From www.bloodjournal.org by guest on June 17, 2017. For personal use only.
Leukemia
By
ROBERT
D.
in Atomic
I.
General
LANGE,
M.D.,
mental
large
human
The
‘
ferred
to the
gether
with
cases
up
marked
present
Atomic
in atomic
to
AND
massive
x-ray
in man
in Japan
doses
of ionizing
from
the
bomb
total
survivors
other
irradiation
survivors
of leukemia
1948
to
and
and in experiexposed
two
in leukemia
among
of a review
of all cases
bringing
to April
seventy-five
was
re-
1952
to-
established
in Hiroshima
and
Nagasaki
,
METHODS
In the
but
Commissioii
cases,
occurring
1 1953.
January
brief
Casualty
new
exposures
been recognized
atomic
bombs
consists
Bomb
M.D.,
MOLONEY,
M.D.
repeated
long
of the
increase
study
thirty-nine
of leukemia
to
has
to single
a
reported.4
by
energy
explosion
populations
andsubsequently
C.
WILLIAM
YAMAWAKI,
induced
forms
of radiation
ammals.’3
The
Survivors
Observations
ToKuso
EUKEMOGENESIS
Bomb
five year
period
from
by
Atomic
the
AND
MATERIALS
1948 through
were
investigated
were
with
excluded
because
of failure
blood
smears,
bone marrow
Bomb
1952,
one
Casualty
hundred
and
Commission.
to meet the criteria
smears,
or autopsy
fifty
Of
of adequate
material
cases
these,
of leukemia
twenty-six
clinical
available
and
cases
radiation
for
data
study
by
the
authors.
The
sources
of the
1. Patients
survivors.
Ten
hundred
epilated
Ishibashi,
five
such
and
hundred
by
and
2. Patients
visited
by
3. Cases
discovered
clinical
the
cases
Yamasowa
in
is
bombings.
applied
the
Submitted
This
work
The
without
saki,
of
7
and
in
of
Snell,
survey
nine
Neel,
of two
and
thousand
by
local
physicians
or
hospitals.
those
bone
bomb
survey
Nagasaki.8
Nagasaki
and
of atomic
by
Commission
Only
blood
medical
and
certificates.
with
the
Casualty
and
surveys
a hematologic
in 1947-1948
during
Hiroshima
in Hiroshima
death
hematologic
during
studied
six
Bomb
history
and twenty-four
in nonexposed
anyone
cases
marrow
is
Laboratories
of
sponsored
by
Research
in
further
the
11, 1953;
August
cases of leukemia
individuals.
The
present
Exposure
of Sciences-National
Energy
and
four
in which
smears
there
was
available
for
adestudy
included.
to
was
1949,6,
Atomic
through
radiation
follows:
originally
survivors
the
doctors
were
report,
From
adult
to
as
medical
discovered:
survivors
In all, one hundred
exposed
and forty-nine
atomic
been
Hiroshima
and
authors
were
routine
have
eighty
Conimission
cases
during
referred
by
quate
leukemia
encountered
the
Atomic
of
for
Atomic
Council,
by
Bomb
accepted
the
cities
qualified
were
term
Hiroshima
the
Bomb
of
Nagasaki
distance
Commission,
during
from
the
Hiroshima,
Commission,
supplied
among
in this
the
hypoJapan.
10, 1954.
February
Casualty
funds
and
factors
Casualty
publication
with
studied,
seventy-five
“exposed”,
as used
by
the
National
United
Academy
States
Atomic
Commission.
authors
wish to acknowledge
the fact that this study
would
not have
the assistance
of many
American
and Japanese
physicians
in Hiroshima
too numerous
to list by name.
We wish especially
to mention
Dr. William
the
University
Atomic
Bomb
of
Casualty
California
at
Commission
Los
Angeles
gave
who
marked
study.
574
in
his
assistance
capacity
in the
as
been
possible
and
a consultant
earlier
Naga-
N. Valentine
phase
to
the
of this
From www.bloodjournal.org by guest on June 17, 2017. For personal use only.
R.
D.
LANGE,
1.-Cases
TABLE
W.
C.
MOLONEY
of
0-999
birth
Pop.
from
1000-1499
575
YAMAWAKI
and Prefecture
hypocenter
by Age and
in meters
1500-2499
Pop.
‘
T.
in Hiroshima
City
Exposure
Distance
of Leukemia
Distance
Date
AND
Over
Pop.
2500
Total
Pop.
Pop.
Male
1941-1945
39
1936-1940
32
1926-1935
157
1916-1925
1896-1915
1895 &
before.
.
.
