Criteria for the selection of radiation accident victims for stem cell transplantation

Abstract

The management of acute radiation syndrome in persons inadvertently exposed to total-body irradiation greatly benefits from the experience gained in previous clinical management situations. Within the framework of exposure to high doses, one of the most critical issues is the question of whether hematopoietic stem cell transplantation is indicated. A valid answer can be given with appropriate accuracy based on a thorough analysis and evaluation of all accessible case histories. Based on the clinical evaluation of patients severely affected with acute radiation syndrome, the following recommendations may be issued. There is limited indication for stem cell transplantation when there is accompanying severe radiation damage to organ systems other than the hematopoietic system. The optimum duration of pancytopenia can be estimated using the biomathematical model introduced in this article.

The Prolonged Gastrointestinal Syndrome in Rhesus Macaques

“…The model would also provide an opportunity to assess the long-term reconstitution of the hematopoietic system as well as that of severe thymic-derived naïve T-cell immunosuppression. In this regard, the model would mimic the human response to potentially lethal radiation exposure and treatment effects consequent to an accidental or terrorist nuclear event (Densow et al 1997; MacVittie et al 1996; Anno et al 2003; Ricks and Fry 1990; Baranov et al 1994;Meineke and Fliedner 2005; Liu et al 2008; Konchalovsky et al 2005; Konchalovsky 2010; Browne et al 1990). …”

Mitigation of Lung Injury after Accidental Exposure to Radiation

“…In the work presented here we focused on the combination of whole-lung and whole-torso irradiation since this is a possible scenario if there is a radiation accident and there is a possibility of interacting effects in lung relating to multi-organ damage (8–10). We were particularly interested in the effects of genistein as a mitigator of radiation-induced lung damage because of its antioxidant and anti-NFκB activity and its wide availability and low toxicity (16–18, 43).…”

“…Radiation damage to the bone marrow is a major concern and may be treatable by bone marrow transplantation, but the gastrointestinal tract is also radiation sensitive; another organ of similar sensitivity is the lung. These and other organs may become of significant concern in patients exposed to partial-body or nonuniform exposures, particularly in the context of multi-organ effects that can significantly affect treatment outcome (8–10). Appropriate strategies to mitigate or treat such exposures are currently very limited (11–15).…”

Recombinant Human G-CSF Enhances Recovery and Improves Survival from Severe Radiation-Induced Myelosuppression

“…Bacteremia, sepsis, and hemorrhage can be delayed or averted depending on radiation dose and severity and duration of consequent myelosuppression. The data provided for the Chernobyl victims clearly emphasized the positive role of medical management in patients with severe acute radiation syndrome and the minimal role to be played by bone marrow or stem cell transplantation [38,[77][78][79][80].…”