Parallel Stem Cell Niche in Bone Marrow and Oral Cavity – Key to Extramedullary Hematopoiesis and Support of Hematological Malignancies on Oral Tissues

This review article addresses an area of the literature with unanswered questions; although relevant to future treatment of leukemias. The literature describes bone marrow stromal microenvironment as support of leukemias. A key stromal support is mesenchymal stem cells (MSCs), which are similar to those identified in oral tissues, including the dental pulp (DPSC). Hematopoiesis has been reported in oral tissues, although the described activity seems to be distinct from extramedullary hematopoiesis at other sites when there is bone marrow dysfunction such as myelofibrosis. Another parallel between the bone marrow and oral tissues is the survival of leukemia cells. This review describes cases in which the dentist diagnoses leukemia, in particular acute myeloid leukemia (AML). The literature showed AML and other hematological malignancies in gingiva, leaving the question of the source of leukemia. We propose that this question is relevant considering the similar stromal support in bone marrow and oral tissues. It is difficult to determine if current treatments can target leukemia in oral tissues. This article consists of information to argue for continued research in this field.