Oral mucositis prevention in allogeneic hematopoietic stem cell transplantation with the photobyomodulation: A single center case series

Background: Oral mucositis (OM) is an early adverse event of allogeneic hematopoietic stem cell transplantation (HSCT) that occurs approximately in 85% of cases, nega- tively affecting quality of life of patients. Photo- biomodulation (FBM) has been proposed by the Multinational Association of Supportive Care in Cancer and the International Society of Oral Oncology for the preven- tion and treatment of chemotherapy-induced OM, as a result of its anti-inflammatory, biomodulator and tissue repair The 45th Annual Meeting of the European Society for Blood and Marrow Transplantation: Physicians. . . 373 properties. The aim of this study was to evaluate pro- spectively the efficacy of a FBM protocol for the prevention of OM in patients undergoing a HSCT. Methods: All patients consecutively who underwent a HSCT at our Center from 201X onwards received five weekly FBM sessions with a bidiodic laser (Lumix 2®, Prodent, Italy), which simultaneously emitted at 650nm and 910nm with a power of 89mW and energy of 4J per point. The procedure started the day before the beginning of the conditioning regimen up to the tenth day post-transplant. The laser was applied in a defocused mode on each of the mucosal surfaces (12 areas). At each session, the morphine dose, the OM level (according to the WHO scale) and pain through a Numerical Rating Scale (NRS) were recorded. Results: 27 consecutive patients (19 male/8 female) submitted to a HSCT were analyzed. The median age was 44 years (range 4-66). Eighteen patients had acute leukemia, 3 myelodysplastic syndromes, 6 lymphoproliferative dis- eases. The median number of treatment lines before HSCT was 2 (range 1-5). At transplant, 13 patients had advanced disease. The myeloablative conditioning regimen MAC (Thyotepa, Busulphan, Fludarabine) was employed in 17 patients; the same conditioning, with a reduced dose of Busulphan (RIC), was infused in 10 patients. Seven patients (26%) had no evidence of OM. The incidence of grade II-IV OM was 65% in the group of patients receiving MAC and the median duration 12 days (range 3-28); grade 4 OM was observed, for 1 day, in 1 patient. In the RIC group the incidence of OM was 50%, the median duration 11 days (range 7-16); no patient had evidence of grade IV OM. In the whole population, the maximum NRS value was 4. Morphine administration was required in 23 patients, due to the occurrence of non-oral complications. Conclusions: In our experience, prophylaxis with FBM to prevent or reduce OM was safe and effective, compared to results of previous experiences reported in the literature, which used no prevention against this complication that negatively affects the quality of life of transplanted patients. Further studies on a large series of are necessary to confirm our results.