{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T10:15:45Z","timestamp":1785406545877,"version":"3.56.0"},"reference-count":52,"publisher":"Cambridge University Press (CUP)","license":[{"start":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T00:00:00Z","timestamp":1770595200000},"content-version":"unspecified","delay-in-days":39,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Disaster med. public health prep."],"published-print":{"date-parts":[[2026]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"S193578932510061X_sec1\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S193578932510061X_sec2\" sec-type=\"methods\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S193578932510061X_sec3\" sec-type=\"results\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      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%],\n                      <jats:italic>P<\/jats:italic>\n                      = &lt;0.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S193578932510061X_sec4\" sec-type=\"conclusions\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1017\/dmp.2025.10061","type":"journal-article","created":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T07:10:27Z","timestamp":1770621027000},"source":"Crossref","is-referenced-by-count":0,"title":["Bone Marrow Colony Stimulating Factors (CSF) and Stem Cell Therapy as Medical Countermeasures (MCM) for Treatment of Hematopoietic-Acute Radiation Syndrome: A Systematic Review"],"prefix":"10.1017","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-8352-2563","authenticated-orcid":false,"given":"Arnold","family":"Bogis","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/007bn8q13","id-type":"ROR","asserted-by":"publisher"}],"name":"Association of State and Territorial Health Officials"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-7365-6887","authenticated-orcid":false,"given":"Skylar","family":"Pulver","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/042twtr12","id-type":"ROR","asserted-by":"publisher"}],"name":"Centers for Disease Control and Prevention"},{"name":"Oak Ridge Institute for Science and Education"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Charp","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/042twtr12","id-type":"ROR","asserted-by":"publisher"}],"name":"Centers for Disease Control and Prevention"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erica","family":"Wills","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/042twtr12","id-type":"ROR","asserted-by":"publisher"}],"name":"Centers for Disease Control and Prevention"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ziad","family":"Kazzi","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03czfpz43","id-type":"ROR","asserted-by":"publisher"}],"name":"Emory University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Buzzell","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/042twtr12","id-type":"ROR","asserted-by":"publisher"}],"name":"Centers for Disease Control and Prevention"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanna M.","family":"Prasher","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/042twtr12","id-type":"ROR","asserted-by":"publisher"}],"name":"Centers for Disease Control and Prevention"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6206-9191","authenticated-orcid":false,"given":"Arthur","family":"Chang","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/042twtr12","id-type":"ROR","asserted-by":"publisher"}],"name":"Centers for Disease Control and Prevention"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2026,2,9]]},"reference":[{"key":"S193578932510061X_r7","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions","volume":"6","author":"McKenzie","year":"2023"},{"key":"S193578932510061X_r19","doi-asserted-by":"publisher","DOI":"10.1093\/rpd\/ncw176"},{"key":"S193578932510061X_r37","unstructured":"37. Administration for Strategic Preparedness and Response. Strategic National Stockpile. Published 2024. 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United States Food and Drug Administration. Animal Rule Information. Published 2024. Accessed 11-13-2025. https:\/\/www.fda.gov\/emergency-preparedness-and-response\/mcm-regulatory-science\/animal-rule-information."},{"key":"S193578932510061X_r30","first-page":"22211","article-title":"Bone marrow stromal cell therapy improves survival after radiation injury but does not restore endogenous hematopoiesis","volume":"10","author":"Diaz","year":"2020","journal-title":"Sci."},{"key":"S193578932510061X_r44","doi-asserted-by":"publisher","DOI":"10.1007\/s11095-020-02839-3"},{"key":"S193578932510061X_r5","doi-asserted-by":"publisher","DOI":"10.1097\/HP.0b013e3181b3fce5"},{"key":"S193578932510061X_r46","first-page":"10659","article-title":"The thrombopoietin mimetic romiplostim leads to the complete rescue of mice exposed to lethal ionizing radiation","volume":"8","author":"Yamaguchi","year":"2018","journal-title":"Sci."