Carcinoma espinocelular oral em pacientes pós-transplante de células-tronco hematopoiéticas: uma revisão integrativa.

Abstract

Hematopoietic stem cell transplantation (HSCT) is a therapeutic modality used in the treatment of hematologic and oncohematologic diseases, aiming to restore bone marrow function after myeloablative conditioning regimens. With the increase in patient survival, late complications have become more frequent, among which secondary malignant neoplasms stand out, particularly those affecting the oral cavity. This study aimed to outline the clinical and epidemiological profile of patients who developed oral squamous cell carcinoma (OSCC) following HSCT. An integrative literature review was carried out in the PubMed, Scopus, SciELO, and Virtual Health Library (VHL) databases, including publications from the last 20 years in Portuguese, English, and Spanish. Twenty-nine articles were selected, totaling 59 clinical cases. There was a predominance of male patients (67.8%) with a mean age of 34 years. The most frequent underlying diseases were Fanconi anemia (40.68%), acute myeloid leukemia (15.25%), and acute lymphoblastic leukemia (10.17%). The most common transplant type was allogeneic, with related donors in 40.68%, unrelated donors in 11.86%, and haploidentical donors in 11.86%. Chronic oral graft-versus-host disease (GVHD) was reported in 72.88% of patients. The mean interval between HSCT and OSCC diagnosis was nine years, while patient delay ranged from 20 days to two years, with an average of 13.3 months. The most affected sites were the tongue (36.36%), buccal mucosa (22.73%), and gingiva/alveolar ridge (13.64%), with ulcerated lesions being the most common presentation (53.57%). The mortality rate was high (47.05%), while 39.21% of patients remained free of recurrence or metastasis. It is concluded that oral squamous cell carcinoma secondary to hematopoietic stem cell transplantation has a multifactorial etiology, a significant incidence, and clinical characteristics that justify long-term and continuous dental surveillance.