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Eduardo F.D.P.,Unit of Bone Marrow Transplantation | Bezinelli L.M.,Unit of Bone Marrow Transplantation | De Carvalho D.L.C.,Unit of Bone Marrow Transplantation | Lopes R.M.D.G.,Unit of Bone Marrow Transplantation | And 7 more authors.
Pediatric Transplantation | Year: 2015

OM is a painful inflammatory condition of the oral mucosa, derived from the toxic effects of chemotherapy and radiotherapy. High OM severity is frequently present in HSCT pediatric patients, who exhibit multiple painful ulcers that limit their mastication and swallowing, leading to poor nutritional status. Few studies have demonstrated OM clinical outcomes in young patients undergoing HSCT. Feasibility of oral care and LLLT on OM prophylaxis and treatment is also poorly discussed. The aim of this study was to describe a specialized oral care protocol that included LLLT for pediatric patients undergoing transplantation and to demonstrate the clinical outcomes after OM prevention and treatment. Data from OM-related morbidity were collected from 51 HSCT pediatric patients treated daily with LLLT, followed by standard oral care protocols. All the patients, even infants and young children, accepted the daily oral care and LLLT well. The majority (80.0%) only exhibited erythema in the oral mucosa, and the maximum OM degree was WHO II. Patients who had undergone autologous and HLA-haploidentical transplants showed OM with the lowest severity. The frequency of total body irradiation and methotrexate prescriptions was higher in adolescents when compared with infants (p = 0.044), and adolescents also exhibited OM more severely than infants and young children. We found that good clinical outcomes were obtained using this therapy, mainly in regard to the control of OM severity and pain reduction in the oral cavity. Specialized oral care, including LLLT, is feasible and affordable for HSCT pediatric patients, although some adaptation in the patient's oral hygiene routine must be adopted with help from parents/companions and clinical staff. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd. Source

de Paula Eduardo F.,Unit of Bone Marrow Transplantation | Bezinelli L.M.,Unit of Bone Marrow Transplantation | Bezinelli L.M.,University of Sao Paulo | da Graca Lopes R.M.,Unit of Bone Marrow Transplantation | And 3 more authors.
Hematological Oncology | Year: 2015

Melphalan followed by hematopoietic stem-cell transplantation (HSCT) is the standard treatment for multiple myeloma and other hematopoietic neoplasms. However, high doses of melphalan cause severe oral mucositis (OM). The objective was to verify the efficacy of cryotherapy plus laser therapy on reduction of OM severity. HSCT patients undergoing melphalan chemotherapy (n=71) were randomly divided into two groups according to OM treatment: oral cryotherapy performed with ice chips for 1h 35min followed by low-level laser therapy (InGaAIP, 660nm, 40mW, 6J/cm2) (n=54) and laser therapy alone with the same protocol (n=17). A control group (n=33) was composed of HSCT patients treated with melphalan who received no specific treatment for OM. OM scores and clinical information were collected from D0 to D+11. The cryotherapy/laser therapy group showed the lowest OM scores (maximum Grade I) and the lowest mean number of days (8days) with OM in comparison with the other groups (p<0.001). OM Grades III and IV were present with high frequency only in the control group. The association of cryotherapy with laser therapy was effective in reducing OM severity in HSCT patients who underwent melphalan conditioning. © 2015 John Wiley & Sons, Ltd. Source

Bezinelli L.M.,Unit of Bone Marrow Transplantation | Bezinelli L.M.,University of Sao Paulo | de Paula Eduardo F.,Unit of Bone Marrow Transplantation | da Graca Lopes R.M.,Unit of Bone Marrow Transplantation | And 6 more authors.
Hematological Oncology | Year: 2014

Oral mucositis (OM) is one of the side effects of hematopoietic stem cell transplantation (HSCT), resulting in major morbidity. The aim of this study was to determine the cost-effectiveness of the introduction of a specialized oral care program including laser therapy in the care of patients receiving HSCT with regard to morbidity associated with OM. Clinical information was gathered on 167 patients undergoing HSCT and divided according to the presence (n=91) or absence (n=76) of laser therapy and oral care. Cost analysis included daily hospital fees, parenteral nutrition (PN) and prescription of opioids. It was observed that the group without laser therapy (group II) showed a higher frequency of severe degrees of OM (relative risk=16.8, 95% confidence interval -5.8 to 48.9, p<0.001), with a significant association between this severity and the use of PN (p=0.001), prescription of opioids (p<0.001), pain in the oral cavity (p=0.003) and fever>37.8°C (p=0.005). Hospitalization costs in this group were up to 30% higher. The introduction of oral care by a multidisciplinary staff including laser therapy helps reduce morbidity resulting from OM and, consequently, helps minimize hospitalization costs associated with HSCT, even considering therapy costs. © 2013 John Wiley & Sons, Ltd. Source

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