Supportive Care in Cancer

, Volume 22, Issue 1, pp 3–6 | Cite as

Caphosol, a therapeutic option in case of cancer therapy-induced oral mucositis in children?

Results from a prospective multicenter double blind randomized controlled trial
  • M. F. RaphaelEmail author
  • A. M. den Boer
  • W. J. W. Kollen
  • H. Mekelenkamp
  • F. C. H. Abbink
  • G. J. L. Kaspers
  • K. Zomer-Kooijker
  • B. H. W. Molmans
  • W. J. E. Tissing
Letter to the editor


In pediatric oncology, chemotherapy- or radiotherapy-induced oral mucositis (OM) is accompanied by decreased oral intake, pain, analgesics use, and hospital admission [1, 2]. Moreover, OM is correlated with an increased risk of sepsis [3, 4]. Recently, Caphosol, a supersaturated Ca2+/PO43− mouth rinse, became available to prevent or treat mucositis [5]. Papas et al. demonstrated Caphosol to have a beneficial prophylactic effect in adult hematopoietic stem cell transplantation (HSCT) patients, but evidence in pediatric patients is lacking [6]. We studied whether Caphosol can be used to treat OM in a prospective randomized study.

Patients and methods

Patients and settings

Four university hospitals in The Netherlands participated, and Institutional Review Board (IRB) approval was obtained. Pediatric cancer patients aged 4–18 years old were enrolled from January 2011 until March 2012 before the start of chemotherapy or HSCT. Once mucositis occurred, patients were randomized to...


Hematopoietic Stem Cell Transplantation Oral Mucositis Mouth Rinse Palifermin Obtain Blood Culture 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Study medications were sponsored by EUSA Pharma (international division of Jazz Pharmaceuticals).

Conflict of interest

The authors have declared no conflicts of interest.


