Department of Medicine, Division of Hematology and Oncology, Case Western Reserve University, Cleveland, OH, United States of America.
Department of Medicine, University of Nebraska, Omaha, NE, United States of America.
J Radiol Prot. 2021 Nov 10;41(4). doi: 10.1088/1361-6498/ac0bff.
Therapy of acute, high-dose whole-body exposures of humans to ionizing radiations is a complex medical challenge. Since 1944 more than 400 radiologic accidents have been registered with more than 3000 substantial radiation exposures and 127 fatalities. There are several potential interventions including supportive care, transfusions, preventative or therapeutic anti-infection drugs, molecularly-cloned myeloid growth factors and hematopoietic cell transplants. We discuss the use of the granulocyte and granulocyte-macrophage colony-stimulating factor (G-CSF and GM-CSF) to treat acute high-dose ionizing radiation exposures. Considerable data in experimental models including monkeys indicate use of these drugs accelerates bone marrow recovery and in some but not all instances increases survival. In ten accidents since 1996, 30 victims received G-CSF alone or with other growth factors. Twenty-six victims survived. In seven accidents since 1986, 28 victims received GM-CSF alone or with other growth factors; 18 victims survived. However, absent control or data from randomized trials, it is not possible to know with certainty what role, if any, receiving G-CSF or GM-CSF was of benefit. Given the favorableratio of molecularly-cloned myeloid growth factors, their use soon after exposure to acute, high-dose whole-body ionizing radiations is reasonable.
治疗人类急性、大剂量全身放射性照射是一项复杂的医学挑战。自 1944 年以来，已经有超过 400 起放射事故记录，涉及超过 3000 例严重放射性照射和 127 例死亡。有几种潜在的干预措施，包括支持性护理、输血、预防性或治疗性抗感染药物、分子克隆的髓系生长因子和造血细胞移植。我们讨论了使用粒细胞集落刺激因子（G-CSF）和粒细胞-巨噬细胞集落刺激因子（GM-CSF）治疗急性大剂量电离辐射照射的情况。大量的实验模型数据，包括猴子的数据，表明使用这些药物可以加速骨髓恢复，并且在某些但不是所有情况下都可以提高生存率。自 1996 年以来的 10 起事故中，有 30 名受害者单独或与其他生长因子一起接受 G-CSF 治疗。26 名受害者幸存。自 1986 年以来的 7 起事故中，有 28 名受害者单独或与其他生长因子一起接受 GM-CSF 治疗；18 名受害者幸存。然而，由于缺乏对照或随机试验数据，我们无法确定接受 G-CSF 或 GM-CSF 是否有任何作用。鉴于分子克隆的髓系生长因子的有利比例，在遭受急性、大剂量全身电离辐射照射后不久使用这些因子是合理的。
