Photobiomodulation in the prevention of oral mucositis in blood cancer patients undergoing high-dose methotrexate: preliminary findings of a prospective, randomized, double-blind clinical study

IF 2 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Oral Surgery Oral Medicine Oral Pathology Oral Radiology Pub Date : 2025-02-01 DOI:10.1016/j.oooo.2024.10.100

Ana Carolina Prado-Ribeiro , Leticia Rodrigues-Oliveira , Ana Leticia Mores , Maria Claudia Cuzzullin , Carolina Alves Guimarães , Natalia Palmier , Maria Cecilia Querido de Oliveira , Pablo Vargas , Alan Roger Santos-Silva , Thaís Bianca Brandão

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Abstract

Objective

This study aimed to assess the efficacy of photobiomodulation (PBM) in preventing oral mucositis (OM) in adults with blood cancer undergoing high-dose methotrexate (HD-MTX ≥1 g/m²) treatment. Additionally, the correlation between serum creatinine and MTX, urinary pH, and the development and severity of OM were investigated.

Methods

A prospective, randomized, and double-blind study recruited patients before their first cycle of HD-MTX. Participants were assigned to 2 groups: group 1 (prophylactic PBM) and group 2 (placebo), and assessments were conducted at infusion (D0)/D1 (24 h)/D2 (48 h) /D3 (72 h) /D4 (96 h)/D10. Group 1 received PBM (660 nm, 100 mW, spot size 0.028 cm², fluence 10 J/cm² per point/10 s) in the oral mucosa from the first day until D5 post HD-MTX infusion or until MTX plasma concentrations were <5 µmol/L at D1, <1 µmol/L at D2, and <0.1 µmol/L at D3. Serum MTX and creatinine, and urine pH were assessed at D1/D2/D3. OM was classified according to World Health Organization criteria. Logistic regression, Mann-Whitney U, and χ² tests were used to identify predictive factors for OM.

Results

A total of 36 patients were allocated to the PBM or placebo group (50% each). Most patients (66.6%) were female, with mean ages of 39.8 and 39.6 in groups 1 and 2, respectively. Regarding OM, group 2 developed grade 2 earlier at D2 (5.6%), D3 (11.1%), and D4 (50%) compared with group 1, which only developed grade 2 at D4 (5.6%). The Mann-Whitney test for overall OM grade comparison (group 1 vs group 2) at D4 showed a P < .001, and the χ² test demonstrated a P = .003 (grades 0 and 1 vs grades 2/ 3). Elevated creatinine serum levels at D2 postinfusion predicted the incidence of OM. No correlation was found between serum MTX levels, urine pH, and OM.

Conclusion

PBM proves effective in preventing OM and reducing its incidence and severity in patients undergoing HD-MTX protocols. Elevated creatinine serum levels at D2 appear to be a predictor of OM.

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来源期刊

Oral Surgery Oral Medicine Oral Pathology Oral Radiology DENTISTRY, ORAL SURGERY & MEDICINE-

CiteScore

3.80

自引率

6.90%

发文量

1217

审稿时长

2-4 weeks

期刊介绍： Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology is required reading for anyone in the fields of oral surgery, oral medicine, oral pathology, oral radiology or advanced general practice dentistry. It is the only major dental journal that provides a practical and complete overview of the medical and surgical techniques of dental practice in four areas. Topics covered include such current issues as dental implants, treatment of HIV-infected patients, and evaluation and treatment of TMJ disorders. The official publication for nine societies, the Journal is recommended for initial purchase in the Brandon Hill study, Selected List of Books and Journals for the Small Medical Library.