title: Palifermin and Chlorhexidine Mouthwashes in Prevention of Chemotherapy-Induced Mucositis in Children with Acute Lymphocytic Leukemia: a Randomized Controlled Trial.
abstract: BACKGROUND
  Over the past three decades, significant improvements have been achieved in the survival of children with cancer. However, the considerable morbidity which occurs as a result of chemotherapy often restricts the treatment intensity. One of the important dose-limiting and costly adverse effects of cancer therapy is mucositis. Children with hematological malignancies are greatly at risk of developing mucositis.
  
  
  OBJECTIVE
  This study aimed to assess the effectiveness of palifermin in preventing mucositis in children with acute lymphocytic leukemia (ALL) who undergo chemotherapy.
  
  
  METHODS
  In this clinical trial, 90 children with ALL were randomized to receive chlorhexidine (n=45) or palifermin (n=45). One group received 60 μg/ kg/ day palifermin as an intravenous bolus once daily for 3 days before and 3 days after the chemotherapy. Chlorhexidine mouthwash was administered once daily for 3 days before and 3 days after the chemotherapy. The world health organization (WHO) oral toxicity scale was employed for grading the mucositis. The data were analyzed by using two-way ANOVA.
  
  
  RESULTS
  The two groups were matched for age and gender. The study groups were significantly different in terms of mucositis grading (P values after 1 and 2 week therapy were 0.00). Palifermin decreased the incidence and severity of chemotherapy-induced mucositis.
  
  
  CONCLUSIONS
  Palifermin reduces the oral mucositis in children with ALL. Several mechanisms of action are suggested for keratinocyte growth factor (such as palifermin) including promotion of cell proliferation and cytoprotection, restraining the apoptosis, and changing the cytokine profile.
authors.affiliation: Dept. of Oral Medicine, School of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran, Dept. of Oral Medicine, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Narges
authors.initials: N
authors.lastname: Gholizadeh
authors.affiliation: Dept. of Oral Medicine, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Masoumeh
authors.initials: M
authors.lastname: Mehdipoor
authors.affiliation: School of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Hasan
authors.initials: H
authors.lastname: Sajadi
authors.affiliation: Dept. of Oral Medicine, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Mahdieh-Sadat
authors.initials: MS
authors.lastname: Moosavi
keywords:  Leukemia;  Palifermin ; Oral Mucositis 