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Lessons from bone marrow transplantation for a victim of a radiological accident with acute radiation syndrome

Department of Bone Marrow Transplantation and Cancer Immunotherapy, Hadassah University Hospital, Jerusalem, Israel

Correspondence: Shimon Slavin, MD, Department of Bone Marrow Transplantation & Cancer Immunotherapy, Hadassah University Hospital, PO Box 12000, Jerusalem 91120, Israel. E-mail: slavin@cc.huji.ac.il

Unintentional acute exposure to whole body radiation has become a serious threat in recent years. Whole body irradiation leads to the acute radiation syndrome, with manifestations depending on the dose to which the patient was exposed. At high doses of radiation, a large number of cells die as a result of impairment of DNA replication owing to irreversible double-strand DNA damage. A whole body absorbed dose greater than 4–6 Gy causes severe gastrointestinal and bone marrow damage, and ultimately leads to death in most cases. Patients exposed to a total dose of ionising irradiation up to 12–14 Gy may be rescued with autologous or allogeneic stem cells, however the role of stem cell transplantation for patients exposed to higher doses of radiation is questionable and depends on the degree of damage to non-haematopoietic tissues. Here we report on a patient following an accidental exposure to whole body irradiation (estimated dose 10–20 Gy) from a -source in a commercial atomic reactor. The patient was treated with a haploidentically mismatched related stem cell allograft, featuring the problems associated in treating patients exposed to a supralethal but unknown dose of radiation.