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Tamburacı Uslu ZD, Ekici F, Yalçın K, Küpesiz A, Güler E, Dönmez L. The serial changes in myocardial functions after paediatric haematopoietic stem cell transplantation. Cardiol Young 2023; 33:1606-1613. [PMID: 36102124 DOI: 10.1017/s1047951122002712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The aim of this study is to evaluate the changes in myocardial functions in children who underwent haematopoietic stem cell transplantation along with associated chemotherapy. Additionally, we evaluated the effect of baseline echocardiographic parameters on mortality. We evaluated 39 patients (mean age 7.4 years) who underwent haematopoietic stem cell transplantation owing to non-malignant disease. The control group included 39 healthy children who had normal cardiac findings. The myocardial functions were evaluated in all subjects by conventional echocardiography and tissue Doppler echocardiography before haematopoietic stem cell transplantation and in the 1st, 3rd, 6th, and 12th month after haematopoietic stem cell transplantation. All patients had normal left ventricular ejection fraction before haematopoietic stem cell transplantation, except one case. Before haematopoietic stem cell transplantation, the patient group had significantly greater mean pulmonary artery pressure and lower tricuspid valve annular plane excursion rate. Baseline E' velocities for mitral lateral annuli, septum, and tricuspid lateral annuli were lower in the patient group than the control group. The E' velocities for the left ventricle decreased in the patient group after haematopoietic stem cell transplantation, and then returned to baseline levels at the 6 months. E' and S' velocities for tricuspid lateral annuli also decreased after haematopoietic stem cell transplantation and were still depressed in the first year after haematopoietic stem cell transplantation. Baseline E' velocity for septum was significantly lower in patients who died after haematopoietic stem cell transplantation than patients who survived (p = 0.009). Subclinical impairment in both ventricular functions was observed after haematopoietic stem cell transplantation and the right ventricular functions were affected for longer periods than left ventricle after haematopoietic stem cell transplantation. The myocardial functions should be monitored after the first year of haematopoietic stem cell transplantation.
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Affiliation(s)
| | - Filiz Ekici
- Pediatric Cardiology, Akdeniz University Hospital, Antalya, Turkey
| | - Koray Yalçın
- Pediatric Hematology, Akdeniz University Hospital, Antalya, Turkey
| | - Alphan Küpesiz
- Pediatric Hematology, Akdeniz University Hospital, Antalya, Turkey
| | - Elif Güler
- Pediatric Hematology, Akdeniz University Hospital, Antalya, Turkey
| | - Levent Dönmez
- Public Health, Akdeniz University Medicine Faculty, Antalya, Turkey
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Viprakasit V, Hamdy MM, Hassab HMA, Sherief LM, Al-Bagshi M, Khattab M, Chuncharunee S, Dung PC, Küpesiz A, Shekhawat A, Sonawane Y, Perez LT, Slader C, Taher AT. Patient preference for deferasirox film-coated versus dispersible tablet formulation: a sequential-design phase 2 study in patients with thalassemia. Ann Hematol 2023:10.1007/s00277-023-05240-3. [PMID: 37227493 DOI: 10.1007/s00277-023-05240-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 04/17/2023] [Indexed: 05/26/2023]
Abstract
Iron chelation therapy (ICT) is the mainstay of treatment in patients with thalassemia requiring blood transfusions. This phase 2 JUPITER study evaluated patient preference between film-coated tablet (FCT) and dispersible tablet (DT) in transfusion-dependent thalassemia (TDT) or non-TDT (NTDT) patients treated with both formulations in a sequential manner. The primary endpoint was patient-reported preference for FCT over DT, while secondary outcomes included patient reported outcomes (PROs) evaluated by overall preference, and by age, thalassemia transfusion status, and previous ICT status. Out of 183 patients screened, 140 and 136 patients completed the treatment periods 1 and 2 of the core study, respectively. At week 48, the majority of patients preferred FCT over DT (90.3 vs. 7.5%; difference of percentage: 0.83 [95% confidence interval (CI), 0.75-0.89; P < 0.0001]). FCT scored better on secondary PROs and showed less severe gastrointestinal symptoms than DT, except in the change of modified Satisfaction with Iron Chelation Therapy (mSICT) preference scores, which were similar for both the formulations. Patients with TDT had stable ferritin levels, while it showed a downward trend up to week 48 in patients with NTDT on deferasirox treatment. Overall, 89.9% of patients reported ≥ 1 adverse event (AE), of which 20.3% experienced ≥ 1 serious AE. The most common treatment-emergent AEs were proteinuria, pyrexia, urine protein/creatinine ratio increase, diarrhea, upper respiratory tract infections, transaminase increase, and pharyngitis. Overall, this study reinforced the observations from the previous study by showing a distinct patient preference for FCT over DT formulation and further supported the potential benefits of life-long compliance with ICT.
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Affiliation(s)
- Vip Viprakasit
- Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok Noi, Bangkok, 10700, Thailand
| | - Mona M Hamdy
- Clinical Research Center, Cairo University, Cairo, 11562, NA, Egypt
| | - Hoda M A Hassab
- Pediatric Department & Clinical Research Center, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Laila M Sherief
- Faculty of Medicine, Zagazig University, Zagazig Sharqia, 44519, Egypt
| | | | - Mohammed Khattab
- Centre d'Hématologie Et d'oncologie Pédiatrique - CHU Ibn Sina Rabat, 10102, Rabat, Morocco
| | | | - Phu Chi Dung
- Hochiminh City Blood Transfusion Hematology Hospital, Ho Chi Minh City, 700000, Vietnam
| | | | | | - Yamini Sonawane
- Novartis Healthcare Private Limited, Hyderabad, India, 500081
| | | | | | - Ali T Taher
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
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Tayfun Küpesiz F, Akınel AN, Akbaş H, Sivrice Ç, Tüysüz Kintrup G, Karagüzel G, Melikoğlu M, Gelen MT, Aydınlı B, Küpesiz A, Güler E. Multidisciplinary Management of Pediatric Hepatoblastoma: A 20-Year Single-Center Experience. Turk J Gastroenterol 2022; 33:1069-1078. [PMID: 36262102 PMCID: PMC9797744 DOI: 10.5152/tjg.2022.21827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Hepatoblastoma is rare cancer that responds well to risk-based chemotherapy, and surgical treatment is needed to achieve complete remission and satisfactory survival rates in hepatoblastoma patients. In this study, we evaluated the clinical features and treatment outcomes of pediatric hepatoblastoma patients treated in our clinic. METHODS Eighteen patients with hepatoblastoma who were treated and followed up in our center between June 1999 and June 2020 were analyzed retrospectively. All patients were evaluated by a multidisciplinary team and managed using a risk-based protocol (SIOPEL-1 and SIOPEL-3). RESULTS The patients' mean age at diagnosis was 38.33 ± 52.34 months. Sixteen patients (89%) received neoadjuvant chemotherapy, and 2 patients (11%) who underwent complete mass excision at diagnosis received adjuvant chemotherapy. After neoadjuvant therapy, the tumor was completely resected in 8 patients (45%), while liver transplantation was performed in 6 patients (34%) because complete resection of the tumor was not possible. Two patients died before surgical treatment. One patient relapsed with lung metastasis after salvage chemotherapy. She is alive without disease at 64 months. The mean follow-up time was 59.3 ± 49.8 months; 5-year overall and disease-free survival rates were 88.9% and 80.8%, respectively. The 5-year overall survival rate was 100% for both liver transplant and resected patients, whereas 5-year disease-free survival was lower in transplant patients (75% vs 100%, P < .001). CONCLUSION Multidisciplinary follow-up is especially important for patients who may need liver transplantation. Some patients may benefit from new treatment options such as radiofrequency ablation and cyberknife treatment.
