Intervention: Phenylephrine
Trial phase: Phase 1 | Phase 2
ATC code: C01CA06 | R01AA04 | R01AB01 | R01BA03 | R01BA53 | S01FB01 | S01FB51 | S01GA05 | S01GA55
SMILES: CNC[C@H](O)c1cccc(O)c1
Sex: All
Age groups: Adult | Older Adult
Healthy volunteers: No
Participants at risk: 3
Group description: Patients undergoing a cyclophosphamide and total body irradiation regimen receive topical phenylephrine solution via spray to the oral mucosa 15-20 minutes prior to each cyclophosphamide infusion, 25-30 minutes after the beginning of each cyclophosphamide infusion, and 15-20 minutes prior to each radiation treatment.

Topical Phenylephrine Solution: Given topically via spray
Eligibility criteria:
Inclusion Criteria:

Be planning to receive a conditioning regimen for stem cell transplant (SCT) consisting of cyclophosphamide and total body irradiation and must meet inclusion criteria for SCT which include:
Patients must have an Eastern Cooperative Oncology Group (ECOG) performance status of 2 or less
Patients must have no evidence of active infections at the time of transplantation
Patients must be human immunodeficiency virus (HIV) non-reactive
Females of childbearing potential must not be pregnant or breastfeeding on admission for conditioning for SCT and a pregnancy test will be required for all females of child-bearing potential
Patients must have a pre-transplant multi-organ assessment with the following outcome:
A resting ejection fraction of 50% or greater which increases with exercise as demonstrated by resting/exercise multigated acquisition (MUGA)
A forced expiratory volume in one second (FEV1) of 60% or greater, a diffusion capacity of 50% or greater, and a oxygen partial pressure (PO2) of 80 mm mercury (Hg) or greater on pulmonary function testing
A serum creatinine of equal or less than 2.0mg/Dl and a creatinine clearance of 50 mL/min or greater on 24 hour urine collection
A total bilirubin of less than 2.5 mg/dL, unless these values are due to underlying hematologic malignancy
An aspartate aminotransferase (AST) less than 2 times the upper limit of normal, unless these values are due to underlying hematologic malignancy
Be able to tolerate topical application of phenylephrine to the oral mucosa
All patients must sign a written informed consent

Exclusion Criteria:

Open or unhealed wounds or ulcers in the oral cavity
Current use or use within past two weeks of an monoamine oxidase inhibitor (MAOI)
Primary or secondary tumor in the oral cavity
Known allergy to phenylephrine

Uncontrolled hypertension (defined as blood pressure in adults > 150/95)

Patients on anti-hypertensive medications are eligible if blood pressure is controlled
Enrollment in any other mucositis prevention study from screening up to day 45 post-stem cell transplant
Patients who are not eligible to receive SCT with cyclophosphamide and total body irradiation (TBI) conditioning because they do not meet transplant criteria are also not eligible for this phenylephrine study

General exclusion criteria for transplant include:

Patients who have angina and/or congestive heart failure requiring treatment, or who have had a myocardial infarction within the past year
Patients who have had any complication that makes the risk of death during transplantation from non-malignant causes greater than the risk of relapse
Patients who have any active infection; if the infection is successfully treated, the patient may be reconsidered for transplantation at a later date
Patients with diabetes who are not controlled by medical management will be ineligible
Psychiatric illness requiring psychiatric counseling or medical intervention other than antidepressant medications may make an individual ineligible and will be considered on a case-by-case basis
Psychosocial assessment by the bone marrow transplant team may identify individuals for whom this form of therapy may be contraindicated; these decisions will be based upon estimated adequacy of patient support systems and prediction of patient's compliance with medications, required diagnostic procedures, and/or follow-up care
Patients who have an ECOG performance status of greater than 2
Patients who have decreased pulmonary function due to any disorder as demonstrated by a diffusion capacity of less than 50% of predicted, a FEV1 of less than 60% of predicted, or a PO2 of less than 80mmHg on pulmonary function testing
Patients who have a resting ejection fraction of less than 50%
Patients who have renal disease as demonstrated by a serum creatinine clearance of greater than 2.0 mg/dL and/or a creatinine clearance of less than 50 mL/min
Patients who are pregnant or breast feeding at the time of admission for conditioning
Any mental or physical condition, in the opinion of the principal investigator (PI) or PI designee, which could interfere with the ability of the subject to understand or adhere to the requirements of the study