Effect of low-level laser therapy on inflammatory mediator release during chemotherapy-induced oral mucositis: a randomized preliminary study

Abstract

Patients undergoing hematopoietic stem cell transplantation (HSCT) are submitted to a conditioning regimen of high-dose chemotherapy, with or without radiation therapy, which usually results in oral ulcerations and mucosal barrier breakdown. Oral mucositis (OM) is a common and debilitating toxicity side effect of autologous and allogeneic HSCT. The aim of this study was to evaluate the effect of low-level laser therapy (LLLT) on the severity of OM and inflammatory mediator (TNF-α, IL-6, IL-1β, IL-10, TGF-β, metalloproteinases, and growth factors) levels in saliva and blood of HSCT patients. Thirty patients were randomly assigned to two groups: control (n = 15) and laser (n = 15). LLLT was applied from the first day of the conditioning regimen until day 7 post-HSCT (D + 7). Saliva and blood were collected from patients on admission (AD), D-1, D + 3, D + 7, and on marrow engraftment day (ME). Clinical results showed less severe OM in the laser group (p < 0.05). The LLLT group showed increased matrix metalloproteinase 2 (MMP-2) levels in saliva on D + 7 (p = 0.04). Significant differences were also observed for IL-10 on D + 7 and on ME in blood plasma, when compared to the control group (p < 0.05). No significant differences were seen in saliva or blood for the other inflammatory mediators investigated. LLLT was clinically effective in reducing the severity of chemotherapy-induced OM in HSCT patients, and its mechanism of action does not seem to be completely linked to the modulation of pro- or anti-inflammatory cytokines, growth factors or matrix metalloproteinases.

The Impact of Low-Level Laser Therapy on Oral Mucositis and Quality of Life in Patients Undergoing Hematopoietic Stem Cell Transplantation Using the Oral Health Impact Profile and the Functional Assessment of Cancer Therapy-Bone Marrow Transplantation Questionnaires

“…Members of our research group published two studies recently showing the clinical effectiveness of LLLT for the prevention and treatment of OM in patients undergoing HSCT. 11,12 Their findings coincide with the clinical findings of this study.…”

“…For ethical purposes, and because there is evidence in the literature showing the effectiveness of laser therapy in the treatment of OM, [10][11][12] in the present study laser treatment was applied to patients in the control group who had developed grade 3 OM. Only three patients in the control group had received laser prior to D + 7, and the statistical analyses without these patients did not change the results.…”

“…7 However, recents studies have shown the effectiveness of low-level laser therapy (LLLT) for preventing and treating chemotherapy-induced OM, as a result of its anti-inflammatory, biomodulator, and tissue repair properties. [8][9][10][11][12] With regard to the impact of LLLT on the QoL of patients receiving cancer treatment, recents studies involving patients undergoing chemoradiation for head and neck cancer have shown positive effects of LLLT on their QoL. [13][14][15][16] Most studies related to LLLT deal with the clinical aspects of laser treatment in chemotherapy-induced mucositis, 10,11,17 but there is no evidence of its effect on subjective aspects of patients undergoing HSCT.…”

Review of Oral Mucositis Studies in Post Stem Cell Transplant Patients

“…(14,17) HKHN yapılan hastalarda oral mukozit üzerindeki olumlu etkilerini doğrulayan çalışmalar mevcuttur.…”

“…Silva ve arkadaşlarının (17) randomize kontrollü çalışmalarında HKHN uygulanan yüksek dozda kemoterapi alan hastalarda total vücut ışınlaması olsun ya da olmasın düşük doz lazer terapisinin (DDLT) oral mukozitin şiddetine, in amatuvar medyatörlerin seviyelerine (kan-tükürük) etkisini araştırmışlardır. "HKHN uygulanan 30 hasta" (15 kontrol ve 15 DDLT uygulanan) tedavinin ilk gününden nakil sonrası 7. güne kadar göz-lemlenmiştir.…”