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Affiliation(s)
- Funda Tayfun Küpesiz
- Division of Pediatric Hematology, Oncology and BMT, Department of Pediatrics, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Ayşe Nur Akınel
- Division of Pediatric Hematology, Oncology and BMT, Department of Pediatrics, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Hilal Akbaş
- Department of Hematology-Oncology, Clinic of Pediatrics, Konya City Hospital, Konya, Turkey
| | - Çiğdem Sivrice
- Division of Pediatric Hematology, Oncology and BMT, Department of Pediatrics, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Gülen Tüysüz Kintrup
- Division of Pediatric Hematology, Oncology and BMT, Department of Pediatrics, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Güngör Karagüzel
- Department of Pediatric Surgery, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Mustafa Melikoğlu
- Department of Pediatric Surgery, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | | | - Bülent Aydınlı
- Division of Organ Transplantation, Department of General Surgery, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Alphan Küpesiz
- Division of Pediatric Hematology, Oncology and BMT, Department of Pediatrics, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Elif Güler
- Division of Pediatric Hematology, Oncology and BMT, Department of Pediatrics, Akdeniz University Faculty of Medicine, Antalya, Turkey,Corresponding author: Elif Güler, e-mail:
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Akarsu A, Halaçlı S, Tan Ç, Kuşkonmaz B, Küpesiz A, Çetinkaya D, Sanal Ö, Tezcan İ, Çağdaş D. A single-center study points to diverse features and outcome in patients with Hyperimmunoglobulin M Syndrome and Class- Switch Recombination defects. Scand J Immunol 2022; 96:e13213. [PMID: 36808635 DOI: 10.1111/sji.13213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 07/03/2022] [Accepted: 08/14/2022] [Indexed: 11/27/2022]
Abstract
Isotype class-switch recombination (CSR), somatic hypermutation (SHM), B cell signalling and DNA repair mechanisms defects are responsible for high IgM. The hyperimmunoglobulin M (HIGM) phenotype and CSR-related defects are now classified under primary antibody defects, combined immunodeficiencies or syndromic immunodeficiencies groups. The aim of the study is to evaluate the diverse phenotypic/genotypic/laboratory characteristics and outcome of patients with CSR defects and HIGM-related defects. We enrolled 50 patients. The most common gene defect was Activation-induced cytidine deaminase (AID) deficiency (n = 18), followed by CD40 Ligand (CD40L) (n = 14) and CD40 (n = 3) deficiency. Median ages at first symptom and diagnosis were significantly lower in CD40L deficiency (8.5 and 30 months, respectively) than AID deficiency (30 and 114 months, respectively) (p = .001 and p = .008, respectively). Frequent clinical symptoms were recurrent (66%) and severe (14.9%) infections, and/or autoimmune/non-infectious inflammatory features (48.4%). Eosinophilia and neutropenia were at a higher rate in CD40L deficiency patients (77.8%, p = .002 and 77.8%, p = .002, respectively) when compared to AID deficiency. Median serum IgM level was low in 28.6% of CD40L deficiency patients. It was significantly lower when compared to AID deficiency (p < 0.001). Six patients (CD40L deficiency n = 4, CD40 deficiency n = 2) underwent hematopoietic stem cell transplantation. Five were alive at the last visit. Four patients two patients with CD40L deficiency, one with CD40 deficiency and one with AID deficiency had novel mutations. In conclusion; patients with CSR defects and HIGM phenotype may present with a wide range of clinical manifestations and laboratory findings. Low IgM, neutropenia and eosinophilia were prominent in patients with CD40L deficiency. Characterization of genetic defect-specific clinical and laboratory features may ease the diagnosis, prevent the underdiagnoses of patients and ameliorate the outcome.
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Affiliation(s)
- Ayşegül Akarsu
- Hacettepe University Faculty of Medicine, Department of Pediatric Immunology, Ankara, Turkey
| | - Sevil Halaçlı
- Hacettepe University, Health Science Institute, Institute of Child Health, Department of Pediatric Immunology, Ankara, Turkey
| | - Çağman Tan
- Hacettepe University, Health Science Institute, Institute of Child Health, Department of Pediatric Immunology, Ankara, Turkey
| | - Barış Kuşkonmaz
- Hacettepe University Faculty of Medicine, Department of Pediatric Hematology, Ankara, Turkey
| | - Alphan Küpesiz
- Akdeniz University Faculty of Medicine, Department of Pediatric Hematology, Antalya, Turkey
| | - Duygu Çetinkaya
- Hacettepe University Faculty of Medicine, Department of Pediatric Hematology, Ankara, Turkey
| | - Özden Sanal
- Hacettepe University Faculty of Medicine, Department of Pediatric Immunology, Ankara, Turkey
| | - İlhan Tezcan
- Hacettepe University Faculty of Medicine, Department of Pediatric Immunology, Ankara, Turkey
| | - Deniz Çağdaş
- Hacettepe University Faculty of Medicine, Department of Pediatric Immunology, Ankara, Turkey
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Kavaklı K, Antmen B, Okan V, Şahin F, Aytaç S, Balkan C, Berber E, Kaya Z, Küpesiz A, Zülfikar B. Gene therapy in haemophilia: literature review and regional perspectives for Turkey. Ther Adv Hematol 2022; 13:20406207221104591. [PMID: 35898436 PMCID: PMC9310332 DOI: 10.1177/20406207221104591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 05/16/2022] [Indexed: 01/19/2023] Open
Abstract
Haemophilia is an X-linked lifelong congenital bleeding disorder that is caused by insufficient levels of factor VIII (FVIII; haemophilia A) or factor IX (FIX; haemophilia B) and characterized by spontaneous and trauma-related bleeding episodes. The cornerstone of the treatment, factor replacement, constitutes several difficulties, including frequent injections due to the short half-life of recombinant factors, intravenous administration and the risk of inhibitor development. While extended half-life factors and subcutaneous novel molecules enhanced the quality of life, initial successes with gene therapy offer a significant hope for cure. Although adeno-associated viral (AAV)-based gene therapy is one of the most emerging approaches for treatment of haemophilia, there are still challenges in vector immunogenicity, potency and efficacy, genotoxicity and persistence. As the approval for the first gene therapy product is coming closer, eligibility criteria for patient selection, multidisciplinary approach for optimal delivery and follow-up and development of new pricing policies and reimbursement models should be concerned. Therefore, this review addresses the unmet needs of current haemophilia treatment and explains the rationale and principles of gene therapy. Limitations and challenges are discussed from a global and national perspective and recommendations are provided to adopt the gene therapies faster and more sufficient for the haemophilia patients in developing countries like Turkey.
