Systematic review of cytokines and growth factors for the management of oral mucositis in cancer patients

Support Care Cancer. 2013 Jan;21(1):343-55. doi: 10.1007/s00520-012-1594-5. Epub 2012 Sep 18.


Purpose: The aim of this project was to review the literature and define clinical practice guidelines for the use of cytokines and growth factor agents for the prevention or treatment of oral mucositis induced by cancer chemotherapy or radiotherapy.

Methods: A systematic review was conducted by the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society for Oral Oncology (MASCC/ISOO). The body of evidence for each intervention, in each cancer treatment setting, was assigned an evidence level. Based on the evidence level, one of the following three guideline determinations was possible: Recommendation, Suggestion, No guideline possible.

Results: Sixty-four clinical studies across 11 interventions were evaluated. A recommendation was made for the use of recombinant human KGF-1 (palifermin) at a dose of 60 μg/kg per day for 3 days prior to conditioning treatment and for 3 days post-transplant for prevention of oral mucositis in patients receiving high-dose chemotherapy and total body irradiation followed by autologous stem cell transplantation for hematological malignancies. A suggestion was made against using granulocyte macrophage colony-stimulating factor mouthwash for the prevention of oral mucositis in the setting of high-dose chemotherapy followed by autologous or allogeneic stem cell transplantation. No guideline was possible for any other cytokine or growth factor agents due to inconclusive evidence.

Conclusions: Of the cytokine and growth factor agents studied for oral mucositis, the evidence only supports use of palifermin in the specific population listed above. Additional well-designed research is needed on other cytokine and growth factor interventions and in other cancer treatment settings.

Publication types

  • Consensus Development Conference
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Cytokines / adverse effects
  • Cytokines / therapeutic use*
  • Evidence-Based Medicine
  • Fibroblast Growth Factor 7 / adverse effects
  • Fibroblast Growth Factor 7 / therapeutic use
  • Fibroblast Growth Factors / adverse effects
  • Fibroblast Growth Factors / therapeutic use
  • Granulocyte Colony-Stimulating Factor / adverse effects
  • Granulocyte Colony-Stimulating Factor / therapeutic use
  • Granulocyte-Macrophage Colony-Stimulating Factor / adverse effects
  • Granulocyte-Macrophage Colony-Stimulating Factor / therapeutic use
  • Humans
  • Intercellular Signaling Peptides and Proteins / adverse effects
  • Intercellular Signaling Peptides and Proteins / therapeutic use*
  • Mouthwashes
  • Neoplasms / complications*
  • Neoplasms / drug therapy
  • Neoplasms / radiotherapy
  • Practice Guidelines as Topic
  • Stomatitis / etiology
  • Stomatitis / prevention & control
  • Stomatitis / therapy*


  • Cytokines
  • Intercellular Signaling Peptides and Proteins
  • Mouthwashes
  • Fibroblast Growth Factor 7
  • Granulocyte Colony-Stimulating Factor
  • Fibroblast Growth Factors
  • Granulocyte-Macrophage Colony-Stimulating Factor