How does Cancer effect how we treat your Arthritis and Tendinitis.

Weekly Education Meeting- 20200831
-History of Cancer and treatment of arthritis and tendinitis.
How it affects stem cell and PRP treatments.
How it affects biologic medication treatments.

-Boosting Stem cell treatment with PRP.

  • Okay. Hello everyone. This is Siddharth Tambar, from Chicago Arthritis and Regenerative Medicine. Welcome to our weekly educational broadcast. It’s August 31st, 2020. Welcome, I hope everyone’s doing well and welcome to the broadcast. So I know, we have a couple of questions already and on this weekly broadcast, I’m focused on answering questions that patients ask and that team members ask regarding what we do here at Chicago Arthritis and Regenerative Medicine. I know Jackie’s already got a question, but I was going to first discuss something that on occasion comes up, which is how does a history of cancer effect the treatments that we’re trying to do in the office. So this is a question that I want to discuss for a couple of reasons. Number one is it’s something that does get asked by patients on occasion. And the other one is, I was thinking about cancer this past weekend because Chadwick Boseman, died of colon cancer. He’s the star of Black Panther. And, I think a lot of us are, surprised that he died at the age of 43 from colon cancer. I know more people were affected by that death than maybe they realized, even though I only knew one movie of his, Black Panther, I mean, he certainly had a certain amount of presence and dignity that, I think affected people with his death.

So when patients have a history of cancer, how does that affect how we’re treating their arthritis and tendonitis specifically when it comes to either cell-based treatments, bone marrow stem cells, platelets for arthritis and tendonitis. And also how does it affect how we’re treating inflammatory arthritis with some of the biologic medications that we’re using. And in some ways we have, evidence, data and information to guide us. In some ways there’s still, a great deal of nuance and personalization and just making good principal decisions.
So if somebody does not have a prior history of cancer, how does that affect the cell-based treatments, bone marrow, and PRP for arthritis and tendonitis? So simple answer is it does not. So there is evidence from the Regenexx registry. There’s also evidence from Philip Hernigou, in France of 15-20 years of doing BMAC where there’s no evidence that these treatments increase the risk of cancer. So if you don’t have a history of cancer then no worries, when it comes to cell-based treatments.

If you’re taking a biologic medication for rheumatoid arthritis, psoriatic arthritis, are there any issues with being on these meds? So when TNF blockers that’s meds like Humira, Enbrel, Remicade came out 20 plus years ago, originally there was some concern about the risk of lymphoma and hematologic malignancies in patients that were taking these medications. Over time there’s some nuance thinking to that, which is that just having those kinds of autoimmune issues and chronic inflammation makes you more prone to those kind of cancers. And so our current thinking is that if you don’t have a history of that kind of cancer, then you’re likely okay to take those kind of medications. Obviously, if you have a dramatically increased risk in the family where every single person has had that type of cancer, you probably should be mindful of that and discuss that with your physician. Prevention is the main thing in that case, meaning that age appropriate cancer screening you definitely want to follow through with that as recommended.

So it gets a little bit more complicated if you’ve already had a history of cancer. So if you’ve had a history of cancer, but you’re in remission, however that’s defined, then there’s really not a ton of data when it comes to using stem cells and PRP in arthritis patients. But knowing that those patients at baseline, when they get treated with these kind of regenerative medicine treatments, don’t have higher risk of cancer, you’re likely okay. It’s a little bit more complicated if you have active cancer, if you have active cancer, I would not recommend getting bone marrow aspirate concentrate or platelet rich plasma in part because, you do have a elevation in growth factors, with these treatments that can accentuate certain cancers. And so I think if you have an active cancer, I would not recommend one of those treatments. What I would recommend instead is actually utilizing, Dextrose Prolotherapy, sugar water, which is sort of the original regenerative medicine treatment, not as strong as platelet rich plasma or bone marrow, but certainly effective as well, and can give pain relief and functional improvement. So even if you have that history of cancer, there is certainly, treatments that are available that can still help.

On the other hand, if you have a history of cancer and you’re thinking about taking a biologic medication for rheumatoid arthritis or tendonitis, then it gets a little bit more complicated. Number one, understand that, there’s nuance in this, in that if you’ve had a history of, let’s say skin cancer, certain biologic medications, you need to be careful with things like TNF blockers, there’s other biologic medications that don’t have that kind of cancer risk. And so you can certainly make some decisions there where you can still treat somebody with those medications without putting them at higher risk for recurrence.
Again, there’s nuance here in that cancer treatment itself has changed over time where there’s a lot of people that now have, that are living with chronic cancer, where they may never reach formal remission, but they’re okay for years at a time. And then intermittently they still need to get an occasional chemotherapeutic agent or surgery, but otherwise they’re doing okay. I think the main point that I would emphasize is that if you’ve had a history of cancer and you’re thinking about treatment, whether it’s cell-based treatment or a biologic medication for your arthritis or tendonitis, you need to have that kind of nuance discussion with your physician to make sure you’re on the right path. Questions regarding that guys.

  • [Jackie] No questions.
  • Okay. Jackie, I know you had a question for me.
  • [Jackie] Yes.
  • Go ahead please.
  • [Jackie] A patient did ask me why can’t they have the bone marrow, together with the platelet rich plasma on the same day?
  • So, great question. So Jackie’s question is in patients who are getting bone marrow drived stem cell treatment, the protocol that we follow is the Regenexx Stem Cell Protocol it’s a three-step protocol. That’s a protocol that’s been around since 2005. And essentially the initial treatment is with Dextrose Prolotherapy, it creates a mild inflammatory reaction that sort of preps the joint or tendon for treatment few days later. Second treatment is where you aspirate bone marrow aspirate concentrate, and inject that in the same day. In that treatment, we do also prep platelet rich plasma. And then the last treatment few days later is one more platelet rich plasma treatment. So the reason why platelet rich plasma is even utilized in bone marrow stem cell treatment is the growth factors from the platelets help to stimulate the mesenchymal stem cells that you see from the bone marrow. The reason why we do that repeat in platelet rich plasma treatment a few days after the first bone marrow treatment is that it kind of helps to, accentuate the effect of the bone marrow cells. But even during that first treatment, Jackie, we do in fact use platelet rich plasma during that as well. So, patients are getting that sort of repeat exposure to their own platelet growth factors with that stem cell treatment that helps to drive a progressively better response with that initial stem cell treatment.
  • [Jackie] So they’re having platelet rich plasma on the bone marrow day as well.
  • Yes. So in fact, during that bone marrow day, they get not only that treated, but they do get platelet rich plasma on that day. And then also a few days later to sort of keep the effect going and get that longer term better response. And in fact, if we end up doing a booster platelet treatment, few months down the line, the benefit of that is again, the growth factors from that are helping to boost that initial bone marrow treatment that was done few months previous.
  • [Jackie] Okay. Thank you.
  • Any other questions, Jackie?
  • [Jackie] That was my main one, because I really didn’t know how to answer that.
  • Okay. Susan or Devi. Okay. Well this was brief, but, big takeaways, nuances when it comes to cancer and treatment of your arthritis, your physician should have, not only experience with that, but should have a nuanced, personalized approach to that in your case. And until our next live stream, hope everyone is doing well. As a reminder, we do this Mondays and Wednesdays and until next time, have a good day and live well. Thank you. Good bye.

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About this video
In this video Siddharth Tambar MD from Chicago Arthritis and Regenerative Medicine discusses how cancer effects how we treat you arthritis and tendinitis.