gms | German Medical Science

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2017)

24.10. - 27.10.2017, Berlin

Stem cell therapy in osteonecrosis occurring after therapy for malignancy: risks of tumor occurrence and transplantation at the site of stem cell treatment?

Meeting Abstract

Suche in Medline nach

  • presenting/speaker Philippe Hernigou - Hospital Henri Mondor, Creteil, France

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2017). Berlin, 24.-27.10.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocIN11-173

doi: 10.3205/17dkou002, urn:nbn:de:0183-17dkou0022

Veröffentlicht: 23. Oktober 2017

© 2017 Hernigou.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objectives: While usually the cause of osteonecrosis is not related to cancer, osteonecrosis may occur after therapy for malignancy. These patients with cancer may need autologous cell therapy from the iliac crest. However bone is the predominant metastatic soil for a number of cancers, including prostate, breast and lung cancers as well as leukemia. Numerous studies have demonstrated the presence of disseminated tumor cells in the bone marrow from these patients. Therefore bone marrow aspiration in patients with known cancer may aspirate these cells with risk of tumor cells transplantation at the site of injection.

Methods: We therefore performed an evaluation of the long-term risk for risk of tumorigenesis (metastases) at sites where autologous bone marrow-derived concentrated cell preparations were injected in 253 patients (108 hematologic and 145 solid cancers) who had been treated for hip osteonecrosis using autologous bone marrow progenitor cells in patients. The average number of MSCs returned to the patients was 350 000 MSCs (range, 75 000 to 1 800 000 MSCs). The cancer treatment had to be stopped since one year or more; and the cancer status was without metastases for all the patients. The patients, mean age of 34 ± 15 years (range 15 - 65 years), were managed over a period of twenty years from 1990 to 2010 and were monitored through December, 2016. Among the 253 patients (506 hips), 102 (40%) underwent unilateral hip osteonecrosis treatment, 98 (40%) patients had bilateral osteonecrosis treatment (with bone marrow grafting on one side and hip arthroplasty for collapse on the other side), and 52 (20%) had bilateral bone marrow grafting.

Results and Conclusion: MRIs of the pelvis and/or radiographs after the procedure every year until the most recent follow-up visit. No tumor formation of the proximal femur was observed on the 654 magnetic resonance images and 4260 radiographs of the 203 patients without recurrence of cancer. 50 patients (31 with hematologic, 19 with solid) had recurrence either of previous cancer site, either other sites of the previous cancer or occurrence of a new cancer (5 patients). Among these 50 patients, 23 presented tumorigenesis of the proximal femur with the same histology of the previous cancer in 18 cases and different in 5 cases. Tumorigenesis of the proximal femur was not more frequent on the treatment site than on the contralateral side for patients who had received bone marrow only on one side. Tumorigenesis was not more frequent in patients who had received bone marrow concentrate on both sides than on patients with unilateral treatment. Bone marrow aspiration at the site of a misdiagnosis of a pelvic bone metastases in 6 patients was not followed by tomorigenesis at the site of MSCs injection.

This study found no increased of tumor transplantation risk at the site of stem cell treatment after a mean period of 15 years (range 10 to 25).