Case Report: Running through transplant: preserved aerobic capacity in an elite endurance athlete after allogeneic hematopoietic cell transplantation

Allogeneic hematopoietic cell transplantation (HCT) imposes profound hematologic, inflammatory, and immunologic stress, and survivors typically show reduced cardiorespiratory fitness that may be further compromised by chronic graft-versus-host disease (cGvHD) and corticosteroid therapy. Competitive, performance-oriented endurance training through these phases has not been described. We report the longitudinal clinical and training course of a 54-year-old elite endurance runner with previously treated Hodgkin lymphoma who resumed structured treadmill exercise on Day +1 after matched-sibling allogeneic peripheral blood stem cell transplantation for diffuse large B-cell lymphoma transformed from follicular lymphoma. Daily physiologic training data were aligned with transplant milestones, donor chimerism, donor lymphocyte infusions (DLI), and immunosuppression, and serial cardiopulmonary exercise testing was performed before and after HCT. The patient exercised through marrow aplasia and progressed to timed running within 100 days; he recorded a 5K of 17:55 (Day +314) and a 10K of 41:00 (Day +340), both during active cGvHD on prednisone plus cyclosporine. Directly measured peak oxygen uptake (VO 2 peak) was 75.8 mL/kg/min before HCT and 71.5 mL/kg/min at 7 months post-HCT. Oxygen uptake (VO 2 ) at the first ventilatory threshold (VT1) was 53.0, 48.0, and 42.4 mL/kg/min before HCT and at 7 and 20 months post-HCT, respectively. VO 2 at the second ventilatory threshold (VT2) was 66.0 and 59.9 mL/kg/min before HCT and at 7 months post-HCT, respectively. The 20-month assessment was submaximal; therefore, VO 2 peak was not determined. This case illustrates that exceptional aerobic capacity and high-level endurance performance can be maintained during recovery from allogeneic HCT, including during corticosteroid-treated cGvHD, with continued structured training.