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All TopicsForum: Lymphedema → Topic: Fat grafting to treat Lymphedema, a case study

Topic: Fat grafting to treat Lymphedema, a case study

Forum: Lymphedema — Risks, tips for prevention, and info about products that can address the symptoms of lymphedema.

Posted on: Jun 14, 2016 01:02AM - edited Jun 14, 2016 01:04AM by macb04

macb04 wrote:

Hi I am having an aching arm recently, worried it is start of lymphedema .

Saw this article about fat grafting done for this woman with lymphedema. Seemed pretty good to me. Glad to hear they will be doing a larger study.

Cell-Assisted Lipotransfer Using Autologous Adipose-Derived Stromal Cells for Alleviation of Breast Cancer-Related Lymphedema
  1. Navid Mohamadpour Toyserkania,
  2. Charlotte Harken Jensenb,
  3. Søren Paludan Sheikhband
  4. Jens Ahm Sørensena

+Author Affiliations

  1. aDepartment of Plastic and Reconstructive Surgery, Odense University Hospital, Odense, Denmark
  2. bDepartment of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
  1. Correspondence: Navid Mohamadpour Toyserkani, M.D., Odense University Hospital, Plastic and Reconstructive Surgery, Sdr. Boulevard 29, Odense C, 5000, Denmark. Telephone: 45 65411861; E-Mail:navid.m.toyserkani@rsyd.dk
  • Received November 20, 2015.
  • Accepted March 1, 2016.
  • Published online before print May 5, 2016.
Abstract

Lymphedema is one of the most frequent side effects following cancer treatment, and treatment opportunities for it are currently lacking. Stem cell therapy has been proposed as a possible novel treatment modality. This study was the first case in which freshly isolated adipose-derived stromal cells were used to treat lymphedema. Treatment was given as a cell-assisted lipotransfer in which 4.07 × 107 cells were injected with 10 ml of lipoaspirate in the axillary region. Four months after treatment, the patient reported a great improvement in daily symptoms, reduction in need for compression therapy, and volume reduction of her affected arm. There were no adverse events. The outcome for this patient provides support for the potential use of cellular therapy for lymphedema treatment. We have begun a larger study to further test the feasibility and safety of this procedure (ClinicalTrials.gov Identifier NCT02592213).

Significance

Lymphedema is a very debilitating side effect of cancer treatment and has very few treatment options. Stem cell therapy has the potential to change the treatment paradigm from a conservative to a more curative approach. Freshly isolated, autologous, adipose-derived stromal cells were combined with a fat-graft procedure to treat lymphedema. The treated patient had great improvement in daily symptoms, a reduced need for compression therapy, and a reduction in arm volume after 4 months. There were no adverse events. The use of cellular therapy for lymphedema treatment is supported by this patient's outcome. A phase II study has begun to further test its feasibility and safety.

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Jun 18, 2016 02:53AM macb04 wrote:

What do you all think of this??

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Jun 18, 2016 01:14PM floaton wrote:

Macb04, thanks for posting this. On the surface I certainly like it better than anything that requires a lymph node to be moved from another location and the risk that entails. It's great they're doing it in the context of a trial to (hopefully) give people some real information about risks and benefits, rather than just starting to offer the procedure without objectively assessing whether it is helpful or harmful. I hope there's significant length of follow up and collection of info on whether it has any effect on cancer recurrence.

One day you're waiting for the sky to fall; the next you're dazzled by the beauty of it all - Bruce Cockburn Dx 9/2013, IDC, 2cm, Stage IIA, Grade 3, 0/8 nodes, ER+/PR+, HER2- Surgery 9/14/2013 Lymph node removal: Right, Underarm/Axillary; Mastectomy: Right Chemotherapy 10/14/2013 AC + T (Taxol) Hormonal Therapy 2/14/2014 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Jun 18, 2016 11:24PM macb04 wrote:

Yes, I certainly like the thought of this kind of treatment. This is exactly the same kind of fat grafting that has been used for years in fat grafting for Breast Reconstruction that has never been shown to cause reoccurrence. I would expect they will see much the same results, at least of reoccurrence risk. I hope it is a viable method of helping Lymphedema sufferers. Guess we have will have to wait and see. If I were local to the trial, I would go into it for sure.

