Clinical report of two patients diagnosed as intestinal form and extremely severe bone marrow form of acute radiation sickness treated with allogeneic peripheral stem cell transplantation / 解放军医学杂志

ABSTRACT

Objective To explore the clinical significance of allogeneic peripheral stem cell transplantation in the treatment of acute radiation sickness.Methods Two victims were accidentally irradiated by a 60Co source in a nuclear accident in Jining,Shandong province,China in 2004.They were exposed to more than 20-25 Gy(patient A)and 9-15Gy(patient B)of 60Co-ray,and were diagnosed as having developed intestinal form of acute radiation sickness(ARS)and extremely severe bone marrow form of ARS,respectively.After the treatment with the preparative regimens based on low-doses of fludarabine,antilymphocyte globulin and cyclophosphamide,the two patients successfully received HLA-haploidentical(patient A)and HLA-identical(patient B)peripheral blood stem cell transplantation(PBSCT),respectively,7 days after the exposure.Cyclosporin A combined with mycophenolate mofetil was used for the prevention of graft-versus-host disease(GVHD).In addition,bone marrow mesenchymal stem cells from a donor were administered into patient A by intra-bone marrow injection.Results Both peripheral blood and bone marrow examinations showed the recovery of hemopoiesis after PBSCT,and neither patients displayed obvious clinical signs of GVHD.However,patient A died of septicemia and multi-organ failure on day 33 after the exposure,while patient B died of heart failure dominant multi-organ failure on day 75 after the exposure.Conclusions Allogeneic PBSCT is a feasible and effective treatment for ARS,while infection and multi-organ failure are major causes of death of the patients.