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Abstract
Purpose To develop an evidence-based clinical practice guideline for the prevention of oral mucositis in children (0–18 years) receiving treatment for cancer or undergoing haematopoietic stem cell transplantation (HSCT).
Methods The Mucositis Prevention Guideline Development Group was interdisciplinary and included internationally recognised experts in paediatric mucositis. For the evidence review, we included randomised controlled trials (RCTs) conducted in either children or adults evaluating the following interventions selected according to prespecified criteria: cryotherapy, low level light therapy (LLLT) and keratinocyte growth factor (KGF). We also examined RCTs of any intervention conducted in children. For all systematic reviews, we synthesised the occurrence of severe oral mucositis. The Grades of Recommendation, Assessment, Development and Evaluation approach was used to describe quality of evidence and strength of recommendations.
Results We suggest cryotherapy or LLLT may be offered to cooperative children receiving chemotherapy or HSCT conditioning with regimens associated with a high rate of mucositis. We also suggest KGF may be offered to children receiving HSCT conditioning with regimens associated with a high rate of severe mucositis. However, KGF use merits caution as there is a lack of efficacy and toxicity data in children, and a lack of long-term follow-up data in paediatric cancers. No other interventions were recommended for oral mucositis prevention in children.
Conclusions All three specific interventions evaluated in this clinical practice guideline were associated with a weak recommendation for use. There may be important organisational and cost barriers to the adoption of LLLT and KGF. Considerations for implementation and key research gaps are highlighted.
- mucositis
- prevention
- clinical practice guideline
- cryotherapy
- low level light therapy
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- Data supplement 1 - Online appendix 1
- Data supplement 10 - Online appendix 10
- Data supplement 11 - Online appendix 11
- Data supplement 12 - Online appendix 12
- Data supplement 13 - Online appendix 13
- Data supplement 2 - Online appendix 2
- Data supplement 3 - Online appendix 3
- Data supplement 4 - Online appendix 4
- Data supplement 5 - Online appendix 5
- Data supplement 6 - Online appendix 6
- Data supplement 7 - Online appendix 7
- Data supplement 8 - Online appendix 8
- Data supplement 9 - Online appendix 9
Footnotes
Correction notice This article has been corrected since it published Online First. The Open Access licence has now been added.
Contributors LS, PR and LLD contributed to the conception and design, collection and assembly of data, data analysis and interpretation, and manuscript writing. NT, TB, PG, WT, JW and JB contributed to the interpretation and manuscript writing. All authors approved the final manuscript.
Funding Funding support was provided by the Pediatric Oncology Group of Ontario. LS is supported by a New Investigator Award from the Canadian Institutes of Health Research (Grant no. 87719).
Competing interests None.
Provenance and peer review Not commissioned; externally peer-reviewed.
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