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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Autores principales:	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
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Dysautonomia Orthostatic hypotension Postural tachycardia syndrome Bone marrow transplant Chemotherapy Diseases of the circulatory (Cardiovascular) system RC666-701 Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
Acceso en línea:	https://doaj.org/article/078f38647efb4b74ae18aaeebe8d3fa2
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spelling	oai:doaj.org-article:078f38647efb4b74ae18aaeebe8d3fa22021-12-05T12:24:38ZOrthostatic intolerance syndromes after hematopoietic cell transplantation: clinical characteristics and therapeutic interventions in a single-center experience10.1186/s40959-021-00126-72057-3804https://doaj.org/article/078f38647efb4b74ae18aaeebe8d3fa22021-11-01T00:00:00Zhttps://doi.org/10.1186/s40959-021-00126-7https://doaj.org/toc/2057-3804Abstract 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.Alessandra VecchiéGeorgia ThomasEdoardo BressiAldo BonaventuraJustin M. CanadaDavid ChuquinDinesh KadariyaUsman PirachaDelia EndicottRoshanak MarkleyAmir ToorMichael HessAntonio AbbateBMCarticleDysautonomiaOrthostatic hypotensionPostural tachycardia syndromeBone marrow transplantChemotherapyDiseases of the circulatory (Cardiovascular) systemRC666-701Neoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENCardio-Oncology, Vol 7, Iss 1, Pp 1-11 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Dysautonomia Orthostatic hypotension Postural tachycardia syndrome Bone marrow transplant Chemotherapy Diseases of the circulatory (Cardiovascular) system RC666-701 Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
spellingShingle	Dysautonomia Orthostatic hypotension Postural tachycardia syndrome Bone marrow transplant Chemotherapy Diseases of the circulatory (Cardiovascular) system RC666-701 Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 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
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.
format	article
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
title	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_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_sort	orthostatic intolerance syndromes after hematopoietic cell transplantation: clinical characteristics and therapeutic interventions in a single-center experience
publisher	BMC
publishDate	2021
url	https://doaj.org/article/078f38647efb4b74ae18aaeebe8d3fa2
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Orthostatic intolerance syndromes after hematopoietic cell transplantation: clinical characteristics and therapeutic interventions in a single-center experience

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