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Affiliation(s)
- Kaan Kavaklı
- Division of Hematology, Department of Pediatrics, Ege University Faculty of Medicine, Bornova, 35100 İzmir, Turkey
| | - Bülent Antmen
- Division of Hematology, Department of Pediatrics, Acıbadem Adana Hospital, Adana, Turkey
| | - Vahap Okan
- Division of Hematology, Department of Internal Diseases, Gaziantep University Faculty of Medicine, Gaziantep, Turkey
| | - Fahri Şahin
- Division of Hematology, Department of Internal Diseases, Ege Adult Hemophilia and Thrombosis Center, Ege University Faculty of Medicine, İzmir, Turkey
| | - Selin Aytaç
- Division of Hematology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Can Balkan
- Division of Hematology, Department of Pediatrics, Ege University Faculty of Medicine, İzmir, Turkey
| | - Ergül Berber
- Department of Molecular Biology and Genetics, İstanbul Arel University, İstanbul, Turkey
| | - Zühre Kaya
- Division of Hematology, Department of Pediatrics, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Alphan Küpesiz
- Division of Hematology, Department of Pediatrics, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Bülent Zülfikar
- Division of Hematology, Department of Pediatrics, İstanbul University Faculty of Medicine, İstanbul, Turkey
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Yalçın K, Tüysüz G, Küpesiz FT, Bozkurt S, Küpesiz A, Güler E. Can peripheral blood monocyte percentage and lymphocyte monocyte ratio at diagnosis predict survival in pediatric neuroblastoma patients? Turk J Pediatr 2021; 63:884-892. [PMID: 34738370 DOI: 10.24953/turkjped.2021.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Previous studies have shown that the immune system plays a critical role in cancer pathogenesis. The lymphocyte monocyte ratio (LMR) and monocyte percentage (MP) have been found to be prognostic factors in various types of adult cancers. But studies about pediatric tumors are scarce and to our knowledge, there are no studies evaluating the immune system effect in pediatric neuroblastoma patients. The aim of this study was to assess whether LMR and MP at diagnosis may have an effect on prognosis in neuroblastoma patients. METHODS We retrospectively analyzed MP and LMR at diagnosis in 71 pediatric neuroblastoma patients treated between 2002 and 2016. RESULTS The optimal cut-off values of LMR and MP were determined using the receiver operating characteristics curves (ROC) and area under the curve (AUC). We found that a low LMR (≤3.5) and a high MP (≥7.5%) were correlated with worse overall survival and shorter event-free survival in univariate analysis. Multivariate analysis revealed that elevated LMR was an independent factor for better OS and EFS. CONCLUSIONS In conclusion, LMR and MP might be valuable prognostic factors for predicting OS in neuroblastoma patients. Multicenter and prospective studies are warranted to confirm this hypothesis.
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Affiliation(s)
- Koray Yalçın
- Departments of Pediatric Hematology/Oncology and BMT Unit, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Gülen Tüysüz
- Departments of Pediatric Hematology/Oncology and BMT Unit, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Funda Tayfun Küpesiz
- Departments of Pediatric Hematology/Oncology and BMT Unit, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Selen Bozkurt
- Departments of Biostatistics and Medical Informatics, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Alphan Küpesiz
- Departments of Pediatric Hematology/Oncology and BMT Unit, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Elif Güler
- Departments of Pediatric Hematology/Oncology and BMT Unit, Akdeniz University Faculty of Medicine, Antalya, Turkey
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Hazar V, Tezcan Karasu G, Öztürk G, Küpesiz A, Aksoylar S, Özbek N, Uygun V, İleri T, Okur FV, Koçak Ü, Kılıç SÇ, Akçay A, Güler E, Kansoy S, Karakükcü M, Bayram İ, Aksu T, Yeşilipek A, Karagün BŞ, Yılmaz Ş, Ertem M, Uçkan D, Fışgın T, Gürsel O, Yaman Y, Bozkurt C, Gökçe M. Prognostic factors for survival in children who relapsed after allogeneic hematopoietic stem cell transplantation for acute leukemia. Pediatr Transplant 2021; 25:e13942. [PMID: 33320995 DOI: 10.1111/petr.13942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 11/06/2020] [Accepted: 11/23/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Post-transplant relapse has a dismal prognosis in children with acute leukemia undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT). Data on risk factors, treatment options, and outcomes are limited. PROCEDURE In this retrospective multicenter study in which a questionnaire was sent to all pediatric transplant centers reporting relapse after allo-HSCT for a cohort of 938 children with acute leukemia, we analyzed 255 children with relapse of acute leukemia after their first allo-HSCT. RESULTS The median interval from transplantation to relapse was 180 days, and the median follow-up from relapse to the last follow-up was 1844 days. The 3-year overall survival (OS) rate was 12.0%. The main cause of death was disease progression or subsequent relapse (82.6%). The majority of children received salvage treatment with curative intent without a second HSCT (67.8%), 22.0% of children underwent a second allo-HSCT, and 10.2% received palliative therapy. Isolated extramedullary relapse (hazard ratio (HR): 0.607, P = .011) and relapse earlier than 365 days post-transplantation (HR: 2.101, P < .001 for 0-180 days; HR: 1.522, P = .041 for 181-365 days) were found in multivariate analysis to be significant prognostic factors for outcome. The type of salvage therapy in chemosensitive relapse was identified as a significant prognostic factor for OS. CONCLUSION A salvage approach with curative intent may be considered for patients with post-transplant relapse, even if they relapse in the first year post-transplantation. For sustainable remission, a second allo-HSCT may be recommended for patients who achieve complete remission after reinduction treatment.
