Reduction of Oral Mucositis Severity using a Topical Vasoconstrictor in Bone Marrow Transplant Patients | Chapter 6 | New Frontiers in Medicine and Medical Research Vol. 10

 Oral mucositis (OM) of grade 3 has been seen in over 90% of bone marrow transplant patients who received the cyclophosphamide + whole body irradiation (CY+TBI) conditioning regimen in the past. In two preclinical animal models, an orotopically administered adrenergic vasoconstrictor prevented up to 100 percent of radiation-induced oral mucositis. Three patients (ages 24-29) who had the CY+TBI conditioning regimen had an adrenergic vasoconstrictor (phenylephrine in an aqueous-alcohol NG11-1 formulation) orotopically applied, and they were compared to five matched controls who had no orotopical vasoconstrictor. Within the University of Wisconsin Adult Bone Marrow Transplant Program, all patients received the CY+TBI conditioning regimen for acute lymphoblastic leukaemia. During the seven-day CY+TBI conditioning regimen, a vasoconstrictor was applied topically to the oral cavity 20 minutes before each treatment, either radiation or chemotherapy, and patients were subsequently given 1.5 Gy whole-body radiation or IV cyclophosphamide. Physical examinations, daily pictures of the oral cavity, oral pain and oral function score sheets, and recorded narcotic usage were used to assess OM severity over a three-week period. Both “Grade 3 OM” and “any OM” durations were significantly shorter in vasoconstrictor-treated individuals than in the five control patients. Although three out of five control patients received a nasogastric tube or total parenteral feeding, none of the three vasoconstrictor-treated patients received these supportive care interventions. When compared to matched control patients who all underwent the identical CY+TBI conditioning regimen, orotopically applied NG11-1 vasoconstrictor formulation significantly reduced the incidence and severity of “Grade 3” and “any” oral mucositis. Patients tolerated the liquid orotopical formulation well, both in terms of ease of administration and lack of adverse effects.

Author (S) Details

Ningfeng Fiona Li
Erasmus University Rotterdam, The Netherlands and London University, UK.

William E. Fahl
McArdle Laboratory for Cancer Research at the University of Wisconsin-Madison, USA.

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