Centre for Haematology, Department of Immunology and Inflammation, Imperial College London, London, UK.
Department of Medicine, Division of Hematology and Oncology, Univ. Nebraska, Omaha, NE, USA.
Blood Rev. 2021 Jan;45:100690. doi: 10.1016/j.blre.2020.100690. Epub 2020 Apr 2.
Exposure to acute, high-dose, high dose-rate whole-body ionizing radiations damages the bone marrow resulting in rapid decreases in concentrations of blood cells, especially lymphocytes, granulocytes and platelets with associated risks of infection and bleeding. In several experimental models including non-human primate radiation exposure models giving molecularly cloned haematopoietic growth factor including granulocyte/macrophage colony-stimulating factor (G/M-CSF; sargramostim) and granulocyte colony-stimulating factor (G-CSF; filgrastim and pegylated G-CSF [peg-filgrastim]) accelerates bone marrow recovery and increases survival. Based on these data these molecules are US FDA approved for treating victims of radiation and nuclear incidents, accident and events such as nuclear terrorism and are included in the US National Strategic Stockpile. We discuss the immediate medical response to these events including how to estimate radiation dose and uniformity and which interventions are appropriate in different radiation exposures settings. We also discuss similarities and differences between molecularly cloned haematopoietic growth factors.
急性、高剂量、高剂量率全身电离辐射会损害骨髓，导致血液细胞，尤其是淋巴细胞、粒细胞和血小板浓度迅速下降，从而增加感染和出血的风险。在包括非人类灵长类动物辐射暴露模型在内的几个实验模型中，给予分子克隆的造血生长因子，包括粒细胞/巨噬细胞集落刺激因子（G/M-CSF；沙格司亭）和粒细胞集落刺激因子（G-CSF；非格司亭和聚乙二醇化 G-CSF [PEG-非格司亭]），可加速骨髓恢复并提高存活率。基于这些数据，这些分子已获得美国食品和药物管理局（FDA）批准，用于治疗辐射和核事故、事故以及核恐怖主义等事件的受害者，并被纳入美国国家战略储备。我们讨论了对这些事件的即时医疗反应，包括如何估计辐射剂量和均匀性，以及在不同的辐射暴露环境下哪些干预措施是合适的。我们还讨论了分子克隆造血生长因子之间的相似之处和差异。
