Med Lasers 2024; 13(2): 71-74  https://doi.org/10.25289/ML.24.018
Exploring the intersection of laser technology and neutropenia: mechanisms, impacts, and mitigation strategies
Hyun Seok Ryu
Beckman Laser Institute Korea, Cheonan, Republic of Korea
Correspondence to: Hyun Seok Ryu
E-mail: rhs2005@naver.com
ORCID: https://orcid.org/0000-0002-9718-5501
Received: June 18, 2024; Accepted: June 24, 2024; Published online: June 30, 2024.
© Korean Society for Laser Medicine and Surgery. All rights reserved.

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Laser technology, characterized by its precision and high-intensity applications, is being used increasingly in medical treatments, ranging from oncology to dermatology and ophthalmology. Neutropenia, a hematological condition marked by a critically low neutrophil count, presents significant clinical challenges because of its association with increased infection risk. This review explores the intricate relationship between laser technology and neutropenia, emphasizing the mechanisms through which laser treatments can induce neutropenia, their clinical implications, and strategies for mitigation. High-intensity laser therapies, such as photodynamic therapy, can generate systemic inflammatory responses and oxidative stress, potentially impairing the bone marrow function and reducing neutrophil production. Clinically, managing the risk of neutropenia involves pre-treatment evaluation, continuous monitoring of blood counts, and prophylactic measures such as granulocyte colony-stimulating factor. Recent advancements, including the development of selective photosensitizers and personalized treatment protocols, show promise in enhancing the safety and efficacy of laser treatments. This review underscores the need for comprehensive patient management and ongoing research to balance the therapeutic benefits of laser technology with potential hematological risks, ultimately aiming to optimize patient outcomes while minimizing the adverse effects.
Keywords: Laser; Neutropenia; Neutrophils; Immunosuppression; Mitigation strategies
INTRODUCTION

Laser, an acronym for light amplification by stimulated emission of radiation, represents a sophisticated technology that produces coherent light through the amplification of stimulated emission. The coherent light produced by lasers is characterized by its monochromaticity, directionality, and high intensity, making it ideal for precise medical applications. In medical practice, lasers are utilized for both diagnostic and therapeutic purposes. For instance, in oncology, laser technology is employed in procedures such as laser-induced interstitial thermotherapy (LITT) and photodynamic therapy (PDT). LITT involves the insertion of laser fibers directly into tumors, heating and destroying malignant cells with minimal damage to surrounding tissues. PDT, on the other hand, combines a photosensitizing agent with laser light to produce reactive oxygen species that selectively kill cancer cells.

Neutropenia is defined by an abnormally low concentration of neutrophils, typically measured as an absolute neutrophil count (ANC) of less than 1,500 cells per microliter of blood. Neutrophils are essential components of the innate immune system, providing the first line of defense against bacterial and fungal infections. The etiology of neutropenia is multifaceted, encompassing congenital conditions (such as severe congenital neutropenia and cyclic neutropenia), acquired disorders (including aplastic anemia and myelodysplastic syndromes), and treatment-induced causes. Chemotherapy and radiation therapy, common treatments for malignancies, are well-known culprits, as they often target rapidly dividing cells indiscriminately, including those in the bone marrow. Additionally, certain infections, autoimmune diseases, and medications can also precipitate neutropenia.

The mechanisms by which laser treatments might induce neutropenia are complex and multifactorial. One significant factor is the inflammatory response triggered by laser-tissue interactions. The thermal and photochemical effects of laser irradiation can lead to the release of pro-inflammatory cytokines and mediators. These inflammatory signals can have a systemic effect, potentially disrupting the bone marrow microenvironment and inhibiting hematopoiesis. Furthermore, the direct cytotoxic effects of reactive oxygen species generated during PDT can cause apoptosis of hematopoietic progenitor cells, reducing the bone marrow’s capacity to replenish neutrophils.

Recent research is focused on enhancing the safety and efficacy of laser treatments while minimizing their systemic impact. For instance, the use of nanoparticles as carriers for photosensitizers in PDT has shown potential in improving the selectivity and targeting of laser therapy, thereby reducing collateral damage. Furthermore, personalized medicine approaches that tailor laser treatment protocols based on individual patient characteristics, such as genetic predispositions and existing comorbidities, are being explored to optimize therapeutic outcomes and minimize adverse effects like neutropenia. Neutropenia, characterized by an abnormally low concentration of neutrophils, poses significant clinical challenges, particularly in patients undergoing treatments that can affect bone marrow function, such as chemotherapy and high-intensity laser therapies. This review aims to explore the mechanisms through which laser technology might induce neutropenia, the clinical implications of this condition, and strategies for mitigating its risks.

