Transient hematopoietic stem cell rescue using umbilical cord blood for a lethally irradiated nuclear accident victim.
We performed stem cell rescue and allogeneic skin transplantation on a lethally neutron-irradiated nuclear accident victim. HLA-DRB1 mismatched unrelated umbilical cord blood cells (2.08 x 10(7)/kg recipient body weight) were transplanted to an 8-10 Gy equivalent neutron-irradiated patient because of a lack of a suitable bone marrow or peripheral blood donor. Pre-transplant conditioning consisted of anti-thymocyte gamma-globulin alone, and GVHD prophylaxis was a combination of cyclosporine (CYA) and methylprednisolone (mPSL). Granulocyte colony-stimulating factor (G-CSF), erythropoietin (EPO), and thrombopoietin (TPO) were concurrently administered after transplantation. The absolute neutrophil count reached 0.5 x 10(9)/l on day 15, the reticulocyte count rose above 1% on day 23, and the platelet count was over 50 x 10(9)/l on day 27, respectively. Cytogenetic studies of blood and marrow showed donor/recipient mixed chimerism. Rapid autologous hematopoietic recovery was recognized after withdrawal of CYA and mPSL. Repeated pathological examinations of the skin revealed no evidence of acute GVHD. Eighty-two days after the irradiation, skin transplantation was performed to treat radiation burns. Almost 90% of the transplanted skin engrafted. Immunological examination after autologous hematopoietic recovery revealed an almost normal T cell count. However, immune functions were severely impaired. The patient died from infectious complication 210 days after the accident.
Nagayama
H
H
Institute of Medical Science, University of Tokyo, Tokyo, Japan.
Misawa
K
K
Tanaka
H
H
Ooi
J
J
Iseki
T
T
Tojo
A
A
Tani
K
K
Yamada
Y
Y
Kodo
H
H
Takahashi
T A
TA
Yamashita
N
N
Shimazaki
S
S
Asano
S
S
D000328:Adult; D017809:Fatal Outcome; D005312:Fetal Blood / Q000166:cytology; D006085:Graft Survival; D018380:Hematopoietic Stem Cell Transplantation; D006650:Histocompatibility Testing; D006801:Humans; D007107:Immune System / Q000254:growth & development; D008297:Male; D009502:Neutrons; D011829:Radiation Dosage; D011832:Radiation Injuries / Q000473:pathology / Q000628:therapy*; D018788:Radioactive Hazard Release; D012128:Respiratory Distress Syndrome / Q000209:etiology; D016038:Skin Transplantation; D018183:Transplantation Chimera; D014184:Transplantation, Homologous