Evidence-Based Recommendations for Management of Radiation-Associated Injury to the Hematopoietic and Non-Hematopoietic Organ Systems

Nicholas Dainiak MD FACP
Bridgeport & New Haven Connecticut USA

Abstract

Diverse clinical practices have been used to manage individuals with acute injury from ionizing radiation. To assess these practices, a panel of experts was convened in Geneva by the WHO. The panel ranked the evidence for medical countermeasures for management of ARS in a hypothetical scenario involving the hospitalization of 100-200 victims. English-language articles were identified in MEDLINE and PUBMED. Studies included case series and case reports of ARS, randomized controlled trials (RCTs) of relevant interventions used to treat non-irradiated individuals, reports of well-controlled studies in irradiated animals, and prior recommendations of subject matter experts. Studies addressing treatment of the hematopoietic syndrome (HS) were extracted, using the Grading of Recommendations Assessment Development and Evaluation (GRADE) system. In cases where data were limited or incomplete, a narrative review of the observations was made. The panel assessed the quality of evidence and classified recommendations as strong or weak. No RCTs of medical countermeasures have been completed for individuals with ARS. The use of GRADE analysis of countermeasures for injury of hematopoietic tissue was restricted by the lack of comparator groups in man. Based upon GRADE analysis and narrative review of HS, a strong recommendation was made for administration of G-CSF or GM-CSF, and a weak recommendation was made for the use of erythropoiesis-stimulating agents or hematopoietic stem cell transplantation. A consensus on management of injury to non-hematopoietic organ systems was achieved by narrative review of data generated in non-irradiated humans and in experimental animals: a strong recommendation was made for seven countermeasures (six in favor, 1 against); and a weak recommendation was made in favor of seven other countermeasures.