Preventive versus Curative photobiomodulation in patients with multiple myeloma undergoing hematopoietic stem cells transplantation: which approach is more effective?

Purpose There is increasing evidence that photobiomodulation (PBM) therapy is both an effective and safe approach in hematopoietic stem cells transplantation (HSCT) for the management of oral mucositis (OM), but its use in clinical practice is still limited and the timing of application is under discussion. The aim of this retrospective study was to evaluate possible differences between patients treated either with preventive or curative PBM therapy. Methods The retrospective study included 24 patients suffering from multiple myeloma who underwent the same conditioning and transplantation protocol. Patients were treated either with preventive PBM starting from the first day of conditioning up to two days post-HSCT, or with curative PBM (starting at OM onset for four days). OM score, pain and functional parameters were recorded. Results All patients developed OM. Preventive PBM was significantly more effective in limiting OM severity (p < 0.0001) and pain (p < 0.0001) 7 days post-HSCT than curative PBM. We found a lower number of patients reporting discomfort in all subjective parameters (pain during swallowing, chewing and speaking) at T7 in the preventive PBM group. No adverse events related to PBM therapy were recorded in both groups. Conclusion The timing for PBM therapy in patients undergoing HSCT is crucial: when started on the first day of conditioning, it significantly reduces both pain and OM severity, providing an important benefit also in subjective oral functions such as speaking, swallowing, and chewing thus increasing the overall adherence to the oncological therapies.