Oral Dysplastic Complications after HSCT: Single Case Series of Multidisciplinary Evaluation of 80 Patients
Abstract
:1. Introduction
2. Materials and Methods
- Demographic variables: age, sex.
- Clinical hematological data: underlying disease, type of conditioning regimen, stem cell source (bone marrow or peripheral blood), donor’s sex, HLA matching, post-transplant response, recurrence, mortality.
- Data regarding aGVHD and cGVHD: drug prophylaxis, organs involvement, grading documented according to the 2014 National Institutes of Health consensus criteria, treatment protocol.
3. Results
4. Discussion
Author Contributions
Funding
Conflicts of Interest
References
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N | (%) | |
---|---|---|
All patients | 80 | |
Age, median years (range) | 40.8 (18.4–65.1) | |
Recipient sex | ||
M | 41 | (51.2) |
F | 39 | (48.7) |
Sex match between recipient and donor | ||
Matching | 41 | (51.2) |
Mismatching | 39 | (48.7) |
Disease | ||
AML | 32 | (40) |
CML | 9 | (11.2) |
ALL | 6 | (7.5) |
ALL ph+ | 5 | (6.2) |
CLL | 1 | (1.2) |
MM | 4 | (5) |
AA | 6 | (7.5) |
HL | 3 | (3.7) |
NHL | 2 | (2.5) |
DC | 1 | (1.2) |
AML POST SMD | 6 | (7.5) |
MF | 1 | (1.2) |
MDS | 1 | (1.2) |
FA | 3 | (3.7) |
Stem cell source | ||
BM | 52 | (65) |
PB | 28 | (35) |
HLA compatibility | ||
HAPLO | 30 | (37.5) |
MUD | 19 | (23.7) |
HLA-id | 31 | (38.7) |
Type of conditioning regimen | ||
NMC | 12 | (15) |
MAC | 65 | (81.2) |
RIC | 3 | (3.7) |
Conditioning regimen | ||
Benda/Flu/Mel | 2 | (2.5) |
Tbf | 42 | (52.5) |
Bu/Cy | 8 | (10) |
Bu/Flu | 11 | (13.7) |
Cy | 2 | (2.5) |
Flu/Cy | 7 | (8.7) |
Flu/Cy/Tbi | 3 | (3.7) |
Flu/Tep | 5 | (6.2) |
GVHD Prophylaxis | ||
CsA | 1 | (1.2) |
Alemtuzumab | 4 | (5) |
Alemtuzumab+ATG | 1 | (1.2) |
MMF+ATG | 2 | (2.5) |
MMF+Cy | 34 | (42.5) |
MTX | 21 | (26.2) |
MTX+ATG | 14 | (17.5) |
MTX+ATG+Alemtuzumab | 1 | (1.2) |
MTX+Alemtuzumab | 1 | (1.2) |
MTX+MMF+ATG | 1 | (1.2) |
Toxicity post-HSCT 1 | ||
Liver | 4 | (5) |
Cardiac | 4 | (5) |
GI | 32 | (40) |
Mucosal | 56 | (70) |
Kidney | 9 | (11.2) |
Vascular | 5 | (6.2) |
Hypertension | 2 | (2.5) |
Lyell’s syndrome | 1 | (1.2) |
Outcome post-HSCT | ||
Complete remission | 60 | (75) |
Partial remission | 4 | (5) |
Data not available | 14 | (17.5) |
Graft Failure | 1 | (1.25) |
Death | 1 | (1.25) |
Relapse | 15 | (18.7) |
Death | 36 | (45) |
Median follow up of survivors, months (range) | 22 (1–78) |
N | (%) | |
---|---|---|
aGVHD | ||
All patients | 46 | (57.5) |
Age, median years (range) | 41.9 (18.4–61.8) | |
Sites involved 1 | ||
Skin | 39 | (84.9) |
Liver | 19 | (41.3) |
Gastrointestinal tract | 17 | (36.9) |
Grading | ||
I | 18 | (39.1) |
II | 20 | (43.5) |
III | 8 | (17.4) |
IV | 0 | |
Therapy | ||
First therapy | 43 | (93.5) |
6-MP | 41 | (89.1) |
Alemtuzumab | 2 | (4.3) |
Second therapy | 5 | (10.9) |
Begelomab | 2 | (4.3) |
Alemtuzumab | 1 | (2.2) |
MMF | 1 | (2.2) |
ATG | 1 | (2.2) |
Third therapy | 1 | (2.2) |
MMF | 1 | (2.2) |
cGVHD | ||
All patients | 39 | (48.7) |
Age, median years (range) | 41.4 (23.2–65.1) | |
Sites involved | ||
Skin | 31 | (81.6) |
Liver | 27 | (71.1) |
Oral cavity | 22 | (56.4) |
Eyes | 15 | (39.5) |
Gastrointestinal tract | 9 | (23.7) |
Lungs | 7 | (18.4) |
Genitalia | 6 | (15.8) |
Muscles, fascia, joints | 2 | (5.3) |
Grading | ||
Mild | 16 | (41) |
