Baranov A, Gale R P, Guskova A, Piatkin E, Selidovkin G, Muravyova L, Champlin R E, Danilova N, Yevseeva L, Petrosyan L
Institute of Biophysics of the Ministry of Health and Clinical Hospital, Moscow, U.S.S.R.
N Engl J Med. 1989 Jul 27;321(4):205-12. doi: 10.1056/NEJM198907273210401.
On April 26, 1986, an accident at the Chernobyl nuclear power station in the Soviet Union exposed about 200 people to large doses of total-body radiation. Thirteen persons exposed to estimated total-body doses of 5.6 to 13.4 Gy received bone marrow transplants. Two transplant recipients, who received estimated doses of radiation of 5.6 and 8.7 Gy, are alive more than three years after the accident. The others died of various causes, including burns (the cause of death in five), interstitial pneumonitis (three), graft-versus-host disease (two), and acute renal failure and adult respiratory distress syndrome (one). There was hematopoietic (granulocytic) recovery in nine transplant recipients who could be evaluated, six of whom had transient partial engraftment before the recovery of their own marrow. Graft-versus-host disease was diagnosed clinically in four persons and suspected in two others. Although the recovery of endogenous hematopoiesis may occur after exposure to radiation doses of 5.6 to 13.4 Gy, we do not know whether it is more likely after the transient engraftment of transplanted stem cells. Because large doses of radiation affect multiple systems, bone marrow recovery does not necessarily ensure survival. Furthermore, the risk of graft-versus-host disease must be considered when the benefits of this treatment are being weighed.
1986年4月26日，苏联切尔诺贝利核电站发生事故，约200人受到大剂量全身辐射。13名估计全身剂量在5.6至13.4戈瑞之间的受辐射者接受了骨髓移植。两名估计受辐射剂量分别为5.6戈瑞和8.7戈瑞的移植接受者在事故发生三年多后仍然存活。其他受辐射者死于各种原因，包括烧伤（5人死因）、间质性肺炎（3人）、移植物抗宿主病（2人）以及急性肾衰竭和成人呼吸窘迫综合征（1人）。在9名可评估的移植接受者中出现了造血（粒细胞）恢复，其中6人在自身骨髓恢复之前有短暂的部分植入。4人临床诊断为移植物抗宿主病，另外2人疑似患有该病。虽然在受到5.6至13.4戈瑞辐射剂量后可能会出现内源性造血恢复，但我们不知道在移植干细胞短暂植入后是否更有可能出现这种情况。由于大剂量辐射会影响多个系统，骨髓恢复不一定能确保存活。此外，在权衡这种治疗的益处时，必须考虑移植物抗宿主病的风险。