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Jun 26, 2016 01:03PM macb04 wrote:

Hi, I heard back from the researcher who is doing the trial in Denmark. He says so far so good for the patients who had the fat cells grafted in the axilla as part of this Lymphedema Treatment Trial. VERY EXCITING!

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Jun 26, 2016 05:37PM Binney4 wrote:

macb04, thanks for posting this, as it's really enticing. I'm not understanding what "so far so good" might mean. Or even how long the phrase "so far" represents. How far into the Phase II study are they? How many patients are involved now? How many have seen positive results? Have imaging studies been done that indicate newly functioning lymphatics? The problem I'd see with this would be with the length of time positive results might be expected to last (and of course our ever-present risk of infection--grrrrrr!) Would really appreciate more information. Thanks!
Be well,
Binney

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Jun 26, 2016 11:48PM macb04 wrote:

Hi Binney,

Alas, the researcher wouldn't go into details with me, so we will just have to wait and see what are the answers to your very good questions. Looking back at the initial study info above, it said a Phase II trial had started, when it had been submitted in November 2015.

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Jun 27, 2016 01:42PM glennie19 wrote:

It will be interesting to see how the study goes. Thanks for posting!

Fibromyalgia and Truncal Lymphedema,,, some of the fun things I live with. Total hysterecomy 9/29/14 Dx 6/27/2013, Paget's, 1cm, Stage 0, Grade 3, 0/6 nodes, ER+/PR+, HER2- Surgery 8/8/2013 Lymph node removal: Left, Sentinel; Mastectomy: Left Dx DCIS
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Sep 25, 2016 12:26PM rengeko wrote:

i had hoped this might work. i will watch with interest.

Dx 6/2/2011, IDC, 6cm+, Stage IV, Grade 3, 3/7 nodes, mets, ER+/PR+, HER2+
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Aug 12, 2017 01:14AM - edited Aug 12, 2017 01:15AM by macb04

They did more research, here is the latest http://onlinelibrary.wiley.com/doi/10.1002/sctm.17-0037/full

Human Clinical Article

Treatment of Breast Cancer-Related Lymphedema with Adipose-Derived Regenerative Cells and Fat Grafts: A Feasibility and Safety Study Authors
  • Navid Mohamadpour Toyserkanko
  • Charlotte Harken Jensen,
  • Ditte Caroline Andersen,
  • Søren Paludan Sheikh,
  • Jens Ahm Sørensen
  • Authored by a member of IFATS.
Abstract

Breast cancer-related lymphedema (BCRL) is a debilitating late complication with a lack of treatment opportunities. Recent studies have suggested that mesenchymal stromal cells can alleviate lymphedema. Herein, we report the results from the first human pilot study with freshly isolated adipose-derived regenerative cells (ADRC) for treating lymphedema with 6 months follow-up. Ten BCRL patients were included. ADRC was injected directly into the axillary region, which was combined with a scar-releasing fat graft procedure. Primary endpoints were change in arm volume. Secondary endpoints were change in patient reported outcome and safety. The study is registered with ClinicalTrials.gov (NCT02592213). During follow-up, a small volume reduction was noted but was not significant. Five patients reduced their use of conservative management. Patient-reported outcomes improved significantly over time. ADRCs were well tolerated and only minor transient adverse events related to liposuction were noted. In this pilot study, a single injection of ADRC improved lymphedema based on patient-reported outcome measures, and there were no serious adverse events in the 6 months follow-up period. In addition, half of the patients reduced their use of conservative management. ADRC therapy is a promising interventional therapy for alleviating lymphedema, but results need to be confirmed in randomized clinical trials. Stem Cells Translational Medicine2017;6:1666–1672

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