Guideline for the prevention of oral and oropharyngeal mucositis in children receiving treatment for cancer or undergoing haematopoietic stem cell transplantation.
Guideline for the prevention of oral and oropharyngeal mucositis in children receiving treatment for cancer or undergoing haematopoietic stem cell transplantation.
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DOI：
10.1136/bmjspcare-2014-000804
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发表时间：
2017-03
影响因子：
2.7
通讯作者：
Dupuis LL
中科院分区：
文献类型：
--
作者：
Sung L;Robinson P;Treister N;Baggott T;Gibson P;Tissing W;Wiernikowski J;Brinklow J;Dupuis LL
制定循证临床实践指南，预防接受癌症治疗或接受造血干细胞移植 (HSCT) 的儿童（0-18岁）口腔粘膜炎。粘膜炎预防指南制定小组是跨学科的，包括国际公认的儿科粘膜炎专家。为了进行证据审查，我们纳入了在儿童或成人中进行的随机对照试验（RCT），评估根据预先设定的标准选择的以下干预措施：冷冻疗法、低强度光疗法（LLLT）和角质形成细胞生长因子（KGF）。我们还检查了对儿童进行的任何干预措施的随机对照试验。对于所有系统评价，我们综合了严重口腔粘膜炎的发生情况。推荐、评估、制定和评估方法的等级用于描述证据的质量和建议的强度。我们建议对接受化疗或 HSCT 治疗且粘膜炎发生率高的治疗方案的配合儿童进行冷冻治疗或 LLLT。我们还建议可以向接受 HSCT 治疗的儿童提供 KGF，这些治疗方案与严重粘膜炎的高发率相关。然而，KGF 的使用值得谨慎，因为缺乏儿童的疗效和毒性数据，以及儿童癌症的长期随访数据。没有推荐其他干预措施来预防儿童口腔粘膜炎。本临床实践指南中评估的所有三种具体干预措施均与弱推荐使用相关。采用 LLLT 和 KGF 可能存在重要的组织和成本障碍。强调了实施的考虑因素和关键研究差距。
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). 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. 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. 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.