BM toxicity is a major cause of morbidity and mortality after exposure
to acute high dose total body radiation. Here, we consider therapeuti
c strategies useful in victims of radiation accidents including suppor
tive care (antibiotics, protected environments and transfusions), hema
topoietic growth factors and BMTs. Selecting the best strategy require
s precise knowledge of the details of radiation exposure. This informa
tion is rarely available in accidents. An alternative is to assess ris
k:benefit ratios for different strategies at approximate radiation dos
es. Using this approach, we suggest supportive care be given to all pe
rsons at risk of developing BM failure. The favorable risk:benefit rat
io of hematopoietic growth factors argues for their use when moderate
to severe BM failure is predicted. Transplants, which have the least f
avorable risk:benefit ratio, should be used only when there is a subst
antial risk of irreversible BM damage.