Oral epithelial dysplasia and squamous cell carcinoma following allogeneic hematopoietic stem cell transplantation: clinical presentation and treatment outcomes - PubMed (original) (raw)

Multicenter Study

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

H Mawardi et al. Bone Marrow Transplant. 2011 Jun.

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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Figures

Figure 1

Figure 1

Exophytic plaque on the left buccal mucosa that demonstrated verrucous hyperplasia histopathologically. Note the lighter white reticulations attributed to long-standing oral cGVHD (arrow).

Figure 2

Figure 2

Exophytic plaque on the lower lip that demonstrated dysplasia histopathologically (Day +390 post allo-HSCT) showing A) white reticular changes involving the uppper and lower lip; B) round dysplastic plaque on the lower lip; and C) complete healing of the lower lip dysplastic lesion after excision and topical treatment with 5-FU (Day +592).

Figure 3

Figure 3

Invasive squamous cell carcinoma that initially presented as persistent erythema of the left buccal mucosa (Panel A; Day +5080) that then developed into multiple pink exophytic verrucous masses (Panel B; Day +5290) as well as more flat, erythematous and speckled involvement of the right mandibular facial gingiva (Panel C) and left lingual alveolar ridge (Panel D).

Figure 4

Figure 4

Invasive squamous cell carcinoma of the right buccal mucosa. A) Lesion prior to biopsy that presented as a distinct area of erythema and atrophy in the context of bilateral oral cGVHD changes; B) painful, exophytic indurated white and red mass with focal ulceration (arrow).

Figure 5A

Figure 5A. Overall Survival

Kaplan-Meier curve of overall survival (OS) for patients who developed VH/dysplasia (N = 8) or invasive carcinoma (N = 18) post-HSCT. Curves are calculated from the time of diagnosis of VH/dysplasia or invasive carcinoma.

Figure 5B

Figure 5B. Freedom from Recurrence (FFR)

Kaplan-Meier curve of freedom from recurrence (FFR) for patients who developed invasive carcinoma (N = 18) post-HSCT. Curves are calculated from the time of diagnosis of invasive carcinoma.

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