Total
1
2,257
528
406
1
1,826
1
1,424
4
5,117
91
3
662
273
1
2,020
105
1
697
7
3,843
1
6,667
2
2,946
5,210
2
7,343
14,041
5
5,679
16,261
5
6
2,063
2
2,863
4
5,808
1
8,160
1,019
1
3,492
6,059
10
20,563
1
4,692
1
9,308
3
4
29,847
2
57,166
23
1
Female
1941-1945
39
1936-1940
29
3,687
6,579
5
1,734
2,998
5,139
2
6,854
14,160
6
5,935
11,941
7
20,011
6
10,045
3
5,321
239
1,454
2
4,313
184
1
2,386
4
7,808
62
1
1
3,672
1
5,312
893
9
15
25,138
4
34,413
1
67,875
29
1
1
7,524
5,944
1
13,246
10,349
28,201
7
4
11
1896-1915
Total
2,290
1
3
1916-1925
.
4
378
1,645
340
before..
569
3
3
1926-1935
1895 &
1
999
7,431
2
9,633
1
Combined
1941-1945
78
1
1,097
4
4,547
1936-1940
61
1
784
2
3,560
1926-1935
497
4
3,069
7
10,438
1916-1925
330
6
2,116
2
6,376
4
8,798
17,620
12
1896-1915
457
2
4,406
8
13,616
1
17,793
1
36,272
12
167
2
2,018
2
7,164
1
10,004
1
19,353
6
1,590
16
45,701
8
64,260
3
125,041
52
and
a history
1895
&
before...
Total
center,*
shielding,
radiation
sickness
The
same
formation
methods
concerning
following
the
of study
the
13,490
25
of the
presence
14,197
of
or absence
complaints
indicative
of
bombing.
were
nonexposed
used
cases
for
both
the
is included
nonexposed
in this
and
report;
exposed
however,
groups.
the
In-
are
in regard
data
not used in a comparative
analysis
because
of the differences
in the two groups
to age and sex.
An estimation
of the surviving
population
presents
many
difficulties
mainly
because
movements
of survivors
to and from the cities
makes
the determination
of the number
of
survivors
conjectural.
In 1949 the Commission
to determine
the numbers,
age, sex, and distance
siding in the cities of Hiroshima
and Nagasaki,
were
98,265
*
The
survivors
hypocenter
in Hiroshima
is that
point
and
96,962
on the
ground
carried
from
from
out
a radiation
the
hypocenter
which it was
survivors
immediately
in
census
Nagasaki.
below
in an
of the
determined
In
the
attempt
survivors
rethat
there
1950,
during
the
bomb
burst.
From www.bloodjournal.org by guest on June 17, 2017. For personal use only.
576
LEUKEMIA
IN
2.-Cases
TABLE
ATOMIC
BOMB
0-999
of birth
from
1000-1499
Pop.
I
in Nagasaki
City and Prefecture
Exposure
Distance
of Leukemia
Age and
Distance
Date
SURVIVORS.
hypocenter
in meters
1500-2499
Pop’
by
2500
Over
Pop.
Total
Pop.
Pop.
Male
1941-1945
24
147
2
614
1936-1940
1926-1935
34
105
119
706
1
1
596
1,359
1
1
1916-1925
104
314
1
444
2
3,305
1896-1915
122
605
1
10,417
1895
before
&
Total
1,178
172
29
418
5,372
701
2,063
6,674
4,892
5
6,157
5,460
11,478
5
42,706
2
1
6,209
13,648
4,167
3
3
1
12,322
7,576
4
1
5
2
3
50,079
15
Female
635
1
5,412
1
6,213
2
1941-1945
37
129
1936-1940
36
136
1
631
5,350
6,153
1
1926-1935
189
873
2
1,491
11,786
14,339
4
1916-1925
83
507
1,114
10,290
1
1896-1915
71
352
1,697
13,387
39
118
799
7,598
1895
&
before
2
455
Total
2
3
2,115
8,586
6,367
1
1
15,507
8,554
52,119
2
1
61,056
8
-
Combined
1941-1945
61’
276
2
1,249
1
10,784
1936-1940
70
255
2
1,227
1926-1935
294
3
2,850
1
1
10,810
23,264
1916-1925
187
193
821
957
1,558
2
11,891
2,875
1
23,804
68
290
14,272
94,825
1896-1915
1895 & before
Total
873
Japanese
were
National
from
this
prefectures
of Hiroshima
Japan.
Since the leukemia
cities
of Hiroshima
calculate
the
and
sex
the
figures
and
combined
of survivors
for
survivors
of the
city
supposition
information
cities
(see
to
the
1,500
4,178
8
as
was
to
the
and Nagasaki
cases reported
Nagasaki
but
1 and
prefecture
in
in
were
the
known
age
and
sex
2).
