Soviets Disparage Transplants for Chernobyl Victims

Soviet medical authorities have concluded that the highly publicized efforts of American doctors to save the lives of radiation victims from Chernobyl with bone marrow transplants, while well-intentioned, turned out to have only small practical value and may have hastened the death of two patients.

This pessimistic view is contained in the official report the Soviet government prepared on the April 26 Chernobyl nuclear reactor accident for the International Atomic Energy Agency in Vienna.

Soviet doctors also voiced skepticism about the value of such a drastic form of treatment in a news conference Wednesday and in technical sessions at the weeklong meeting the IAEA is conducting to discuss the lessons of the accident.

“Reading the mass media, I get the impression that this is some kind of panacea,” Dr. Leonid A. Ilyin, vice chairman of the Soviet Academy of Medicine, said at the news conference. “This is probably a faulty opinion.”

Dr. Robert P. Gale, the American doctor who organized a team of colleagues to help the Soviets carry out bone marrow transplants on severely irradiated patients, said later in an interview that he thought the Soviets were overstating the drawbacks of the technique and generalizing too broadly from what will probably prove to be a unique nuclear disaster. Two of the victims were killed during the reactor blast, and 29 others died later of radiation sickness.

Viewed as Success or Failure

Noting that four of 13 marrow transplant patients are still alive, Gale said that “if you conclude that this helped keep them alive, then it was a fabulous success. Or you can say the four would have lived anyway, so it was a fabulous failure.”

Within a week after the accident, Gale and his colleagues at UCLA became larger-than-life symbols of East-West cooperation in the midst of a nuclear disaster that transcended national boundaries and political divisions.

To the occasional irritation of the Soviets, however, the thrust of Western news reports appeared to portray Gale and his marrow transplants as a decisive factor in a survival of scores of badly irritated victims at Chernobyl.

In fact, the Soviet report says, bone marrow transplants proved feasible and appropriate for only 13 of 203 patients who were hospitalized for radiation sickness, and in these patients turned out to be “only moderately effective.”

“In general, it can be said that bone marrow transplants were not a decisive factor in treatment after this particular accident,” the Soviet report concluded.

Bone Marrow Extermination

One of the lethal effects of severe radiation is the extermination of bone marrow, the body’s main blood-forming tissue and the source of its immune system.

The aim of the transplants, obtained from close relatives of the victims, was to sustain a patient until surviving cells of his or her own marrow could begin to reproduce and recover, or to provide the patients with the starting seeds of new blood-forming tissue and a new immune protection system.

The first problem encountered, according to the Soviet report, was the difficulty in the midst of a major medical emergency of finding and screening suitable donors among close relatives. For the 13 patients, 113 potential donors had to be screened for blood and tissue type, during which “considerable organizational difficulties were experienced,” the report said.

In the end, Soviet doctors found that patients who were irradiated so severely that their immune systems had been totally suppressed--and thus would not reject a marrow transplant--died of other causes, chiefly skin burns and intestinal damage.

But patients who were less severely radiated, and stood a better chance of survival, tended to retain some immune capacity and to reject the marrow transplant, in some cases with devastating effect as “graft-host,” or rejection, illness, set in.

In two cases, the Soviet report said, rejection may have contributed to death from kidney failure, lung insufficiency and a blood infection.

No-Win Situation

“It’s a situation where perhaps you can’t win,” Morris Rosen, the IAEA’s head of reactor safety, said in summarizing Soviet comments during a technical discussion on Wednesday of the accident’s medical aspects. The IAEA had barred journalists from attending the technical discussions.

For these reasons, most Western specialists at the meeting appeared to agree with Soviet doctors that bone marrow transplants would benefit only a small number of patients exposed to a narrow range of radiation doses.

Dr. Roger E. Linnemann, an associate professor of radiology at the University of Pennsylvania Medical School, said that for the rest, the wisest approach may be the least dramatic--to support a patient with antibiotics and blood transfusions until any surviving marrow cells begin to multiply on their own.

“First, do no harm,” Linnemann said, quoting an ancient medical adage.

In future radiation accidents, the written Soviet report predicted, the number of patients for whom such treatment will be clearly beneficial “is very small.”

Unduly Gloomy View

In an interview, Gale said he believed that marrow rejection contributed to the death of only one of the two patients, and that overall, the Soviets took an unduly gloomy view of a technique that is still new to them.

Moreover, he said, the Chernobyl accident probably was not representative of radiation accidents likely to occur in the future, because it combined injuries from fire and radiation in the same patients, many of whom were firefighters.

“Are these conclusions generally applicable? I think the Russians agree they are not,” Gale said. “Take a nuclear submarine accident, where there’s no fire. These conclusions wouldn’t be applicable.”

He added that the Soviets should not have been surprised at the appearance of rejection complications, or graft-host disease, as it appears in 45% of his own patients.

Gale emphasized that his principal aim was not to promote a particular medical technology for dealing with radiation accidents, but to encourage government authorities and the medical profession to think systematically about how to handle future reactor accidents on the scale of Chernobyl.