Clinical analysis of patients with acute radiation syndrome due to total body irradiation or total lymphatic irradiation

Objective: To study the severity of iatrogenic acute radiation syndrome, treatment, hematopoietic recovery and related complications in patients subjected to total body irradiation (TBI) or total lymphatic irradiation (TLI) prior to hematopoietic stem cell transplantation. Methods: 100 tumor patients (91 with leukemia and 9 with other tumors), after receiving 500∼1000 cGy (in an average of 738.6 cGy) of TBI or TLI with super high dose chemotherapy as conditioning regimen during the process of hemopoietic stem cell transplantation, developed severe or even extremely severe, mainly bone marrow form acute radiation syndrome. Results: The patients' white blood cell count once dropped to (0∼0.15) x 109/L, platelet count fell to (1∼17) x 109/L, bone marrow was depleted with only a few non-hemopoietic cells and rare hemopoietic cells, and a high risk of complicating with infection and hemorrhage was observed. Treated with a variety of measures including protective isolation, supportive care, administration of growth factors such as GM-CSF or G-CSF, blood component transfusion and effective antibiotics, 92 cases restored their normal hemopoiesis, while 8 cases died of infection or hemorrhage. The clinical course of these patients indicated that a majority of the patients with severe and extremely severe, iatrogenic acute radiation syndrome involving bone marrow could restore their normal hemopoiesis, and hemopoietic stem cell transplantation played an important role in the treatment. Conclusion: Hemopoietic stem cell transplantation and administration of growth factors are very useful for the treatment of acute radiation syndrome