Bone Marrow Colony Stimulating Factors (CSF) and Stem Cell Therapy as Medical Countermeasures (MCM) for Treatment of...

A nuclear detonation resulting in radiation exposure to a large population can cause acute radiation syndrome (ARS). Bone marrow colony stimulating factors (CSF), also known as cytokines, are FDA approved to treat hematopoietic-acute radiation syndrome (H-ARS). This review characterizes the use of CSFs (filgrastim, pegfilgrastim, romiplostim, and sargramostim) and stem cell therapies for H-ARS.

Using identified keywords, the literature search was conducted on biomedical databases from January 1996-July 2022 and returned 7452 articles. However, after review based on PICO and exclusion criteria, a total of 39 animal studies were included in this systematic review.

Data synthesis using vote counting demonstrated that 34 of 39 studies reported benefit with CSFs or stem cell therapies based on an increase in percent survival or physiological improvement in the experimental group when compared to the control (87% [95% CI 71.77%-95.18%], P = <0.001).

While studies looking at efficacy of CSFs given after 24 hours were limited, 2 studies included in this review showed that delayed administration of CSFs up to 120 hours may be beneficial compared to no treatment. Lack of standardization in experimental study design (e.g. radiation doses, animal species, interventions) between studies prevented direct comparisons using meta-analytic statistical approach.