This
calculation
same
relative
the
which, of course, may
these
but also
in this
survivor
prefectures
in each
included
number
also
not
population
be
6
11,259
a questionnaire
census
tables
is obtained,
1
city-prefecture
in the
the
1,579
2
Census,
obtained
tural
2
category
correct.
estimates
of
for survivors
study
were
an
population.
Since
not
the
were
4
1
16,130
1
7
111,135
23
for
until
only
the
has
figures
cities
been
total
from
to
age,
and
in
and
in other
parts
of
not only in the
the
that
proportions
the
4
attempt
distance
presupposes
are
14,457
27,829
only
expanded
However,
1
3
residing
encountered
prefectures,
but
3
7
survivors
not
4
27,987
1
P
concerning
survivors
12,370
12,362
the
the
survivors
prefec-
moved
and
further
and
ones
available.
to
age,
hypocenter,
include
sex,
made
number,
more
distance,
accurate
out
a
From www.bloodjournal.org by guest on June 17, 2017. For personal use only.
H.
D.
LANGE,
W.
C.
MOLONEY
RESULTS
AND
T.
)d
YAMAWAKI
I
STUDIES
OF
Sex
Of the seventy-five
there
were
thirty-eight
exposed
tables
exposed
males
cases
there
were
1 and 2, in certain
thirty-one
age groups
the
numbers
of males
Hiroshima
data
showed
the atomic
bomb
of the twenty-four
until
1942
tional
occurred
occurrence
and
no
survivors
cases
exposure
in
cases of leukemia
and thirty-seven
and
were
in figures
1, 2, and 3,
of the forty-nine
non-
eighteen
relatively
females.
However,
influence
of sex 011 the
females.
marked
a statistical
occurrence
of that city. This is of some
of leukemia
following
radiation
males.’
of males
This
since
of leukemia
males
there
as shown
females;
the
following
was
undoubtedly
present
the
exposure
analysis
of leukemia
importance
exposure
due
study
As shown
differences
to the
shows
no
iii
of the
among
since twenty
reported
up
increased
sex
in
occupa-
difference
the
in
to radiation.
Age
An analysis
hitherto
not
tion
has
been
of the age
been possible
influence
on the leukemogenic
effect
since all of the prior cases of leukemia,
of radiation
have
the
implicated,
occurred
adults
in
and
were
in
in
has
which
radia-
nature
of
an
occupational
hazard.’-3
The age at death
or the present
age of living
individuals
in this series
is graphically
shown
in figure
4. (It should
be noted
that
the age
recorded
here differs
from
that
in tables
1 and 2, where
the date
of birth
is re-
N
EIPOUO
0701
003
J1STAN
1500
7431
2113$
20047
54210
17075
125041
1’..
1.-Distribution
survivors
I34
43701
134U3[
57111
of
A
S
S
0
P
L
U
I
#{163}
U
I
A
.,I
III
loll
10513
FIG.
C
I
solo
population
HA
NI
TOTAL
uAL#{128}TvFuALtrT.TALS
D..,._..
SOS
POPULATION
1400
2400
IOI523
:::
$
21
UALE
23
FEIALU
20
TOTAL
52
I,p.
of leukemia
in
Hiroshima
cases
City
by
and
distance
Prefecture.
from
the
hypocenter
compared
to
From www.bloodjournal.org by guest on June 17, 2017. For personal use only.
578
LEUKEMIA
IN
ATOMIC
BOMB
NAG
A
#{163}XP.IUOP.PVLATI:N
SA
SURVIVORS.
I
UI
)ISTAF#{128}t
CASUS
OP
TOTALS
LUVIUUIA
:..
21*5
417$
$307
1121$
::::
:::
szno
5007$
FIG.
2.-Distribution
population
of
corded.)
Ill
age ; sixteen
cases
By
survivors
the
of 1 and
cases
in
cases
40
5 aiid
the
of
leukemia
cases
by
Nagasaki
City
and
series
In
five
cases
the
in table
patient
to 59;
of
that
The
reason
chaotic
in the
cal analysis
strates
that
of the Hiroshima
the leukemogenic
other
to
9 years
6 to
cases
age
30
groups
and
serve
discrepancy
lack
to
of
39 ; nine
age of 60.
the ages
there
were
the sex differences
as proper
group
for exposed
of radiation
ill
or
were
the
in the
of medical
before
included
indicates
that
young
mice
effects
of radiation.9’
radiation
has been limited
data
effect
compared
leukemia,
incidence
available
exposed
hypocenter
occurring
after
the
sixteen
cases
between
young
infants
of survivors
been
the
of
groups
and
is
have
23
six
20 to 29; four cases 30 to 39; four
three
cases
beyond
the age of 60.
comparative
most
lack
leukemia
reported
the
age
for the
3 could
work
leukemogenic
following
1
29 ; thirteen
were
and
conditions
Experimental
ones to the
with leukemia
cases
this series cannot
in
discussion
3. Another
of the
information
concerning
patient
younger
than
youngest
50
indicates
bombings.