MECHANISMS OF LASER-INDUCED NEUTROPENIA

The use of high-intensity laser therapies, such as PDT, involves the administration of a photosensitizer followed by laser activation, generating reactive oxygen species that can cause oxidative stress and cellular damage [1]. While PDT is primarily designed to target tumor cells, the systemic dissemination of reactive intermediates and collateral damage to surrounding tissues can occur. This oxidative stress can potentially impact hematopoietic stem cells in the bone marrow, impairing their ability to produce neutrophils and leading to treatment-induced neutropenia.

Furthermore, the inflammatory response triggered by laser-tissue interactions plays a significant role. The thermal and photochemical effects of laser irradiation can lead to the release of pro-inflammatory cytokines and mediators [2]. These inflammatory signals can disrupt the bone marrow microenvironment, inhibiting hematopoiesis and reducing neutrophil production. Additionally, the direct cytotoxic effects of reactive oxygen species generated during PDT can cause apoptosis of hematopoietic progenitor cells, further compromising the bone marrow’s capacity to replenish neutrophils [3].

CLINICAL MANAGEMENT OF LASER TREATMENT-INDUCED NEUTROPENIA

From a clinical perspective, managing the risk of neutropenia in patients undergoing laser treatments necessitates a comprehensive approach. Pre-treatment evaluation should include a thorough assessment of the patient’s hematologic status, including baseline ANC. Continuous monitoring of blood counts during treatment is essential to detect early signs of neutropenia. Prophylactic measures, such as the administration of granulocyte colony-stimulating factor, can stimulate neutrophil production and reduce the duration and severity of neutropenia [4].

Additionally, optimizing laser treatment parameters to minimize collateral damage and systemic inflammatory responses is crucial. Advances in laser technology, such as the development of more selective photosensitizers and precision delivery systems, hold promise in reducing adverse effects on the hematopoietic system. Recent research on nanoparticles as carriers for photosensitizers in PDT has shown potential in improving the selectivity and targeting of laser therapy, thereby reducing collateral damage [5].

PERSONALIZED MEDICINE AND FUTURE DIRECTIONS

The integration of personalized medicine in the context of laser technology and neutropenia is paramount for maximizing therapeutic efficacy while minimizing risks. Personalized medicine approaches that tailor laser treatment protocols based on individual patient characteristics, such as genetic predispositions and existing comorbidities, are being explored to optimize therapeutic outcomes and minimize adverse effects like neutropenia [6]. Gene profiling can develop personalized laser treatment protocols considering genetic predisposition to neutropenia and the patient’s unique immune response profile. By regularly monitoring biomarkers, the parameters of laser treatment can be adjusted to produce optimal outcomes. Through comprehensive gene profiling and biomarker monitoring, it is possible to tailor treatments to the patient’s specific characteristics and response, thereby optimizing efficacy while minimizing side effects. This customized approach ensures that each patient receives the most appropriate and effective laser therapy based on their individual genetic and biological markers.

Ongoing research aims to enhance the safety and efficacy of laser treatments while minimizing their systemic impact. The development of next-generation photosensitizers that can selectively accumulate in tumor cells while sparing healthy tissue is an active area of investigation [7,8]. The use of real-time imaging and monitoring techniques during laser therapy could help minimize collateral damage and systemic effects.

CONCLUSION

Laser technology represents a powerful tool in modern medicine, offering precise and targeted treatment options for various conditions. However, the systemic effects of high-intensity laser treatments, particularly the risk of inducing neutropenia, necessitate careful consideration and management. Comprehensive patient evaluation, continuous monitoring, and the adoption of prophylactic and mitigating strategies are essential to balance the therapeutic benefits of laser treatments with potential hematological risks. Ongoing research and technological advancements hold promise in further refining laser therapies to enhance their safety and efficacy, ultimately broadening their application while safeguarding patient health. By integrating advanced technologies, personalized medicine, and rigorous clinical management, the future of laser therapy can achieve optimal outcomes with minimized adverse effects.

SUPPLEMENTARY MATERIALS

None.

ACKNOWLEDGMENTS

None.

AUTHOR CONTRIBUTIONS

All work was done by HSR.

CONFLICT OF INTEREST

No potential conflict of interest relevant to this article was reported.

FUNDING

None.

DATA AVAILABILITY

None.

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