Novel Implementation of Photobiomodulation Therapy Decreases Oral Mucositis Severity in Pediatric Stem Cell Transplant (SCT) Patients

Background Oral mucositis (OM) is a common acute SCT complication affecting up to 90% of pediatric patients undergoing SCT. OM consists of painful ulcerations in the oral cavity and throat that interfere with dietary intake and oral care compliance. Patients with high-grade OM require patient-controlled analgesia (PCA), total parenteral nutrition (TPN) and intravenous (IV) medications thus increasing length of stay (LOS) and hospital costs. Methods A comparative analysis between a retrospective and an intervention group was completed. Eighty three patients receiving routine oral care transplanted from January to December 2021 were reviewed. Sixty two received an allogeneic SCT for a variety of diagnosis (leukemia, metabolic and genetic disease, bone marrow failure syndrome and hemoglobinopathy) and 21 autologous for neuroblastoma. An intervention group consisting of fifty-eight patients received intra and extra oral PBM from January to September 2023 while undergoing an allogeneic SCT 55) and auto (3) SCT for neuroblastoma. The analysis looked at variables including OM pain scores, number of days of mucositis, length of PCA and TPN days, oral care adherence, TPN at discharge, analysis of OM associated costs, length of stay, and demographic variables. Results PBM was well tolerated and administered to 88% of eligible patients (66). PBM therapy contributed to a 20% reduction in overall PCA usage (63% vs. 50%) and a reduction in oral pain scores from 4.4 (range 1-10) to 3.6 (range 1-10). TPN use also decreased with a baseline of 91% of patients requiring TPN for an average of 22 days to 83% of patients requiring TPN for an average of 16 days. OM-associated costs decreased by an average of $33, 306 per patient and 55% fewer patients were discharged home on TPN. This reduction in TPN was most striking in our leukemia cohort which showed at baseline 41% of patients required TPN at discharge and in our intervention cohort 6% of patients required TPN at discharge. Specifically in our leukemia cohort we demonstrated at LOS reduction from 44 days (n=27) to 40 days (n=17).Additionally, the total CLABSI rate in the pre-intervention timeframe was reduced from 4.6/1000 line days to 3.0/1000 line days in the post-intervention timeframe (incidence rate ratio [IRR] 0.655 [0.341 – 1.190], p = 0.148). This was primarily driven by a reduction in oral MBI CLABSI rate (IRR 0.0.210 [0.024 – 0.863], p = 0.014). Conclusions We implemented PBM as standard of care in our BMT unit with the goal of preventing and treating OM during HSCT and sought to determine its effect in OM severity, need for PCA, TPN and hospital costs/healthcare utilization when compared to routine oral care. We have demonstrated successfully how intra and extra oral PBM could lead to decreased PCA and TPN use, decreased LOS, a reduction in oral MBI-CLABSI rate and minimized hospital costs; all important variables that are impactful in our patient population.