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Affiliation(s)
- Volkan Hazar
- Pediatric BMT Unit, Medstar Yıldız Hospital, Antalya, Turkey
| | | | - Gülyüz Öztürk
- Pediatric BMT Unit, Acıbadem Altunizade Hospital, Acıbadem University Faculty of Medicine, Istanbul, Turkey
| | - Alphan Küpesiz
- Pediatric BMT Unit, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Serap Aksoylar
- Pediatric BMT Unit, Ege University Faculty of Medicine, Izmir, Turkey
| | - Namık Özbek
- Pediatric BMT Unit, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Vedat Uygun
- Pediatric BMT Unit, Medical Park Antalya Hospital, Antalya, Turkey
| | - Talia İleri
- Pediatric BMT Unit, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Fatma Visal Okur
- Pediatric BMT Unit, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ülker Koçak
- Pediatric BMT Unit, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Suar Çakı Kılıç
- Pediatric BMT Unit, Medical Park Göztepe Hospital, Istanbul, Turkey
| | - Arzu Akçay
- Pediatric BMT Unit, Acıbadem Altunizade Hospital, Acıbadem University Faculty of Medicine, Istanbul, Turkey
| | - Elif Güler
- Pediatric BMT Unit, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Savaş Kansoy
- Pediatric BMT Unit, Ege University Faculty of Medicine, Izmir, Turkey
| | - Musa Karakükcü
- Pediatric BMT Unit, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - İbrahim Bayram
- Pediatric BMT Unit, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Tekin Aksu
- Pediatric BMT Unit, Ankara Dışkapı Child Health and Diseases Hematology Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Akif Yeşilipek
- Pediatric BMT Unit, Medical Park Antalya Hospital, Antalya, Turkey
| | - Barbaros Şahin Karagün
- Pediatric BMT Unit, Adana Hospital,, Acıbadem University Faculty of Medicine, Adana, Turkey
| | - Şebnem Yılmaz
- Pediatric BMT Unit, Dokuz Eylül University Faculty of Medicine, Izmir, Turkey
| | - Mehmet Ertem
- Pediatric BMT Unit, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Duygu Uçkan
- Pediatric BMT Unit, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Tunç Fışgın
- Pediatric BMT Unit, Altınbaş University Faculty of Medicine, Bahçelievler Medical Park Hospital, İstanbul, Turkey
| | - Orhan Gürsel
- Pediatric BMT Unit, GATA Hospital, University of Health Sciences, Ankara, Turkey
| | - Yöntem Yaman
- Pediatric BMT Unit, İstanbul Medipol University Faculty of Medicine, Istanbul, Turkey
| | - Ceyhun Bozkurt
- Pediatric BMT Unit, İstinye University Faculty of Medicine, Bahçelievler Medical Park Hospital, Istanbul, Turkey
| | - Müge Gökçe
- Pediatric BMT Unit, GOP Hospital, Yüzüncü Yıl University Faculty of Medicine, Istanbul, Turkey
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Kavaklı K, Özbek SS, Antmen AB, Şahin F, Aytaç ŞS, Küpesiz A, Zülfikar B, Sönmez M, Çalışkan Ü, Balkan C, Akbaş T, Arpacı T, Tamsel İ, Seber T, Oğuz B, Çevikol C, Bulakçı M, Koşucu P, Aydoğdu D, Şaşmaz İ, Tüysüz G, Koç B, Tokgöz H, Mehrekula Z, Özkan B. Impact of the HEAD-US Scoring System for Observing the Protective Effect of Prophylaxis in Hemophilia Patients: A Prospective, Multicenter, Observational Study. Turk J Haematol 2021; 38:101-110. [PMID: 33508912 PMCID: PMC8171214 DOI: 10.4274/tjh.galenos.2021.2020.0717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: This study aimed to observe the preventive effect of prophylactic treatment on joint health in people with hemophilia (PwH) and to investigate the importance of integration of ultrasonographic examination into clinical and radiological evaluation of the joints. Materials and Methods: This national, multicenter, prospective, observational study included male patients aged ≥6 years with the diagnosis of moderate or severe hemophilia A or B from 8 centers across Turkey between January 2017 and March 2019. Patients were followed for 1 year with 5 visits (baseline and 3rd, 6th, 9th, and 12th month visits). The Hemophilia Joint Health Score (HJHS) was used for physical examination of joints, the Pettersson scoring system was used for radiological assessment, point-of-care (POC) ultrasonography was used for bilateral examinations of joints, and the Hemophilia Early Arthropathy Detection with Ultrasound (HEAD-US) score was used for evaluation of ultrasonography results. Results: Seventy-three PwH, of whom 62 had hemophilia A and 11 had hemophilia B, were included and 24.7% had target joints at baseline. The HJHS and HEAD-US scores were significantly increased at the 12th month in all patients. These scores were also higher in the hemophilia A subgroup than the hemophilia B subgroup. However, in the childhood group, the increment of scores was not significant. The HEAD-US total score was significantly correlated with both the HJHS total score and Pettersson total score at baseline and at the 12th month. Conclusion: The HEAD-US and HJHS scoring systems are valuable tools during follow-up examinations of PwH and they complement each other. We suggest that POC ultrasonographic evaluation and the HEAD-US scoring system may be integrated into differential diagnosis of bleeding and long-term monitoring for joint health as a routine procedure.
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Affiliation(s)
- Kaan Kavaklı
- Ege University Children’s Hospital, Clinic of Children’s Health and Diseases, Division of Pediatric Hematology, İzmir, Turkey
| | - Süha Süreyya Özbek
- Ege University Medical Faculty Hospital, Clinic of Radiology, Division of Hematology, İzmir, Turkey
| | - Ali Bülent Antmen
- Acıbadem Adana Hospital, Clinic of Pediatric Hematology, Adana, Turkey
| | - Fahri Şahin
- Ege University Medical Faculty Hospital, Clinic of Internal Diseases, Division of Hematology, İzmir, Turkey
| | - Şevkiye Selin Aytaç
- Hacettepe University Faculty of Medicine, Department of Children’s Health and Diseases, Division of Pediatric Hematology, Ankara, Turkey
| | - Alphan Küpesiz
- Akdeniz University Hospital, Clinic of Children’s Health and Diseases, Antalya, Turkey
| | - Bülent Zülfikar
- İstanbul University Hemophilia Comprehensive Care Center, İstanbul, Turkey
| | - Mehmet Sönmez
- Karadeniz Technical University Medical Faculty Farabi Hospital, Clinic of Internal Diseases, Division of Hematology, Trabzon, Turkey
| | - Ümran Çalışkan
- Necmettin Erbakan University Meram Medical Faculty Hospital, Department of Children’s Health and Diseases, Konya, Turkey
| | - Can Balkan
- Ege University Children’s Hospital, Clinic of Children’s Health and Diseases, Division of Pediatric Hematology, İzmir, Turkey
| | - Tuğana Akbaş
- Acıbadem Adana Hospital, Clinic of Radiology, Adana, Turkey
| | - Taner Arpacı
- Acıbadem Adana Hospital, Clinic of Radiology, Adana, Turkey
| | - İpek Tamsel
- Ege University Medical Faculty Hospital, Clinic of Radiology, Division of Hematology, İzmir, Turkey
| | - Turgut Seber
- Hacettepe University Faculty of Medicine, Department of Radiology, Ankara, Turkey
| | - Berna Oğuz
- Hacettepe University Faculty of Medicine, Department of Radiology, Ankara, Turkey
| | - Can Çevikol
- Akdeniz University Hospital, Clinic of Radiology, Antalya, Turkey
| | - Mesut Bulakçı
- İstanbul University Hemophilia Comprehensive Care Center, İstanbul, Turkey
| | - Polat Koşucu
- Karadeniz Technical University Medical Faculty Farabi Hospital, Clinic of Radiology, Trabzon, Turkey
| | - Demet Aydoğdu
- Necmettin Erbakan University Meram Medical Faculty Hospital, Clinic of Radiology, Konya, Turkey
| | - İlgen Şaşmaz
- Acıbadem Adana Hospital, Clinic of Pediatric Hematology, Adana, Turkey
| | - Gülen Tüysüz
- Akdeniz University Hospital, Clinic of Children’s Health and Diseases, Antalya, Turkey
| | - Başak Koç
- İstanbul University Hemophilia Comprehensive Care Center, İstanbul, Turkey
| | - Hüseyin Tokgöz
- Necmettin Erbakan University Meram Medical Faculty Hospital, Department of Children’s Health and Diseases, Konya, Turkey
| | - Zuhal Mehrekula
- Ege University Medical Faculty Hospital, Clinic of Internal Diseases, Division of Hematology, İzmir, Turkey
| | - Burcu Özkan
- Pfizer Pharmaceuticals, Rare Disease Department, İstanbul, Turkey
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9
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Yalçın K, Tüysüz G, Kazan S, Gürer Eİ, Karaali K, Küpesiz A, Güler E. An infant with intradural extramedullary synovial sarcoma: the youngest case in the literature. Turk J Pediatr 2020; 61:765-770. [PMID: 32105010 DOI: 10.24953/turkjped.2019.05.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Yalçın K, Tüysüz G, Kazan S, Gürer Eİ, Karaali K, Küpesiz A, Güler E. An infant with intradural extramedullary synovial sarcoma: the youngest case in the literature. Turk J Pediatr 2019; 61: 765-770. Spinal cord involvement of synovial sarcoma is extremely rare. So far only two cases have been reported. Herein we describe the youngest case in the literature. She is 14-month-old and first presented with difficulty in walking ongoing for a week. Imagining showed a spinal cord mass at C5-T3 levels. The patient had gone under Decompressive surgery and histopathologic examination of the specimen revealed the presence of synovial sarcoma. Although the tumor regressed after chemotherapy, she was lost due to viral pneumonia. Synovial sarcoma should be kept in mind while evaluating spinal tumors even in infantile group.
