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Cord Blood Stem Cells

Transient hematopoietic stem cell rescue using umbilical cord blood for a lethally irradiated nuclear accident victim

Bone Marrow Transplantation volume 29, pages 197–204 (2002)Cite this article

Abstract

We performed stem cell rescue and allogeneic skin transplantation on a lethally neutron-irradiated nuclear accident victim. HLA-DRB1 mismatched unrelated umbilical cord blood cells (2.08 × 107/kg recipient body weight) were transplanted to an 8–10 Gy equivalent neutron-irradiated patient because of a lack of a suitable bone marrow or peripheral blood donor. Pre-transplant conditioning consisted of anti-thymocyte γ-globulin alone, and GVHD prophylaxis was a combination of cyclosporine (CYA) and methylprednisolone (mPSL). Granulocyte colony-stimulating factor (G-CSF), erythropoietin (EPO), and thrombopoietin (TPO) were concurrently administered after transplantation. The absolute neutrophil count reached 0.5 × 109/l on day 15, the reticulocyte count rose above 1% on day 23, and the platelet count was over 50 × 109/l on day 27, respectively. Cytogenetic studies of blood and marrow showed donor/recipient mixed chimerism. Rapid autologous hematopoietic recovery was recognized after withdrawal of CYA and mPSL. Repeated pathological examinations of the skin revealed no evidence of acute GVHD. Eighty-two days after the irradiation, skin transplantation was performed to treat radiation burns. Almost 90% of the transplanted skin engrafted. Immunological examination after autologous hematopoietic recovery revealed an almost normal T cell count. However, immune functions were severely impaired. The patient died from infectious complication 210 days after the accident.

Bone Marrow Transplantation (2002) 29, 197–204. doi:10.1038/sj.bmt.1703356

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Acknowledgements

We thank Dr Yasuto Sasaki (Director of National Institute of Radiological Science, Chiba, Japan), and Prof Kazuhiko Maekawa (Chairman of Emergency Network Congress against Nuclear Accident, Department of Critical Care Medicine, University of Tokyo, Tokyo, Japan) for their excellent organization of the Network Congress. We thank Dr Katsuaki Sato (Department of Medical Zoology, University of Kagoshima, Japan), Prof Naoki Shirafuji (Department of Hematology, Teikyo University, Tokyo), Tetuya Kinugasa (Mitsubishi Industrial Kobe Hospital, Kobe, Japan), Masahiko Kimura, (Kyorin University, Tokyo), Dr Pablo Rubinstein (New York Blood Center, New York, NY), Prof Joanne Kurtzberg (Duke University, Durham, NC), and Dr Robert Peter Gale (Salick Health Care, Inc., Los Angeles, CA) for their critical comments and clinical intervention.

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Authors and Affiliations

  1. Institute of Medical Science, University of Tokyo, Tokyo, Japan

    H Nagayama, K Misawa, J Ooi, T Iseki, A Tojo, K Tani, Y Yamada, TA Takahashi, N Yamashita & S Asano

  2. Keio University School of Medicine, Tokyo, Japan

    H Nagayama

  3. Fuchu Metropolitan Hospital, Tokyo, Japan

    H Kodo

  4. Kyorin University, Tokyo, Japan

    H Tanaka & S Shimazaki

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  1. H Nagayama
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Nagayama, H., Misawa, K., Tanaka, H. et al. Transient hematopoietic stem cell rescue using umbilical cord blood for a lethally irradiated nuclear accident victim. Bone Marrow Transplant 29, 197–204 (2002). https://doi.org/10.1038/sj.bmt.1703356

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