POTS and Orthostatic Hypotension After HSCT: High Incidence Linked to Sympathetic Overactivation.

A prospective study published in JACC: CardioOncology evaluated 46 patients undergoing hematopoietic stem cell transplantation (HSCT). Prior to transplant, 4.3% had postural orthostatic tachycardia syndrome (POTS) and 4.3% had orthostatic hypotension (OH). By 30 days post-HSCT, new-onset POTS was identified in 23.1% and OH in 12.8%. At 100 days, prevalence declined to 14.3% for POTS and 5.7% for OH, with partial recovery in over half of the cases.

Patients with POTS exhibited significantly greater norepinephrine increases upon standing (median 231% vs. 100% pre-HSCT) and higher adrenergic receptor–modulating autoantibody activity compared with those without POTS, both correlating with heart rate changes. No conventional cardiovascular risk factors predicted the onset of POTS or OH.

The findings underscore the importance of monitoring orthostatic vitals in HSCT follow-up, as autonomic dysfunction can impair recovery and quality of life. Potential therapeutic strategies include nonselective beta-blockers or ivabradine to counter sympathetic overactivation.

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#CardioOncology #HSCT #POTS #OrthostaticHypotension #AutonomicDysfunction