The influence of dental care associated with laser therapy on oral mucositis during allogeneic hematopoietic cell transplant: retrospective study.

Fernanda De Paula Eduardo,Luciana Correa,Martha Simões Ribeiro,Nelson Hamerschlak,Mariane Couto Estácio Orsi,Morgani Rodrigues,Letícia Mello Bezinelli

doi:10.1590/s1679-45082011ao1848

Fernanda De Paula Eduardo, Luciana Correa + Show 5 more

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https://doi.org/10.1590/s1679-45082011ao1848

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Abstract

To verify decrease in frequency and severity of oral mucositis in patients submitted to dental care and laser therapy during allogeneic hematopoietic cell transplant. Medical records of patients submitted or not to dental care associated with laser therapy during allogeneic transplant were reviewed. The following data were collected: sex, age, underlying disease, myeloablative conditioning regimens, prophylaxis for graft versus host disease, extension and severity of oral mucositis, pain in the oral cavity and when swallowing, diarrhea, need of peripheral parenteral nutrition and presence of acute graft versus host disease. Significant reduction in extension and severity of oral mucositis, as well as in frequency of oral cavity pain, was observed in patients with dental care/laser therapy (p < 0.01). There were no statistically significant differences regarding frequency of diarrhea, pain when swallowing, and need of parenteral nutrition among the groups. Significant association was found between acute graft versus host disease and pain when swallowing (p < 0.01). Acute graft versus host disease was not associated with oral mucositis severity, oral cavity pain, and diarrhea. Dental care associated with laser therapy reduces the extension and severity of oral mucositis in patients with allogeneic hematopoietic transplant. Further studies are necessary to clarify the isolate efficacy of laser therapy in these conditions, mainly regarding the influence of reduced oral mucositis on the graft versus host disease.

Highlights

Oral complications due to high doses of chemotherapy and radiation therapy during the hematopoietic stem cell transplantation (HSCT) cause high morbidity and can affect transplant success
Comparison between the groups with and without dental care Table 1 contains the general characteristics of patients and of the myeloablative and prophylactic regimen for graft versus host disease (GVHD)
Mann-Whitney test and likelihood ratio test. * Grouped busulphan + fludarabine, busulphan + cytarabine + anti-thymocyte globin (ATG); ** grouped only for cyclophosphamide, cyclophosphamide + total body radiation (TBI), cyclophosphamide + fludarabine + TBI, cyclophosphamide + etoposide + carmustine, cyclophosphamide + cytarabine + TBI; *** grouped melphalan + thioTEPA + fludarabine, melphalan + fludarabine, busulphan + etoposide + cytarabine + melphalan (R-BEAM); **** grouped only for fludarabine and fludarabine + cytarabine + TBI; patients submitted to autologous transplant

Summary

Introduction

Oral complications due to high doses of chemotherapy and radiation therapy during the hematopoietic stem cell transplantation (HSCT) cause high morbidity and can affect transplant success. The rupture of the oral cavity’s epithelial defense due to the cytotoxic effect of the myeloablative regimen, together with the submucosal involvement, leads to several clinical events, such as opportunistic infections, pain, and difficulties in mastication and swallowing. This can result in severe nutritional deficiencies requiring parenteral nutrition and more hospitalization. The high severity of OM and longer hospital stay were associated with higher risk of graft versus host disease (GVHD)(2) All these factors significantly affect the patient’s quality of life and increase hospital costs

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