A friend of mine, who has just had his second autologous stem cell transplant here in Italy, wrote me a note this morning about a paper presented at the recent ASH meeting on gadolinium, which is used as a contrast agent in MRIs. The paper (March 2017: I replaced the original link, which no longer works, with this one, which will take you to the abstract: http://www.bloodjournal.org/content/114/22/1809?sso-checked=true) shows that the most common Gd-containing agent, Omniscan, has a proliferative effect on myeloma cells in vitro: Omniscan induced both time and dose dependent MM cell growth in vitro (8-20 fold increase relative to control). Importantly, the presence of BMSC enhanced the effect of Omniscan on growth of both MM cell lines and primary MM cells.
![180px-Gadolinium-2[1]](http://margaret.healthblogs.org/files/2009/12/180px-Gadolinium-21.jpg "180px-Gadolinium-2[1]")
And this stuff is being injected into myeloma patients??? By the way, BMSCs (see above quote) stands for bone marrow stromal cells, which are part of the bone marrow microenvironment (discussed in previous posts) and play a crucial role in myeloma cell survival.
Well, needless to say, I am hopping mad about this gadolinium news because my friend so far has had two MRIs with injections of this myeloma-friendly substance. I mean, this is simply OUT-RAGE-OUS! Has nobody ever tested these contrast agents to see if they could possibly be harmful to us??? I will check PubMed in a second. First, let me see what gadolinium is. Ah, okay, see here (I took this photo from Wikipedia, btw): http://en.wikipedia.org/wiki/Gadolinium
There is an overwhelming amount of info on gadolinium online. I learned that its use as a contrast agent for MRIs was approved in 1988 by the FDA, but it was only about 20 years later that the FDA issued a warning on five of the gadolinium-based contrast agents, which can be fatal for patients with moderate or severe kidney disease. Fatal? Oh, this is simply shocking…
And here (http://tinyurl.com/ybmtml8) we have the case of a relapsed IgA lambda patient…if you do a search for “gadolinium” in this study, you will find that the patient underwent a gadolinium-enhanced MRI on her brain shortly after admission (see Figure 1a and b). This study was published in September 2009…the authors confess to being puzzled as to why bortezomib treatment didn’t work. Could the use of gadolinium have played a part in her relapse? Who knows…
To be fair, I found a 2009 study stating that the use of gadolinium in myeloma MRIs is safe, see: http://tinyurl.com/ye9abar (the full study can be downloaded for free, just click on the “Full text article” link). The authors declare that doses of up to 5 times normally used may not induce significant adverse effects. (Note that they use the conditional tense: “may.”) Ah, but further on, I came upon a highly suspicious sentence (my emphasis): Furthermore, given that 95–98% of gadodiamide is cleared away by 24 h after injection (according to manufacturer data), there is probably only a very small amount remaining thereafter.
So, let’s see, in this study, “according to manufacturer data,” this toxic stuff is eliminated from the body within 24 hours? Uh, wouldn’t that be a bit like saying that an asbestos company guarantees that, based on their data, inhaling asbestos fibers isn’t harmful? Oh yeah, that is really reassuring! (=Please note the sarcasm in my tone…) Sloppy work, very sloppy work, guys.
If I had to put my money on one of these gadolinium studies, I would choose the above-mentioned Harvard Dana-Farber (etc.) one. No question. In the ASH-presented study, in fact, autopsies on eight myeloma patients with repeated exposure to Omniscan revealed massive quantities of gadolinium accumulation in tissues of these MM patients regardless of their renal function. Massive quantities…well, so much for the manufacturer data…phooey, I say!
In conclusion, if my doctor ever suggested that I have an gadolinium contrast MRI, you can imagine what my answer would be…
What I read earlier today is unbelievable…I don’t know whether to be appalled or teed off…I think I will go add a few ornaments to our Xmas tree to get my mind off this topic and cool down…bloody hell…
The problem here is that straight scans without some enhancement often do not give the best results and may miss important lesions. This is true of CT for sure and MRI too. So the dilemma is having an incomplete test with inadequate result versus something that is better but potentially harmful. This is often the dilemma we face in medicine where it always a risk vs benefit scenario. I’m glad you found something positive from the Dana Farber Institute regarding gadolinium as that is a very reputable medical center. Gerry
Oops — I didn’t realize it was the DFI that showed the stimulating effect on MM cells — Have you found other enhancing agents that could be used in place of gadolinium? Gerry
would this be the same stuff they injected to do the scintografia? twice? for my parathyroid problem….just prior to the blood assay where my lambda light chain went from 26 (where it had been more or less for maybe 5 years) to 1590? that would explain it. sono senza parole…then again maybe it was something else nasty…but that is the only occasion of stuff going in that i can think of. does this mean that it could also come back down?…i will have to look deeper into this, solve one and create another
LOL here in Oregon Margaret. I had the contrast dye with my most recent MRI in October. That, plus all my re-vaccinations will make me a clinical trial of one when I get re-examined in January.
