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Impact of pre-transplantation sinus abnormalities assessed by Lund-Mackay scoring system on sinusitis occurrence after allogeneic hematopoietic cell transplantation in acute leukemia patients

Jacek Sokołowski Joanna Drozd-Sokołowska Katarzyna Kobylińska Przemysław Biecek Ewa Karakulska-Prystupiuk Agnieszka Tomaszewska Tomasz Gotlib Kazimierz Niemczyk Wiesław Wiktor-Jędrzejczak Grzegorz Władysław Basak

Folia Medica Cracoviensia | 2021 | Vol. 61 | No 1 | 109-120 | DOI: 10.24425/fmc.2021.137217

Keywords allogeneic hematopoietic cell transplantation allo-HCT sinusitis Lund-Mackay scoring system computed tomography screening

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Abstract

Introduction: Screening sinonasal evaluation is routinely performed before allogeneic hematopoietic cell transplantation (allo-HCT), however, data supporting such evaluation is inconsistent.
Objectives: Assessment of the utility of screening sinonasal evaluation with computed tomography (CT).
Methods: A retrospective analysis of acute leukemia patients who underwent allo-HCT, for whom screening sinonasal CT scans were reevaluated, and for whom Lund-Mackay score (LMS) was calculated.
Results: Forty-eight patients, the median age at allo-HCT 38 years (18–58), 52% males, were included. 79% had acute myeloid leukemia (AML), 21% acute lymphoblastic leukemia (ALL). Conditioning inten-sity was myeloablative in 96% of patients, 21% of patients received total body irradiation. 19% of patients had a history of sinusitis before allo-HCT. Screening sinus CT was performed a median of 22 days before allo-HCT. The median LMS was 1 point (0– 10). The severity of sinus abnormalities was: no abnormalities (31%), mild (67%), moderate (2%), severe (0%). Mucosal thickening was the most frequent abnormality (69%). Eleven patients experienced sinusitis after a median of 93 days (11–607) after allo-HCT. 1-year cumulative incidence of sinusitis was 22%. No threshold of LMS and no type of sinus abnormalities were correlated with sinusitis development after allo-HCT. Mild sinus disease at screening did not negatively impact survival in comparison to no sinus disease.
Conclusions: Despite the fact, that majority of analyzed patients had either no or mild sinus disease at screening a significant proportion of patients developed sinusitis after allo-HCT. Evaluation of LMS before allo-HCT did not help predict the development of sinusitis after the procedure.

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Authors and Affiliations

Jacek Sokołowski

Joanna Drozd-Sokołowska

Katarzyna Kobylińska

Przemysław Biecek

Ewa Karakulska-Prystupiuk

Agnieszka Tomaszewska

Tomasz Gotlib

Kazimierz Niemczyk

Wiesław Wiktor-Jędrzejczak

Grzegorz Władysław Basak

Department of Otolaryngology, Medical University of Warsaw, Warsaw, Poland
Department of Hematology, Transplantation and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
Faculty of Mathematics and Information Science, Warsaw University of Technology, Warsaw, Poland

Outcomes of Jehovah’s Witnesses with hematological malignancies treated without transfusions — single center experience

Joanna Ewa Drozd-Sokołowska Anna Waszczuk-Gajda Jadwiga Dwilewicz-Trojaczek Alicja Walesiak Monika Krzyżanowska Monika Paluszewska Jolanta Wieczorek Wiesław Wiktor-Jędrzejczak

Folia Medica Cracoviensia | 2020 | Vol. 60 | No 4 | 53-64 | DOI: 10.24425/fmc.2020.136204

Keywords Jehovah’s Witnesses leukemia lymphoma blood transfusion platelet transfusion

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Abstract

Malignancies of the hematopoietic system frequently are associated with severe cytopenias requiring transfusions of blood components. Refusal of blood components by Jehovah’s Witnesses (JW) produces challenges to treatment. In this report we describe the outcome of hematological malignancies of JW patients treated without transfusions. Altogether, eight JW, diagnosed 1994–2015, 6 (75%) females, the median age at diagnosis 40 years (range, 20–78), were included into the analysis. The diagnoses were: acute lymphoblastic leukemia (2, 25%), acute myeloid leukemia (2, 25%), non-Hodgkin’s lymphomas (4, 50%). One patient died without treatment while the remaining 7 patients received treatment, including imatinib in 1 patient with BCR-ABL1+ acute lymphoblastic leukemia. Five (62.5%) patients received erythropoiesis stimulating agents. Median hemoglobin concentration at diagnosis was 8.7 g/dL (range, 6.3–13.1), and it decreased to 3.2 g/dL (range, 2.6–9.3) during first-line treatment. Median platelet count at diagnosis was 52 × 109/L (range, 15–392). All patients became thrombocytopenic upon treatment reaching median platelet count 8 × 109/L (range, 2–85). Five patients developed respiratory failure. Anemia contributed substantially to the death of 3 out of 6 patients (50%). One patient (17%) developed central nervous system bleeding in the course of thrombocytopenia. Objective response rate was 43%, with 29% complete remissions after first-line treatment. Despite the median overall survival of 15.3 months (95% CI, 0.2–52.2), all but one acute leukemia patients succumbed shortly after the diagnosis. To conclude, the outcome of JW treated because of hematological malignancies without blood transfusions is very dismal, nevertheless, selected patients can obtain complete remissions. Anemia contributes significantly to the death of JW.

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Authors and Affiliations

Joanna Ewa Drozd-Sokołowska

Anna Waszczuk-Gajda

Jadwiga Dwilewicz-Trojaczek

Alicja Walesiak

Monika Krzyżanowska

Monika Paluszewska

Jolanta Wieczorek

Wiesław Wiktor-Jędrzejczak

Department of Hematology, Transplantation and Internal Medicine, Medical University of Warsaw, Poland

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Impact of pre-transplantation sinus abnormalities assessed by Lund-Mackay scoring system on sinusitis occurrence after allogeneic hematopoietic cell transplantation in acute leukemia patients

Abstract

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Outcomes of Jehovah’s Witnesses with hematological malignancies treated without transfusions — single center experience

Abstract

Bibliography

Authors and Affiliations