1
TOTAL
$
from
cases
there
disproportionate
individuals
because
group;
PEOALU
to
five
6 to 9.
in any
ent;
ten
20
59 ; and
from
five cases
information
prior
to the
to
were
cases
cases
the nonexposed
shown
50
0
Prefecture.
series
exposed
Recent
cities
there
15
distance
nonexposed
19 age
from
groups
UALE
in
cases
six
10 to
to 49;
It is obvious
111*35
10 to 19 ; fourteen
40 to 49 ; eight
contrast,
in the
2
3
3127
01051
exposed
cases
2
1948
in
was
this
6 years
of
evacuated
lowest
age
age
groups
facilities,
leukemia.
from the
group
is
is apparno reliable
and
therefore,
no
series.
Actually
the
than
older
of age.
are more
sensitive
‘#{176}
In humans,
prior
to adults.
However,
cases
based
is manifested
for the
controls
type
that
on
table
in all
experience
a statisti1 demonage levels
From www.bloodjournal.org by guest on June 17, 2017. For personal use only.
B.
D.
FIOALF
1117
0*22
2463
954A
7660
3*303
72553
06332
C.
MOLONEY
AND
0 S
C
F
5
0
F
L
T.
F
A
A
F
0
1
579
-
YAMAWAKI
0
TOTAL
340
25435
W.
o,snsri
POP LLATIO’.
APOSIS
OAI.F
N
I
7
IllS
::::
033
36960
-
39003
3.-Combined
Fie.
LANGE,
#{176}#{176}
data
on
7
cases
of leukemia
in hiroshima
and
3
0
Nagasaki
Cities
and
Prefectures.
0
0
4
2
2
6
4
3
2
5
4
.
4
4
.
4
3
2
5
ftft$$$$
IUft!
this
younger
in
Type
of
The
9
?ft#{149}
o#{149}’
of exposed
series
and,
individuals,
5
‘#{176}‘
,,$
..L
I
j$
3
0
.11_I
cases
by
that- there
is no
the data
collected
from
9
224
ttmsd nonexpose(l
further,
‘4
Ii
72
5059
of leukemia
manner
into
acute,
type
of leukemia
subacute,
subacute
to ascertain
oc(urrmg
as myelogenous,
subdivided
cases are further
and
5
S
age
and
increased
thus
sex.
susceptibility
far.
Leukemia
types
accepted
IS
ft$$$$$
30#{149}39
2
ill
apparent
0
2
$$$$$$$$$$$$
#{149}O29
4.-Distribution
represented
6
9
H$t?
I
FIG.
4
69
lQl9
6
2
.
$.3
16
and
found
leukemias
the
in this
seiies
lymphatic,
according
been
classified
and
maturity
and duration
figure
5, which
graphically
In
the exposed
and
nonexposed
are combined.
In seven
cases it was
in
cell type,
and
were
these
the
in
usually
cell.
reticulum
cell
to
chronic.
have
monocytic,
of tile
The
disease,
portrays
the
the
populations,
not possible
listed as acute
leukemia,
exposed
there
acute
definitely
type
un-
specified.
It
cases
may
of
be seen
chronic
cases
of acute
cases
of acute
cases of acute
from
figure
5 that
myelogenous,
lymphatic
leukemia,
reticulum
leukemia.
type
cell,
and
In the nonexposed
leukemia,
fifteen
groups
there
cases
of acute
myelogenous
acute
and
only
and
two
cases
11
twenty
of
group
acute
Of tile remaining
unspecified,
only a
three
single
lymphatic
lymphatic
case
cases
of
one
leukemia,
case
of acute
leukemia.
are
myelogenous,
twelve
twenty-three
were
monocytic,
of chronic
tile
cases
cases,
of acute
chronic
cases
four
were
monocytic,
six
two
leukemia.
acute
cases
leukemia,
twelve
there
lymphatic
of
thirty-one
and
myelogenous
each
tyl)e
of
chronic
unspecified,
From www.bloodjournal.org by guest on June 17, 2017. For personal use only.
