Strategy Developed for Clinical Response
to Radiological Accident or Terrorist Attack

A clinical response to a nuclear accident or terrorist attack causing toxic marrow injuries is the sharply defined objective of a committee that has been meeting, gathering information and developing contingency plans.

Those efforts culminated last month in the formation of a Radiation Injury Transplant Network (RITN) that can mobilize to evaluate and treat victims of radiation exposure.  (The previous working name of the coalition had been the Transplant Center Core Contingency Network.)

The development of the contingency plans and the creation of the network have been led by ASBMT and the National Marrow Donor Program (NMDP).  In its meeting last month, the committee:

·         Approved the structure and the function for the Radiation Injury Transplant Network to coordinate a response to a radiological accident or terrorist event.

·         Agreed that the RITN will issue guidelines, collect data and provide health professional education to prepare for the clinical assessment and treatment of victims of radiation exposure and toxic marrow injuries. 

·         Approved Preparatory Regimen Guidelines that include conditioning for hematopoietic stem cell transplant after radiation or marrow toxic exposure.

·         Approved Donor Search Criteria for finding suitable HLA-compatible related or unrelated donors and cord blood units.

·         Continued work on a draft of Database Protocol and Consent Form, for data collection after marrow toxic injury. 

·         Approved criteria for primary and secondary transplant centers, donor centers and cord blood banks that would participate in the RITN network. 

The transplant facilities in the network would not be first responders – a responsibility that belongs to local emergency services personnel and community health officials and centers.  Rather, the network members would coordinate the management of victims who are transferred for treatment of marrow suppressive injuries.

Co-chairs of the committee are Dennis Confer, MD, and Nelson Chao, MD, representing NMDP and ASBMT respectively.

At last month’s meeting in Chicago, Dr. Confer reported that the newly established C. W. Bill Young Marrow Donor Program requires a military contingency and Homeland Security initiative for the treatment of casualties exposed to marrow toxic injury. 

Dr. Chao updated the group on a Radiation Events Medical Management (REMM) model that has been developed with the help of the U.S. Department of Health and Human Services (HHS), the National Institutes of Health (NIH) and the National Library of Medicine (NLM). 

REMM will provide health care professionals with protocols, evidence-based recommendations, guidelines for follow up and surveillance, and access to resources such as the Strategic National Stockpile of medications and laboratory tests.  The information will be available in several electronic formats.

Each transplant center participating in the network will have a recovery plan with protocol for diagnosis and treatment of moderate-dose exposure patients – those who can recover.  Special training will be provided for staff at the participating facilities.  Some participating facilities already have been issued satellite telephones so they can communicate with one another as well as using the Government Emergency Telephone System (GETS). 

Private sector and government agencies that have been participating in the planning meetings include the U.S. Health Resources and Services Administration, the Navy, HHS, NIH, NLM, NMDP and ASBMT.

A number of transplant centers also have been active in the planning:

·         Barnes-Jewish Hospital at Washington University

·         Cincinnati Children’s Hospital Medical Center

·         City of Hope National Medical Center

·         Dana-Farber/Partners Cancer Care

·         Duke University Medical Center

·         Hackensack University Medical Center

·         M.D. Anderson Cancer Center

·         Memorial Sloan-Kettering Cancer Center

·         Presbyterian/St. Lukes Medical Center

·         Seattle Cancer Care Alliance

·         Stanford Hospital and Clinics

·         Texas Children’s Hospital

·         University of Minnesota BMT Program

·         University of Pennsylvania Medical Center

·         University of Michigan Medical Center