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

Cardio-Oncology - Tập 7 - Trang 1-11 - 2021
Alessandra Vecchié1,2, Georgia Thomas1, Edoardo Bressi1, Aldo Bonaventura1,2,3, Justin M. Canada1, David Chuquin1, Dinesh Kadariya1, Usman Piracha1, Delia Endicott1, Roshanak Markley1, Amir Toor4, Michael Hess1, Antonio Abbate1
1VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, USA
2Department of Internal Medicine, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi, Varese, Italy
3First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy
4Massey Cancer Center, Virginia Commonwealth University, Richmond, USA

Tóm tắt

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. 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. 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%). 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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Cardio-Oncology

Tập 7

1-11

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