Peritransplant Orthostatic Hypotension and Multiple Myeloma
Posted: Friday, May 14, 2021
According to Matthew Ho, MBBCh, BAO, PhD, of the Mayo Clinic, Rochester, Minnesota, and colleagues, new-onset orthostatic hypotension seemed to occur frequently during the peritransplant period in patients with multiple myeloma who were undergoing autologous stem cell transplant. The results of this retrospective, single-center study were presented during the NCCN 2021 Virtual Annual Conference (Abstract CLO21-016) and published in JNCCN–Journal of the National Comprehensive Cancer Network.
“Orthostatic hypotension is a well-recognized phenomenon occurring in patients with multiple myeloma undergoing autologous stem cell transplant that poses a morbidity and mortality threat due to increased risk of falls,” the investigators remarked. “Surprisingly, few studies have examined its incidence, risk and protective factors, and prognostic implications.”
The investigators focused on 226 patients with newly diagnosed multiple myeloma who were admitted for their first autologous stem cell transplant between June 2012 and April 2014. Of this study population, 73% were diagnosed with orthostatic hypotension during their hospital admission. On the day of the first orthostatic vitals check, 51 patients were found to have orthostatic hypotension; thus, it seemed difficult to distinguish whether orthostatic hypotension was preexistent or developed during the transplant admission. Excluding these 51 patients, 65% developed orthostatic hypotension during the peritransplant period. Moderate to severe dehydration occurred in 11 of these patients; thus, according to the investigators, orthostatic hypotension could not simply be explained by volume depletion.
Based on a multivariable analysis, White race, use of gabapentin, and antihypertensives were identified as risk factors for peritransplant orthostatic hypotension. Antihistamines and proton pump inhibitors were identified as protective factors. Orthostatic hypotension did not seem to significantly impact the length of hospitalization, progression-free survival, and overall survival.
Disclosure: The study authors reported no conflicts of interest.
