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MASCC/ISOO Clinical Practice Statement: The risk of secondary oral cancer following hematopoietic cell transplantation

Affiliations
  • 1Department of Oral Medicine, Academic Center for Dentistry Amsterdam (ACTA), Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam and VU University, University of Amsterdam, Gustav Mahlerlaan 3004, 1081 LA, Amsterdam, The Netherlands. j.raber.durlacher@acta.nl.
  • 2Division of Oral Medicine and Dentistry Brigham and Women’s Hospital and Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA.
  • 3Department of Oral Medicine and Saligman Clinics, Faculty of Dental Medicine, The Hebrew University of Jerusalem, and Hadassah Medical Center, Jerusalem, Israel.
  • 4Department of Oral Medicine, University of Washington School of Dentistry and Fred Hutchinson Cancer Center, Seattle, WA, USA.
  • 5Centro de Oncologia Molecular, Instituto de Ensino e Pesquisa, Hospital Sírio-Libanês, São Paulo, SP, Brazil.
  • 6Dental Oncology Service, City of Hope Comprehensive Cancer Center, Duarte, CA and Cedars-Sinai Health System, Los Angeles, CA, USA.
  • 7Oral Medicine, Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA.

Published on:

July 24, 2024

Abstract

PURPOSE

A MASCC/ISOO Clinical Practice Statement (CPS) is aimed at generating a concise tool for clinicians that concentrates practical information needed for the management of oral complications of cancer patients. This CPS is focused on the risk of secondary oral cancer following hematopoietic cell transplantation (HCT).

METHODS

This CPS was developed based on critical evaluation of the literature followed by a structured discussion of a group of leading experts, members of the Oral Care Study Group of MASCC/ISOO. The information is presented in the form of succinct bullets to generate a short manual about the best standard of care.

RESULTS

Studies described a 7-16-fold higher risk of secondary oral cancer (mainly squamous cell carcinoma) in allogeneic HCT (alloHCT) recipients, particularly in those who developed chronic graft versus host disease (cGVHD). Risk increases over time and is influenced by several risk factors. In autologous HCT, oral cancer risk seemed only slightly elevated.

CONCLUSION

Clinicians should be aware of the higher oral cancer risk in alloHCT survivors, and emphasize the importance of lifelong oral cancer surveillance (at least every 6-12 months) and avoiding cancer promoting lifestyle factors in an empathic way, particularly of those with (a history of) cGVHD. Post-HCT for Fanconi anemia or dyskeratosis congenita, education and rigorous follow-up is even more crucial. In case of suspected oral lesions in the presence of oral mucosal cGVHD, a GVHD intervention may facilitate diagnosis. Suspected lesions should be biopsied. More research is needed on the role of HPV in oral cancer post-HCT.

Keywords:

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