Oral Cancer in HSCT Pediatric Patients Arising on GVHD: A Comprehensive Review

Abstract

After haematopoietic stem cell transplantation and a history of GVHD, the risk of developing secondary malignancies, including oral cancer, is higher. This risk increases with time post-transplantation; therefore, pediatric patients undergoing HSCT, who have long-term survival chances, are in a high-risk category. The aim of this review is to provide data on HSCT, GVHD, clinical manifestations, histological features and treatment of oral cancer, and outcomes in HSCT pediatric patients, affected by oral GVHD, who have been developed OSCC. Descriptive statistics were used to validate data. Fifteen studies on a total of 33 patients were selected. Data on oral cancer showed that the tongue was the most frequently involved site (13 pts; 39.39%), followed by the floor of the mouth (4 pts; 12.12%), and buccal mucosa (4 pts; 12.12%). Oral squamous cell carcinoma was the histological feature reported. There were 19 (57.58%) deaths occurring between 2 and 46.5 months after OC diagnosis. Eleven patients survived with a median follow-up of 34 months. Considering the high risk of developing oral cancer, a conventional oral examination every 6 months is recommended for HSCT pediatric patients who have developed GVHD.

Tongue cancer developing after haematopoietic stem cell transplantation for treatment of acute promyelocytic leukaemia: a case report

“…Curtis et al reported a significantly increased risk of developing secondary cancer (2.1-fold) after HSCT among 28,874 bone marrow transplant patients. 2 Furthermore, the risk of cancer of the oral cavity and pharynx was reported as about seven-fold that of cancers occurring in other parts of the body. 2 The development of oral cancer after HSCT has also been reported as a risk factor for bone marrow transplantation at a young age, after total-body irradiation, long-term use of immunosuppressive drugs, chronic GVHD, male gender, and viral infections.…”

“…2 Furthermore, the risk of cancer of the oral cavity and pharynx was reported as about seven-fold that of cancers occurring in other parts of the body. 2 The development of oral cancer after HSCT has also been reported as a risk factor for bone marrow transplantation at a young age, after total-body irradiation, long-term use of immunosuppressive drugs, chronic GVHD, male gender, and viral infections. 7 In particular, administration of immunosuppressive drugs after bone marrow transplantation, has been reported to increase carcinogenicity due to decreased immune surveillance against cancer.…”

“…In addition, the tongue is the most common site of oral cancer after HSCT, followed by the gingiva. 2 The time from HSCT to the development of oral cancer reportedly ranges from two to over 17 years,10 with an average of eight years. 10 In the present case, 17 years passed before tongue cancer developed, and the patient had a long interval until the development of secondary cancer.…”

“…1 However, the development of graft-versus-host disease (GVHD) and secondary cancers after HSCT is a problem. 2 The risk of developing a secondary cancer after HSCT is reported to be 2.16-fold more than that of developing a normal secondary cancer. 1 Furthermore, secondary cancers developing in the oral cavity and pharynx are reported to be approximately 7-16fold more common than secondary cancers occurring in other regions of the body.…”

Late Complications in Long-Term Childhood Cancer Survivors: What the Oral Health Professional Needs to Know

“…CCS with (a history of) cGVHD are especially at risk of developing oral cancer (see below) even many years after HCT [77]. Therefore, regular dental check-ups, including screening for oral cancer, are particularly important in these survivors [78].…”