D’Hondt et al fractionated irradiation (Farell et al 1998; Dörr et al 2002). Recently in allogeneic and haploidentical bone marrow transplant animal models, KGF has shown interesting properties in reducing the incidence of graft-versus-host disease (GvHD). This effect seemed to be independent of repair of conditioning- induced injuries (Panoskaltsis-Mortari, Taylor, et al 2000); Vanclée et al 2005). In addition, it has been demonstrated that KGF has a favorable effect on lung repair in mice after allogeneic bone marrow transplant (Panoskaltsis-Mortari, Ingbar, et al 2000). A recent clinical study reported 69 patients who received palifermin after high-dose chemo-radiotherapy and allogeneic bone marrow transplantation. This medication was shown to be safe and well tolerated and did not have any negative effects on engraftment, GvHD, and survival (Blazar et al 2005). Another clinical study even suggested a survival benefit in patients with a high risk for acute GvHD when palifermin was added to tacrolimus and methotrexate (Reynolds et al 2004). Palliative cares Palliative cares are implemented when mucositis is present. Continuation of routine oral care should be advised (Wright et al 2005). In addition, dietary guidelines should be respected with avoidance of tobacco, alcohol, and spicy food. In some cases, parenteral or enteral supports may even be required. Finally, correct analgesia should be implemented. Morphine has been recommended as the treatment of choice for patients with mucositis undergoing HDC and HSCT (Rubenstein et al 2004). Prevailing clinical guidelines can help the clinician to choose to best analgesia for the patient (WHO 1996). These guidelines include the use of opioids, nonopioids, adjuvant medications, and assessment tools. Topical anesthetics such as viscous lidocaine are frequently used to decrease pain related to oral mucositis; however, there are no experimental studies to support this approach. In addition, viscous lidocaine requires frequent applications and can be accompanied by burning sensation and the blunting of taste (Saadeh 2005). A summary of available therapeutic and prophylactic interventions is presented in Table 2. Conclusions Oral mucositis is a frequent complication of anticancer treatments that has long been overlooked and underreported. The discrepancies between the different scales used to assess the severity of mucositis add more confusion, and large randomized clinical studies are scarce. Recently there has been greater focus on the frequency, physiopathology, consequences, 166 and treatments of oral mucositis. These treatments remain largely based on anecdotal reports and assumptions, but some interesting studies have been done to provide evidence for these approaches. The understanding of the physiopathological basis of mucositis led to the development of target drug therapies, of which palifermin is the hallmark. This new drug constitutes a milestone in the management of cancer treatment-induced toxicity. Other molecules are currently under investigation, including transforming growth factor-β3, IL-11, and FGF-20 (Peterson and Cariello 2004). The physiopathology of mucositis can also explain why some preventive treatments like topical anti-infective agents may have some paradoxical effects. Guidelines have recently been developed to help clinicians in the daily management of this devastating toxicity (Rubenstein et al 2004; Sonis et al 2004). One can not insist enough on the importance of prevention, systematic oral care, and good patient information. When oral mucositis is profuse, appropriate analgesia is required. It is clear that treatment of mucositis is not based on a unique and non-existent magic drug, but rather on a logical and rational use of different modalities. Combining drugs in specific sequences and at different times relative to the administration of anticancer treatment will probably be the solution for adequate management of oral mucositis. In the near future, dose, timing, and sequencing of anti-mucositis agents will probably be as well developed as chemotherapy regimens (Peterson and Cariello 2004). It is interesting to note that new drugs in development seem to have different mechanisms of action. In addition, it is no longer pure optimism to expect effective specific treatments of mucositis in the near future (Sonis 2004). Table 2 Candidate interventions for the management of oral mucositis General oral care Prevention Comprehensive patient Cryotherapy education Standard oral care protocol Low-level laser therapy Brushing teeth twice daily Amifostine Daily flossing Mouth rinsing with sterile water Avoidance of spicy food, alcohol, tobacco Gelclair® Benzydamine AES-14 Palifermin Palliative cares Continuation of routine oral cares Dietary guidelines: avoidance of alcohol, tobacco, spicy food Enteral or parenteral support Correct analgesia Therapeutics and Clinical Risk Management 2006:2(2)