First global consensus for evidence-based management of the hematopoietic syndrome resulting from exposure to ionizing radiation

Nicholas Dainiak, Robert Nicolas Gent, Zhanat Carr, Rita Schneider, Judith Bader, Elena Buglova, Nelson Chao, C. Norman Coleman, Arnold Ganser, Claude Gorin, Martin Hauer-Jensen, L. Andrew Huff, Patricia Lillis-Hearne, Kazuhiko Maekawa, Jeffrey Nemhauser, Ray Powles, Holger Schunemann, Alla Shapiro, Leif Stenke, Nelson ValverdeDavid Weinstock, Douglas White, Joseph Albanese, Viktor Meineke

Research output: Contribution to journalReview article

Abstract

Objective: Hematopoietic syndrome (HS) is a clinical diagnosis assigned to people who present with ≥1 new-onset cytopenias in the setting of acute radiation exposure. The World Health Organization convened a panel of experts to evaluate the evidence and develop recommendations for medical countermeasures for the management of HS in a hypothetical scenario involving the hospitalization of 100 to 200 individuals exposed to radiation. The objective of this consultancy was to develop recommendations for treatment of the HS based upon the quality of evidence. Methods: English-language articles were identified in MEDLINE and PubMed. Reference lists of retrieved articles were distributed to panel members before the meeting and updated during the meeting. Published case series and case reports of individuals with HS, published randomized controlled trials of relevant interventions used to treat nonirradiated individuals, reports of studies in irradiated animals, and prior recommendations of subject matter experts were selected. Studies were extracted using the Grading of Recommendations Assessment Development and Evaluation (GRADE) system. In cases in which data were limited or incomplete, a narrative review of the observations was made. No randomized controlled trials of medical countermeasures have been completed for individuals with radiation-associated HS. The use of GRADE analysis of countermeasures for injury to hematopoietic tissue was restricted by the lack of comparator groups in humans. Reliance on data generated in nonirradiated humans and experimental animals was necessary. Results: Based upon GRADE analysis and narrative review, a strong recommendation was made for the administration of granulocyte colony-stimulating factor or granulocyte macrophage colony-stimulating factor and a weak recommendation was made for the use of erythropoiesis-stimulating agents or hematopoietic stem cell transplantation. Conclusions: Assessment of therapeutic interventions for HS in humans exposed to nontherapeutic radiation is difficult because of the limits of the evidence.

Original languageEnglish (US)
Pages (from-to)202-212
Number of pages11
JournalDisaster medicine and public health preparedness
Volume5
Issue number3
DOIs
StatePublished - Oct 1 2011

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Keywords

  • Acute radiation syndrome management
  • Countermeasures for ARS
  • Cytokines and radiation injury
  • Hematopoietic syndrome management
  • Transplantation for ARS

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

Dainiak, N., Gent, R. N., Carr, Z., Schneider, R., Bader, J., Buglova, E., Chao, N., Coleman, C. N., Ganser, A., Gorin, C., Hauer-Jensen, M., Huff, L. A., Lillis-Hearne, P., Maekawa, K., Nemhauser, J., Powles, R., Schunemann, H., Shapiro, A., Stenke, L., ... Meineke, V. (2011). First global consensus for evidence-based management of the hematopoietic syndrome resulting from exposure to ionizing radiation. Disaster medicine and public health preparedness, 5(3), 202-212. https://doi.org/10.1001/dmp.2011.68