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Affiliation(s)
- Koray Yalçın
- Departments Pediatric Hematology and Oncology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Gülen Tüysüz
- Departments Pediatric Hematology and Oncology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Saim Kazan
- Department Neurosurgery, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Elif İnanç Gürer
- Department Pathology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Kamil Karaali
- Department Radiology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Alphan Küpesiz
- Departments Pediatric Hematology and Oncology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Elif Güler
- Departments Pediatric Hematology and Oncology, Akdeniz University Faculty of Medicine, Antalya, Turkey
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10
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Hazar V, Karasu GT, Uygun V, Özbek N, Karakükçü M, Öztürk G, Daloğlu H, Kılıç SÇ, Aksu T, Ünal E, Koçak Ü, Yeşilipek A, Akçay A, Gürsel O, Küpesiz A, Okur FV, İleri T, Kansoy S, Bayram İ, Karagün BŞ, Gökçe M, Kaya Z, Ok Bozkaya İ, Patıroğlu T, Aksoylar S. Role of a second transplantation for children with acute leukemia following posttransplantation relapse: a study by the Turkish Bone Marrow Transplantation Study Group. Leuk Lymphoma 2020; 61:1465-1474. [PMID: 32037917 DOI: 10.1080/10428194.2020.1716220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We examined outcomes of 51 pediatric patients with relapsed acute leukemia (AL) who underwent a second allogeneic hematopoietic stem cell transplantation (alloHSCT). After a median follow-up of 941 days (range, 69-2842 days), leukemia-free survival (LFS) and overall survival (OS) at 3 years were 26.6% and 25.6%, respectively. The nonrelapse mortality rate (NMR) and cumulative incidence of relapse (CIR) were 36.4% and 42.4%, respectively. The Cox regression analysis demonstrated that the risk factors at second transplantation for predicting limited LFS were active disease (hazard ratio (HR) = 5.1), reduced intensity conditioning (RIC) (HR = 5.0), matched unrelated donor (MUD) (HR = 3.4) and performance score <80 (HR = 3.2). Pediatric patients with AL who relapsed after their first alloHSCT may survive with a second alloHSCT. Disease status, conditioning intensity, donor type, and performance score at the second transplantation are the relevant risk factors. A score based on these factors may predict the results of the second transplantation.
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Affiliation(s)
- Volkan Hazar
- Pediatric BMT Unit, Medical Park Göztepe Hospital, Istanbul, Turkey
| | | | - Vedat Uygun
- Pediatric BMT Unit, Medical Park Antalya Hospital, Antalya, Turkey
| | - Namık Özbek
- Pediatric BMT Unit, Ankara Dışkapı Child Health and Diseases Hematology Oncology Training and Research Hospital, Ankara, Turkey
| | - Musa Karakükçü
- Pediatric BMT Unit, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Gülyüz Öztürk
- Pediatric BMT Unit, Acıbadem University Faculty of Medicine, Acıbadem Atakent Hospital, Istanbul, Turkey
| | - Hayriye Daloğlu
- Pediatric BMT Unit, Medical Park Antalya Hospital, Antalya, Turkey
| | - Suar Çakı Kılıç
- Pediatric BMT Unit, Medical Park Göztepe Hospital, Istanbul, Turkey
| | - Tekin Aksu
- Pediatric BMT Unit, Ankara Dışkapı Child Health and Diseases Hematology Oncology Training and Research Hospital, Ankara, Turkey
| | - Ekrem Ünal
- Pediatric BMT Unit, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Ülker Koçak
- Pediatric BMT Unit, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Akif Yeşilipek
- Pediatric BMT Unit, Medical Park Antalya Hospital, Antalya, Turkey
| | - Arzu Akçay
- Pediatric BMT Unit, Acıbadem University Faculty of Medicine, Acıbadem Atakent Hospital, Istanbul, Turkey
| | - Orhan Gürsel
- Pediatric BMT Unit, University of Health Sciences Faculty of Medicine, Ankara GATA Hospital, Ankara, Turkey
| | - Alphan Küpesiz
- Pediatric BMT Unit, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Fatma Visal Okur
- Pediatric BMT Unit, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Talia İleri
- Pediatric BMT Unit, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Savaş Kansoy
- Pediatric BMT Unit, Ege University Faculty of Medicine, Izmir, Turkey
| | - İbrahim Bayram
- Pediatric BMT Unit, Çukurova University Faculty of Medicine, Adana, Turkey
| | | | - Müge Gökçe
- Pediatric BMT Unit, Yüzüncü Yıl University Faculty of Medicine, GOP Hospital, Istanbul, Turkey
| | - Zühre Kaya
- Pediatric BMT Unit, Gazi University Faculty of Medicine, Ankara, Turkey
| | - İkbal Ok Bozkaya
- Pediatric BMT Unit, Ankara Dışkapı Child Health and Diseases Hematology Oncology Training and Research Hospital, Ankara, Turkey
| | - Türkan Patıroğlu
- Pediatric BMT Unit, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Serap Aksoylar
- Pediatric BMT Unit, Ege University Faculty of Medicine, Izmir, Turkey
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11
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Atik T, Işık E, Onay H, Akgün B, Shamsali M, Kavaklı K, Evim M, Tüysüz G, Özbek NY, Şahin F, Salcıoğlu Z, Albayrak C, Oymak Y, Ünal E, Belen FB, Yılmaz Keskin E, Balkan C, Baytan B, Küpesiz A, Culha V, Tahtakesen Güçer TN, Güneş AM, Özkınay F. Factor 8 Gene Mutation Spectrum of 270 Patients with Hemophilia A: Identification of 36 Novel Mutations. Turk J Haematol 2020; 37:145-153. [PMID: 32026663 PMCID: PMC7463214 DOI: 10.4274/tjh.galenos.2020.2019.0262] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective Hemophilia A (HA) is the most severe X-linked inherited bleeding disorder caused by hemizygous mutations in the factor 8 (F8) gene. The aim of this study is to determine the mutation spectrum of the F8 gene in a large HA cohort from Turkey, and then to establish a phenotype-genotype correlation. Materials and Methods All HA cases (270 patients) analyzed molecularly in the Ege University Pediatric Genetics Molecular Laboratory between March 2017 and March 2018 were included in this study. To identify intron 22 inversion (Inv22), intron 1 inversion (Inv1), small deletion/insertions, and point mutations, molecular analyses of F8 were performed using a sequential application of molecular techniques. Results The mutation detection success rate was 95.2%. Positive Inv22 was found in 106 patients (39.3%), Inv1 was found in 4 patients (1.5%), and 106 different disease-causing sequence variants were identified in 137 patients (50.6%). In 10 patients (3.7%), amplification failures involving one or more exonic regions, considered to be large intragenic deletions, were identified. Of 106 different F8 mutations, 36 were novel. The relationship between F8 genotype and inhibitor development was considered significant. Conclusion A high mutation detection rate was achieved via the broad molecular techniques applied in this study, including 36 novel mutations. With regard to mutation types, mutation distribution and their impact on clinical severity and inhibitor development were found to be similar to those previously reported in other hemophilia population studies.