  1. 1.
    Cheng KKF, Lee V, Li CH et al (2011) Incidence and risk factors of oral mucositis in paediatric and adolescent patients undergoing chemotherapy. Oral Oncol 47:153–162PubMedCrossRefGoogle Scholar
  2. 2.
    Otmani N, Alami F, Hessissen L et al (2011) Determinants of severe oral mucositis in paediatric cancer patients: a prospective study. Int J Paediatr Dent 21(3):210–216PubMedCrossRefGoogle Scholar
  3. 3.
    Allen G, Logan R, Gue S (2010) Oral manifestations of cancer treatment in children: a review of the literature. Clin J Oncol Nurs 14(4):481–490PubMedCrossRefGoogle Scholar
  4. 4.
    Sonis ST, Elting LS, Keefe D et al (2004) Perspectives on cancer therapy-induced mucosal injury. pathogenesis, measurement, epidemiology, and consequences for patients. Cancer 100(9 Suppl):1995–2025PubMedCrossRefGoogle Scholar
  5. 5.
    Singh M, Papas A (2009) Long-term clinical observation of dental caries in salivary hypofunction patients using a supersaturated calcium-phosphate remineralizing rinse. J Clin Dent 20(3):87–92PubMedGoogle Scholar
  6. 6.
    Papas AS, Clark RE, Martuscelli G et al (2003) A prospective, randomized trial for the prevention of mucositis in patients undergoing hematopoietic stem cell transplantation. Bone Marrow Transplant 31(8):705–712PubMedCrossRefGoogle Scholar
  7. 7.
    Cancer Therapy Evaluation Program (2006) Common terminology criteria for adverse events, version 3.0. Aug 9, 2006. Accessed 19 May 2012
  8. 8.
    Wong DL, Baker CM (1988) Pain in children: comparison of assessment scales. Pediatr Nurs 14(1):9–17PubMedGoogle Scholar
  9. 9.
    Clarkson JE, Worthington HV, Furness S et al (2010) Interventions for treating oral mucositis for patients with cancer receiving treatment. Cochrane Database Syst Rev Issue 8. doi: 10.1002/14651858.CD001973.pub4
  10. 10.
    Worthington HV, Clarkson JE, Bryan G et al (2011) Interventions for preventing oral mucositis for patients with cancer receiving treatment. Cochrane Database of Systematic Review, Issue 4. doi: 10.1002/14651858.CD000978.pub5
  11. 11.
    Waśko-Grabowska A, Rzepecki P, Oborska S et al (2011) Efficiency of supersaturated calcium phosphate mouth rinse treatment in patients receiving high-dose melphalan or BEAM prior to autologous blood stem cell transplantation: a single-center experience. Transplant Proc 43(8):3111–3113PubMedCrossRefGoogle Scholar
  12. 12.
    Hawcutt D, Awoghemi O, Bell E et al (2010) Mucositis prevention: efficacy of supersaturated calcium and phosphate solution in high risk paediatric oncology patients. Pediatr Blood Cancer 55(5):PR025Google Scholar
  13. 13.
    Miyamoto C, Wobb J, Micaily B et al (2009) A retrospective match controlled study of supersaturated calcium phosphate oral rinse (Scpor) vs. supportive care for radiation induced oral mucositis (Om). [Abstract] (no. 10–087). Presented at the 2009 international MASCC/ISOO symposium; June 25–27, 2009; Rome, Italy. In: Support Care Cancer 17:911Google Scholar
  14. 14.
    Bechtel T, Devine S, James AG (2009) Use of a calcium/phosphate oral rinse (Caphosol) to lessen the mucositis following an autologous peripheral blood stem cell transplantation. Biol Blood Marrow Transplant 15(2 Suppl):154CrossRefGoogle Scholar
  15. 15.
    Haas ML, Mercedes T, Manyak J et al (2008) Reduction of painful oral mucositis by supersaturated calcium phosphate oral rinse in head and neck cancer patients receiving chemotherapy and radiation. [Poster] (no. 2530). Presented at the 50th congress of the American Society of Therapeutic Radiology and Oncology 2008 (ASTRO); Sep 21–25, 2008; Boston, USA. Accessed 8 Feb 2012
  16. 16.
    Mourao E, Correira A, Pires R (2010) Finally something good. [Abstract]. Presented at the 36th annual meeting of the European Group for Blood and Marrow Transplantation (EBMT); Mar 21–24, 2010; Vienna, Austria. In: Bone Marrow Transplantation (Suppl. 2) 45:S369Google Scholar
  17. 17.
    Nicolatou-Galitis O, Sarri T, Kouloulias V et al (2010) Efficacy and safety of Caphosol on oral mucositis in head and neck cancer patients who received radiotherapy with or without chemotherapy. A pilot study. [Abstract] (no. 08–070). Presented at the 2010 international MASCC/ISOO symposium; June 24–26, 2010; Vancouver, Canada. In: Support Care Cancer 18:S111–S112Google Scholar
  18. 18.
    Skorobogatova EV, Dyshlevaia ZM, Karachunsky AI et al (2011) First Russian experience of calcium phosphate mouth rinse usage for treatment of children with oral mucositis undergoing haematopoietic stem cell transplantation. Bone Marrow Transplant 46(Suppl 1):S192–S193Google Scholar
  19. 19.
    Lazic J, Janic D, Dokmanovic L et al (2011) Incidence of oral mucositis and efficient therapy with supersaturated calcium and phosphate solution in pediatric cancer patients. [Poster]. Presented at the 43rd congress of the International Society of Paediatric Oncology; Oct 26–30, 2011; Auckland, New Zealand. In: Ped Blood Canc 57(5):835Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • M. F. Raphael
    • 1
    Email author
  • A. M. den Boer
    • 1
  • W. J. W. Kollen
    • 2
  • H. Mekelenkamp
    • 2
  • F. C. H. Abbink
    • 3
  • G. J. L. Kaspers
    • 3
  • K. Zomer-Kooijker
    • 4
  • B. H. W. Molmans
    • 5
  • W. J. E. Tissing
    • 6
  1. 1.Department of Pediatric Hematology and Oncology, Wilhelmina Children’s HospitalUniversity Medical Center UtrechtUtrechtThe Netherlands
  2. 2.Department of Pediatric Hematology and OncologyLeiden University Medical CenterLeidenThe Netherlands
  3. 3.Department of Pediatric Hematology and OncologyVU University Medical CenterAmsterdamThe Netherlands
  4. 4.Department of Pediatrics, Wilhelmina Children’s HospitalUniversity Medical Center UtrechtUtrechtThe Netherlands
  5. 5.Department of Hospital and Clinical Pharmacy, Beatrix Children’s Hospital, University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
  6. 6.Department of Pediatric Hematology and Oncology, Beatrix Children’s Hospital, University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands

Personalised recommendations