Summary of recommendations for the prevention of oral mucositis in paediatric patients receiving treatment for cancer or undergoing haematopoietic stem cell transplantation
| Health question and recommendations | Strength of recommendation Level of evidence |
|---|---|
| What prophylactic interventions are effective at preventing or reducing the severity of oral and oropharyngeal mucositis in children (0–18 years) receiving treatment for cancer or undergoing haematopoietic stem cell transplantation (HSCT)? | |
| Recommendation 1.1: We suggest that cryotherapy may be offered to cooperative children receiving chemotherapy or HSCT conditioning with regimens associated with a high rate of mucositis Remarks: This recommendation places high value on the possible reduction in mucositis with an intervention with a low risk of harm. It is a weak recommendation because of the lack of paediatric-specific evidence, because the majority of studies that demonstrated the benefit of cryotherapy were conducted using chemotherapy regimens not commonly given to children and because of the methodological limitations of the conducted trials. Regimens appropriate for cryotherapy are restricted to agents with a short infusion time and a short half-life | Weak recommendation Moderate-quality evidence |
| Recommendation 1.2: We suggest that low-level light therapy may be offered to cooperative children receiving chemotherapy or HSCT conditioning with regimens associated with a high rate of mucositis Remarks: This recommendation places high value on the possible reduction in mucositis with an intervention with a low risk of harm. It is a weak recommendation because this strategy requires specialised equipment and expertise and it is unknown whether it is feasible to deliver this therapy modality in routine clinical practice, particularly in a paediatric population. The ideal treatment parameters and cost-effectiveness of this approach are unknown | Weak recommendation High-quality evidence |
| Recommendation 1.3: We suggest that keratinocyte growth factor (KGF) may be offered to children receiving HSCT conditioning with regimens associated with a high rate of severe mucositis Remarks: This recommendation places high value on the evidence of efficacy of KGF in adult populations. It is a weak recommendation because of the lack of efficacy and toxicity data in children, a theoretical concern that young children may be at increased risk of adverse effects related to mucosal thickening and the lack of long-term follow-up data in paediatric cancers | Weak recommendation High-quality evidence |