Sinus surgery in bone marrow transplantation patients.

Area of Science:

• Transplantation immunology
• Infectious diseases
• Otolaryngology

Background:

• Bone marrow transplantation (BMT) is a critical treatment for malignancies, but it increases infection risk, particularly sinusitis, due to immunosuppression.
• Allogeneic BMT carries a higher infection risk than autologous BMT.
• Fungal sinusitis in immunocompromised BMT patients is a severe complication with high mortality.

Purpose of the Study:

• To evaluate the outcomes of different management strategies for fungal sinusitis in bone marrow transplant recipients.
• To compare an aggressive surgical approach with a more conservative, medically oriented strategy.

Main Methods:

• Retrospective review of bone marrow transplant patients with sinusitis between 1991 and 1993.
• Comparison of outcomes between an aggressive surgical intervention period (1991-1992) and a medically oriented monitoring period (1993).
• Analysis of patient data including transplant type (allogeneic vs. autologous), clinical status, CT scans, and surgical interventions.

Main Results:

• During 1991-1992, 57% of allogeneic BMT patients undergoing sinus surgery died, while all autologous BMT patients survived surgery.
• In 1993, a shift to a medically oriented approach resulted in the survival of three allogeneic BMT recipients who underwent surgery.
• No fungal sinus infections were documented in any BMT patients during the 3-year study period under either approach.

Conclusions:

• An aggressive surgical approach for sinusitis in BMT patients, particularly allogeneic recipients, is associated with high mortality.
• A conservative, medically oriented approach with careful monitoring can be effective in managing sinusitis in BMT patients.
• Judicious patient selection, thorough evaluation, and preventative measures are key to managing this complication without unnecessary surgery.