Cell-Assisted Lipotransfer Using Autologous Adipose-Derived Stromal Cells for Alleviation of Breast Cancer-Related Lymphedema

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 × 10(7) 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.

Keywords: Adipose-derived regenerative cells; Adipose-derived stem cells; Adipose-derived stromal cells; Cell-based therapy; Lymphedema; Mesenchymal stem cell transplantation; Regenerative medicine; Stromal vascular fraction; Tissue-based therapy.

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Figures

Figure 1.

Photographs and dual-energy x-ray absorptiometry (DXA) scan of the injection of the stromal vascular fraction of freshly isolated adipose-derived stromal cells in the procedure described in this study. (A): Lipoaspirate (320 ml) was obtained using water-assisted liposuction. This was transferred to 60-ml syringes and then injected into the Celution System (Cytori Therapeutics). (B): The adipose-derived stromal cells were isolated within 2 hours and were suspended in 5 ml of lactated Ringer’s solution. (C): During the surgical procedure, 10 ml of lipoaspirate was used for fat grafting to the axillary region. (D): The adipose-derived stromal cells were injected into the same region at eight prespecified points immediately after isolation; the patient was awake at this time. (E): Whole-body DXA scans were used to calculate arm volume pre- and postoperatively. The lines isolating the arms, including the shoulders, represent the areas from which volume was calculated.