Subclinical autonomic dysfunction in patients with Hodgkin's disease and non‐Hodgkin's lymphoma

Abstract

A prospective study was carried out to determine the prevalence of autonomic dysfunction in patients with lymphoma, and to assess the effect on this of chemotherapy. Twenty consecutive patients presenting with Hodgkin's disease, high-grade non-Hodgkin's lymphoma, or low-grade non-Hodgkin's lymphoma were studied. All had advanced disease, requiring combination chemotherapy which included the use of vinca alkaloids. Clinical assessment and standard cardiovascular autonomic function tests were carried out prior to and following completion of chemotherapy. Although no patients had clinical evidence of autonomic neuropathy at presentation, 16 (80%) had abnormal cardiovascular autonomic function tests. There was no correlation with the presence or absence of mediastinal disease. There was significant improvement in autonomic scores with treatment despite the use of drugs of known neurological toxicity. Some patients showed residual abnormalities of autonomic function despite disease resolution. We suggest that subclinical autonomic dysfunction is common in patients with lymphoma, and probably represents a paraneoplastic syndrome--the pathogenesis and prevalence of which deserve further study. This phenomenon may predispose patients with lymphoma to develop gastrointestinal and genitourinary dysfunction, or postural hypotension, and should be considered during the evaluation of the neurotoxicity of chemotherapy regimens.

Cardiac Surgery in Patients with a History of Malignancy: Increased Complication Rate but Similar Mortality

“…There have been reports of increased rates of AF in patients with malignancies such as colorectal cancer. One hypothesis for Heart, Lung and Circulation Cardiac surgery and malignancy 2012;21:255-259 the finding of increased rates in AF in our population is that patients with malignancies have autonomic dysfunction [10,11], which in turn is related to increased rates of arrhythmia [12][13][14].…”

Hodgkin Lymphoma and Hypothermia: Case Report and Review of the Literature

“…Both subclinical and clinical autonomic neuropathy were reported in association with Hodgkin lymphoma [15,16,17]. Autonomic neuropathy is a known risk factor for hypothermia in diabetic patients [18], mostly through excess vasodilatation.…”

Autonomic Dysfunction in Hodgkin and Non-Hodgkin Lymphoma. A Paraneoplastic Syndrome?

“…Autonomic dysfunction is documented in cases of lymphoma, 5 but it is important to clarify whether this is a paraneoplastic manifestation or a consequence of chemotherapy 7,12 because, in the first hypothesis, chemotherapy can cure the alteration, while in the second one it may exacerbate the dysfunction, with all the well-known consequences. In fact, autonomic impairment is responsible for a higher mortality rate due to cardiovascular disease, such as sudden death resulting from cardiac arrhythmia.…”

“…Some papers report acute dysautonomia involving the parasympathetic and sympathetic system, like a paraneoplastic syndrome, in Hodgkin lymphoma 1–4 and others describe improvements after the treatment of the disease. 5 Some studies suggest that such autonomic changes are related to the malignant disease, 6 but others claim that they are the consequence of chemotherapy. 7,8 …”