580
LEUKEMIA
IN
3.-Population
TABLE
ATOMIC
BOMB
of Hiroshima
Total
Male
Total
19274
15431
18419
15036
1()-14
12022
11905
13146
Male
-
37693
30467
I
1950
survivors
Female
3
,
Total
-
3
5641
Male
6
5614
4545
4501
27794
4683
4291
30871
4671
6300
14239
26779
1500
4991
11461
21904
2090
4337
10172
20442
2463
4441
9965
10771
11040
9129
12540
30-34
10443
35-39
40-44
10270
8441
8163
16604
2800
4467
7267
45-49
6980
5658
3967
2888
3163
3408
2597
7391
55-59
60-64
65-69
2022
13661
10897
7861
6138
4656
4228
50-54
70-74
1269
6681
5239
3894
325()
2634
2029
75-79
531
80-84
‘
1680
3554
‘
678
507
746
155
328
68
180
248
57
130
Unknown
29
17
46
4
9
The
above
marked
observations
difference
are
in the
types
doubt
related
myelogenous
and comprised
has been
one case of chrome
of t-he reasons
in the
cases
for
the
lack
discussion.
A fourth
in the exposed
group
exposed
group
were
chrome
Incidence
The
fort-y-three
42591
‘
noteworthy
55511
for
the
of interest
acute
and
is that
thirty-two
of t-he forty-nine
cases
13538
3696
in
this
1933
1556
592
263
61
8
First
not
187610
,
there
cases.
acute
and
by
the
there
in
group.
be
of the
while
chronic,
matched
Thirdly,
will
is a
groups,
reported
exposed
series
33
-
87989
are
1174
-
unexposed
foi.ty-three
were
2653
50
type
the
:3935
1283
1 103
980
802
421
179
99621
respect-s.
in
6270
1685
11
and
9337
2453
25
to the fact that
t-he two groups
leukemia
was the most
frequent
fifty-one
of the seventy-five
point
were
5731
13
exposed
lymphatic
leukemia
of lymphatic
leukemia
15477
7807
5641
187
98102
in several
recorded
but this is nO
age. Secondly,
exposed
group
only
285712
20288
7124
1370
4205
830
31(X)
576
2124 ‘
372
1088
171
483
84
-
19900
9248
2250
‘
18820
‘,
8353
3817
6962
239
,
8855
5208
1227
410
,
6904
85 & over
143500
6427
‘
1654
19212
14881
8974
10971
6491
25-29
2058
37687
9422
7404
15429
1446
897
Total
7477
15442
2611
2147
________
9046
14648
142212
population
18416
9790
,
15-19
Total
Sex
Female
19271
11255
23927
3298
and
Unexposed
20-24
1099
by Age
________________________
_______
-
Female
0-4
5-9
in October
A-Bomb
-
Age
City
SURVIVORS.
Some
presented
seventy-five
in the
nononly
six
cases
t-he
diffi-
of Leukemia
determination
of the
incidence
of leukemia
is complicated
by
culties
in the estimation
of the number
of survivors
and the lack of information
regarding
the amount
of radiation
each survivor
received.
This
has been
partly
overcome
by the determination
of the dist-ance
from the hypocenter,
degree
of
shielding,
and a careful
evaluation
of the radiation
complaints
occurring
after
the
bombing.
The total
are
1, 2, and
a fixed
but
number
of cases
of leukemia
which
have
occurred
in tables
1 and 2, and graphically
3. It is emphasized
that
the figures
represent
population
exposed
cannot
given
population
increase
which
its Ilumbers
theoretically
as in a normal
can
only
population.
ill
relation
to the
represented
in figures
a five year compilation
in
decrease
In the
t-hrough
2463
death
survivors
From www.bloodjournal.org by guest on June 17, 2017. For personal use only.
B.
D.
LANGE,
W.
C.
TOTAl-S
NON
1Iji
3
MOLONEY
TOPI
LFI6FNIA
EUPOSPO
AND
T.
581
YAMAWAKI
TOTALS
OP
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S
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206
22
::___________
U0LE
Fn;.
3)
F0l0LI
5.-Types
exposed
of leukemia
under
1000
covered.
thirty-three
Among
cases
fourteen
cases
sixty-five
occurring
30
NAtE
in one
Since
thus
leukemia.
of leukemia
110 significant
2500
hundred
IINAU.
and
37
73
TOTAL
twenty-four
exposed
of leukemia
have
and
11015-
that
the
posure
must
complaints
best
evidence
questionable
variation,
tion
The
wit-h leukemia
exposed
under
value
thirty-three
nificant
of
in
such
pointed
meters
1000
there
patients
exposed
radiation
complaiiit-s,
meters,
nine
from
exposed
had
may
ing w’as a factor
in t-he
meters.
