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Hematopoietic Stem Cell Transplants After Radiation Emergencies

  • Consider stem cell transplant if marrow recovery is unlikely.
  • Feasibility of very large numbers of transplants in large mass casualty settings is uncertain.
  • Most irradiated individuals will not be candidates for transplant- See Illustration.
  • Requires patient transfer to transplant center, although initial management may be outpatient in some cases.
  • The Radiation Injury Treatment Network (RITN) is likely to help coordinate transplants on a national scale.
  • If stem cell transplant is considered, steps need to be taken to identify a human leukocyte antigen (HLA) matched donor.
    • HLA matching helps prevent complications of stem cell transplant such as rejection and graft vs host disease (GVHD).
    • Assistance in HLA matching can be obtained from the National Marrow Donor Program: 1 (800) MARROW 2 or (612) 627-5800 or from RITN.
    • The conventional optimal donor choice is an HLA-matched family member, most often a matched sibling, though other unrelated donors can sometimes also be used.
    • Verifying HLA matched donors can take weeks and may take longer in a mass casualty setting.

References


  1. See: Radiation Injury Treatment Network (RITN) bibliography
  2. Confer DL, Weisdorf D, Weinstock D, Case C, Chao N. Radiation disasters: role of the BMT team. Biol Blood Marrow Transplant. 2012 Jan;18(1 Suppl):S189-92. [PubMed Citation]
  3. Dainiak N, Gent RN, Carr Z, et al. First global consensus for evidence-based management of the hematopoietic syndrome resulting from exposure to ionizing radiation.. Disaster Med Public Health Prep. 2011 Oct;5(3):202-12. [PubMed Citation]
  4. Ross JR, Case C, Confer D, Weisdorf DJ, Weinstock D, Krawisz R, Chute J, Wilhauk J, Navarro W, Hartzman R, Norman Coleman C, Hatchett R, Chao N. Radiation injury treatment network (RITN): healthcare professionals preparing for a mass casualty radiological or nuclear incident. Int J Radiat Biol. 2011 Aug;87(8):748-53. [PubMed Citation]
  5. Davids MS, Case C Jr, Confer DL, Weisdorf DJ, Weinstock DM. Medical management of radiation victims in the United States. Health Phys. 2010 Jun;98(6):833-7. [PubMed Citation]
  6. Weinstock DM, Case C Jr, Bader JL, Chao NJ, Coleman CN, Hatchett RJ, Weisdorf DJ, Confer DL. Radiologic and nuclear events: contingency planning for hematologists/oncologists. Blood. 2008 Jun 15;111(12):5440-5. [PubMed Citation]
  7. Weisdorf D, Chao N, Waselenko JK, Dainiak N, Armitage JO, McNiece I, Confer D. Acute radiation injury: contingency planning for triage, supportive care, and transplantation. Biol Blood Marrow Transplant. 2006 Jun;12(6):672-82. [PubMed Citation]
  8. Copelan EA. Hematopoietic stem-cell transplantation. N Engl J Med. 2006 Apr 27; 354(17):1813-26. [PubMed Citation]
  9. Dainiak N, Ricks RC. The evolving role of haematopoietic cell transplantation in radiation injury: potentials and limitations. BJR Suppl. 2005; 27:169-74.
  10. Waselenko JK, MacVittie TJ, Blakely WF, Pesik N, Wiley AL, Dickerson WE, Tsu H, Confer DL, Coleman CN, Seed T, Lowry P, Armitage JO, Dainiak N; Strategic National Stockpile Radiation Working Group. Medical management of the acute radiation syndrome: recommendations of the Strategic National Stockpile Radiation Working Group. Annals of Internal Medicine 2004; Vol. 140:1037-51. [PubMed Citation]
  11. Maangum DS, Caywood E. A clinician’s guide to HLA matching in allogeneic hematopoietic stem cell transplant. Hum Immunol. 2022; 83(10): 687-694. [PubMed Citation]
  12. Spellman SR. Hematology 2022—What is complete HLA match in 2022? Hematology Am Soc Hematol Educ Program. 2022; 1: 83-89. [PubMed Citation]