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

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 synd...

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Autores principales: Vecchié, Alessandra, Thomas, Georgia, Bressi, Edoardo, Bonaventura, Aldo, Canada, Justin M., Chuquin, David, Kadariya, Dinesh, Piracha, Usman, Endicott, Delia, Markley, Roshanak, Toor, Amir, Hess, Michael, Abbate, Antonio
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8630909/
https://www.ncbi.nlm.nih.gov/pubmed/34847948
http://dx.doi.org/10.1186/s40959-021-00126-7
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author Vecchié, Alessandra
Thomas, Georgia
Bressi, Edoardo
Bonaventura, Aldo
Canada, Justin M.
Chuquin, David
Kadariya, Dinesh
Piracha, Usman
Endicott, Delia
Markley, Roshanak
Toor, Amir
Hess, Michael
Abbate, Antonio
author_facet Vecchié, Alessandra
Thomas, Georgia
Bressi, Edoardo
Bonaventura, Aldo
Canada, Justin M.
Chuquin, David
Kadariya, Dinesh
Piracha, Usman
Endicott, Delia
Markley, Roshanak
Toor, Amir
Hess, Michael
Abbate, Antonio
author_sort Vecchié, Alessandra
collection PubMed
description 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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s40959-021-00126-7.
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spelling pubmed-86309092021-12-01 Orthostatic intolerance syndromes after hematopoietic cell transplantation: clinical characteristics and therapeutic interventions in a single-center experience Vecchié, Alessandra Thomas, Georgia Bressi, Edoardo Bonaventura, Aldo Canada, Justin M. Chuquin, David Kadariya, Dinesh Piracha, Usman Endicott, Delia Markley, Roshanak Toor, Amir Hess, Michael Abbate, Antonio Cardiooncology Research 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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s40959-021-00126-7. BioMed Central 2021-11-30 /pmc/articles/PMC8630909/ /pubmed/34847948 http://dx.doi.org/10.1186/s40959-021-00126-7 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Vecchié, Alessandra
Thomas, Georgia
Bressi, Edoardo
Bonaventura, Aldo
Canada, Justin M.
Chuquin, David
Kadariya, Dinesh
Piracha, Usman
Endicott, Delia
Markley, Roshanak
Toor, Amir
Hess, Michael
Abbate, Antonio
Orthostatic intolerance syndromes after hematopoietic cell transplantation: clinical characteristics and therapeutic interventions in a single-center experience
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 Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8630909/
https://www.ncbi.nlm.nih.gov/pubmed/34847948
http://dx.doi.org/10.1186/s40959-021-00126-7
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