TABLE 4.

Among Individuals With Bone Marrow Failure After Exposure to Ionizing Radiation, Does Bone Marrow Transplantation vs No Transplantation Affect Overall Survival?^32–35

							Summary of Findings
Quality Assessment							No. Patients
No. Studies (No. participants)	Design	Study limitations	Consistency	Directness	Precision	Other Considerations	No. Treated With Transplantation/Participants (%)	No. Not Treated With Transplantation/Participants (%)	Effect*†	Quality	Importance
3 (19 graft recipients reported in 3 studies; outcome in 14 unmatched comparators available in 1 study‡)	3 observational studies; 1 of these studies reports some data on an unmatched comparative population	No serious study limitations	Large range of dose exposures in which 7/19 cases may not have been exposed to radiation dose associated with inevitable bone marrow failure	No un equivocal evidence of engraftment or graft failure reported in 6 treated cases (5/6 of whom survived) from 1 study§	No serious imprecision	Survival outcome strongly influenced by severity of damage to other organs and effects of treatment to prevent graft rejection and development of graft-vs-host disease	19/33 (58)	14/33 (42)	Survival observed in 2/13 (15%) treated patients Survival observed in 6/14 (43%) patients not treated	⊕⊕⊕○ Moderate	Critical||

^*Relative risk not calculable with available data.

^†Effect reported only for data aggregated for Chernobyl studies because recruitment/dose exposure (evidence of bone marrow failure and/or dose exposure not inevitably associated with bone).

^‡Criticality accident, Chernobyl, former Soviet Union³⁴ (marrow failure) and/or endpoint (engraftment) not clearly documented or proven.

^§Criticality accident, Boris Kidrich Institute, Vinca, Yugoslavia.³⁵

^||Outcome of intervention has great clinical significance (survival vs death).