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Post-Transplant Events

Oral epithelial dysplasia and squamous cell carcinoma following allogeneic hematopoietic stem cell transplantation: clinical presentation and treatment outcomes

Bone Marrow Transplantation volume 46, pages 884–891 (2011)Cite this article

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Abstract

Late complications of allogeneic hematopoietic stem cell transplantation (HSCT) include a risk of secondary malignancies. Optimization for early diagnosis and treatment of oral premalignant or malignant lesions requires an assessment of potential predisposing risk factors. The medical records of patients who developed oral epithelial dysplasia (OED) and oral squamous cell carcinoma (OSCC) following allogeneic-HSCT were reviewed. Data on HSCT course, chronic graft-versus-host disease (cGVHD), and clinical outcome were recorded; landmark survival was calculated. Twenty-six patients with OED (n=8) and OSCC (n=18) were identified with a median follow-up of 26.5 and 21.5 months, respectively. Premalignant and malignant oral lesions were diagnosed at a median time of 2.5 and 8 years after HSCT, respectively. Chronic GVHD was present in 96% of patients and of these, 96% had oral involvement. Multifocal oral cancer was found in 28% of cases, and localized recurrence was observed in 44% of cases. These results suggest that oral cGVHD may be considered a potential risk factor for the development of OSCC following allogeneic-HSCT. The observation that oral cancers were frequently multifocal and recurred locally suggests that these cancers may be more aggressive. Vigilant follow-up and coordination of care are critical.

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Acknowledgements

The oral medicine specialists (HM, SE, MEC, S-BW and NT) thank the Hematopoietic Cell Transplantation and Head and Neck Oncology departments at their respective institutions for their daily collaboration in the management of these patients. We also extend our gratitude to our patients and their families. Supported in part by NIH Grant CA142106.

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Authors and Affiliations

  1. Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA

    H Mawardi, S-B Woo, S Almazrooa & N Treister

  2. Department of Oral Medicine, Hebrew University–Hadassah School of Dental Medicine, Jerusalem, Israel

    S Elad

  3. Dental Ambulatory, Hematology and Blood Transfusion Center, University of Campinas, São Paulo, Brazil

    M E Correa

  4. Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA

    K Stevenson

  5. Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, MA, USA

    S-B Woo & N Treister

  6. Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA

    R Haddad

  7. Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, MA, USA

    J H Antin & R Soiffer

  8. Department of Oral Medicine, King Abdulaziz University Faculty of Dentistry, Jeddah, Saudi Arabia

    H Mawardi & S Almazrooa

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  1. H Mawardi
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Correspondence to H Mawardi.

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Mawardi, H., Elad, S., Correa, M. et al. Oral epithelial dysplasia and squamous cell carcinoma following allogeneic hematopoietic stem cell transplantation: clinical presentation and treatment outcomes. Bone Marrow Transplant 46, 884–891 (2011). https://doi.org/10.1038/bmt.2011.77

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