1. RITN ® Overview National Marrow Donor Program As of April 9, 2010

2. RITN Overview Presentation 2 Agenda Who is RITN? What Needs Does RITN Fill? What Can RITN Offer? What is RITN Doing to Prepare? Concerns

3. RITN Overview Presentation 3 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).

4. RITN Overview Presentation 4 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.

5. RITN Overview Presentation 5 RITN Development Timeline 1986 - 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 emphasis NMDP solicits HSCT physician support 2006 - NMDP initiates agreements with 13 transplant centers RITN steering committee finalizes materials 2007 - Expansion of RITN to include donor centers and cord blood banks (52 total centers) Tomorrow…

6. RITN Overview Presentation 6 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.govwww.remm.nlm.gov Leading hematopoietic stem cell transplantation physicians

8. RITN Overview Presentation 8 RITN Distribution Across USA

10. RITN Overview Presentation 10 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

11. RITN Overview Presentation 11 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

12. RITN Overview Presentation 12 RITN centers plan to receive patients from impacted area RITN centers are not first responders or a local response asset

13. RITN Overview Presentation 13 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

14. RITN Overview Presentation 14 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

15. RITN Overview Presentation 15 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.netwww.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

16. RITN Overview Presentation 16 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.netwww.RITN.net Coordination with international organizations –EBMT and WHO - REMPAN

17. RITN Overview Presentation 17 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

18. 18 Office of Assistant Secretary for Preparedness and Response http://www.hhs.gov/aspr/ASPR Dr. Nicole Lurie Office of Policy & Strategic Planning Biomedical Advanced Research & Development Authority Office of Medicine, Science & Public Health Office of Preparedness & Emergency Operations Immediate Office of the ASPR

19. 19 For treatment guidelines, training & references: www.REMM.NLM.gov www.RITN.net

20. RITN Overview Presentation 20 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

21. RITN Overview Presentation 21 Resources for further investigation Incidents: –IAEA nuclear incidents list: http://www-news.iaea.org/news/http://www-news.iaea.org/news/ –Database of Radiological Incidents and Related Incidents: www.johnstonsarchive.net/nuclear/radevents/index.html www.johnstonsarchive.net/nuclear/radevents/index.html Treatment: –Radiation Injury Treatment Network (RITN): www.RITN.netwww.RITN.net –Radiation Event Medical Management (REMM): www.remm.nlm.govwww.remm.nlm.gov –Radiation Emergency Assistance Center/Training Site (REAC/TS): www.orau.gov/reacts www.orau.gov/reacts –Radiation Countermeasures Center of Research Excellence (RadCCORE): www.radccore.orgwww.radccore.org Bio-dosimetry & Treatment: –Armed Forces Radiobiology Research Institute (AFRRI): www.afrri.usuhs.mil www.afrri.usuhs.mil Other: –IAEA Library: http://www.iaea.org/DataCenter/Library/catresources.htmlhttp://www.iaea.org/DataCenter/Library/catresources.html –Radiation Emergency Medical Preparedness and Assistance Network (REMPAN): www.who.int/ionizing_radiation/a_e/rempan/www.who.int/ionizing_radiation/a_e/rempan/