This update of the 2013 clinical practice guideline provides clinicians with guidance regarding the use of aprepitant and palonosetron for the prevention of acute chemotherapy-induced nausea and vomiting (CINV) in children. The recommendations were based on three systematic reviews. Substantive changes were made to the guideline recommendations including the inclusion of palonosetron to the 5-HT antagonists recommended for children receiving highly emetogenic chemotherapy (HEC) and the recommendation of aprepitant for children 6 months of age or older receiving HEC. To optimize CINV control in children, future work must focus on closing critical research gaps.

PurposeTo 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).MethodsThe 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.ResultsWe 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.ConclusionsAll 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.

In acidic aqueous solutions, gluconate protonation is coupled with lactonization of gluconic acid. With the decrease of pC H , two lactones (δ/γ) are sequentially formed. The δ-lactone forms more readily than the γ-lactone. In 0.1 M gluconate solutions, if pC H is above 2.5, only the δ-lactone is generated. When pC H is decreased below 2.0, the formation of the γ-lactone is observable although the δ-lactone predominates. At I = 0.1 M NaClO 4 and room temperature, the deprotonation constant of the carboxylic group, using the NMR technique, was determined to be log K a = 3.30 ± 0.02; the δ-lactonization constant, by the batch potentiometric titrations, was obtained to be log K L = -(0.54 ± 0.04). Using ESI-MS, the rate constants of the δ-lactonization and the hydrolysis at pC H ~ 5.0 were estimated to be k 1 = 3.2 x 10 -5 s -1 and k -1 = 1.1 x 10 -4 s -1 , respectively.

No abstract