},{"key":"S193578932510061X_r12","doi-asserted-by":"publisher","DOI":"10.2174\/1389201016666150826125331"},{"key":"S193578932510061X_r33","first-page":"13","article-title":"Effects of a granulocyte colony stimulating factor, Neulasta, in mini pigs exposed to total body proton irradiation","volume":"5","author":"Sanzari","year":"2015","journal-title":"Life Sci Space Res (Amst)."},{"key":"S193578932510061X_r32","doi-asserted-by":"publisher","DOI":"10.1667\/RR14555.1"},{"key":"S193578932510061X_r14","doi-asserted-by":"publisher","DOI":"10.1097\/HP.0000000000000878"},{"key":"S193578932510061X_r9","unstructured":"9. Wells, GA , Shea, B , O\u2019Connell, D , et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. 2000."},{"key":"S193578932510061X_r34","doi-asserted-by":"publisher","DOI":"10.1097\/HP.0000000000000960"},{"key":"S193578932510061X_r47","doi-asserted-by":"publisher","DOI":"10.1016\/j.exphem.2007.04.017"},{"key":"S193578932510061X_r51","doi-asserted-by":"publisher","DOI":"10.1007\/s00210-019-01702-6"},{"key":"S193578932510061X_r39","doi-asserted-by":"publisher","DOI":"10.1667\/RR13940.1"},{"key":"S193578932510061X_r20","doi-asserted-by":"publisher","DOI":"10.1097\/HP.0b013e3182a4df10"},{"key":"S193578932510061X_r15","doi-asserted-by":"publisher","DOI":"10.1097\/HP.0000000000000350"},{"key":"S193578932510061X_r48","doi-asserted-by":"publisher","DOI":"10.1667\/RR14647.1"},{"key":"S193578932510061X_r21","first-page":"1","article-title":"Efficacy of delayed administration of sargramostim up to 120 hours post exposure in a nonhuman primate total body radiation model","author":"Zhong","year":"2020","journal-title":"Int J Radiat Biol"},{"key":"S193578932510061X_r49","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2005.03.045"},{"key":"S193578932510061X_r6","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-140-12-200406150-00015"},{"key":"S193578932510061X_r43","doi-asserted-by":"publisher","DOI":"10.1097\/HP.0b013e3182a4dd4e"},{"key":"S193578932510061X_r8","doi-asserted-by":"publisher","DOI":"10.1214\/ss\/1009213286"},{"key":"S193578932510061X_r10","first-page":"863","article-title":"Granulocyte colony-stimulating factor administered as a single intraperitoneal injection modifies the lethal dose95\/30 in irradiated B6D2F1 mice","volume":"83","author":"Sureda","year":"1998","journal-title":"Haematologica."},{"key":"S193578932510061X_r52","doi-asserted-by":"publisher","DOI":"10.1016\/j.freeradbiomed.2019.03.023"},{"key":"S193578932510061X_r29","doi-asserted-by":"publisher","DOI":"10.1002\/sctm.20-0455"},{"key":"S193578932510061X_r11","doi-asserted-by":"publisher","DOI":"10.1186\/s13287-020-01861-x"},{"key":"S193578932510061X_r27","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0014486"},{"key":"S193578932510061X_r38","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39489.470347.AD"},{"key":"S193578932510061X_r35","doi-asserted-by":"publisher","DOI":"10.1001\/dmp.2011.68"},{"key":"S193578932510061X_r26","doi-asserted-by":"publisher","DOI":"10.1007\/s10616-016-9993-y"},{"key":"S193578932510061X_r2","first-page":"105","article-title":"Acute radiation syndrome (ARS) - treatment of the reduced host defense","volume":"5","author":"Heslet","year":"2012","journal-title":"Int J Gen Med."},{"key":"S193578932510061X_r18","doi-asserted-by":"publisher","DOI":"10.1667\/RR3049.1"},{"key":"S193578932510061X_r31","doi-asserted-by":"publisher","DOI":"10.4252\/wjsc.v14.i3.245"},{"key":"S193578932510061X_r17","doi-asserted-by":"publisher","DOI":"10.1097\/HP.0000000000000968"},{"key":"S193578932510061X_r24","doi-asserted-by":"publisher","DOI":"10.1080\/09553002.2019.1625488"},{"key":"S193578932510061X_r4","volume-title":"Oncologic Emergency Medicine: Principles and Practice","author":"Dainiak","year":"2016"},{"key":"S193578932510061X_r25","first-page":"8670","article-title":"Human umbilical cord mesenchymal stem cell transplantation restores hematopoiesis in acute radiation disease","volume":"13","author":"Yang","year":"2021","journal-title":"Am J Transl Res."},{"key":"S193578932510061X_r50","doi-asserted-by":"publisher","DOI":"10.1667\/RR15038.1"},{"key":"S193578932510061X_r28","first-page":"646","article-title":"The healing effect of bone marrow-derived stem cells in acute radiation syndrome","volume":"32","author":"Mortazavi","year":"2016","journal-title":"Pak."},{"key":"S193578932510061X_r13","doi-asserted-by":"publisher","DOI":"10.1667\/RR2783.1"},{"key":"S193578932510061X_r1","doi-asserted-by":"publisher","DOI":"10.1097\/00000441-200206000-00006"}],"container-title":["Disaster Medicine and Public Health Preparedness"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S193578932510061X","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T07:10:36Z","timestamp":1770621036000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S193578932510061X\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026]]},"references-count":52,"alternative-id":["S193578932510061X"],"URL":"https:\/\/doi.org\/10.1017\/dmp.2025.10061","relation":{},"ISSN":["1935-7893","1938-744X"],"issn-type":[{"value":"1935-7893","type":"print"},{"value":"1938-744X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026]]},"article-number":"e33"}}