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Affiliation(s)
- Tahir Atik
- Ege University, School of Medicine, Department of Pediatrics, Division of Pediatric Genetics, Izmir, Turkey,Equal contributors
| | - Esra Işık
- Ege University, School of Medicine, Department of Pediatrics, Division of Pediatric Genetics, Izmir, Turkey,Equal contributors
| | - Hüseyin Onay
- Ege University, School of Medicine, Department of Medical Genetics, Izmir, Turkey
| | - Bilçağ Akgün
- Ege University, School of Medicine, Department of Pediatrics, Division of Pediatric Genetics, Izmir, Turkey
| | - Moharram Shamsali
- Ege University, Institute of Health Sciences, Division of Health Bioinformatics, Izmir, Turkey
| | - Kaan Kavaklı
- Ege University, School of Medicine, Department of Pediatrics, Division of Pediatric Hematology, Izmir, Turkey
| | - Melike Evim
- Uludag University, School of Medicine, Department of Pediatrics, Division of Pediatric Hematology, Bursa, Turkey
| | - Gülen Tüysüz
- Akdeniz University, School of Medicine, Department of Pediatrics, Division of Pediatric Hematology, Antalya, Turkey
| | - Namık Yaşar Özbek
- Health Sciences University Ankara Pediatric Hematology Oncology Training and Research Hospital, Department of Pediatric Hematology, Ankara, Turkey
| | - Fahri Şahin
- Ege University, School of Medicine, Department of Internal Medicine, Division of Hematology, Izmir, Turkey
| | - Zafer Salcıoğlu
- Istanbul Kanuni Sultan Suleyman Education and Research Hospital, Department of Pediatric Hematology and Oncology, Istanbul, Turkey
| | - Canan Albayrak
- Ondokuz Mayis University, Faculty of Medicine, Department of Pediatric Hematology and Oncology, Samsun, Turkey
| | - Yeşim Oymak
- Dr. Behcet Uz Children’s Hospital, Division of Pediatric Hematology, Izmir, Turkey
| | - Ekrem Ünal
- Erciyes University, School of Medicine, Department of Pediatrics, Division of Pediatric Hematology, Kayseri, Turkey
| | - Fatma Burcu Belen
- Katip Celebi University, School of Medicine, Department of Pediatrics, Division of Pediatric Hematology, Izmir, Turkey
| | - Ebru Yılmaz Keskin
- Suleyman Demirel University, School of Medicine, Department of Pediatrics, Division of Pediatric Hematology, Isparta, Turkey
| | - Can Balkan
- Ege University, School of Medicine, Department of Pediatrics, Division of Pediatric Hematology, Izmir, Turkey
| | - Birol Baytan
- Uludag University, School of Medicine, Department of Pediatrics, Division of Pediatric Hematology, Bursa, Turkey
| | - Alphan Küpesiz
- Akdeniz University, School of Medicine, Department of Pediatrics, Division of Pediatric Hematology, Antalya, Turkey
| | - Vildan Culha
- Health Sciences University Ankara Pediatric Hematology Oncology Training and Research Hospital, Department of Pediatric Hematology, Ankara, Turkey
| | - Tuba Nur Tahtakesen Güçer
- Istanbul Kanuni Sultan Suleyman Education and Research Hospital, Department of Pediatric Hematology and Oncology, Istanbul, Turkey
| | - Adalet Meral Güneş
- Uludag University, School of Medicine, Department of Pediatrics, Division of Pediatric Hematology, Bursa, Turkey
| | - Ferda Özkınay
- Ege University, School of Medicine, Department of Pediatrics, Division of Pediatric Genetics, Izmir, Turkey
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12
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Yalçın K, Tüysüz G, Genç M, Özbudak İH, Derin AT, Karaali K, Küpesiz A, Güler E. Pediatric Tonsillar Synovial Sarcoma- Very Rare Localization: A Case Report and Review of the Literature. Turk Patoloji Derg 2020; 36:82-86. [PMID: 30632126 PMCID: PMC10512667 DOI: 10.5146/tjpath.2018.01449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 11/12/2018] [Indexed: 11/18/2022] Open
Abstract
Tonsillar synovial sarcoma is an extremely rare entity and only 9 adult patients have been reported up to now. Here, we describe the first pediatric tonsillar synovial sarcoma of the literature in a patient who presented with a 2-month history of dysphagia and snoring. Clinical and radiological examinations showed that the tumor arose from the right palatine tonsil and narrowed the parapharyngeal space. An incisional biopsy from the palatine tonsil revealed the diagnosis of synovial sarcoma. The patient has underwent total tonsillectomy and received radiotherapy and chemotherapy because of the positive surgical margins. The patient is clinically in good condition and free of tumor 30 months after the initial diagnosis. We achieved a long-term complete remission with a combination of surgery, radiotherapy and chemotherapy in our case. Tonsillar synovial sarcoma should be kept in mind while dealing with tonsillar masses. We can conclude that a multidisciplinary approach is warranted while treating synovial sarcoma with this localization.
