Abstract
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.
Highlights
Hematopoietic cell transplantation (HCT) is an established and potentially curative therapeutic option for hematologic cancers
We aimed to evaluate the occurrence of Orthostatic hypotension (OH) and postural tachycardia syndrome (POTS) in a cohort of patients who were referred to the cardio-oncology clinic for evaluation after HCT for hematologic malignancies to gain insight into clinical features that may be associated with the development of these conditions
The other class of chemotherapy/ immunotherapy drugs used in our cohort are illustrated in Supplemental Fig. 1 and a complete list of agents is provided in the Supplementary Table 1
Summary
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. The incidence and clinical characteristics of patients with OH and POTS after HCT has not been well defined. Hematopoietic cell transplantation (HCT) is the treatment of choice for several hematologic malignancies. Advances in HCT techniques and post-transplant treatments have improved the survival of these patients considerably [1]. Long-term survivors, are at risk for developing treatment-related complications. HCT survivors have a 0.6 to 5.6-fold increased risk of cardiovascular (CV) diseases (CVD) including coronary artery disease, cerebrovascular disease, and heart failure [2]. General autonomic dysfunction was found in 50–63% of patients with advanced cancer and may be predictive of reduced survival [4]
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