Clinical experience in saving a case of very severe acute radiation sickness after failure in bone marrow transplantation

A 17 years old male patient with chronic granulocytic leukemia (CML) in remission received BMT from his younger sister, identical in HLA typing and negative in MLC reaction, after conditioning regime with daunorubicin, cyclophosphamide and total body irradiation (60Co 2,67 cGy/m, 6.5 Gy in two days and altogether 7 Gy including 0.5 Gy a week ago). He had muco-bloody stool without offensive odor or air bubbles since 45 days after irradiation. The stool cultures (21 times) turned out to be negative for bacteria including anaerobic Bacillus fusiformis. Three out of 17 stool cultures for sungi were positive. Muco-blood disappeared in feces after 88 days foolowed by formed stool. The WBC reached the nadir (0.022 x 109/1) on day 7, rose to 0.6 x 109/1 on day 14 and dropped again after severe anaphylaxis, indicating no take of the marrow. It remained at 0.06 x 109/1 on day 30 and rose to above 1.0 x 109/1 after day 66. Application of LAFR, insertion of Hickman catheter kept in patient and sterile to maintain effectviely the water-electrolyte balance and acid-base equilibrium, disinfection of GI tract, alternative combined use of anti-infectious drugs, transfusion of whole blood and its components from donors with CMV titre ≤ 1 : 200 (only 34.29% in 70 donors) and irradiated with 25 Gy, large amount of placental immuno-gamma-globulin, all these effectively avoided the occurrence of CMV pneumonia. He recoered 90 days later and he has been alive for 28 months since TBI and for 41 months since the onset of illness