Hou, C., Wu, X., & Jin, X. (2008). Autologous bone marrow stromal cells transplantation for the treatment of secondary arm lymphedema: A prospective controlled study in patients with breast cancer related lymphedema. Japanese Journal of Clinical Oncology, 38(10), 670–674.

To determine the short- and long-term effects of bone marrow stromal cells (BMSC) transplantation for breast cancer-related lymphedema and to compare and contrast BMSC transplantation with complex decongestive physiotherapy

Patients in the complex decongestive physiotherapy group underwent manual lymphatic drainage, compression therapy, remedial exercises for arm and shoulder, and deep breathing to promote venous and lymphatic flow. Patients in the BMSC transplant group underwent bone marrow aspiration from the iliac crest, were admitted, and underwent brachial plexus or general anesthesia with range of transplantation being around the axilla, chest wall, and upper arm of the affected extremity. After the intensive phase, all patients were measured for and wore custom garment during waking hours. Patients were interviewed via telephone at 3 months and 12 months after treatment.

• The study sample (N = 50) was comprised of the control group (n = 35) and the intervention group (n = 15).
• Patients on an in-patient unit were enrolled and followed for one year.
• All patients had were female and had underwent breast cancer surgery without radiation five years earlier.

The study took place in a single site in China.

The study used a controlled trial design.

• Pain was assessed on numerical scale from 0–5.
• Volume measurements were performed according to Kuhnke’s Disk Model, measuring the circumferences of the arms at 4 cm intervals beginning at the wrist and ending at the shoulder.
• The volume of edema was calculated as the difference between the affected and unaffected arms; the percentage of edema in the arm was then calculated.
• The percentage of change in the edema arm was calculated by the formula [(VT – VI)/ (VI –VN)] 100, where VT is the post-treatment volume of the edema arm, VI the initial volume of the edema arm, and VN the volume of the normal arm.

Both groups of patients experienced a reduction in pain and lymphedema volume. Patients in the BMSC transplant group had better long-term results. At three months (p = 0.0151) and at 12 months (p = 0.0001) patients in the BMSC group had significantly greater reduction in edema in the affected limb.

Autologous BMSC to treat breast cancer-related upper-extremity lymphedema was effective in the study at one year.

• The study size was small, with less than 100 participants.
• Study cites need for lymphoscintigraphy pre- and post-treatment to evaluate formulation of new lymphatic vessels.
• They study had no random assignment.

The study adds evidence to the effectiveness of complex decongestive physiotherapy in this population, which requires compliance with therapy, education, and support for patients and families.