The value of ablating oto-rhino-laryngological (ORL) foci before haematopoietic stem cell transplantation (HSCT).

Between June 1996 and May 1997, 92 patients underwent haematopoietic stem cell transplantation (HSCT) for haematological malignancies. To participate in a prospective single-centre trial to evaluate oto-rhino-laryngological (ORL) related problems, 43 of these patients (27 male, 16 female, median age 38) signed an informed consent. A questionnaire about ORL related problems was assessed before and after HSCT. Only 21 of the patients (49%) could be fully examined after transplantation because of overall mortality and follow-up realised by other health care centres. In the deceased patients, however, a close review of the patients' notes was carried out. An ORL focus was not identified as the cause of death in any of the deceased. Pre-transplant examination revealed 15 patients with ORL relevant infectious foci. To make urgent HSCT possible, surgical pre-transplant ablation of chronic ORL infection sites took place in four patients only. In this cohort, pre-transplant ORL pathology was not amplified after HSCT. None of the 11 patients presenting ORL foci before transplantation experienced enhancement of ORL disease. These data suggest that the indication for surgical intervention with regards to ORL infection prior to HSCT should be regarded cautiously. However, the potential risk of dissemination of a pre-existing fungal infection from an ORL site should be considered and treated on a case-by-case basis.