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Use of Stem Cells in Lymphedema Post Mastectomy (SCL)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT01112189
Recruitment Status : Completed
First Posted : April 28, 2010
Last Update Posted : March 24, 2011
Information provided by:
Hospital Universitario Dr. Jose E. Gonzalez

Brief Summary:

The post-mastectomy lymphedema is a complication of removal of the breast and nodal plexus that causes accumulation of lymph and subsequent enlargement of the upper limb. It is the most common complication of all attributable to mastectomy with axillary dissection and which occurs in one third of patients who undergo radical mastectomy and radiotherapy post-operation. Currently the treatment of lymphedema of the upper limb is mainly the use of compression stockings, the use of pneumatic compression pumps and physiotherapy.

Multiple reports indicate that endothelial progenitor cells (EPC) can differentiate into various cell lines, reproduced and participate in neoangiogenesis. This study was conducted in the General Surgery Service, of the Hospital Universitario "Dr. José Eleuterio González "and proposes the EPC obtained autologous transplantation of bone marrow for the treatment of postoperative lymphedema in upper limb following axillary lymphadenectomy through the stimulation of lymphatic neoangiogenesis. The investigators studied 20 female patients over 18 years after axillary lymphadenectomy. The objective is to develop an innovative and definitive treatment for these patients and to analyze the costs and complications that this treatment may have.

Condition or disease Intervention/treatment Phase
Lymphedema Breast Cancer Procedure: Autologous transplant Other: Compressed sleeve treatment Phase 1 Phase 2

Detailed Description:

Phase 1:

The procedure will be as follows:

10 patients were recruited in the General Surgery or Oncology meeting the inclusion criteria. During the study, patients can´t use any other kind of treatment for the lymphedema.

Visit 1: We explain the procedure by inviting patients to participate after signing informed consent. There will be a complete medical history, review of inclusion and exclusion criteria, signing a letter of informed consent, be requested general laboratory tests (blood count, biochemical profile), tele-ray.

Visit 2: Initiation colony stimulating factor (Filgrastim SC) to 300 micrograms per day for 3 consecutive days.

Visit 3: Conduct a puncture and bone marrow harvesting under local anesthesia of the posterior iliac crest with Jamshidi needle to aspirate (approximately 50 - 100ml). The product obtained will be centrifuged in a refrigerated centrifuge at 3500 Sigma EK15 ® rpm/15 minutes to 8 ° C with HES 6% (pentastarch 6g/100ml) to obtain the mononuclear cell layer. Once the cells were obtained will be transported to the operating room to manage the patient by intramuscular injection of 0.5 to 1 ml in 30 to 50 sites of the affected limb with a depth of about one centimeter, using a needle number 25. The administration will take place in the operating room under local anesthesia or sedation if necessary.

Visit 4 and subsequent: clinical evaluation will be conducted each week, especially data monitoring of infection in the puncture sites. At week 12 post-cell infusion, the latest revision will be made and carried out measurements in both arms to conclude and determine the outcome of treatment.

Phase 2 (Control group):

Another 10 patients with lymphedema will be included in a 6 week study to compare the most common treatment of the lymphedema, the compressed sleeves.

Visit 1: A complete medical history will be performed. A compression sleeve will be given to the patients for their use during the next 2 weeks.

Visit 2 and 3: On week 2 and 3 of the compression sleeve treatment, the patients will be measured in both upper extremities as well as assess the symptoms or not that patients present.

Visit 4 and 5: Patients will stop using the compression sleeve treatment for the next 2 weeks measured both upper extremities and interrogate patients about symptoms during this period.

Visit 6 and 7: The last 2 weeks of the study patients will be asked to restart the compressed sleeves treatment and measured both upper extremities and interrogate patients about symptoms presented during this stage of the study.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 20 participants
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Postoperative Lymphedema Treatment in Upper Extremities Following Axillary Lymphadenectomy by Transplanting Autologous Endothelial Progenitor Cells (EPC)
Study Start Date : September 2009
Actual Primary Completion Date : August 2010
Actual Study Completion Date : September 2010

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
Experimental: Patients with stem cells
Patients that receive the stem cells treatment
Procedure: Autologous transplant
Patients will be stimulated 3 days with Filgrastrim 300 micrograms per day. On the 4th day the autologous transplant of stem cells will be performed.
Other Name: Stem Cells transplant

Active Comparator: Compressed sleeve treatment
Patients that will receive the compressed sleeve treatment
Other: Compressed sleeve treatment

Week 1-2: With compressed sleeve treatment.

Week 3 -4: Without treatment.

Week 5 - 6: With compressed sleeve treatment

Other Name: Compressive sleeve treatment

Primary Outcome Measures :
  1. Determine if the stem cells are effective in patients with lymphedema with the decreased of the volume of the affected limb and improvement of the symptomatology. [ Time Frame: 3 months ]

    Patients will be measured in 4 different areas of both arms with a tape measure, before the transplant and weekly after the transplant for 3 months.

    Measure 1: 10 cm over the epicondyle. Measure 2: 5 cm over the the epicondyle. Measure 3: 5 cm under the the epicondyle. Measure 4: 15 cm under the the epicondyle Also a questionnaire of the most common symptoms will be given to the patients to mark their own symptoms before the transplant and 3 months after the transplant.

Secondary Outcome Measures :
  1. Participants with Adverse Events as a Measure of Safety and Tolerability. [ Time Frame: 3 months ]

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 75 Years   (Adult, Older Adult)
Sexes Eligible for Study:   Female
Accepts Healthy Volunteers:   No

Inclusion criteria:

  • Patients with postsurgical lymphedema in upper extremities following axillary lymphadenectomy.
  • Female gender.
  • Age over 18 years.
  • Patients who wish to participate in the study.
  • Informed consent signed.

Exclusion criteria:

  • Patients with hypercoagulable states.
  • Patients with a history of obstructive vascular disease in the brain, kidneys or heart.
  • Patients with congestive heart failure (ejection fraction less than 30%)
  • Active infectious process, serious, anywhere in the body.
  • Patients over 75 years of age.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT01112189

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Hospital Universitario Dr Jose Eleuterio Gonzalez
Monterrey, Nuevo León, Mexico, 64810
Sponsors and Collaborators
Hospital Universitario Dr. Jose E. Gonzalez
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Principal Investigator: Gerardo E. Muñoz Maldonado, MD Hospital Universitario Dr Jose Eleuterio Gonzalez

Additional Information:
Publications automatically indexed to this study by Identifier (NCT Number):
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Responsible Party: Dr. med Gerardo Enrique Muñoz Maldonado, Hospital Universitario "Dr. José Eleuterio González" Identifier: NCT01112189     History of Changes
Other Study ID Numbers: CG08-005
First Posted: April 28, 2010    Key Record Dates
Last Update Posted: March 24, 2011
Last Verified: February 2010

Keywords provided by Hospital Universitario Dr. Jose E. Gonzalez:
Stem cells
Breast Cancer

Additional relevant MeSH terms:
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Lymphatic Diseases