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Affiliation(s)
- Koray Yalçın
- Department of Pediatric Hematology and Oncology, Akdeniz University Medicine Faculty, Antalya, Turkey
| | - Gülen Tüysüz
- Department of Pediatric Hematology and Oncology, Akdeniz University Medicine Faculty, Antalya, Turkey
| | - Mine Genç
- Department of Radiation Oncology, Akdeniz University Medicine Faculty, Antalya, Turkey
| | - İrem Hicran Özbudak
- Department of Pathology, Akdeniz University Medicine Faculty, Antalya, Turkey
| | - Alper Tunga Derin
- Department of Nose Throat Ear Surgery, Akdeniz University Medicine Faculty, Antalya, Turkey
| | - Kamil Karaali
- Department of Radiology, Akdeniz University Medicine Faculty, Antalya, Turkey
| | - Alphan Küpesiz
- Department of Pediatric Hematology and Oncology, Akdeniz University Medicine Faculty, Antalya, Turkey
| | - Elif Güler
- Department of Pediatric Hematology and Oncology, Akdeniz University Medicine Faculty, ANTALYA, TURKEY
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13
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Yılmaz Karapınar D, Patıroğlu T, Metin A, Çalışkan Ü, Celkan T, Yılmaz B, Karakaş Z, Karapınar TH, Akıncı B, Özkınay F, Onay H, Yeşilipek MA, Akar HH, Tüysüz G, Tokgöz H, Özdemir GN, Aslan Kıykım A, Karaman S, Kılınç Y, Oymak Y, Küpesiz A, Olcay L, Keskin Yıldırım Z, Aydoğan G, Gökçe M, İleri T, Aral YZ, Bay A, Atabay B, Kaya Z, Söker M, Özdemir Karadaş N, Özbek U, Özsait Selçuk B, Özdemir HH, Uygun V, Tezcan Karasu G, Yılmaz Ş. Homozygous c.130-131 ins A (pW44X) mutation in the HAX1 gene as the most common cause of congenital neutropenia in Turkey: Report from the Turkish Severe Congenital Neutropenia Registry. Pediatr Blood Cancer 2019; 66:e27923. [PMID: 31321910 DOI: 10.1002/pbc.27923] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 06/18/2019] [Accepted: 06/26/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Severe congenital neutropenia is a rare disease, and autosomal dominantly inherited ELANE mutation is the most frequently observed genetic defect in the registries from North America and Western Europe. However, in eastern countries where consanguineous marriages are common, autosomal recessive forms might be more frequent. METHOD Two hundred and sixteen patients with severe congenital neutropenia from 28 different pediatric centers in Turkey were registered. RESULTS The most frequently observed mutation was HAX1 mutation (n = 78, 36.1%). A heterozygous ELANE mutation was detected in 29 patients (13.4%) in our cohort. Biallelic mutations of G6PC3 (n = 9, 4.3%), CSF3R (n = 6, 2.9%), and JAGN1 (n = 2, 1%) were also observed. Granulocyte colony-stimulating factor treatment was given to 174 patients (80.6%). Two patients died with infectious complications, and five patients developed myelodysplastic syndrome/acute myeloblastic leukemia. The mean (± mean standard error) follow-up period was 129.7 ± 76.3 months, and overall survival was 96.8% (CI, 94.4-99.1%) at the age of 15 years. In Turkey, severe congenital neutropenia mostly resulted from the p W44X mutation in the HAX1 gene. CONCLUSION In Turkey, mutation analysis should be started with HAX1, and if this is negative, ELANE and G6PC3 should be checked. Because of the very high percentage of consanguineous marriage, rare mutations should be tested in patients with a negative mutation screen.
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Affiliation(s)
| | - Türkan Patıroğlu
- Department of Pediatric Immunology, Erciyes University Faculty of Medicine, İzmir, Turkey
| | - Ayşe Metin
- Department of Pediatric Immunology, Ankara Children's Hematology Oncology Training and Research Hospital, Ankara, Turkey
| | - Ümran Çalışkan
- Department of Pediatric Hematology-Oncology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Tiraje Celkan
- Department of Pediatric Hematology, Cerrahpaşa Medical Faculty, İstanbul University, Istanbul, Turkey
| | - Barış Yılmaz
- Department of Pediatric Hematology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Zeynep Karakaş
- Department of Pediatric Hematology-Oncology, İstanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Tuba H Karapınar
- Department of Pediatric Hematology-Oncology, Dr. Behçet Uz Children Research and Training Hospital, İzmir, Turkey
| | - Burcu Akıncı
- Department of Pediatric Hematology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Ferda Özkınay
- Department of Pediatric Genetic, Ege University Faculty of Medicine, İzmir, Turkey
| | - Hüseyin Onay
- Department of Medical Genetic, Ege University Faculty of Medicine, İzmir, Turkey
| | - Mehmet Akif Yeşilipek
- Pediatric Bone Marrow Transplantation Unit, Medical Park Göztepe Hospital, Istanbul, Turkey
| | - Himmet Haluk Akar
- Department of Pediatric Immunology, Erciyes University Faculty of Medicine, İzmir, Turkey
| | - Gülen Tüysüz
- Department of Pediatric Hematology, Akdeniz University Medical School, Antalya, Turkey
| | - Hüseyin Tokgöz
- Department of Pediatric Hematology-Oncology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Gül Nihal Özdemir
- Department of Pediatric Hematology, Cerrahpaşa Medical Faculty, İstanbul University, Istanbul, Turkey
| | - Ayça Aslan Kıykım
- Department of Pediatric Allergy and Immunology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Serap Karaman
- Department of Pediatric Hematology-Oncology, İstanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Yurdanur Kılınç
- Department of Pediatric Hematology, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Yeşim Oymak
- Department of Pediatric Hematology-Oncology, Dr. Behçet Uz Children Research and Training Hospital, İzmir, Turkey
| | - Alphan Küpesiz
- Department of Pediatric Hematology, Akdeniz University Medical School, Antalya, Turkey
| | - Lale Olcay
- Department of Pediatric Hematology, Başkent University Faculty of Medicine, Ankara, Turkey
| | - Zuhal Keskin Yıldırım
- Department of Pediatric Hematology, Atatürk University Faculty of Medicine, Erzurum, Turkey
| | - Gönül Aydoğan
- Department of Pediatric Hematology, Kanuni Sultan Süleyman Research and Training Hospital, Istanbul, Turkey
| | - Müge Gökçe
- Department of Pediatric Bone marrow Transplantation Unit, Yeni Yüzyıl Üniversitesi, Gaziosmanpaşa Hastanesi, Istanbul, Turkey
| | - Talia İleri
- Department of Pediatric Hematology, Ankara University Medical Faculty, Ankara, Turkey
| | - Yusuf Ziya Aral
- Department of Pediatric Hematology, Adnan Menderes University Faculty of Medicine, Aydın, Turkey
| | - Ali Bay
