Eduardo Fernanda de Paula, Bezinelli Leticia Mello, de Carvalho Danielle Lima Corrêa, Lopes Roberta Marques da Graça, Fernandes Juliana Folloni, Brumatti Melina, Vince Carolina Sgaroni Camargo, de Azambuja Alessandra Milani Prandini, Vogel Cristina, Hamerschlak Nelson, Correa Luciana
Unit of Bone Marrow Transplantation, Hospital Israelita Albert Einstein, São Paulo, Brazil.
Pediatr Transplant. 2015 May;19(3):316-25. doi: 10.1111/petr.12440. Epub 2015 Feb 13.
OM is a painful inflammatory condition of the oral mucosa, derived from the toxic effects of chemotherapy and radiotherapy. High OM severity is frequently present in HSCT pediatric patients, who exhibit multiple painful ulcers that limit their mastication and swallowing, leading to poor nutritional status. Few studies have demonstrated OM clinical outcomes in young patients undergoing HSCT. Feasibility of oral care and LLLT on OM prophylaxis and treatment is also poorly discussed. The aim of this study was to describe a specialized oral care protocol that included LLLT for pediatric patients undergoing transplantation and to demonstrate the clinical outcomes after OM prevention and treatment. Data from OM-related morbidity were collected from 51 HSCT pediatric patients treated daily with LLLT, followed by standard oral care protocols. All the patients, even infants and young children, accepted the daily oral care and LLLT well. The majority (80.0%) only exhibited erythema in the oral mucosa, and the maximum OM degree was WHO II. Patients who had undergone autologous and HLA-haploidentical transplants showed OM with the lowest severity. The frequency of total body irradiation and methotrexate prescriptions was higher in adolescents when compared with infants (p = 0.044), and adolescents also exhibited OM more severely than infants and young children. We found that good clinical outcomes were obtained using this therapy, mainly in regard to the control of OM severity and pain reduction in the oral cavity. Specialized oral care, including LLLT, is feasible and affordable for HSCT pediatric patients, although some adaptation in the patient's oral hygiene routine must be adopted with help from parents/companions and clinical staff.
口腔黏膜炎是一种口腔黏膜的疼痛性炎症状态，由化疗和放疗的毒性作用引起。在接受造血干细胞移植（HSCT）的儿科患者中，口腔黏膜炎的严重程度通常较高，这些患者会出现多个疼痛性溃疡，限制了他们的咀嚼和吞咽，导致营养状况不佳。很少有研究表明接受HSCT的年轻患者的口腔黏膜炎临床结局。口腔护理和低强度激光疗法（LLLT）在口腔黏膜炎预防和治疗方面的可行性也很少被讨论。本研究的目的是描述一种专门的口腔护理方案，该方案包括对接受移植的儿科患者进行LLLT，并展示口腔黏膜炎预防和治疗后的临床结局。从51名每天接受LLLT治疗、随后遵循标准口腔护理方案的HSCT儿科患者中收集了与口腔黏膜炎相关的发病率数据。所有患者，即使是婴幼儿，都很好地接受了每日口腔护理和LLLT。大多数患者（80.0%）仅表现为口腔黏膜红斑，口腔黏膜炎的最大程度为世界卫生组织（WHO）二级。接受自体移植和人类白细胞抗原（HLA）单倍型相合移植的患者口腔黏膜炎严重程度最低。与婴儿相比，青少年全身照射和甲氨蝶呤处方的频率更高（p = 0.044），青少年的口腔黏膜炎也比婴幼儿更严重。我们发现使用这种疗法获得了良好的临床结局，主要体现在控制口腔黏膜炎严重程度和减轻口腔疼痛方面。专门的口腔护理，包括LLLT，对HSCT儿科患者来说是可行且经济实惠的，尽管在家长/陪伴者和临床工作人员的帮助下，必须对患者的口腔卫生常规进行一些调整。
