Sinonasal disorders in hematopoietic stem cell transplantation

INTRODUCTION: hematopoietic stem cell transplantation (HSCT) is associated with more respiratory infections due to immunosuppression. OBJECTIVE: this study aimed to verify the frequency of rhinosinusitis after HSCT, and the association between rhinosinusitis and chronic graft vs. host disease (GVHD) and type of transplantation, clinical treatment, surgical treatment, and survival. METHODS: this was a retrospective study in a tertiary university hospital. A total of 95 patients with hematological diseases undergoing HSCT between 1996 and 2011 were selected. RESULTS: chronic myeloid leukemia was the most prevalent disease. The type of transplant most often performed was the allogenic type (85.26%). The frequency of rhinosinusitis was 36%, with no difference between the autologous and the allogenic types. Chronic GVHD occurred in 30% of patients. Patients with GVHD had a higher frequency and recurrence of rhinosinusitis, in addition to more frequent need for endoscopic sinusectomy and decreased overall survival. CONCLUSION: there was a higher frequency of rhinosinusitis in HSCT and GVHD. The type of transplant does not appear to predispose to the occurrence of rhinosinusitis. GVHD seems to be an aggravating factor and requires a more stringent treatment.引言：造血干细胞移植（hematopoietic stem cell transplantation, HSCT）术后患者因免疫抑制状态，更易发生呼吸道感染。 研究目的：本研究旨在明确造血干细胞移植术后鼻窦炎的发病频率，并探究鼻窦炎与慢性移植物抗宿主病（graft vs. host disease, GVHD）、移植类型、临床治疗、手术治疗及患者生存状况之间的关联。 研究方法：本研究为三级大学医院开展的回顾性研究，纳入1996年至2011年间接受造血干细胞移植的95例血液系统疾病患者。 研究结果：慢性髓系白血病为最常见的基础疾病。最常采用的移植类型为异基因移植（占比85.26%）。鼻窦炎总体发病频率为36%，自体移植与异基因移植患者的发病比例无显著差异。30%的患者出现慢性移植物抗宿主病。合并移植物抗宿主病的患者，其鼻窦炎发病频率及复发率更高，且更需接受鼻窦内镜切除术治疗，整体生存率更低。 研究结论：造血干细胞移植术后鼻窦炎的发病频率较高，且与移植物抗宿主病相关。移植类型似乎并不会增加鼻窦炎的发病风险。移植物抗宿主病是鼻窦炎的加重因素，需采取更为严格的治疗方案。