Reprinted from the Journal of the American Medical Association June 30, 1975 Volume 232 Copyright 1975, American Medical Association nerositony ‘401902 Le Kco2ns COLLECTION MARSHALL Zscangs ONS BOXNe, LZEL! CAL EfALFwEnT /SLICATI rotoen 222 Acute Myelogenous Leukemia Following Fallout Radiation Exposure ACUTE myelogenous leukemia developed in a 19-year-old Marshallese man who had been exposed to radioactive fallout at 1 year of age. He was one of 64 people on Rongelap Island accidentally exposed in 1954 following the testing of an atomic device on Bikini atoll 100 miles away. The acute effects of exposure on this population were hematological depression from total body exposure to gamma radia- arms, and legs, with spotty epilation of the scalp. By six weeks, his leukocyte count had dropped to 3,900/cu mm with depression of both neutrophil and lymphocyte count, while his platelet count had reached a low of 140,000/cu mm at 30 days. There was gradual return of these blood elements to near normal levels, He had remained healthy with only the usual childhood dis- and epilation from deposit of fallout on the skin. There were no deaths, and recovery occurred within a year. Internal absorption of radionuclides from inhalation and consumption of contaminated food and water produced no acute effects, but absorption of radioactive iodine resulted in later development of thyroid lesions in one third of the population; three of these lesions were malignant. The highest incidence was in children exposed at less than 10 years of age, some of whom had growth retardation.’ on a regimen of supplementary levothy- eases until age 18, when benign adenomas of the thyroid gland were detected and surgically removed. He remained euthyroid with normal growth and development roxine sodium treatment. In September 1972, an annual examination showed his leukocyte count to be 2,000/eu mm. There were no other note- worthy findings, and he appeared to be a healthy, husky 19-year-old. Bone marrow Fig 1.—Promyelocytes with Auer rods (x 2,000). Report of a Case The man in this case report experienced nausea, vomiting, and itching of the skin during the first two days following exposure. By two weeks, transient beta-ray burns developed on the skin over the neck, From the Medical Research Center, Brookhaven National Laboratory, Upton, Long Island, NY. Reprint requests to Brookhaven National Laboratory, Upton, NY 11973 (Dr. Conard). S5 ps Jung,30, 1975 @ Vol 232, No 13 a2 Brookhaven National Laboratory Upten, L. L, New York Robert A. Conard, MD tion of 175 rads and beta-ray burns he Medical Research Conter examinations at Brookhaven National Laboratory revealed acute myelogenous leukemia (promyelocytic type with numerous Auer bodies) (Fig 1). Extensive antileukemic therapy was then begun at the National Cancer Institute, but since compatible platelet transfusions were not available to combat severe thrombocytopenia that developed, death from extensive pulmonary bleeding intervened before a remission could be achieved. Comment Retrospective examination of the hematologic data obtained at frequent intervals since exposure is noteworthy. Comparison of this patient’s peripheral blood leukocyte counts (case 54) with the mean levels of eight other boys exposed at less than 5 years of age and eight unexposed Marshallese boys in the same age rangeis plotted in Fig 2. The leukemia case showed greater depression of neutrophil count both during the immediate postexposure period and during subsequent years. Plots of individual cases in the comparison groups showed none with similarly low levels. The platelets showed lesser comparative depression, and the lymphocytes and erythrocytic elements showed verylittle difference in the leukemia case when compared with the other groups. Other hematologic data were generally normal (neutrophilic alkaline phosphatase level, basophil counts, serum protein conAcute Myelogenous Leukemia—Conard