title: Guideline for the prevention of oral and oropharyngeal mucositis in children receiving treatment for cancer or undergoing haematopoietic stem cell transplantation.
abstract: OBJECTIVE
  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.
authors.affiliation: Division of Haematology/Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Lillian
authors.initials: L
authors.lastname: Sung
authors.affiliation: Pediatric Oncology Group of Ontario, Toronto, Ontario, Canada.
authors.forename: Paula
authors.initials: P
authors.lastname: Robinson
authors.affiliation: Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Nathaniel
authors.initials: N
authors.lastname: Treister
authors.affiliation: Cancer Clinical Trials Office, Stanford University, Stanford, California, USA.
authors.forename: Tina
authors.initials: T
authors.lastname: Baggott
authors.affiliation: Section of Hematology and Oncology, Children's Hospital, Western University, London, Ontario, Canada.
authors.forename: Paul
authors.initials: P
authors.lastname: Gibson
authors.affiliation: Department of Pediatric Oncology/Hematology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Wim
authors.initials: W
authors.lastname: Tissing
authors.affiliation: Division of Pediatric Hematology/Oncology, McMaster University, McMaster Children's Hospital, Hamilton, Ontario, Canada.
authors.forename: John
authors.initials: J
authors.lastname: Wiernikowski
authors.affiliation: Division of Pediatric Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Brinklow
authors.affiliation: Division of Haematology/Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
authors.forename: L Lee
authors.initials: LL
authors.lastname: Dupuis
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D017679:Cryotherapy / Q000379:methods*; D051523:Fibroblast Growth Factor 7 / Q000627:therapeutic use*; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D007223:Infant; D052016:Mucositis / Q000517:prevention & control*; D009369:Neoplasms / Q000628:therapy*; D010608:Pharyngeal Diseases / Q000517:prevention & control*; D010789:Phototherapy / Q000379:methods*; D017410:Practice Guidelines as Topic; D013280:Stomatitis / Q000517:prevention & control*
chemical_list: D051523:Fibroblast Growth Factor 7
keywords: clinical practice guideline; cryotherapy; low level light therapy; mucositis; prevention
references.citation: Support Care Cancer. 2013 Nov;21(11):3191-207
references.pmid: 23832272
references.citation: Br J Cancer. 2013 Nov 12;109(10):2515-22
references.pmid: 24129238
references.citation: Cancer. 2014 May 15;120(10):1453-61
references.pmid: 24615748
references.citation: Pediatr Blood Cancer. 2007 Apr;48(4):435-40
references.pmid: 16862549
references.citation: Support Care Cancer. 2013 Jan;21(1):333-41
references.pmid: 23001179
references.citation: BMJ. 2008 Apr 26;336(7650):924-6
references.pmid: 18436948
references.citation: Support Care Cancer. 2007 Oct;15(10):1145-54
references.pmid: 17393191
references.citation: Support Care Cancer. 2013 Jan;21(1):313-26
references.pmid: 23142924
references.citation: Support Care Cancer. 2013 Jan;21(1):357-64
references.pmid: 23052919
references.citation: Support Care Cancer. 2012 Aug;20(8):1771-7
references.pmid: 21947490
references.citation: Clin Infect Dis. 2002 Jun 1;34(11):1524-9
references.pmid: 12015700
references.citation: Adv Med Sci. 2006;51 Suppl 1:66-8
references.pmid: 17460832
references.citation: PLoS One. 2014 Sep 08;9(9):e107418
references.pmid: 25198431
references.citation: Eur J Cancer. 2007 May;43(8):1269-75
references.pmid: 17383174
references.citation: JAMA. 1995 Feb 1;273(5):408-12
references.pmid: 7823387
references.citation: J Clin Oncol. 2000 Apr;18(7):1517-24
references.pmid: 10735900
references.citation: Int J Oral Sci. 2014 Mar;6(1):27-30
references.pmid: 24357856
references.citation: Pediatr Transplant. 2014 Mar;18(2):211-6
references.pmid: 24823628
references.citation: J Clin Oncol. 2002 Jan 15;20(2):441-8
references.pmid: 11786572
references.citation: Support Care Cancer. 2013 Nov;21(11):3233-41
references.pmid: 23842598
references.citation: Br J Cancer. 2014 Sep 23;111(7):1262-8
references.pmid: 25101569
references.citation: Pediatr Dent. 1989 Mar;11(1):37-42
references.pmid: 2626338
references.citation: Blood. 2007 Feb 1;109(3):936-43
references.pmid: 17008536
references.citation: Eur J Cancer. 2006 Aug;42(12):1817-25
references.pmid: 16872825
references.citation: Head Face Med. 2012 Feb 23;8:4
references.pmid: 22361310
references.citation: Blood. 2006 Nov 1;108(9):3216-22
references.pmid: 16835378
references.citation: Biol Blood Marrow Transplant. 2008 Sep;14(9):1017-21
references.pmid: 18721764
references.citation: Cochrane Database Syst Rev. 2011 Apr 13;(4):CD000978
references.pmid: 21491378
references.citation: Pediatr Blood Cancer. 2007 Aug;49(2):149-53
references.pmid: 16628556
references.citation: Support Care Cancer. 2013 Jan;21(1):343-55
references.pmid: 22987094
references.citation: Support Care Cancer. 2013 Nov;21(11):3165-77
references.pmid: 24018908
references.citation: Support Care Cancer. 2014 Jan;22(1):71-5
references.pmid: 23995756
references.citation: Ann Biomed Eng. 2012 Feb;40(2):516-33
references.pmid: 22045511
references.citation: Med Oral. 2001 Nov-Dec;6(5):326-34
references.pmid: 11694865
references.citation: J Clin Oncol. 2010 Jul 20;28(21):3516-24
references.pmid: 20567002
references.citation: Support Care Cancer. 2013 Nov;21(11):3179-89
references.pmid: 23702538
references.citation: Bone Marrow Transplant. 2007 Mar;39(6):347-52
references.pmid: 17277790
references.citation: Biol Blood Marrow Transplant. 2012 Aug;18(8):1309-14
references.pmid: 22542710
references.citation: J Pediatr Hematol Oncol. 2007 Feb;29(2):86-94
references.pmid: 17279004
references.citation: Pharmacoeconomics. 2013 Sep;31(9):753-66
references.pmid: 23963867
references.citation: Eur J Cancer. 2011 Feb;47(3):383-8
references.pmid: 20947338
references.citation: Support Care Cancer. 2013 Jan;21(1):327-32
references.pmid: 22993025
references.citation: Lasers Med Sci. 2010 Jan;25(1):61-5
references.pmid: 19238504
references.citation: BMJ. 2008 May 10;336(7652):1049-51
references.pmid: 18467413
references.citation: J Pediatr. 1988 Oct;113(4):758-63
references.pmid: 3050005
references.citation: Pediatr Blood Cancer. 2007 May;48(5):532-9
references.pmid: 16767731
references.citation: Support Care Cancer. 2013 Nov;21(11):3209-21
references.pmid: 23764678