Table 1.
Characteristics of secondary squamous cell carcinoma of head and neck in the survivors of hematopoietic stem cell transplantation for hematologic malignancies
| Patient | 1 | 2 | 3 | 4 | 5 | 6 |
|---|---|---|---|---|---|---|
| Age at SCC/sex | 49/M | 48/M | 43/F | 66/F | 49/M | 44/M |
| Latency of SCC (years) | 3 | 8 | 8 | 12 | 7 | 13 |
| Hematologic malignancy | Transformed FL to DLBCL | AML | AML | CML | CML | CML |
| Treatment before HSCT | R-CVP, R-CHOP, and BEAM followed ASCT | Daunorubicin + Ara-C | Daunorubicin + Ara-C | Hydroxyurea, interferone, and splenic irradiation | Imatininb | Hydroxyurea, interferone, and splenic irradiation |
| Type of HSCT/sex of donor | RIC MSD/F | Ablative MSD/M | Ablative MSD/F | Ablative MSD/M | Ablative MSD/M | Ablative MSD/F |
| Oral mucositis | Severe needing TPN | Moderate | Moderate | Severe needing TPN | Moderate | Severe needing TPN |
| Acute GVHD | Skin, oral | Skin, GI | Skin | Oral, liver | Skin, GI | None |
| Chronic GVHD location/grade | Oral/extensive | None | Oral/extensive | Skin, oral/extensive | Oral/extensive | Skin, oral, and esophageal/extensive |
| Chronic GVHD treatment | C, P, Ph, and R | None | P, M, and Ph | P, M, and R | P, M, Ph, and R | P, M, Ph, R, and I |
| Site of SCC | L (T1) and R (T2) anterior tongue, the left floor of the mouth | Base of tongue and left tonsil | Left tongue | Right tongue | Right tongue | Distal esophagus |
| Chief complaint/exam finding | Focal pain in the areas of chronic irritation/ill-defined tender plaque with shallow ulcerations | New-onset neck swelling/exophytic growth at the base of the tongue | Focal pain/ulcerated ill-defined tender flat lesion | Focal pain/superficial tender ulcerated lesion | Focal pain/ exophytic ulcerated 2-cm lesion, and diffuse similar lesions nearby mucosa | Dysphagia and distal esophageal exophytic mass by endoscopy |
| Stage of SCC/focality | T2N0/stage II/multifocal | T1N2a/stage IVA/multifocal | T2N0/stage II/multifocal | T4aN2a/stage IVA/unifocal | pT2N1/stage III/multifocal | T3N1/stage III/no resection |
| Grade | 3 | 2 | 2 | 2 | 2 | 2 |
| Resection margin | + for SCC, SCC in situ, and SSD | + for SCC, SCC in situ, and SSD | + for SCC and SSD | + for SCC and SSD | + for SSD | Patient declined resection |
| LVI/PNI | −/− | +/− | −/+ | −/+ | +/+ | −/− |
| Preceding lesions | SD and SP | NPB | SD | SD | NPB | SD |
| Treatment | Neoadjuvant TPF, B/L hemiglossectomy, and floor of mouth excision | B/L tonsillectomy, base of tongue excision, CRT, and neck dissection | Partial glossectomy, neck dissection, and CRT at recurrence | Hemiglossectomy, neck dissection, and CRT with concurrent cetuximab | Hemiglossectomy and neck dissection | CRT and declined surgery |
| Outcome | 2 local recurrence in 2 years and 4 surveillance biopsies showing SSD | Alive at 9 years without recurrence | Died after 4 years from multiple local recurrences, and pulmonary metastasis | Died of progressive SCC in 4 months | Alive at 15 months without recurrence | Alive at 18 months without recurrence |
Pt patients; SCC squamous cell carcinoma; ASCT autologous hematopoietic stem cell transplantation; FL follicular lymphoma; DLBCL diffuse large B-cell lymphoma; AML acute myeloid leukemia; CML chronic myeloid leukemia; R-CVP rituximab, cyclophosphamide, vincristine, prednisone; R-CHOP rituximab, cyclophosphamide, doxorubicin, prednisone; BEAM BCNU, etoposide, cytarabine, melphalan; RIC reduced-intensity conditioning; MSD matched sibling donor; M male; F female; TPN total parenteral nutrition; GI gastrointestinal; GVHD graft-versus-host disease; Ext extensive; C cyclosporine; P prednisone; M mycophenolate mofetil; Ph photopheresis; I imatinib; R right; L left; LVI lymphovascular invasion; PNI perineural invasion; SSD severe squamous dysplasia; SP squamous papilloma; NPB no prior biopsy; CRT chemoradiotherapy; B/L bilateral; TPF docetaxel, carboplatin, and 5-flurouracil; CRT chemoradiation