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Case Report

Osteonecrosis of the jaw in a patient with acute myeloid leukemia, who
received azacitidine

Ourania Nicolatou-Galitis , Dimitra Galiti , Maria Moschogianni , Sotirios Sachanas , Beatrice J. Edwards ,
3
4
3
1
2
Cesar A. Migliorati , Gerassimos Pangalis 6
5
1 Clinic of Hospital Dentistry, Dental Oncology Unit, Dental School, National and Kapodistrian University of Athens, 15451 Athens, Greece.
2 Clinic of Oral Diagnosis and Radiology, Dental School, National and Kapodistrian University of Athens, 15451 Athens, Greece.
3 Department of Hematology, Athens Medical Center-Psychikon Branch, 15451 Athens, Greece.
4 Geriatric Medicine, Department of General Internal Medicine, Center for Research and Education, University of Texas, MD Anderson Cancer
Center, Houston, TX 77042, USA.
5 Department of Diagnostic Sciences and Oral Medicine, University of Tennessee Health Science Center College of Dentistry, Memphis, TX 37174, USA.
6 Department of Hematology, Athens Medical Center-Psychikon Branch, 15451 Athens, Greece.
Correspondence to: Prof. Ourania Nicolatou-Galitis, Clinic of Hospital Dentistry, Dental Oncology Unit, Dental School, National and Kapodistrian
University of Athens, Bouboulinas 41, N. Psyhico, 15451 Athens, Greece. E-mail: nicolatou.galitis@hotmail.com

Ourania Nicolatou-Galitis is Professor and Chair of the Dental Oncology, at the National and Kapodistrian University of
Athens, Greece. She is President of the International Society of Oral Oncology and serves as Chair of the Bone Study
Group, MASCC.org. Osteonecrosis of the jaw in medication is her major research interest.

A B S T R AC T
The first case of osteonecrosis of the jaw (ONJ) related to azacitidine therapy was reported. A 64-year-old male with acute
myeloid leukemia, who received 5-azacitidine, presented with pain and purulence of the right second premolar. An unsuccessful
endodontic therapy resulted in dental extraction 6 months later. The post-extraction non-healing socket was managed with
antibiotics and multiple surgical debridements without response. ONJ stage 2 was diagnosed 12 months after the initial symptoms
of pain and purulence and was managed conservatively. Currently the patient is still receiving 5-azacitidine therapy, while ONJ
remains asymptomatic. This case highlights the presence of alveolar bone disease prior to the appearance of ONJ. Osteonecrosis
in chemotherapy, although rare, may increase as long-term survival of cancer patients, who receive those medications increases.
Health care professionals need to be alert, while collaboration with an experienced oral/dental oncologist would be beneficial to
the patient.

Key words: Acute myeloid leukemia; azacitidine; periodontal/dental disease and infection; dental extraction; osteonecrosis of the jaw

INTRODUCTION was recently associated with ONJ. In patients receiving
[9]
antiresorptives, concurrent chemotherapy was reported as a
Osteonecrosis of the jaw (ONJ) in cancer patients is related risk factor, while chemotherapy alone has also been related
to antiresorptive therapy, such as bisphosphonates and to ONJ in three patients. [10-12]
denosumab, and angiogenesis inhibitors, such as bevacizumab
and sunitinib. [1-3] Medications with antiangiogenic effect, Dental extraction has been considered as one of the causes
[16]
such as sorafenib, imatinib, everolimus, aflibercept, for ONJ. [13-15] This myth has, however, been questioned.
trastuzumab and pazopanib were related to ONJ in few It is now believed that the dental extraction, indicated due
case reports. [4-8] Ipilimumab, a monoclonal antibody against This is an open access article distributed under the terms of the Creative
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How to cite this article: Nicolatou-Galitis O, Galiti D, Moschogianni
M, Sachanas S, Edwards BJ, Migliorati CA, Pangalis G. Osteonecrosis
of the jaw in a patient with acute myeloid leukemia, who received
DOI: azacitidine. J Cancer Metasta Treat 2016;2:220-3.
10.20517/2394-4722.2016.06
Received: 31-01-2016; Accepted: 10-05-2016.

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©2016 Journal of Cancer Metastasis and Treatment ¦ Published by OAE Publishing Inc.