Of the eighteen,
eighteen
eleven
so
to
complaints.
biologic
Moreover,
LeRoy
in
by
acute
radia-
individuals
all eighteen
twenty
between
In contrast,
patients
Japanese
evidenced
Of
complaints.
radiation
at the
to
individual
exposed
1499 meters,
patients
the
owing
of the
4. In
in cx-
represent
as
radiation
had significant
whether
shielding
is less
However,
the
in
table
difference,
radiation
bomb,
as
a
distance
as a factor
symptoms
in
four
a
of
and
Typical
depression,
significant
asymptomatic
‘ere located
combined
large
equivocal.
complaints
in their
population,
atomic
well
have
analysis
the
hypocenter
be
is shown
radiation
2500 meters
to evaluate
among
meters
total
groups
were
of radiation.
that
bone marrow
absence
of other
patients
exposed
beyond
An attempt
was made
cities
to the
as
were
or age
absorption.
between
1000
and
and of t-he fourteen
significant
disw’ere
and
there
in a statistical
the
amount
and
cities,
a homogeneous
radiatioll
radiation
analyzed
sexes
of leukemia
of obtaining
from
information
significant
been
been
under
2500
in the combined
in both
the
history-taking,
out
in the
even
survived
of radiation
from
both
incidence
probability
was
survivors
while
date,
between
actual
who
of
have
occurred
has
who
of a significant
12
syndrome.
presence
to
derived
by
accuracy
the
76,891
to distance
qualified
in an illdividual
available
and others”
leukopenia,
the
are
attributed
be
the
effect
cases
in the
cases
found
existed
leukemogenic
the exposed
groups
than
.001.
The significance
eighteen
between
1000
and
1499
meters
there
1500 to 2499 there
were 56,960
survivors
meters
differences
to the
data,
significant
difference
was found.
In fact,
granting
far
Thus,
in
have been
people
beyond
ten cases.
suscept-il)ility
the Hiroshima
highly
groups
meters,
17,568
survivors
and in the zone
of
cases
of 159,285
beeii only
2499
EII
49
TOTAL
individuals.
exposed
the
1$
had
1500
none
complaints.
time of the
exposed
style
under
houses
cases
the
sig-
and
of t-he
bomb2500
which
From www.bloodjournal.org by guest on June 17, 2017. For personal use only.
582
LEUKEMIA
4.-Type
TABLE
IN
of Leukemia
ATOMIC
BOMB
Related
Complaints,
to Distance
and Sex
Distance
0-999
.
Type
I
from
Hypocenter,
from hypocenter
5000-1499
Radiation
in meters
5500-2499
2500-over
of leukemia
NRC
Chronic
myelogenous
myelogenous
Chronic
lymphatic
F
M
5
5
2
4
5
4
1
3
1
2
3
-
-
-
2
1
-
2
1
1
-
-
-
-
-
F
-
monocytic
type?
-
-
-
-
1
1
-
-
1
1
-
-
Total
-
-
No
radiation
SRC
1
-
F
M
2
2
NRC
SRC
M
F
-
F
1
1
-
-
2
1
4
-
2
1
2
M
F
-
-
-‘
-
1
2
-
--
-‘
1
1
-H7116
N R C
M
M
-
lymphatic
reticulum
F
NRCI
-
Acute
Acute
M
SRC
-
Acute
Acute
NRC
SRC
M
Acute
SURVIVORS.
‘
1
1
-
-
-.
-
-
1
-
1
37
-
-
-
1
-
-
3
-
-
-
complaints
S R C Significant radiation complaints
IT
3
OSSIT
5
S
‘1,
‘1
01
FIG.
the
of
would
have
but was
radiation.
ized
been
Date
In
of exposed
was
in
the
impossible
and
7
nonexposed
37
TOTAL
‘
T5
by year
cases
‘
of onset.
In two
cases,
known.
a minimal
his
fact-or
the
4
amount
of shielding.
One
individual
was
in a train
by the concrete
station
which
probably
offered
protection
from
individual
was in a steel frame
workshop
covered
by galvan-
However,
open
cases,
of
not
offered
shielding
maining
Ift$$$IIIIIHIIIIII
‘“‘
IIIfl$I$$
shielded
Another
metal.
of the
3
921
o11:
onset
7I2
950
IIU$$,,,
6.-Distribution
date
tIIIII
*949
U;$I$$ft
5lO
5’
LSPOSLD
exact
and
position
in the
be determined.
cannot
therefore
presumably
information
shop
Only
was
three
completely
on shielding
was
not
unknown
so the
people
were
extent
said
to have
In two
re-
unprotected.
available.
