High incidence of oral squamous cell carcinoma independent of HPV infection after allogeneic hematopoietic SCT in Taiwan

Abstract

Hematopoietic SCT (HSCT) is a well-recognized therapeutic procedure to prolong life and cure patients with lifethreatening hematological malignancies; however, the risk of developing secondary carcinoma may increase in longterm survivors. The objective of this study was to determine the incidence and risk factors for secondary squamous carcinoma after HSCT. Between 1984 and 2004, 170 allogeneic HSCT recipients aged 415 years, who had survived for 45 years were enrolled. Demographic data and the characteristics of secondary carcinoma were collected and analyzed for the determination of the incidence and risk of developing secondary carcinoma. Eight patients developed secondary carcinoma, including five oral squamous cell carcinomas, one esophageal, one gastric and one ovarian carcinoma, but no cutaneous carcinomas were detected at a median follow-up of 14.1 years (range, 5.1-23.3 years) after HSCT. The accrual 10-year cumulative incidence of secondary carcinoma was 2.89%. In univariate and multivariate analyses, chronic GVHD and age 440 years at the time of HSCT were both significant risk factors independently associated with the development of secondary carcinoma. Thus, the occurrence of secondary carcinoma is one of the late complications in patients undergoing HSCT. Oral squamous cell carcinoma was more common in our patients after HSCT, indicating the need for lifelong surveillance of the oral cavity. Moreover, because of the relatively long latency in developing secondary carcinoma, extended follow-up is required for a thorough understanding of the incidence and characteristics of secondary carcinoma after HSCT.

Orofacial diseases in solid organ and hematopoietic stem cell transplant recipients

“…Oropharyngeal cancer is the most frequent form of solid cancer following HSCT, where the estimated 10‐year cumulative incidence of oral squamous cell carcinoma is 1.5% (Rizzo et al , 2009; Chen et al , 2011). The tongue is the primary cancer location (25–37% of all oral cancer cases) followed by salivary gland (15–16%) and lip (9–22%) (Kruse and Gratz, 2009; Rizzo et al , 2009).…”

“…The tongue is the primary cancer location (25–37% of all oral cancer cases) followed by salivary gland (15–16%) and lip (9–22%) (Kruse and Gratz, 2009; Rizzo et al , 2009). Oral cancer is significantly associated with chronic graft‐versus‐host disease (GVHD) – more than 90% of oral cancer cases in HSCT recipients are preceded by GVHD, as well as with older age and male gender of patients and immunosuppressive regimens, while the role of irradiation is controversial (Demarosi et al , 2005; Kruse and Gratz, 2009; Rizzo et al , 2009; Chen et al , 2011; Mawardi et al , 2011). Solid cancers, and oral cancer in particular, are the major cause of late mortality after HSCT (Rizzo et al , 2009).…”

“…In addition, SOT and HSCT patients should be encouraged to avoid or minimize exposure to other known oral cancer lifestyle risk factors such as tobacco, betel, and alcohol (Petti, 2009). It is essential also that SOT and HSCT recipients be aware of their high oral and lip cancer risks that may develop in the long term, and therefore, they should be encouraged to undergo periodical oral checkups to promote cancer early detection (Kruse and Gratz, 2009; Chen et al , 2011).…”

p16 overexpression in malignant and premalignant lesions of the oral and esophageal mucosa following allogeneic hematopoietic stem cell transplantation

“…One study showed that all oral SCC after HSCT demonstrated pappillomatous aspects (a sign of HPV infection) as well as chronic GVHD features (dense subepithelial lymphoid infiltrate) [16]. In other report, HPV was not associated with oral carcinogenesis after HSCT [17]. The association of HPV infection with esophageal intraepithelial neoplasia is also controversial.…”

Long-Term Incidence of Secondary Malignancies after Allogeneic Hematopoietic Cell Transplantation: A Single-Center Experience

“…The malignancy types comprise a wide spectrum of diseases associated with different risk factors [11]. For instance, squamous cell carcinomas (SCCs) of the oral cavity are more common in older patients, particularly in the presence of local cGVHD [12]. Breast cancer risk is increased for patients transplanted at a younger age and exposed to total body irradiation (TBI) [13].…”