, measured in the domains of physical functioning, quality of life, mental health, and nutrition in this patient population.