Onset
cases
to
of leukemia
delineate
doses
of radiation
interest
therefore
individuals
had
in figure
6, five
the following
1949, twenty-one
previously
a ti’ue
described
latent
since
period
among
the
radiologists,
exposure
absorbed
over a long
period
of time.
to note the dates
of onset- of leukemia
a brief
cases
years
single
of leukemia
t-here
cases
ill
exposure
dated
t-o
the
ionizing
onset
radiation
of their
it has
been
of
small
consisted
It becomes
of particular
in this series,
ill
since these
1945.
symptoms
were twelve
cases wit-h the onset
in 1948,
1950, nineteen
cases
in 1951, and
eleven
As shown
in 1947.
seven
cases
cases in
In
in
1932.
From www.bloodjournal.org by guest on June 17, 2017. For personal use only.
R.
In this
1950,
LANGE,
W.
C.
series it is noteworthy
that
five years
following
exposure.
which
ill
D.
the
onset
of
MOLONEY
AND
the largest
Actually
symptoms
was
in
T.
583
YAMAWAKI
number
of cases
some cases have
1952,
but
these
had
been
cases
their
seen
onset
not
included
are
in
in
1953,
since
this report
covers
the material
seen
from
1948 through
1952.
Cases
of
leukemia
have been reported
as occurring
before
1947, but it has been impossible
to authenticate
these
reports;
therefore
these
cases are not included.
It should
be noted
that
owing
to the attendant
publicity
and heightened
interest,
the
diagiiosis
of leukemia
exposed
has
population
been
recent
in
made
with
years
increasing
(see
fig.
frequency
among
the
non-
6).
DISCUSSION
Recently
Furth
occurring
that
was
and
in both there
leukemogenic.
irradiation
the concept
agent
support
and
the
more
pointed
‘4
.
mice
out
to leukemia
is ample
evidence
In mice
it was
was high
(200
that
gamma
r). The
radiation
the
similarities
in atomic
of leukemia
animals,
frequently
is directly
related
leukemogenesis
in younger
The distribution
well established
of
cases
recently
Scotland,
chronic
However,
ill
enous
of types
pattern
published,
leukemia
leukemia
occurring
was
myelogenous
one
mice.
most
leukemia
from
increase
marrow.
However,
lymphatic
unwarranted
of cases
have
these
a greatly
irradiated
been
presented
in this
paper
been
missed
undoubtedly
the
bomb
in atomic
survery
States
and
occur
most-
(41
(26 per
material
probably
exposed
population.
population
many
other
Another
potential
other
date
cases
obvious
cases
have
fact
of leukemia
acute
one
exposed
to postulate
fact, it seems
t-o radiation.
Cases
omitted
Some
cases
is that
perished
on
t-hat
series.
Inthat
chronic
of this
activity
been
case
cases.
that
effect
of radiation
it was noted
figures.
diagnosis.
1947, and
.
w’ith
only
the nonexposed
the suspicion
minimum
from
myelog-
worthy
of further
investigation.
of leukemia
has been found,
the
t-o confirm
the
occurred
before
out
commonly.”
cent),
To
seen in the seventy-five
it would
he t-empting
in reality
and
the
chronic
per
cent).
rare ill .Japan.
In view
myeloid
leukemogenic
are
also
that
bomi)
survivors,
w’as also infrequent
in
hematologists
confirmed
findings
are certainly
increased
incidence
the lack of adequate
in the exposed
group
among
to
encountered
leukemia
is comparatively
to ascribe
a preferential
Nevertheless,
Although
United
found
in frequency
leukemia
Japanese
data
and
but it was pointed
bombings
and few
of myelogenous
leukemia
was due to t-he direct
However,
while
the groups
are not comparable,
chronic
lymphatic
quiry
made
among
These
is high
series was markedly
dissimilar
to
populations.
In two large series
atomic
frequently
second
of chronic
lymphatic
leukemia
has
In view of this myeloid
preponderance,
the
the
the
was
among
of
to the amount
of irradiation
received.
is influenced
by age, and leukemia
oc-
irradiated
leukemia
state
to irradiation
dose
on leukemia
in survivors
support
energy
was the chief
leukemogenic
of leukemia
in this
occurring
in Western
lymphatic
They
that a single
massive
exposure
found
that
the leukemia-producing
observations
of high
leukemia
survivors.
vivors,
leukemia
occurred
in all age groups
represented
that
infants
were evacuated
from the cities
prior
to the
young
children
were exposed
to atomic
radiation.
the
between
bomb
that
a single
massive
dose produces
leukemia
in man.
premise
that
the leukemogenic
dose of irradiation
the incidence
In experimental
curs
Upton’3
irradiated
ill
number
of leukemia
because
cases
of leukemia
are still appearing
among
the
in the
heavily
bombing
of
From www.bloodjournal.org by guest on June 17, 2017. For personal use only.
