Orthostatic intolerance syndromes after hematopoietic cell transplantation: clinical characteristics and therapeutic interventions in a single-center experience

Cardio-Oncology

Amir Toor¹  Georgia Thomas²  David Chuquin²  Usman Piracha²  Dinesh Kadariya²  Justin M. Canada²  Roshanak Markley²  Michael Hess²  Antonio Abbate²  Edoardo Bressi²  Delia Endicott²  Alessandra Vecchié³  Aldo Bonaventura⁴ 

[1] Massey Cancer Center, Virginia Commonwealth University, Richmond, USA;VCU Pauley Heart Center, Virginia Commonwealth University, 1200 E. Broad Street, Box 980204, 23298, Richmond, VA, USA;VCU Pauley Heart Center, Virginia Commonwealth University, 1200 E. Broad Street, Box 980204, 23298, Richmond, VA, USA;Department of Internal Medicine, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi, Varese, Italy;VCU Pauley Heart Center, Virginia Commonwealth University, 1200 E. Broad Street, Box 980204, 23298, Richmond, VA, USA;Department of Internal Medicine, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi, Varese, Italy;First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132, Genoa, Italy;

关键词: Dysautonomia;    Orthostatic hypotension;    Postural tachycardia syndrome;    Bone marrow transplant;    Chemotherapy;   

DOI  :  10.1186/s40959-021-00126-7

来源: Springer

【 摘 要 】

BackgroundHematopoietic cell transplantation (HCT) is an established and potentially curative therapeutic option for hematologic cancers. HCT survivors are at risk of developing long-term complications impacting on morbidity and mortality. Orthostatic hypotension (OH) and postural tachycardia syndrome (POTS) have been anecdotally described after HCT. However, the incidence and clinical characteristics of patients with OH and POTS after HCT has not been well defined.MethodsThis retrospective study included 132 patients who had HCT between March 2011 and July 2018 and were referred to Cardio-oncology clinic. Patients were screened for OH and POTS. Using logistic regression analysis we evaluated the association between clinical factors and the incidence of OH and POTS.ResultsMedian age was 58 (47–63) years, 87 (66%) patients were male, 95 (72%) were Caucasian. OH was diagnosed in 30 (23%) subjects and POTS in 12 (9%) after the HCT. No significant differences in demographic characteristics were found when comparing patients with and without OH or POTS. The two groups did not differ for cardiovascular diseases prevalence nor for the prior use of antihypertensive drugs. Previous radiotherapy and treatment with specific chemotherapy drugs were found to be associated with the incidence of OH or POTS, but none of the factors maintained the significance in the multivariate model. Pharmacological therapy was required in 38 (91%) cases, including a b-adrenergic blocker (n = 24, 57%), midodrine (n = 24, 57%) and fludrocortisone (n = 7, 18%).ConclusionOrthostatic intolerance syndromes are commonly diagnosed in patients referred to the cardiologist after HCT, involving approximately 1/3 of patients and requiring pharmacological therapy to cope with symptoms in the majority of cases. Risk factors specific to this population are identified but cannot fully explain the incidence of POTS and OH after HCT.

【 授权许可】

CC BY