Moderate | 15 | (38.5) |
Severe | 8 | (20.5) |
Therapy 2 | ||
Immunosuppressors | 39 | (100) |
6-MP | 33 | (84.6) |
CsA | 37 | (94.8) |
MMF | 20 | (51.3) |
RAP | 1 | (2.6) |
mAB/pABs | 9 | (23.1) |
Begedina | 1 | (11.1) |
ATG | 4 | (44.4) |
Rituximab | 3 | (33.3) |
Alemtuzumab | 1 | (11.1) |
Chemoterapies | 15 | (38.4) |
Mtx | 5 | (33.3) |
Cy | 10 | (66.6) |
Steroids | 21 | (53.8) |
TKI | 5 | (12.8) |
ECP | 8 | (20.5) |
PUVA | 4 | (10.2) |
IVIG | 1 | (2.5) |
DLI | 1 | (2.5) |
N | (%) | |
---|---|---|
All patients | 22 | |
Age, Median years (range) | 41.3 (24–65.1) | |
Time lapse between HSCT and oral involvement (months) | 9.7 (3.3–36) | |
Average time to request advice in oral medicine (days) | 18.5 (1–90) | |
Morphology of oral lesions 1 | ||
Keratotic reticular lesions | 7 | (25) |
Keratotic plaque lesions | 5 | (17.9) |
Erosive/Ulcerative lesions | 6 | (21.4) |
Verrucous lesions | 6 | (21.4) |
Atrophic lesions | 2 | (7.1) |
Bullous lesions | 2 | (7.1) |
Sites of oral lesions 1 | ||
Check | 14 | (31.8) |
Dorsal tongue | 7 | (15.9) |
Ventral tongue | 6 | (13.6) |
Floor of the mouth | 2 | (4.5) |
Hard palate | 4 | (9.1) |
Soft palate | 3 | (6.8) |
Lip | 2 | (4.5) |
Gingival mucosa | 6 | (13.6) |
Histopathological diagnosis | ||
No dysplasia | 6 | (27.3) |
Mild/moderate dysplasia | 9 | (40.9) |
CIS | 4 | (18.2) |
OSCC | 3 | (13.6) |
Treatment | Surgical Excision | Resection, Neck Dissection and Radiotherapy | Resection, Neck Dissection and Radiotherapy | Surgical Excision | Surgical Excision | Surgical Excision | Surgical Excision |
---|---|---|---|---|---|---|---|
Staging (TNM) | 0 | IV A | IV A | I | 0 | 0 | 0 |
Intraoral site | Check | Alveolar ridge | Check | Gingival mucosa | Ventral tongue | Ventral tongue | Lip |
cGVHD | Oral cavity, skin, liver, eyes, GI, lungs | Oral cavity, skin, hepatic, eyes, GI | Oral cavity, skin, liver | Oral cavity | Oral cavity, skin, liver, eyes, genitalia, lungs | Oral cavity, skin, liver | Oral cavity, skin, GI |
aGVHD | Liver | Liver, GI | - | - | Skin | - | - |
HLA compatibility/sex of donor | HLA id/F | MUD/M | HLA id/M | HAPLO/M | HLA id/M | MUD/M | HLA id/M |
Conditioning regimen | MAC | NMC | MAC | MAC | MAC | NMC | MAC |
Latency of OSCC (year) | 6 | 3 | 4 | 7 | 4 | 5 | 6 |
Age/sex | 59/M | 37/M | 24/F | 51/M | 40/M | 28/F | 26/F |
Patients | 1 | 2 | 3 | 4 | 5 | 6 | 7 |
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Leuci, S.; Coppola, N.; Blasi, A.; Ruoppo, E.; Bizzoca, M.E.; Lo Muzio, L.; Marano, L.; Risitano, A.M.; Mignogna, M.D. Oral Dysplastic Complications after HSCT: Single Case Series of Multidisciplinary Evaluation of 80 Patients. Life 2020, 10, 236. https://doi.org/10.3390/life10100236
Leuci S, Coppola N, Blasi A, Ruoppo E, Bizzoca ME, Lo Muzio L, Marano L, Risitano AM, Mignogna MD. Oral Dysplastic Complications after HSCT: Single Case Series of Multidisciplinary Evaluation of 80 Patients. Life. 2020; 10(10):236. https://doi.org/10.3390/life10100236
Chicago/Turabian StyleLeuci, Stefania, Noemi Coppola, Andrea Blasi, Elvira Ruoppo, Maria Eleonora Bizzoca, Lorenzo Lo Muzio, Luana Marano, Antonio Maria Risitano, and Michele Davide Mignogna. 2020. "Oral Dysplastic Complications after HSCT: Single Case Series of Multidisciplinary Evaluation of 80 Patients" Life 10, no. 10: 236. https://doi.org/10.3390/life10100236