584
LEUKEMIA
IN
ATOMIC
BOMB
SURVIVORS.
or subsequently
died
of other
causes.
incidence
of leukemia
has been obtained
Ancillary
in the adult
and Nagasaki
of wo thousand
of leukemia
randomly
1500 meters.
in an equal
where
a total
five hundred
This
number
from
a hematologic
there
have
survey
been
cases,
is an incidence
of nonexposed
survey
four
on
the
of ionizing
irradiation
curately
the latent
very
blood
early
of nine
hundred
occurrence
carried
of chronic
in
out
3.
on
bomb
Hiroshima,
data
on these
are presented
The
striking
be
preponderance
cases
massive
this
of
reported
in
dose
more
acMoreover,
detection
hematologic
of
and
a
leukemia
are presented.
in the incidence
of radiation
to chronic
lymphatic
leukemia
has
point-ed
out that
chronic
lymphatic
estimate
in man.
in the
The
will
established
in
to
massive
of
bio-
subsequent
CONCLUSIONS
AND
to a single
effects
represent-ed
a single
resulted
leukemia.
bomb
radiation
a great
increase
due
following
cases
seventy-five
survivors
The leukemogenic
at all age levels
4.
in
individuals
of 1 : 225. The
the samples,
on survivors
preclinical
people
exposed
to atomic
2. These
data
indicate
and
epilated
opportunity
leukemia
myelogenous
these
Observations
atomic
been no cases
sex. Similarly,
incidence
of choosing
a unique
radiation-induced
SUMMARY
.
an
have been found
in a sample
selected
adults
exposed
under
1 :400.
There
have
of the same age and
of leukemia
presented
period
of
examinations
cases
chemical
studies
communication.
I
roughly
controls
information
concerning
the
medical
survey
in Hiroshima
report.8
Observations
routine
of
cases of leukemia,
wit-h the method
together
in another
of six cases
and eighty
I
are
occurring
in
of leukemia
exposure
to ionizing
manifested
equally
among
radiation.
in both
sexes
series.
chronic
been
myelogenous
noted
in
leukemia
leukemia
exposed
compared
individuals
is comparatively
but
rare
it
among
is
the
Japanese.
5.
since
Cases
1950
of leukemia
are still appearing
there
has been a steady
decline
SUMMARIO
Le presente
superviventes
esseva
reportate
e april 1952
Le
1. Le
2.
sexos
3.
insimul
con
39 casos
resultante
exposition
e non
unic
effectos
e a omne
repetite
Es
notate
Nove
casos
leucemiogene
etates
un
del
representate
frappante
lymphatic
augment-a
a un
massa
radiation
continua
le numero
tot-al
a 75.
radiation
es equalmente
ha
ionisante
atomic
de
de leucemia.
Hiroshima
mallifeste
e
ambe
in
iste serie.
preponderantia
chronic,
de
bombardamentos
del frequentia
ill
es comparativemente
de leucemia
que
es:
le superviventes
del
in un grande
augmentation
Le
INTERLINGUA
additional
del studio
inter
super
leucemia
lymphatic
chronic
4.
IN
However,
studio
consiste
de un revist-a
del 36 casos establite
de leucemia
in
del bombardamentos
atomic
de Hiroshima
e Nagasaki
le quales
al Commission
pro le Victimas
de Bombas
Atomic
inter
1948
observationes
resultate
Nagasaki
in atomic
bomb
survivors.
in t-he number
of cases.
de
sed
on
rar
revelar
debe
leucemia
rememorar
myelogene
se
que
chronic
leucemia
in Japoneses.
se
inter
le superviventes
del
bom-
From www.bloodjournal.org by guest on June 17, 2017. For personal use only.
R.
bardamentos
numero
ha
D.
LANGE,
W.
C.
MOLONEY
atomic.
Nonobstante,
essite
notate.
ab
AND
1950
T.
continue
un
585
YAMAWAKI
decrescentia
de
br
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5 DUNLAP,
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the
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34: 562-608,
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by
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282-286,
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J.
FOLLEY,
H.,
the atomic
T.:
YAMAWAKI,
Hemat.
control
8 MOLONEY,
tions
FURTH,
‘#{176}LORENZ,
Rad.
J.
NEEL,
two
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atomic
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on
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AND
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From www.bloodjournal.org by guest on June 17, 2017. For personal use only.
1954 9: 574-585
Leukemia in Atomic Bomb Survivors: I. General Observations
ROBERT D. LANGE, WILLIAM C. MOLONEY and TOKUSO YAMAWAKI
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