title: First global consensus for evidence-based management of the hematopoietic syndrome resulting from exposure to ionizing radiation.
abstract: OBJECTIVE
  Hematopoietic syndrome (HS) is a clinical diagnosis assigned to people who present with ≥ 1 new-onset cytopenias in the setting of acute radiation exposure. The World Health Organization convened a panel of experts to evaluate the evidence and develop recommendations for medical countermeasures for the management of HS in a hypothetical scenario involving the hospitalization of 100 to 200 individuals exposed to radiation. The objective of this consultancy was to develop recommendations for treatment of the HS based upon the quality of evidence.
  
  
  METHODS
  English-language articles were identified in MEDLINE and PubMed. Reference lists of retrieved articles were distributed to panel members before the meeting and updated during the meeting. Published case series and case reports of individuals with HS, published randomized controlled trials of relevant interventions used to treat nonirradiated individuals, reports of studies in irradiated animals, and prior recommendations of subject matter experts were selected. Studies were extracted using the Grading of Recommendations Assessment Development and Evaluation (GRADE) system. In cases in which data were limited or incomplete, a narrative review of the observations was made. No randomized controlled trials of medical countermeasures have been completed for individuals with radiation-associated HS. The use of GRADE analysis of countermeasures for injury to hematopoietic tissue was restricted by the lack of comparator groups in humans. Reliance on data generated in nonirradiated humans and experimental animals was necessary.
  
  
  RESULTS
  Based upon GRADE analysis and narrative review, a strong recommendation was made for the administration of granulocyte colony-stimulating factor or granulocyte macrophage colony-stimulating factor and a weak recommendation was made for the use of erythropoiesis-stimulating agents or hematopoietic stem cell transplantation.
  
  
  CONCLUSIONS
  Assessment of therapeutic interventions for HS in humans exposed to nontherapeutic radiation is difficult because of the limits of the evidence.
authors: Yale University School of Medicine and Yale-New Haven Health-Bridgeport Hospital, USA.
authors: Nicholas
authors: N
authors: Dainiak
authors: Robert Nicolas
authors: RN
authors: Gent
authors: Zhanat
authors: Z
authors: Carr
authors: Rita
authors: R
authors: Schneider
authors: Judith
authors: J
authors: Bader
authors: Elena
authors: E
authors: Buglova
authors: Nelson
authors: N
authors: Chao
authors: C Norman
authors: CN
authors: Coleman
authors: Arnold
authors: A
authors: Ganser
authors: Claude
authors: C
authors: Gorin
authors: Martin
authors: M
authors: Hauer-Jensen
authors: L Andrew
authors: LA
authors: Huff
authors: Patricia
authors: P
authors: Lillis-Hearne
authors: Kazuhiko
authors: K
authors: Maekawa
authors: Jeffrey
authors: J
authors: Nemhauser
authors: Ray
authors: R
authors: Powles
authors: Holger
authors: H
authors: Schünemann
authors: Alla
authors: A
authors: Shapiro
authors: Leif
authors: L
authors: Stenke
authors: Nelson
authors: N
authors: Valverde
authors: David
authors: D
authors: Weinstock
authors: Douglas
authors: D
authors: White
authors: Joseph
authors: J
authors: Albanese
authors: Viktor
authors: V
authors: Meineke
mesh_terms: D054508:Acute Radiation Syndrome / Q000209:etiology* / Q000628:therapy; D016207:Cytokines / Q000627:therapeutic use; D019317:Evidence-Based Medicine / Q000379:methods*; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use*; D006801:Humans; D011839:Radiation, Ionizing; D033581:Stem Cell Transplantation
chemical_list: D016207:Cytokines; D016179:Granulocyte Colony-Stimulating Factor