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The evolving role of haematopoietic cell transplantation in radiation injury: potentials and limitations

¹ Bridgeport Hospital, Yale University School of Medicine, Bridgeport and New Haven, Connecticut, USA and ² Radiation Emergency Accident/Training Site, Oak Ridge, Tennessee, USA

Correspondence: Nicholas Dainiak, MD, Department of Medicine, Bridgeport Hospital, 267 Grant Street, Bridgeport, CT 06610, USA. E-mail: pndain@bpthosp.org

Human stem cell transplantation has been performed for over 50 years. A review of radiation incident registries indicates that, during this time, 31 patients have undergone transplantation with stem cells from the bone marrow, peripheral blood, cord blood or fetal liver. Among these cases, 27 patients have expired and the remaining 4 patients have survived with a rejected allograft. Limitations to success of transplantation have included concomitant injury to non-haematopoietic organs and immunological complications of the transplantation. Selection of cases for stem cell transplantation is based upon clinical signs and symptoms, including: (1) the rate of fall and the absolute level of circulating lymphocytes, granulocytes and platelets; (2) the absence of failure of a non-haematopoietic organ or system; and (3) individual dose assessment, as determined by clinical symptoms (such as time to onset and severity of vomiting), rate of decline in absolute lymphocyte count and the appearance of chromosome aberrations. Owing to a limited amount of resources, case selection in a large-volume scenario will necessarily be modified. Recently, recommendations have been drafted by the US Strategic National Stockpile Working Group that propose a limited dose range for which transplantation should be considered as a therapeutic option for victims in a large-volume scenario. Transplantation will continue to evolve as new sources of stem cells are identified, as efficient, high-yield stem cell purification protocols are defined, and as new methods are developed to improve stem cell function post transplantation.