Paula Eduardo, F., Bezinelli, L.M., Lopes, G., Marques, R., Nascimento Sobrinho, J.J., Hamerschlak, N., & Correa, L. (2015). Efficacy of cryotherapy associated with laser therapy for decreasing severity of melphalan-induced oral mucositis during hematological stem-cell transplantation: A prospective clinical study. Hematological Oncology, 33, 152–158. 

To verify the efficacy of cryotherapy plus low level laser therapy (LLLT) on oral mucositis (OM) in patients receiving high-dose melphalan chemotherapy

Prior to chemotherapy, patients were examined by a dentist who performed prophylaxis, eliminated any oral infections, and provided oral hygiene instructions. All patients received basic oral care, consisting of gargling with alcohol-free mouthwash and brushing of teeth. Daily LLLT was given from the day after chemotherapy was begun until engraftment. Study group patients also received cryotherapy in addition to LLLT with ice chips for five minutes before infusion, during melphalan infusion, and then for 30 minutes after infusion. Mucositis was evaluated daily. Patients who received cryotherapy were compared to historical controls who received only oral hygiene and historical controls who received hygiene plus LLLT.

• N = 104
• MEAN AGE = 56.3 years
• AGE RANGE = 6–73 years
• MALES: 70.2%, FEMALES: 29.8%
• KEY DISEASE CHARACTERISTICS: Patients had multiple tumor types, most had multiple myeloma, and all were undergoing ablative chemotherapy for HCT.
• OTHER KEY SAMPLE CHARACTERISTICS: The majority had autologous HCT.

• SITE: Single site  
• SETTING TYPE: Inpatient  
• LOCATION: Brazil

• PHASE OF CARE: Active antitumor treatment

• Prospective with historical cohort comparisons

• World Health Organization (WHO) oral mucositis scale

Fifty-four patients had LLLT plus cryotherapy, 17 had LLLT, and 33 had only oral hygiene. All patients had some degree of OM. Those who received LLLT plus cryotherapy had the highest prevalence of grade 1 mucositis and lowest prevalence of grade 2 or greater (p < 0.001). The duration of OM was highest in the control group, who had only oral hygiene (p < 0.001).

The combination of LLLT and cryotherapy was associated with the lowest severity of OM compared to controls and patients receiving LLLT alone.

• Baseline sample/group differences of import
• Risk of bias (no random assignment)
• Risk of bias (sample characteristics)
• Significant group differences in age, chemotherapy regimens used, and diagnoses, which could have influenced results

The addition of oral cryotherapy to LLLT for patients undergoing ablative chemotherapy with melphalan prior to HCT demonstrated greater efficacy in reducing the severity of OM. Both LLLT and cryotherapy have demonstrated efficacy for preventing severe OM. This study shows that the addition of oral cryotherapy with melphalan infusions can further reduce this complication. Nurses should employ cryotherapy in appropriate patients such as those receiving high-dose melphalan, and advocate for the concomitant use of LLLT.