Adepitan A. Owosho

Background/Objectives: Chimeric antigen receptor T-cell (CAR-T) therapy has been approved for the management of relapsed and refractory hematologic malignancies, transforming the oncologic landscape and producing durable remissions in patient populations with limited alternatives. The systemic adverse events of CAR-T are well characterized; however, the orofacial adverse events have not been well described. The objective of this study is to leverage a large, de-identified, real-world dataset to (1) estimate the prevalence of orofacial adverse events following CAR-T, (2) compare event rates with the general population, and (3) directly contrast the orofacial toxicity burden of CAR-T with that observed after hemopoietic stem cell transplant (HSCT). Methods: We performed a retrospective cohort study using de-identified electronic health record data from TriNetX. CAR-T and HSCT cohorts were identified via RxNorm and procedure codes; a non-exposed control cohort was included. Patients with prior orofacial conditions or confounding therapies were excluded. New adverse orofacial events within one year were identified by International Classification of Diseases, 10th Revision (ICD-10) codes. Cohorts were 1:1 propensity-matched by age and sex; associations were estimated as odds ratios with two-sided 95% CIs. Results: In 1142 CAR-T recipients (mean age of 62), gastroesophageal reflux disease (GERD) was most frequent (5.18%). Oral mucosal events included stomatitis in 1.52%, mucositis in 1.31%, and lichenoid reactions in 1.03%. Dysphagia occurred in 1.8% and oral candidiasis in 1.6%. Several severe oral conditions were absent. Compared with the general population (CART vs. general population): mucositis—[12/995 vs. 0/1112] (OR 28.3)—and stomatitis—[16/987 vs. 0/1119] (OR 38)—risks were significantly increased, while CAR-T patients had significant lower risks of mucosal complications than HSCT recipients in this analysis (CART vs. HSCT): mucositis—[1.21% vs. 3.72%] (OR 0.316) and stomatitis—[1.42% vs. 3.91%] (OR 0.354). Conclusions: CAR-T therapy carries a distinct and generally lower orofacial toxicity burden than HSCT, but targeted dental assessment and prospective surveillance remain important to optimize supportive care for cellular therapy recipients.

Objectives: The relationship between sociodemographic factors and the development of oral squamous cell carcinoma (OSCC), the most prevalent malignant neoplasm of the oral cavity, remains poorly understood. This scoping review aimed to explore the influence of sociodemographic determinants on the occurrence of OSCC, with a particular focus on disparities affecting Black individuals and the impact of such inequities on prognosis. Methods: This review was registered on the Open Science Framework and conducted in accordance with PRISMA guidelines. Five databases and gray literature were systematically searched. Eligible studies included adult patients diagnosed with OSCC and examined associations between sociodemographic factors, such as socioeconomic status (SES), education level, monthly income, and race and oral cancer outcomes. Data were synthesized descriptively. Results: Sixty-nine studies from 13 countries, totaling 1,009,752 patients, were included. Among patients with reported SES, 71.6% were classified as having low SES. Educational levels were also notably low: 36.2% of patients were illiterate, and 42.6% had only elementary education. Most research originated from countries with high or very high Human Development Index (HDI). Black patients exhibited worse OSCC prognosis compared to White patients, with a five-year survival rate of 33.9% versus 52.9%, advanced-stages diagnosis in 64.9% versus 47%, and higher mortality rates of 68.8% versus 48.8%, respectively. Conclusion: This review highlights a significant relationship between adverse sociodemographic determinants and the occurrence of OSCC. Black individuals showed worse prognostic variables compared to White patients. Despite most included studies being conducted in high- or very-high-HDI countries, racial disparities in OSCC prognosis persisted, suggesting that national development levels do not mitigate these inequities.