Unmasking orthostatic hypotension after cellular therapy: risk factors, implications, and clinical significance

Orthostatic hypotension (OH) is a common complication in cancer care, increasing the risk of falls. However, in hematopoietic cell transplantation (HCT) and cellular therapy, few studies have focused on OH, and its incidence and risk factors remain unclear.

This single-center retrospective study included 297 (autologous, 153; allogeneic, 127; and CAR-T, 17) patients. Blood pressure and heart rate were measured with the patient supine, and again at 1 min and at 3 min after standing. Data were collected to calculate OH incidence by day 30 post-infusion.

The cumulative incidence of any OH by day 30 was 57.6% (median onset, day 5), with symptomatic OH at 21.9% (median onset, day 4). Stratified by therapy type, the cumulative incidence of any and symptomatic OH at day 30 were 62.8% and 28.8% in the auto-HCT, 52.0% and 15.7% in the allo-HCT, and 52.9% and 5.9% in the CAR-T group, respectively. Multivariate analysis identified outpatient treatment (HR = 3.60, p < 0.01) and prior OH history (HR = 1.76, p < 0.01) as significant risk factors for any OH. For symptomatic OH, outpatient status (HR = 4.66, p < 0.01), > 2% weight loss (HR = 2.09, p = 0.02), and infection (HR = 2.57, p = 0.01) were associated with higher risk.

It is important to assess OH before and after cellular therapy. In addition, daily weight monitoring and optimal fluid management may reduce the risk of OH development and lead to improved patient care and quality of life.