Guideline for the prevention of oral and oropharyngeal mucositis in children receiving treatment for cancer or undergoing haematopoietic stem cell transplantation

Abstract

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.

Prise en charge des mucites orales chez les enfants cancéreux : Recommandations de bonnes pratiques en 2015

“…Voir cette chance annulée par un arrêt du traitement ou un report est intolérable, d'où l'intérêt de trouver les traitements pouvant contrer les effets néfastes Fig. 1 Recommandations de bonnes pratiques pour la prise en charge de la mucite orale chez l'enfant [33][34][35][36] KGF : facteur de croissance des kératinocytes ; LLLT : le laser de faible énergie des thérapies en oncologie. La mucite est donc la cible de plusieurs traitements adjuvants dont le laser fait partie.…”

“…La thérapie au laser de faible niveau a également réduit le risque de douleur sévère, la moyenne globale des scores de douleur, le besoin d'analgé-sie opioïde et les interruptions non planifiée des traitements anticancéreux [6,31]. Le laser de faible énergie est considéré comme un traitement prometteur pour la mucite orale par des Tableau 2 Les recommandations pratiques pour la prévention de la mucite orale chez la population pédiatrique [36]. Elevé études fondées sur des preuves récentes (Tableau 2).…”

Impacto de un protocolo de prevención y atención de mucositis oral en pacientes con diagnóstico oncológico pediátrico

“…Al igual que muchos centros de referencia internacional 12 , se está iniciando la implementación de protocolos tanto preventivos como terapéuticos en la MO; sin embargo, no existen directrices nacionales definitivas para su tratamiento en población pediátrica. Se ha demostrado que los niños tienen mayor riesgo de desarrollar MO que los adultos 13 , y que el pobre control de la misma puede tener un resultado negativo en el desarrollo infantil.…”

Impact of a protocol for the prevention and care of oral mucositis in pediatric patients diagnosed with cancer

“…As in many international reference centers 12 , implementation of both OM preventive and therapeutic protocols is being initiated; however, there are no definitive national guidelines for its treatment in pediatric population. Children have been shown to be at higher risk for developing OM than adults 13 , and poor control of this condition can have a negative outcome in children's development.…”