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

Abstract Background Hematopoietic 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 tachycar...

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Main Authors: Alessandra Vecchié, Georgia Thomas, Edoardo Bressi, Aldo Bonaventura, Justin M. Canada, David Chuquin, Dinesh Kadariya, Usman Piracha, Delia Endicott, Roshanak Markley, Amir Toor, Michael Hess, Antonio Abbate
Format: Article
Language:English
Published: BMC 2021-11-01
Series:Cardio-Oncology
Subjects:
Online Access:https://doi.org/10.1186/s40959-021-00126-7
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author Alessandra Vecchié
Georgia Thomas
Edoardo Bressi
Aldo Bonaventura
Justin M. Canada
David Chuquin
Dinesh Kadariya
Usman Piracha
Delia Endicott
Roshanak Markley
Amir Toor
Michael Hess
Antonio Abbate
author_facet Alessandra Vecchié
Georgia Thomas
Edoardo Bressi
Aldo Bonaventura
Justin M. Canada
David Chuquin
Dinesh Kadariya
Usman Piracha
Delia Endicott
Roshanak Markley
Amir Toor
Michael Hess
Antonio Abbate
author_sort Alessandra Vecchié
collection DOAJ
description Abstract Background Hematopoietic 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. Methods This 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. Results Median 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%). Conclusion Orthostatic 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.
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spelling doaj.art-078f38647efb4b74ae18aaeebe8d3fa22022-12-21T23:11:09ZengBMCCardio-Oncology2057-38042021-11-017111110.1186/s40959-021-00126-7Orthostatic intolerance syndromes after hematopoietic cell transplantation: clinical characteristics and therapeutic interventions in a single-center experienceAlessandra Vecchié0Georgia Thomas1Edoardo Bressi2Aldo Bonaventura3Justin M. Canada4David Chuquin5Dinesh Kadariya6Usman Piracha7Delia Endicott8Roshanak Markley9Amir Toor10Michael Hess11Antonio Abbate12VCU Pauley Heart Center, Virginia Commonwealth UniversityVCU Pauley Heart Center, Virginia Commonwealth UniversityVCU Pauley Heart Center, Virginia Commonwealth UniversityVCU Pauley Heart Center, Virginia Commonwealth UniversityVCU Pauley Heart Center, Virginia Commonwealth UniversityVCU Pauley Heart Center, Virginia Commonwealth UniversityVCU Pauley Heart Center, Virginia Commonwealth UniversityVCU Pauley Heart Center, Virginia Commonwealth UniversityVCU Pauley Heart Center, Virginia Commonwealth UniversityVCU Pauley Heart Center, Virginia Commonwealth UniversityMassey Cancer Center, Virginia Commonwealth UniversityVCU Pauley Heart Center, Virginia Commonwealth UniversityVCU Pauley Heart Center, Virginia Commonwealth UniversityAbstract Background Hematopoietic 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. Methods This 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. Results Median 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%). Conclusion Orthostatic 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.https://doi.org/10.1186/s40959-021-00126-7DysautonomiaOrthostatic hypotensionPostural tachycardia syndromeBone marrow transplantChemotherapy
spellingShingle Alessandra Vecchié
Georgia Thomas
Edoardo Bressi
Aldo Bonaventura
Justin M. Canada
David Chuquin
Dinesh Kadariya
Usman Piracha
Delia Endicott
Roshanak Markley
Amir Toor
Michael Hess
Antonio Abbate
Orthostatic intolerance syndromes after hematopoietic cell transplantation: clinical characteristics and therapeutic interventions in a single-center experience
Cardio-Oncology
Dysautonomia
Orthostatic hypotension
Postural tachycardia syndrome
Bone marrow transplant
Chemotherapy
title Orthostatic intolerance syndromes after hematopoietic cell transplantation: clinical characteristics and therapeutic interventions in a single-center experience
title_full Orthostatic intolerance syndromes after hematopoietic cell transplantation: clinical characteristics and therapeutic interventions in a single-center experience
title_fullStr Orthostatic intolerance syndromes after hematopoietic cell transplantation: clinical characteristics and therapeutic interventions in a single-center experience
title_full_unstemmed Orthostatic intolerance syndromes after hematopoietic cell transplantation: clinical characteristics and therapeutic interventions in a single-center experience
title_short Orthostatic intolerance syndromes after hematopoietic cell transplantation: clinical characteristics and therapeutic interventions in a single-center experience
title_sort orthostatic intolerance syndromes after hematopoietic cell transplantation clinical characteristics and therapeutic interventions in a single center experience
topic Dysautonomia
Orthostatic hypotension
Postural tachycardia syndrome
Bone marrow transplant
Chemotherapy
url https://doi.org/10.1186/s40959-021-00126-7
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