The role of adenotonsillectomy in graft-versus-host disease.
The aim of this study was to better characterize the impact of pre-transplant adenotonsillectomy in the development of graft-versus-host disease in pediatric patients undergoing allogeneic stem cell transplantation. This retrospective study involved 211 children undergoing stem cell transplantation at Duke University. Patients who had undergone transplant were characterized by age at transplant, age at adenotonsillectomy (if applicable), age at graft-versus-host disease (if applicable), average length of follow up and other factors. Statistical analyses were performed to determine the relative risks associated with each variable. A total of 136 patients developed graft-versus-host disease and 75 did not. Average length of follow up was 2 years for GVHD and 1.7 years for non-GVHD patients. The relative risk (RR) of graft-versus-host disease was significantly increased under univariate analysis if the donor and recipient were unrelated (RR=2.1, p<0.0001) and if the HLA match was not identical (RR=1.6, p<0.001). A history of adenotonsillectomy prior to transplant did not affect the risk of developing graft-versus-host disease (RR=1.1, p=0.70). Adenotonsillectomy prior to bone marrow transplant has no significant impact either protectively or adversely on the risk of developing graft-versus-host disease after transplantation in pediatric patients. Future studies are needed to further examine the impact of otolaryngologic surgery on pediatric patients in terms of immune system modification. Research should specifically focus on the immunological effects of surgery on patients who will be undergoing bone marrow transplant.