This study will evaluate the effectiveness of a new bone injection technique for treating
bone disease in patients with polyostotic fibrous dysplasia or McCune-Albright syndrome. In
these patients, some bones develop areas with much less mineral, making the bones more prone
to fracture or deformity and causing pain. This new treatment is intended to reduce the risk
of fracture, minimize deformities and improve overall function in these patients.
Patients 4 years of age and older with bone lesions that are highly likely to cause
significant pain and illness may be eligible for this 2-year study. Participants must be
simultaneously enrolled in NIDCR's research protocol 98-D-0145 (Screening and Natural
History of Patients with Polyostotic Fibrous Dysplasia and McCune-Albright Syndrome) or
98-D-0146 (A Randomized, Placebo-Controlled Trial of Alendronate in the Treatment of
Polyostotic Fibrous Dysplasia and McCune-Albright Syndrome).
Within 14 days of the bone injection procedure, patients will have a medical history,
routine blood tests, urinalysis and check of vital signs (blood pressure, pulse and
temperature) and will complete a 30-minute quality-of-life questionnaire. Women of
child-bearing potential will have a pregnancy test. Patients who do not have recent X-rays
and bone density scans available for review will have new ones taken. When these studies are
completed, patients will undergo the bone injection procedure, followed immediately by bone
densitometry and coned-down X-rays, as follows:
- Bone injection - Patients will be given an anesthetic either to make them sleepy or put
them to sleep completely. A portion of bone marrow will be withdrawn through a needle
inserted into the hip bone and, at the same time, abnormal bone in the arms and legs
will be sucked out using a needle. The abnormal bone will be replaced with a mixture of
bone marrow and collagen (connective tissue protein) injected into the hole in the
bone. The areas of injection will be closed
- Bone densitometry - X-rays of the operated bone and opposite normal bone will be taken.
- Coned-down X-rays - Magnified normal X-rays will be taken as close-ups of an active
Patients will have a history and physical examination by their local physician or at NIH
every month for the first 4 months after the procedure. Every 6 months after the procedure,
patients will return to NIH for follow-up, including a physical examination and completion
of a quality-of-life questionnaire. Imaging studies of the injected site will be done 3, 6,
and 12 months after the procedure.
Polyostotic fibrous dysplasia (PFD) is a sporadic disorder which affects multiple sites in
the skeleton. The bone at these sites is rapidly resorbed and replaced by abnormal fibrous
tissue. PFD may occur alone or as part of the McCune-Albright Syndrome (MAS), a syndrome
originally defined by the triad of PFD, cafe au lait pigmentation of the skin, and
precocious puberty. The bony lesions are frequently disfiguring and painful. In addition,
depending on the location of the lesion, they can cause significant morbidity. Lesions in
weight-bearing bones can lead to disabling fractures, while lesions in the skull can lead to
compression of vital structures such as the cranial nerves.
Currently there are no clearly-defined systemic or local therapies for the bone disease, and
results of the use of conventional surgical treatment of sites of impending fracture have
been universally disappointing. In this study, we will treat osteolytic lesions in the long
bones of the upper and lower extremities, the sites of potential fracture, with a novel
surgical approach. This will involve 1) the removal of abnormal tissue through percutaneous
aspiration, and 2) the use of skeletal precursor cells taken from the unaffected sites,
mixed with a bone grafting substitute, and injected into the affected sites to bring about
an improvement in local bone quality and overall patient function.
- INCLUSION CRITERIA:
Patients will be otherwise healthy women, men, and children, with polyostotic fibrous
dysplasia (PFD)/McCune-Albright Syndrome (MAS).
Children will be greater than 4 years of age.
The diagnosis will be based on evidence of the clinical spectrum of the disease and
confirmed by the presence of typical findings on bone biopsy.
All patients must be actively enrolled in the Screening and Natural History Protocol and
possibly the Bisphosphonate Protocol.
Patients will be enrolled in the study if they have a lytic lesion of the humerus, femur,
or tibia which satisfies at least one of the following criteria: the lesion encompasses at
least 50% of the width of the bone at that point on both AP and lateral radiographs; the
lesion has caused a change in the anatomical shape and contour of the bone; the lesion has
a bone density less than 50% of the density of the contralateral, normal side.
Patients on previous or concomitant therapy are eligible for enrollment.
Patients on the Bisphosphonate Protocol must have received at least one month of treatment
on that protocol before receiving a bone marrow injection in this protocol.
Women in childbearing age will be offered barrier methods of contraception to decrease the
risk of pregnancy for a period of one year following the transplant. Subjects who become
pregnant during year one of the study will be transferred to the inactive participant
group. Pregnancy testing will be performed prior to research procedures and surgery.
Subjects using oral contraceptive agents are included. Women without normal menstrual
cycles will be offered hormone replacement therapy for a period of 3 cycles prior to
Subjects must agree to travel to NIH during the first 24 months and remain in the Bethesda
area for the post-operative period as defined by protocol requirements.
Subjects will be excluded if they receive phenobarbital or related antiepileptic agents,
including Dilantin or Tegretol.
Medical problems which will preclude participation in the study include: pregnancy;
chronic or active dermatological disease; chronic anemia (thalassemia, etc.); diabetes
mellitus (fasting blood glucose in excess of 140 mg/dl); active or chronic pulmonary
disease including COPD, chronic bronchitis, or asthma requiring medications; active or
chronic gastrointestinal disease including gastric and duodenal ulcer disease and
inflammatory bowel disease; history of cancer except for dermal lesions; intestinal
malabsorption, chronic or active renal disease including a serum creatinine above 1.8
mg/dl; chronic or active hepatic disease including hepatitis; HIV infection.
Subjects may not smoke more than one pack of cigarettes per day.
Alcohol consumption must be less than 1.5 oz per day, without binge drinking.
Subjects should have no dietary aberrations and no history of anorexia nervosa within the
past 10 years.
Subjects must be willing to receive transfusions of blood products if it is deemed
medically necessary to preserve their well-being or their life.
Patients will be excluded if they have a history of an allergy to all of the following
antibiotics: penicillin, tetracycline, and cephalosporins.