Weissheimer Camila, Curra Marina, Gregianin Lauro J, Daudt Liane E, Wagner Vivian P, Martins Marco Antonio T, Martins Manoela D
Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Av. Limeira, 901, Piracicaba, 13414-903, Brazil.
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.
Lasers Med Sci. 2017 Dec;32(9):2013-2021. doi: 10.1007/s10103-017-2314-7. Epub 2017 Aug 24.
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.
口腔黏膜炎（OM）是造血干细胞移植（HSCT）受者的一种不良副作用。这项回顾性研究的目的是评估每周进行三次与每周进行七次光生物调节（PBM）对接受HSCT患者的预防效果。还评估了与OM发生率和严重程度相关的风险因素。这是一项回顾性研究，评估了99名接受不同PBM方案的HSCT受者。第一组每周接受三次治疗，第二组每天接受治疗。使用连续波二极管激光器（InGaAlP；MM Optics，巴西圣保罗州圣卡洛斯）进行PBM，波长为660nm（可见红光），每点总辐射能量为0.24J。从病历中收集基线疾病、移植类型、预处理类型、移植物抗宿主病预防措施、OM分级、绝对白细胞和血小板计数以及肝肾功能标志物水平。患者年龄在13至7岁之间（平均/标准差，40.54±16.45）。在第一组和第二组之间，在性别、年龄、种族、诊断、供体类型和预处理治疗方面未观察到显著差异。两种PBM方案在预防OM方面同样有效（p=0.34，方差分析）。无论使用何种PBM方案，接受异基因移植的患者（p<0.01-费舍尔精确检验）、全身照射（TBI-12Gy）（p=0.01-卡方检验）、白消安+环磷酰胺（p<0.01-卡方检验）或含甲氨蝶呤方案（p<0.01-费舍尔精确检验）的OM发生率和严重程度更高。骨髓抑制（p<0.01-曼-惠特尼检验）和肾功能受损（p=0.02-曼-惠特尼检验）也被认为是OM的风险因素。基于这些回顾性数据，PBM即使每周应用三次，对接受HSCT的患者预防OM也是有效的。可能需要进行前瞻性研究来证实这些发现。