I was surprised at the news about Gadolinium and yet… I’ve learned again and again since my son was injured in 2002, that much of medicine is guesswork and we are the guinea pigs. I don’t fault the company for the danger involved as long as they now seek a way to work around the problem or advise against the use of G in myeloma patients.
Interesting thing about that agent and MRI’s – I had an MRI about 15 years ago – don’t know if that agent was used but I will make sure I remember the name in case I get further MRI’s.
I find this odd because I get full body bone marrow MRI (BM-MRI) without contrast at least every 6 months. (I have very low protein secretion levels). It provides a high quality assessment of % bone marrow involvement or level of activity of MM. Finding holes in the bones is more effective with CT and x-rays but they do not indicate activity. Normal PET indicates activity with reasonable specificity but only modest sensitivity. Therefore PET doesn’t indicate false positives but it does miss MM lesions that are not very active. Adding gadolinium chelate agents to a MRI provides minimal enhancement of metastases. It has been discontinued for about 4-5 years in most modern MM treatment facilities in lieu of T1 and T2-weighted images used in conjunction with other imaging modalities. With my untrained eye the T1-weighted images seem to show my lesions bright and clearly…
Hi LP –when you say “I have very low protein secretion levels” –does that include the newer FreeLite levels? Many people with so-called “nonsecretory myeloma” in the past are now recognized as having significant levels of free light chains that were not detected with the older tests. Also you sound like a radiologist — do you have any background in that field? Gerry
I am not a radiologist, just a MMer with significant bone involvement who is subjected to a lot of imaging. I have no M-spike and my FreeLite levels are high enough to watch and have been stable for over a year. Stable does not mean inactive! Stable in my case has occasionally meant a growing lesion in one location and reduced activity in another location. My FreeLite (free light chain) protein expression levels have been getting smaller and my percent bone marrow involvement has gone up. MM is a very personalized disease. Every one of us is a little different.
Yes LP I understand how variable MM is with very protean manifestations of disease. I wonder if there is more bone involvement with certain types of MM. I suspect that people like me with high free light chains and low intact immunoglobulins are more prone to infections and renal/kidney disease. Presently I am smouldering but probably progressing to light chain myeloma (LCMM). Gerry
M — Great post and timely too! I read your post here in PA while my hubby was in a waiting room at Mayo MN going through his normal tests.
I picked up the cell phone and called hubby & emailed him the link. So, yesterday he had a MRI with no G. : )
I wonder if there is a way to put that in his medical charts (and maybe paste it to his forehead just in case) like any other medical allergy…?
John — “plus all my re-vaccinations” Do vacines have G in them? Anything else we should watch?
P.S. All is stable for curcumin-taking hubby. Good news for the new year.
Hi everybody,
I have just been asked to have a RMN (I think = MRI) of my spine in my town in Italy (together with a full body RX, after that of last July). I think RMN it is the same as what you call MRI, so there is the risk for me that Gadolinium is used.
As, of course, I absolutely want to avoid it, could you clarify better, from your experience or your knowledge which the alternatives are ?
I understood from your posts the alternatives are at least:
– T1 and T2-weighted images, used in conjunction with other
imaging modalities (L.P. cells)
– MRI (RMN) with no Gadolinium (Sandy Ballard)
In order to not flood Marg’s blog with answers you can also write to [=e-mail address deleted by blog author: hi everyone, please leave a comment for Francesco here or, if you’d prefer, write me a private message via my “Contact” form, and I will forward it to him. I don’t think it’s a good idea to publish e-mail addresses on a blog…there are too many Spam crazies out there…so I deleted Francesco’s e-mail address, scusami Francesco ma è meglio per te fare in questo modo e a me non scoccia fare da tramite]
(I’ll make a synthesys in case for general interest and post it).
Many, many thanks.
Just to give you a picture I am smouldering, but with a monoclonal protein progressing very fast this year (doubling), no renal problem, no symptoms at all, hemoglobin slowly going down, no bone lesions till July last year (latest RX an PET-CT).
I am a curcumin taker (8g a day), + 3 months cycles of VitC+VitE+Ac.Lcarnitin alternated with 3 months cycles of: Magnesium+alpha lipoic acid.
Added IP6 + Inositol from last July.
Thanks again
Francesco
Francesco, I have had MRIs, of my spine (two since 2005, I think), and I have never had any gadolinium injected into me. If I were you, I would just make sure that gadolinium (gadolinio in Italian) is not requested as a “mezzo di contrasto.”
A recent MRA of my kidneys seems to have caused a severe reaction, which, even after a week and a half, is still lingering. I have Peripheral Neuropathy, an autoimmune disorder similar to Lupus, and have the protein which is present for MM, though my Oncologist says I do not have it. I wonder… Since the Scan, my blood pressure is way on up there and the burning pain, which moves around is really miserable… I have no idea what to do for this… Upping my Prednisone has helped some, but I cannot just keep upping it… Help!
Cathie
I failed to mention above, that the contrast media used in my MRA Scan was gadolinium.
I also wondered if this could be chelated out, since it is my understanding it is a metal…
Thank you,
Cathie