Clinicopathologic characteristics of secondary squamous cell carcinoma of head and neck in survivors of allogeneic hematopoietic stem cell transplantation for hematologic malignancies

Chakra P Chaulagain,Andreas K Klein,Kellie A Sprague,Kenneth B Miller,Monika Pilichowska,Janet Cowan,Esha Kaul

doi:10.1038/s41409-018-0299-x

Abstract

The risk of late complications including secondary malignancies is increased in long-term survivors of allogeneic hematopoietic stem cell transplants (HSCT). There is limited literature on the biological behavior and clinical features of squamous cell carcinoma (SCC) of head and neck post-HSCT. We present the clinical and pathologic characteristics on six patients who were diagnosed with SCC while in remission following an allogeneic HSCT. Median follow-up was 8 years. Five patients (83%) developed SCC of tongue and one developed esophageal SCC. Five patients had oral chronic graft-versus-host disease (cGvHD). The conventional risk factors of alcohol, tobacco, and human papillomavirus were absent. The most common presenting finding was the new-onset focal oral pain and ulcerated plaques clinically indistinguishable from a flare of their oral cGvHD lesions. We demonstrated that the SCC in three patients was of donor origin.

Highlights

Advances in hematopoietic stem cell transplants (HSCT) are curing an increasing number of patients with hematologic malignancies leading to an increase in the number of long-term survivors
In a large reported cohort of HSCT recipients, the oral cavity was one of the most common squamous cell carcinoma (SCC) sites accounting for 15% of all solid cancers [5]
This study and other small series have identified a strong association between oral SCC and chronic graft-versus-host disease [6,7,8,9]

Summary

Introduction

Advances in hematopoietic stem cell transplants (HSCT) are curing an increasing number of patients with hematologic malignancies leading to an increase in the number of long-term survivors. Survivors are developing late complications following the HSCT, including an increase in delayed cardiovascular morbidity, late pulmonary complications, and an increased risk of secondary solid cancers[1,2,3]. The risk of secondary solid cancers is increased both with total body irradiation (TBI) and non-TBI-based conditioning regimens [3, 4]. The advent of reduced-intensity conditioning (RIC) has greatly expanded the scope of HSCT but the risk of secondary malignancies after RIC HSCT is similar to patients who receive a myeloablative conditioning regimen [4]. We report on six patients who developed SCC and review the literature of reports of SCCs. This study and other small series have identified a strong association between oral SCC and chronic graft-versus-host disease (cGvHD) [6,7,8,9].

Methods

Results

Conclusion