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New photobiomodulation protocol prevents oral mucositis in hematopoietic stem cell transplantation recipients—a retrospective study

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Abstract

Oral mucositis (OM) is an adverse side effect among hematopoietic stem cell transplantation (HSCT) recipients. The objective of this retrospective study was to evaluate the preventive effect of photobiomodulation (PBM) applied three times per week versus seven times per week in patients undergoing HSCT. The risk factors related to the incidence and severity of OM were also assessed. This was a retrospective study that evaluated 99 HSCT recipients who received different PBM protocols. Group I received three sessions per week, and group II received daily treatment. PBM was applied using a continuous-wave diode laser (InGaAlP; MM Optics, São Carlos, SP, Brazil) at a wavelength of 660 nm (visible-red) and a total radiant energy of 0.24 J per point. The baseline disease, type of transplant, type of conditioning, prophylaxis against graft-versus-host disease, OM grade, absolute leukocyte and platelet counts, and levels of liver and renal function markers were collected from medical records. The patients’ age ranged from 13 to 71 years (mean/SD, 40.54 ± 16.45). No significant difference was observed between groups I and II regarding sex, age, ethnic, diagnosis, donor type, and conditioning treatment. Both PBM protocols were equally efficient in preventing OM (p = 0.34, ANOVA). Independent of the PBM protocol used, patients who received allogeneic transplant (p < 0.01—Fischer’s exact test), total body irradiation (TBI-12Gy) (p = 0.01—chi-square test), busulfan + cyclophosphamide (p < 0.01—chi-square test), or methotrexate-containing regimens (p < 0.01—Fischer’s exact test) demonstrated higher OM incidence and severity. Myelosuppression (p < 0.01—Mann-Whitney test) and impaired renal function (p = 0.02—Mann-Whitney test) were also considered risk factors for OM. Based on this retrospective data, PBM was effective in preventing OM in patients undergoing HSCT even when it was applied three times a week. A prospective study might be necessary to confirm these findings.

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Acknowledgements

The authors are grateful to Capes Foundation within the Ministry of Education, Brazil for student scholarship and to Biostatistics Unit of the Postgraduate Research Group of the Porto Alegre University Hospital for performing the statistical analysis. Manoela Domingues Martins are research fellows funded by the Brazilian National Council for Scientific and Technological Development (CNPq). This work was supported by Brazilian Federal Agency for Support and Evaluation of Graduate Education (CAPES) and Postgraduate Research Group of the Hospital de Clínicas de Porto Alegre (GPPG/FIPE: 16–0080).

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Author notes

  1. Camila Weissheimer and Marina Curra contributed equally to this article

Authors and Affiliations

  1. Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Av. Limeira, 901, Piracicaba, 13414-903, Brazil

    Camila Weissheimer & Manoela D. Martins

  2. Department of Oral Pathology, School of Dentistry, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, 2492, Porto Alegre, Rio Grande do Sul, 90035-003, Brazil

    Marina Curra, Vivian P. Wagner, Marco Antonio T. Martins & Manoela D. Martins

  3. Department of Oral Medicine, Hospital de Clínicas de Porto Alegre (HCPA/UFRGS), Rua Ramiro Barcelos, 2350, Porto Alegre, Rio Grande do Sul, 90035-903, Brazil

    Marina Curra, Marco Antonio T. Martins & Manoela D. Martins

  4. Pediatric Oncology Service, Clinical Hospital, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, 2350, Porto Alegre, Rio Grande do Sul, 90035-903, Brazil

    Lauro J. Gregianin

  5. Hematopoietic Stem Cell Transplantation Service, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, 2350, Porto Alegre, Rio Grande do Sul, 90035-903, Brazil

    Liane E. Daudt

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  1. Camila Weissheimer
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Correspondence to Manoela D. Martins.

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The study received the Human Research Ethics Committee approval—52651216000005327. All patients that agreed to participate in this study signed an informed consent.

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Weissheimer, C., Curra, M., Gregianin, L.J. et al. New photobiomodulation protocol prevents oral mucositis in hematopoietic stem cell transplantation recipients—a retrospective study. Lasers Med Sci 32, 2013–2021 (2017). https://doi.org/10.1007/s10103-017-2314-7

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  • DOI: https://doi.org/10.1007/s10103-017-2314-7

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