Chromosomal analysis of peripheral lymphocytes of patients before and after radiation synovectomy with samarium-153 particulate hydroxyapatite

O'duffy, E. K.; Oliver, Fiona; Chatters, Steve; Walker, Helen M.; Lloyd, David; Edwards, J. C. W.; Ell, Peter J.

doi:10.1093/rheumatology/38.4.316

Cited by 26 publications

(18 citation statements)

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“…However, past experience in patients with rheumatoid arthritis and some recent studies have shown no evidence of treatmentrelated neoplasia in patients treated with isotopes [13,24]. In another study using a radioisotope samarium-153 particulate hydroxyapatite, chromosomal analysis did not reveal any increase in scored chromosometype abnormalities; this further supports the relative safety of isotopic agents in the treatment of haemophilic arthropathy [26]. In another study using a radioisotope samarium-153 particulate hydroxyapatite, chromosomal analysis did not reveal any increase in scored chromosometype abnormalities; this further supports the relative safety of isotopic agents in the treatment of haemophilic arthropathy [26].…”

Section: Discussionmentioning

confidence: 74%

Isotopic synovectomy with P‐32 in paediatric patients with haemophilia

et al. 2000

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Isotopic synovectomy is being proposed as an option in the treatment of patients with haemophilic arthropathy. We present our experience with 11 paediatric patients who underwent 17, P-32 isotopic synovectomies for chronic haemophilic arthropathy. P-32 was injected into the joint per protocol, approved by the institutional review board. All our patients were male. Nine were factor VIII and two were factor IX deficient. The following joints were treated: ankle (n=10 procedures), elbow (n=5) and knee (n=2). The first procedure was performed on December 1993. None were human immunodeficiency virus positive. Mean age at the first procedure was 10.8 years (range, 5.2-15.2 years). Mean pretreatment joint clinical scores using the World Federation of Hemophilia guidelines for the ankle was 5.5 (SD +/- 2.3), the elbow 4.2 (+/-2.5), and knee 5.5 (+/-3.5); the corresponding post-treatment scores were 2.6 (+/-2.0), 1.4 (+/-0.5) and 2.5 (+/-3.5) respectively. Presynovectomy mean radiological scores using the Pettersson method were: ankle 1.8, elbow 1.8, and knee 1.5. A scoring system used in our centre for evaluating joints using magnetic resonance imaging (MRI) gave the following mean pretreatment scores: ankle 9.5, elbow 8.4, and knee 5.0. A marked decrease (an 80-100% decrease) in bleeding was seen in 13 of 17 procedures, and a moderate decrease (51-79% decrease) in two procedures, accounting for 85% reduction in bleeding into the target joints. The procedure was well tolerated and no untoward side-effects were noted as of May 1999, with a median follow-up of 40 months (range 19-65 months). None had any clinical evidence of cancer. Three patients had their joints retreated [elbow (one), ankle (two)]. These procedures were also well tolerated. In conclusion, in our study, isotopic synovectomy using P-32 appears to be feasible, safe and efficacious in the treatment of haemophilic arthropathy in paediatric patients who have been followed for a median of 40 months. As previously shown, MRI appears to give more detailed information about joint arthropathy than plain radiographs.

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Section: Discussionmentioning

confidence: 74%

Isotopic synovectomy with P‐32 in paediatric patients with haemophilia

et al. 2000

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“…O’Duffy et al . [16] studied the potential long‐term effect of radiation exposure with 90 Y and Samarium‐153 ( 153 Sm) analysing the specific chromosome‐type abnormalities in peripheral leucocytes as indicators of whole body radiation exposure. The use of 90 Y increased the aberrations up to 5 times compared with baseline levels and 153 Sm, finding no increase.…”

Section: Resultsmentioning

confidence: 99%

On the safety of synoviorthesis in haemophilia

Fernández-Palazzi¹,

Caviglia

2001

Haemophilia

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One of the best procedures to prevent haem-arthrosis has been radioactive synovectomy (synoviorthesis). Since the first report of radioactive synovectomy in haemophilia of Ahlberg in 1971 [1], many centres adopted this procedure as the one of choice, through fibrosing the synovial membrane, prevent further haemarthrosis. Since 1976 we have performed 104 such radioactive synoviorthesis in 97 patients, age ranging from 6 to 40 years with a mean of 10 years. Sixty-five of these patients were under 12 years of age. The knees were injected in 61 cases, elbow in 26 cases, ankles in 14 cases and shoulders in three cases. The clinical results of this procedure show 80% of excellent results with no further bleeding. In case of failure, a new injection can be given in the same joint at a 6-month interval, or an injection for the same purpose in other joint. One of the criticisms against this method is the possible chromosomal damage induced by the radioactive material. In our centre, four studies have been carried out in order to see whether these changes, when they occur, are everlasting; all have demonstrated that chromosomal changes are reversible. The radioactive material used in the two first studies was Gold-189 (189Au). In 1978, 354 metaphases were studied with 61 ruptures, 17.23% (nonpremalign) and six structural changes, considered premalign (1.69%). Any number below 2% is considered not to be dangerous. A further study was done in 1982, in the same group of patients with a result of 21 ruptures (3.34%) and no structural changes. This demonstrated that the possible premalign changes disappeared with time. A third study was performed in a series of 13 patients that sustained radioactive synoviorthesis with Rhenium-186 (186Re) in November 1991. For comparison, we carried out a chromosomal study just before and 6 months after the radioactive material injection. The results confirmed that changes that could be linked to the radiation, appeared equally in nonirradiated patients, and those changes due to the radiation disappear with time, never reaching the dangerous zone of 2%. In the group treated with 186Re we studied an additional number of 130 metaphases with identical results and no structural changes. In a study on patients where 90Y was the radiocolloid, no premalign change was found before or after the synoviorthesis. It seems, in view of these results, that radioactive synovectomy is safe and gives great benefits to the haemophilic patients.

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“…Several candidates have been proposed to replace commercially available radiocolloid formulations of yttrium-90, rhenium-186 and erbium-169. These formulations include phosphorus-32 colloid [9,10], rhenium-186 sulphide [11], samarium-153 conjugated to particulate hydroxyapatite [12,13], dysprosium-165 ferric hydroxide [14,15], holmium-166 boromacroaggregates [16,17], ytterbium-175 and lutetium-177 hydroxyapatite [18,19]. In this study, the therapeutic efficacy of yttrium-90 citrate was compared to that of phosphorus-32 and rhenium-188 colloids.…”

Section: Discussionmentioning

confidence: 99%