Hematopoietic Recovery using Multi-Cytokine Therapy in 8 Patients Presenting Radiation-Induced Myelosuppression after Radiological Accidents - Archive ouverte HAL Access content directly
Journal Articles Radiation Research Year : 2021

Hematopoietic Recovery using Multi-Cytokine Therapy in 8 Patients Presenting Radiation-Induced Myelosuppression after Radiological Accidents

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Abstract

Treatment of accidental radiation-induced myelosuppression is primarily based on supportive care and requires specific treatment based on hematopoietic growth factors injection or hematopoietic cell transplantation for the most severe cases. The cytokines used consisted of pegylated erythropoietin (darbepoetin alfa) 500 IU once per week, pegylated G-CSF (pegfilgrastim) 6 mg 3 2 once, stem cell factor 20 lg.kg–1 for five days, and romiplostim (TPO analog) 10 lg.kg1 once per week, with different combinations depending on the accidents. As the stem cell factor did not have regulatory approval for clinical use in France, the French regulatory authorities (ANSM, formerly, AFSSAPS) approved their compassionate use as an investigational drug ‘‘on a case-by-case basis’’. According to the evolution and clinical characteristics, each patient’s treatment was adopted on an individual basis. Daily blood count allows initiating GCSF and SCF delivery when granulocyte ,1,000/mm3, TPO delivery when platelets ,50,000/mm3, and EPO when Hb,80 g/L. The length of each treatment was based on blood cell recovery criteria. The concept of ‘‘stimulation strategy’’ is linked to each patient’s residual hematopoiesis, which varies among them, depending on the radiation exposure’s characteristics and heterogeneity. This paper reports the medical management of 8 overexposed patients to ionizing radiation. The recovery of bone marrow function after myelosuppression was accelerated using growth factors, optimized by multiple-line combinations. Particularly in the event of prolonged exposure to ionizing radiation in dose ranges inducing severe myelosuppression (in the order of 5 to 8 Gy), with no indication of hematopoietic stem cell transplantation.
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Dates and versions

irsn-03953974 , version 1 (24-01-2023)

Identifiers

Cite

Marc Benderitter, Eduardo Herrera-Reyes, Yvan Gigov, Bertrand Souleau, Christelle Huet, et al.. Hematopoietic Recovery using Multi-Cytokine Therapy in 8 Patients Presenting Radiation-Induced Myelosuppression after Radiological Accidents. Radiation Research, 2021, 196 (6), ⟨10.1667/RADE-21-00169.1⟩. ⟨irsn-03953974⟩
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