(Oldest posts first…please scroll down for updates)

December 13 2009 post. 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 (see: http://tinyurl.com/ybhb6oc) 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.

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…

Update, July 11 2010. Thanks to another MM blogger, today I can post this helpful link: http://tinyurl.com/3y2zdfe

January 24 2011 post: Do you remember my post on gadolinium? If not, here it is: http://margaret.healthblogs.org/2009/12/13/the-gadolinium-used-in-mris-makes-myeloma-cells-proliferate/ (there is also a corresponding Page, which you can find by scrolling down my Page section on the right).