RITN® Overview

National Marrow Donor Program

As of April 9, 2010

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Agenda

• Who is RITN?

• What Needs Does RITN Fill?

• What Can RITN Offer?

• What is RITN Doing to Prepare?

• Concerns

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Charter

The Radiation Injury Treatment Network® (RITN) provides comprehensive evaluation and treatment for victims of radiation exposure or

other marrow toxic injuries. RITN develops treatment guidelines, educates health care

professionals, works to expand the network, and coordinates situation response. RITN is a

cooperative effort of the National Marrow Donor Program (NMDP) and The American Society for

Blood and Marrow Transplantation (ASBMT).

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RITN Goals

1. Provide facilities and staff for intensive

supportive care and treatment expertise in the

aftermath of a marrow toxic incident resulting in

mass casualties.

2. Educate hematologists, oncologists, and stem

cell transplant practitioners about their potential

involvement in the response to a radiological

incident.

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RITN Development Timeline1986 - Initiation of NMDP - Navy relationship

’86-’01 - Response network realized as an unfulfilled need

2001 - NMDP begins organizing concept of core network

2003 - NMDP transplant center physicians discuss options

2004 - ASBMT joins initiative

2005 - ASBMT increases emphasisNMDP solicits HSCT physician support

2006 - NMDP initiates agreements with 13 transplant centersRITN steering committee finalizes materials

2007 - Expansion of RITN to include donor centers and cord blood banks (52 total centers)

Tomorrow…

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Key Partners in the Development of RITN• American Society for Blood and Marrow Transplantation

(ASBMT)

• Department of Defense - Office of Naval Research (ONR)

• Health Resources and Services Administration (HRSA)

• Center for International Blood and Marrow Transplant Research (CIBMTR)

• Radiation Emergency Assistance Center/Training Site (NNSA, DOE)

• Dept. Health & Human Services - Asst. Secretary of Preparedness and Response (DHHS-ASPR)

• National Library of Medicine - Radiological Event Medical Management (NLM-REMM) www.remm.nlm.gov

• Leading hematopoietic stem cell transplantation physicians

Executive CommitteeCo-Chaired by

NMDP & ASBMT

Steering Committee

Original 13 RITN

Transplant Center Medical

Directors

External Advisors

(civilian and government)

43 NMDPTransplant Centers

7 NMDPDonor

Centers

7 NMDP & NCBI

Cord Blood Banks

ASBMT NMDP

RITN Oversight and Management

RITN Network

Composition

57 RITN Centers

Organization of RITN

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RITN Distribution Across USA

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• Focus of preparations: Any incident resulting in mass casualties with a marrow toxic injury

• Examples of possible events:– Radiological

• Improvised Nuclear Device (IND)• Military grade nuclear weapon• Radiological exposure device (open source)• Radiological Dispersal Device (RDD) a.k.a. dirty bomb

– Less likely to overwhelm existing response resources

– Chemical: Mustard gas– Unknown

Possible Events Involving RITN

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What Need Does RITN Fulfill?

• Provide ready facilities with practicing specialists for intensive supportive care and treatment– Infrastructure and process for transplant if needed

• Increases transplant community awareness about potential need of their services in time of crisis

• Involves transplant community in emergency preparedness

• Most victims of a marrow toxic mass casualty incident will require intensive supportive care to recover without a transplant

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RITN centers plan to receive patients from impacted area

RITN centers are not first responders or a local response asset

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RITN Centers are Cancer Specialists

• RITN centers are NOT first responders

– Not HAZMAT (Hazardous Materials) technicians

– Not victim triage experts

– Not decontamination specialists

– Not emergency medical specialists

– Not trauma or burn specialists

• RITN staff are cancer treatment experts

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RITN Centers are Cancer Specialists

• In the aftermath of a marrow toxic incident, RITN centers may be asked to:– Accept patient transfers to their institutions– Provide treatment expertise to practitioners

caring for victims at other centers– Travel to other centers to provide medical

expertise– Provide data on victims treated at their centers

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What RITN Offers to the Response?

• Provide expert knowledge based on significant practical experience in treating patients with compromised immune-systems

• Treatment facilities for victims• Regional dispersion other transplant physicians

can talk to a peer in RITN• Available through RITN Website: www.RITN.net

– RITN Acute Radiation Syndrome treatment guidelines– RITN center standard operating procedure templates– Donor selection criteria– NMDP data collection protocol– Training resources– Pertinent publications

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RITN Preparedness Efforts

• Standard Operating Procedures

• Standardized admission and treatment orders

• Standardized data collection protocol

• Training

– Basic Radiation Training (over 2000 trained since 2006)

– Additional training resources on www.RITN.net

• Coordination with international organizations

– EBMT and WHO - REMPAN

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RITN Preparedness Efforts

• Conduct readiness exercises– Annual tabletop exercise– Participate in national exercises (TOPOFF 4, Pinnacle 07)– Participate in international exercises (IAEA ConEX 2008)

• Emergency communications equipment– Government Emergency Telecommunication Service

(GETS) calling cards– Satellite telephones

• Contracted HLA typing laboratories 6 – 10,000 per week during an emergency

• Internet based cord blood unit searching• Data collection protocol

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Office of Assistant Secretary for Preparedness and Response

http://www.hhs.gov/aspr/

ASPRASPRDr. Nicole Lurie

Office of Policy &Strategic Planning

BiomedicalAdvanced Research

& Development

Authority

Office of Medicine, Science

& Public Health

Immediate Office of the ASPR

Office ofPreparedness &

EmergencyOperations

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For treatment guidelines, training & references:

www.REMM.NLM.gov

www.RITN.net

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Concerns

• Funding to cover cost of treatment

• Catastrophic event may overwhelm national

capabilities

– 10KT device → 30,000+ victims for treatment??

• Complacency in absence of an actual event

• International coordination

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Resources for further investigation• Incidents:

– IAEA nuclear incidents list: http://www-news.iaea.org/news/ – Database of Radiological Incidents and Related Incidents:

www.johnstonsarchive.net/nuclear/radevents/index.html • Treatment:

– Radiation Injury Treatment Network (RITN): www.RITN.net– Radiation Event Medical Management (REMM): www.remm.nlm.gov– Radiation Emergency Assistance Center/Training Site (REAC/TS):

www.orau.gov/reacts– Radiation Countermeasures Center of Research Excellence

(RadCCORE): www.radccore.org• Bio-dosimetry & Treatment:

– Armed Forces Radiobiology Research Institute (AFRRI): www.afrri.usuhs.mil

• Other:– IAEA Library: http://www.iaea.org/DataCenter/Library/catresources.html – Radiation Emergency Medical Preparedness and Assistance Network

(REMPAN): www.who.int/ionizing_radiation/a_e/rempan/