Human chromaffin cell graft into the CSF for cancer pain management: a prospective phase II clinical study.
A number of pre-clinical studies have demonstrated the value of adrenal medullary allografts in the management of chronic pain. The present longitudinal survey studied 15 patients transplanted for intractable cancer pain after failure of systemic opioids due to the persistence of undesirable side-effects. Before inclusion, all the patients had their pain controlled by daily intrathecal (I-Th) morphine administration. The main evaluation criteria of analgesic activity of the chromaffin cell allograft was the complementary requirement of analgesics and in particular the consumption of I-Th morphine required to maintain effective pain control. Out of the 12 patients who profited from enhanced analgesia with long-term follow-up (average 4.5 months), five no longer required the I-Th morphine (with prolonged interruption of systemic opioids as well), two durably decreased I-Th morphine intake and five were stabilized until the end of their follow-up. Durable decline and stabilization were interpreted as indicative of analgesic activity by comparison with the usual dose escalation observed during disease progression. In most cases, we noted a relationship between analgesic responses and CSF met-enkephalin levels. The results of this phase II open study demonstrate the feasibility and the safety of this approach using chromaffin cell grafts for long-term relief of intractable cancer pain. However, while analgesic efficacy was indicated by the reduction or stabilization in complementary opioid intake, these observations will need to be confirmed in a controlled trial in a larger series of patients.
Lazorthes
Yves
Y
Laboratory of Pain and Cell Therapy, Faculty of Medecine Rangueil, 133 route de Narbonne, 31062 Toulouse, France Miami Project Cure Paralysis, University of Miami School of Medicine, Miami, FL 33136, USA Laboratory of Clinical Pharmacy, Faculty of Pharmaceutical Science, 31077 Toulouse, France Laboratory of Immunology, Hospital Rangueil, 31403 Toulouse Cx 4, France Department of Nuclear Medicine, Hospital Purpan, 31054 Toulouse, France.
Sagen
Jacqueline
J
Sallerin
Brigitte
B
Tkaczuk
Jean
J
Duplan
Hélène
H
Sol
Jean-Christophe
JC
Tafani
Mathieu
M
Bès
Jean-Claude
JC
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D019439:Chromaffin Cells / Q000637:transplantation*; D004744:Enkephalin, Methionine / Q000134:cerebrospinal fluid; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007278:Injections, Spinal; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage*; D009369:Neoplasms / Q000150:complications*; D010146:Pain / Q000134:cerebrospinal fluid / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery*; D010147:Pain Measurement; D010865:Pilot Projects; D011446:Prospective Studies; D012720:Severity of Illness Index; D014184:Transplantation, Homologous; D016896:Treatment Outcome
D000701:Analgesics, Opioid; D004744:Enkephalin, Methionine; D009020:Morphine