von Bultzingslowen, I., Brennan, M.T., Spijkervet, F.K., Logan, R., Stringer, A., Raber-Durlacher, J.E., & Keefe, D. (2006). Growth factors and cytokines in the prevention and treatment of oral and gastrointestinal mucositis. Supportive Care in Cancer, 14, 519–527.

A systematic review of the English medical literature was performed. Only clinical trials were included in the first search, January 1966–May 2002. In the June 2002–May 2005 review, clinical and preclinical trials were included.

In the 2002 review, 35 studies were identified. In the 2005 review, 14 preclinical and 9 clinical studies were identified. Studies reporting on cytokines or growth factors for the amelioration of chemotherapy- and radiation-induced mucositis throughout the entire alimentary canal were included.

Based on the review, guidelines recommend palifermin at a dose of 60 mg/kg per day for three days prior to conditioning for hematologic malignancies receiving high-dose chemotherapy and total body irradiation (TBI) with autologous stem cell transplantation (SCT). Preliminary results indicated effectiveness for repifermin. Trials are in process for velafermin.

Two randomized studies of granulocyte colony-stimulating factor (G-CSF) showed reduction in mucositis incidence. Two cohort studies demonstrated reduced severity of mucositis. One study did not show any positive results for mucositis. Another showed that use of growth factors was not a significant determinant of oral mucositis. Two studies failed to demonstrate improvement with G-CSF in the radiation setting. Studies demonstrate conflicting results. No recommendation can be made at this time.

One cohort study with granulocyte macrophage colony-stimulating factor (GM-CSF) showed reduction in severity and duration of oral mucositis. Another study showed no effect on radiation-induced oral mucositis. Two studies showed some positive effects for radiation-induced mucositis. Studies demonstrated conflicting results. No recommendation can be made at this time. Two studies with GM-CSF mouthwash demonstrated no positive effects. The Multinational Association of Supportive Care in Cancer guideline has been updated to suggest that GM-CSF mouthwash not be used for the prevention of mucositis in the transplant setting.

For other agents, evidence was insufficient or toxicities too severe to recommend use.