title: Systematic review of cytokines and growth factors for the management of oral mucositis in cancer patients.
abstract: OBJECTIVE
  The aim of this project was to review the literature and define clinical practice guidelines for the use of cytokines and growth factor agents for the prevention or treatment of oral mucositis induced by cancer chemotherapy or radiotherapy.
  
  
  METHODS
  A systematic review was conducted by the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society for Oral Oncology (MASCC/ISOO). The body of evidence for each intervention, in each cancer treatment setting, was assigned an evidence level. Based on the evidence level, one of the following three guideline determinations was possible: Recommendation, Suggestion, No guideline possible.
  
  
  RESULTS
  Sixty-four clinical studies across 11 interventions were evaluated. A recommendation was made for the use of recombinant human KGF-1 (palifermin) at a dose of 60 μg/kg per day for 3 days prior to conditioning treatment and for 3 days post-transplant for prevention of oral mucositis in patients receiving high-dose chemotherapy and total body irradiation followed by autologous stem cell transplantation for hematological malignancies. A suggestion was made against using granulocyte macrophage colony-stimulating factor mouthwash for the prevention of oral mucositis in the setting of high-dose chemotherapy followed by autologous or allogeneic stem cell transplantation. No guideline was possible for any other cytokine or growth factor agents due to inconclusive evidence.
  
  
  CONCLUSIONS
  Of the cytokine and growth factor agents studied for oral mucositis, the evidence only supports use of palifermin in the specific population listed above. Additional well-designed research is needed on other cytokine and growth factor interventions and in other cancer treatment settings.
authors.affiliation: Department of Periodontology ACTA (Academic Centre for Dentistry Amsterdam), University of Amsterdam and VU University Amsterdam, Gustav Mahlerlaan 3004, 1081 LA Amsterdam, The Netherlands. jraber@worldonline.nl
authors.forename: Judith E
authors.initials: JE
authors.lastname: Raber-Durlacher
authors.forename: Inger
authors.initials: I
authors.lastname: von Bültzingslöwen
authors.forename: Richard M
authors.initials: RM
authors.lastname: Logan
authors.forename: Joanne
authors.initials: J
authors.lastname: Bowen
authors.forename: Abdul Rahman
authors.initials: AR
authors.lastname: Al-Azri
authors.forename: Hele
authors.initials: H
authors.lastname: Everaus
authors.forename: Erich
authors.initials: E
authors.lastname: Gerber
authors.forename: Jesùs Garcia
authors.initials: JG
authors.lastname: Gomez
authors.forename: Bo G
authors.initials: BG
authors.lastname: Pettersson
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Soga
authors.forename: Fred K L
authors.initials: FK
authors.lastname: Spijkervet
authors.forename: Wim J E
authors.initials: WJ
authors.lastname: Tissing
authors.forename: Joel B
authors.initials: JB
authors.lastname: Epstein
authors.forename: Sharon
authors.initials: S
authors.lastname: Elad
authors.forename: Rajesh V
authors.initials: RV
authors.lastname: Lalla
mesh_terms: D016207:Cytokines / Q000009:adverse effects / Q000627:therapeutic use*; D019317:Evidence-Based Medicine; D051523:Fibroblast Growth Factor 7 / Q000009:adverse effects / Q000627:therapeutic use; D005346:Fibroblast Growth Factors / Q000009:adverse effects / Q000627:therapeutic use; D016179:Granulocyte Colony-Stimulating Factor / Q000009:adverse effects / Q000627:therapeutic use; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D036341:Intercellular Signaling Peptides and Proteins / Q000009:adverse effects / Q000627:therapeutic use*; D009067:Mouthwashes; D009369:Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000532:radiotherapy; D017410:Practice Guidelines as Topic; D013280:Stomatitis / Q000209:etiology / Q000517:prevention & control / Q000628:therapy*
chemical_list: D016207:Cytokines; D036341:Intercellular Signaling Peptides and Proteins; D009067:Mouthwashes; D051523:Fibroblast Growth Factor 7; D016179:Granulocyte Colony-Stimulating Factor; D005346:Fibroblast Growth Factors; D016178:Granulocyte-Macrophage Colony-Stimulating Factor