MASCC/ISOO Clinical Practice Statement: dental evaluation and management prior to treatment for hematologic malignancies and CAR T-cell therapy.

PURPOSE

A MASCC/ISOO Clinical Practice Statement (CPS) aims to provide clinicians with a guide for managing oral conditions in cancer patients. This CPS addresses dental care prior to chemotherapy, hematopoietic cell transplantation, chimeric antigen receptor (CAR) T-cell therapy, and other treatments for hematologic malignancies in pediatric, adult, and elderly patients. Guidance on optimal timing for resuming dental treatment post-therapy is also included.

METHODS

This CPS was developed through a critical evaluation of the literature, followed by a structured discussion of a group of leading experts, members of the Oral Care Study Group of MASCC/ISOO. Information is presented in succinct bullet points and a table to create a practical manual on the best standards of care.

RESULTS

Patients undergoing anti-cancer therapy require a thorough dental assessment and treatment. Pre-therapy dental care aims to prevent oral infection, systemic pathogen spread, oral pain, local irritation, and risk of aspiration and to educate patients on oral hygiene and managing the expected common oral complications. This preventive approach supports oral intake, relieves pain, prevents treatment interruptions, enhances quality of life, and potentially reduces mortality. This CPS outlines the essential considerations for the dental evaluation and treatment, focusing on key dental diagnoses, procedural prioritization, and timing relative to the hemato-oncologic therapy.

CONCLUSIONS

This CPS provides clinicians with strategies for effective dental clearance, improving patient outcomes and minimizing complications during and after anti-cancer therapy. CAR T-cell therapy introduces additional considerations in the dental treatment plan before and immediately after the cytoreductive therapy.