Abstract
Acute myeloid leukemia (AML) is a heterogeneous group of diseases, whose classification is based on lineage-commitment and genetics. Although rare in childhood, it is the most common type of acute leukemia in adults, accounting for 80% of all cases in this age group. The prognosis of this disease remains poor (especially in childhood, as compared to acute lymphoblastic leukemia); however, overall survival has significantly improved over the past 30 years. The health of the oral cavity is a remarkable reflection of the systemic status of an individual. Identification of the signs and symptoms of oral lesions can act as a warning sign of hidden and serious systemic involvement. Moreover, they may be the presenting feature of acute leukemia and provide important diagnostic indicators. Primary oral alterations are identified in up to 90% of cases of acute myeloid leukemia and consist of petechiae, spontaneous bleeding, mucosal ulceration, gingival enlargement with or without necrosis, infections, hemorrhagic bullae on the tongue, and cracked lips. Poor oral hygiene is a well-known risk factor for local and systemic infectious complications. Oro-dental complications due to AML treatment can affect the teeth, oral mucosa, soft and bone tissue, and contribute to opportunistic infections, dental decay, and enamel discoloration. The treatment of acute myeloid leukemia is still associated with high mortality and morbidity. The management is multimodal, involving aggressive multidrug chemotherapy and, in most cases, allogenic bone marrow transplantation. Periodontal and dental treatment for patients with leukemia should always be planned and concerted with hematologists.
Highlights
Leukemia is a heterogeneous group of hematological disorders arising from hematopoietic stem cells [1], resulting from the uncontrolled proliferation of neoplastic cells [2,3], characterized by impaired differentiation [1,2] and programmed cell death [2]
Can predispose to pediatric myeloid malignancies [13,14]. Acute leukemia, both lymphoblastic and myeloid in adults [15,16], and myeloid in a child [17] have been reported in cleidocranial dysplasia (CCD) associated with RUNX2 gene mutations
The treatment-related mortality (TRM) of Acute myeloid leukemia (AML) is decreasing due to the introduction of new drugs, improved prognostic factors, and risk group stratification and modern treatment protocols that include intensive induction chemotherapy, followed by post-remission treatment: Additional anthracycline and high dose cytarabine or allogenic hematopoietic stem cell transplantation (HSCT) for subgroups at high risk of recurrence
Summary
Leukemia is a heterogeneous group of hematological disorders arising from hematopoietic stem cells [1], resulting from the uncontrolled proliferation of neoplastic cells [2,3], characterized by impaired differentiation [1,2] and programmed cell death [2]. The failure of maturation of precursor cells results in the accumulation of blasts in the bone marrow with consequent suppression of normal hematopoiesis, leading to deficiency of mature leukocytes, erythrocytes, and platelets [4]. Leukemia is distinguished into acute and chronic [1,5]. According to the lineage of the origin of blasts, leukemia may be classified as lymphoblastic or myelogenous. Both may occur in an acute or chronic form and at different ages. Acute lymphoblastic leukemia (ALL) is typical of the pediatric age, whilst acute myeloid leukemia (AML) is more common in adult age. This review is aimed at emphasizing the oral manifestations and complications of AML resulting from the underlying disease process and following treatment
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