eNews Online - July 2000 Edition

eNews Online
July 2000 Edition

This Lymphedema eNews is being generated through your request from our website.

Stem Cell Transplant

Breast cancer treatment results in lymphedema in about 10 to 35% of patients, especially in patients who undergo surgical resection of the regional lymph nodes along with radiation to the axilla. There have been attempts to improve the therapy for breast cancer and it is our hope that with better treatments for breast cancer, we can reduce the need for extensive surgery and radiation and reduce the incidence of lymphedema. One of the active areas of research in breast cancer therapy is bone marrow and stem cell transplant.

Bone marrow transplants were once thought to offer hope for patients with advanced breast cancer; however, recent studies have not supported the benefit of bone marrow transplant over standard chemotherapy. As a result, a more advanced version of bone marrow transplant has been under investigation. In the more advanced version of bone marrow transplant, stem cells, which are immature bone marrow cells, are harvested from the patient's blood rather from the bone marrow. The stem cells from the blood are eas ier to harvest and are more prolific sources of immune cells. The stem cells are reinfused after the high-dose chemotherapy treatment and produce a large number of mature immune cells. Stem cell transplant is an easier and more effective than bone marrow transplant and it was felt that this technique may be the missing key needed to help improve survival among patients suffering from advanced breast cancer.

The new stem cell transplant method was compared to standard chemotherapy and the results of this study were recently published in the New England Journal of Medicine. Unfortunately, the studies did not find an advantage for stem cell transplant compared to standard chemotherapy. In fact, 3 years after treatment, there were slightly more survivors in the standard therapy group than in the group of patients who received the stem cell transplant. In addition, side-effects including suppression of the immune system and anemia were more common in the patients who received the stem cell transplant.

While this study did not prove that stem cell transplants are better than standard chemotherapy, additional studies are underway and scientists and physicians are working to find an even better methods to treat breast cancer. I believe that better treatments for breast cancer will help us win the battle against lymphedema.

Tony Reid MD Ph.D

Case of the Month

Case Submitted By: Cleveland Regional Rehab, Shelby North Carolina

Mr. DW is a 34 year-old male who presented to Cleveland Regional Rehabilitation on February 28, 2000 with state III bilateral lower extremity lymphedema and stage I lymphedema of the abdomen.

This patient's lymphedema is secondary with complications from his weight and questionable CVI. His medical doctor has not made a diagnosis of CVI. Prior to February 28, 2000, patient has not been treated for his lymphedema.

Functionally, this patient was unable to drive secondary to the size of his abdomen, had difficulty walking secondary to back pain and shortness of breath, and had difficulty finding clothes to fit.

This patient reports the initial signs of swelling first appeared one month after surgery in 1993 for a ruptured vericose vein to the distal anterior portion of the right lower extremity, darkened discoloration, and textured skin changes.

One year after surgery in 1994, this patient experienced a ruptured varicose vein to the left distal lower extremity what was treated with cauterization. This patient again reported an onset of swelling one month post, with no reported history of wounds and one episode of cellulitis.

In January of 2000, this patient presented to his physician with an infection to the lining of his stomach, a significant weight increase and a hard pitting edema in the abdomen. This patient was treated with oral antibiotics and referred for lymphedema treatment.

This patient's initial evaluation was on February 28, 2000 with treatment beginning on March 6th after the patient was cleared medically. A baseline weight was unable to be recorded on evaluation secondary to the patient's size; however, this patient reports an estimate of 525-550 lbs. On April 24, 2000, after 34 treatments, a weight of 453.9 lbs. was recorded.

MLD/CDP was initiated on March 6, 2000 on the right lower extremity after the patient was cleared medically and treated for a fungal infection noted on February 28, 2000. The right lower extremity was selected to treat first because of the open wound that was leaking lymph fluid. The abdomen was treated simultaneously.

The patient was sized for a ReidSleeve Classic two weeks after his treatment began secondary to difficulty maintaining a good fit with bandages/foam/idealbinde. On April 8, 2000 (after 22 treatments), treatment was initiated by using the ReidSleeve Classic. The patient reported immediate reduction in the size of the right lower extremity and softening of the underlying fibrotic tissue.

On April 18, 2000, after nine treatments of MLD/CDT with the ReidSleeve and the 31st treatment overall, the garment needed to be re-sized secondary to the volume reduction in the right lower extremity. Bandages were re-introduced and used until May 4, 2000 when the ReidSleeve was refit to the patient.

On May 10, 2000 (43rd treatment), the patient was sized for a compression garment. MLD/CDT treatment continued 3x/week until June 7, 2000 (52nd treatment) when the patient was fit in his custom CCL III, 40-50mmHg stocking. This patient continues to use his Juzo compression stocking for waking hours and the ReidSleeve for sleeping hours with continued reduction since discharge. This patient continues to be monitored, taking measurements Monday and Friday to track volume reduction.

Depicted below is DW case study: Prior to treatment

Depicted below is DW case study: Volume Reduction: Right Lower Extremity
(Since initiation of treatment with the ReidSleeve Classic)

The graph does not represent volume reduction in the abdomen, for which we had no good measuring tools. Functionally, however, this patient reports decreased pain in the back, decreased difficulty with ambulating, and the ability to fit into his clothes. This patient resumed driving on April 25, 2000 after 35 treatments.

Cleveland Regional Rehab
Cleveland Regional Medical Center
Shelby North Carolina