Risk factors for post-stem cell transplant sinusitis

Abstract

Summary:An understanding of the factors that place the posttransplant patient at increased risk for sinusitis would help identify patients likely to develop disease and possibly allow for interventions that would decrease the incidence or severity of sinus disease. This retrospective study investigates the ability of screening paranasal sinus computed tomographic scans (CTs), clinical history, and potential risk factors for sinusitis, including history of tobacco use, history of allergies or asthma, IgG level, history of sinusitis, remission status and acute graft-versus-host disease (GVHD) to predict post-transplant sinusitis. Medical records and sinus CTs of 100 allogeneic bone marrow recipients were reviewed. There was no increased risk of developing sinusitis post SCT for patients with significant disease on screening CT, symptoms at time of transplant, a history of tobacco use, asthma or allergies, low IgG level, history of sinusitis or for patients at high risk of relapse. Patients with GVHD were 4.3 times more likely than patients without GVHD to develop sinusitis post transplant (95% CI: 1.7-11.0, P = 0.002). Acute GVHD places patients at greater risk of developing sinus infections.

Valor prognóstico da tomografia computadorizada de seios paranasais no transplante de células-tronco hematopoiéticas

“…5,6,9 Half of the patients in this study that presented post-HSCT rhinosinusitis had no prior CT findings or any clinical diagnosis of this condition. About 57% of patients with pre-transplantation CT findings had post-transplant rhinosinusitis, although there was not a significant correlation.…”

“…[2][3][4][5][6][7] The published estimated rate of rhinosinusitis in transplant patients is 36.9%. 3 The rate found in our study (32.2%) was roughly close to this estimate.…”

“…However, some authors have defended carrying out paranasal sinus CT in all patients before HSCT, arguing that signs suggesting rhinosinusitis in this exam -and their intensity -are effective prognostic factors. 5,6,7,9,10 Carrying out CT in all patients before transplantation may increase costs and the preparation time, as radiology units are under great demand for routine exams. Thus, the purpose of this study was to verify the need for paranasal sinus CT in all patients before HSCT and the relation between tomography findings of prior nasosinusal disease and the development of rhinosinusitis after HSCT.…”

“…They therefore are at a higher risk for viral, bacterial or fungal infection, in particular upper airway infections, because of direct contact with the environment. [2][3][4][5][6][7] Other complicating factors for respiratory infection are prolonged hospital stay, graft versus host disease, and corticosteroid therapy. [2][3][4][5][6][7] These patients have a 37% risk for developing rhinosinusitis after transplantation, compared to a 15% rate in patients with normal immune status.…”

“…[2][3][4][5][6][7] Other complicating factors for respiratory infection are prolonged hospital stay, graft versus host disease, and corticosteroid therapy. [2][3][4][5][6][7] These patients have a 37% risk for developing rhinosinusitis after transplantation, compared to a 15% rate in patients with normal immune status. 3,8 Several laboratory tests are required by the hematology unit before HSCT, including paranasal sinus radiography, done in all patients to investigate possible sinus disease.…”