- Department of Pediatric Hematology, Gaziantep University Faculty of Medicine, Gaziantep, Turkey
| | - Berna Atabay
- Department of Pediatric Hematology, Tepecik Teaching and Research Hospital, İzmir, Turkey
| | - Zuhre Kaya
- Department of Pediatric Hematology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Murat Söker
- Department of Pediatric Hematology, Dicle University Faculty of Medicine, Diyarbakır, Turkey
| | | | - Uğur Özbek
- Department of Genetics, İstanbul University Faculty of Medicine, Istanbul, Turkey
| | - Bilge Özsait Selçuk
- Department of Genetics, İstanbul University Faculty of Medicine, Istanbul, Turkey
| | - Hamiyet Hekimci Özdemir
- Department of Pediatric Hematology and Oncology, Faculty of Medicine, Fırat University, Elazığ, Turkey
| | - Vedat Uygun
- Pediatric Bone Marrow Transplantation Unit, Medical Park Antalya Hospital, Antalya, Turkey
| | - Gülsün Tezcan Karasu
- Pediatric Bone Marrow Transplantation Unit, Medical Park Antalya Hospital, Antalya, Turkey
| | - Şebnem Yılmaz
- Department of Pediatric Hematology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
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14
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Hazar V, Karasu GT, Uygun V, Öztürk G, Kiliç SÇ, Küpesiz A, Daloglu H, Aksoylar S, Atay D, Ince EÜ, Karakükçü M, Özbek N, Tayfun F, Kansoy S, Özyürek E, Akçay A, Gürsel O, Haskologlu S, Kaya Z, Yilmaz S, Tanyeli A, Yesilipek A. Risks and outcomes of invasive fungal infections in pediatric allogeneic hematopoietic stem cell transplant recipients receiving fluconazole prophylaxis: a multicenter cohort study by the Turkish Pediatric Bone Marrow Transplantation Study Group. Med Mycol 2019; 57:161-170. [PMID: 29608706 DOI: 10.1093/mmy/myy015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 03/04/2018] [Indexed: 12/23/2022] Open
Abstract
Invasive fungal infections (IFIs) are a major cause of infection-related morbidity and mortality in patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT). Data from pediatric settings are scarce. To determine the incidence, risk factors and outcomes of IFIs in a 180-day period post-transplantation, 408 pediatric patients who underwent allogeneic HSCT were retrospectively analyzed. The study included only proven and probable IFIs. The cumulative incidences of IFI were 2.7%, 5.0%, and 6.5% at 30, 100, and 180 days post-transplantation, respectively. According to the multivariate analysis, the factors associated with increased IFI risk in the 180-day period post-HSCT were previous HSCT history (hazard ratio [HR], 4.57; 95% confidence interval [CI] 1.42-14.71; P = .011), use of anti-thymocyte globulin (ATG) (HR, 2.94; 95% CI 1.27-6.80; P = .012), grade III-IV acute graft-versus-host-disease (GVHD) (HR, 2.91; 95% CI 1.24-6.80; P = .014) and late or no lymphocyte engraftment (HR, 2.71; 95% CI 1.30-5.62; P = .007). CMV reactivation was marginally associated with an increased risk of IFI development (HR, 1.91; 95% CI 0.97-3.74; P = .063). IFI-related mortality was 1.5%, and case fatality rate was 27.0%.The close monitoring of IFIs in pediatric patients with severe acute GVHD who receive ATG during conditioning is critical to reduce morbidity and mortality after allogeneic HSCT, particularly among those with prior HSCT and no or late lymphocyte engraftment.
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Affiliation(s)
- Volkan Hazar
- Department of Pediatric Hematology&Oncology and BMT Unit, Medical Park Göztepe Hospital, Istanbul
| | - Gülsün Tezcan Karasu
- Department of Pediatric Hematology&Oncology and BMT Unit, Medical Park Göztepe Hospital, Istanbul
| | - Vedat Uygun
- Department of Pediatric Hematology&Oncology and BMT Unit, Medical Park Antalya Hospital, Antalya
| | - Gülyüz Öztürk
- Department of Pediatric Hematology&Oncology and BMT Unit, Acibadem University Faculty of Medicine, Acibadem Atakent Hospital, Istanbul
| | - Suar Çaki Kiliç
- Department of Pediatric Hematology&Oncology and BMT Unit, Medical Park Göztepe Hospital, Istanbul
| | - Alphan Küpesiz
- Department of Pediatric Hematology&Oncology and BMT Unit, Akdeniz University Faculty of Medicine, Antalya
| | - Hayriye Daloglu
- Department of Pediatric Hematology&Oncology and BMT Unit, Medical Park Antalya Hospital, Antalya
| | - Serap Aksoylar
- Department of Pediatric Hematology&Oncology and BMT Unit, Ege University Faculty of Medicine, Izmir
| | - Didem Atay
- Department of Pediatric Hematology&Oncology and BMT Unit, Acibadem University Faculty of Medicine, Acibadem Atakent Hospital, Istanbul
| | - Elif Ünal Ince
- Department of Pediatric Hematology&Oncology and BMT Unit, Ankara University Faculty of Medicine, Ankara
| | - Musa Karakükçü
- Department of Pediatric Hematology&Oncology and BMT Unit, Erciyes University Faculty of Medicine, Kayseri
| | - Namik Özbek
- Department of Pediatric Hematology&Oncology and BMT Unit, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, Ankara
| | - Funda Tayfun
- Department of Pediatric Hematology&Oncology and BMT Unit, Akdeniz University Faculty of Medicine, Antalya
| | - Savas Kansoy
- Department of Pediatric Hematology&Oncology and BMT Unit, Ege University Faculty of Medicine, Izmir
| | - Emel Özyürek
- Department of Pediatric Hematology&Oncology and BMT Unit, Medical Park Samsun Hospital, Samsun
| | - Arzu Akçay
- Department of Pediatric Hematology&Oncology and BMT Unit, Acibadem University Faculty of Medicine, Acibadem Atakent Hospital, Istanbul
| | - Orhan Gürsel
- Department of Pediatric Hematology&Oncology and BMT Unit, Gülhane Military Medical Academy, Ankara
| | - Sule Haskologlu
- Department of Pediatric Hematology&Oncology and BMT Unit, Ankara University Faculty of Medicine, Ankara
| | - Zühre Kaya
- Department of Pediatric Hematology&Oncology and BMT Unit, Gazi University Faculty of Medicine, Ankara
| | - Sebnem Yilmaz
- Department of Pediatric Hematology&Oncology and BMT Unit, Dokuz Eylül University Faculty of Medicine, Izmir
| | - Atila Tanyeli
- Department of Pediatric Hematology&Oncology and BMT Unit, Çukurova University Faculty of Medicine, Adana
| | - Akif Yesilipek
- Department of Pediatric Hematology&Oncology and BMT Unit, Medical Park Antalya Hospital, Antalya.,The Chief of the Turkish Pediatric BMT Study Group
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Iltar U, Salim O, Küpesiz A. Severe thrombocytopenia related to filgrastim mobilization in a healthy donor. Transfus Apher Sci 2018; 57:777-778. [DOI: 10.1016/j.transci.2018.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 09/26/2018] [Accepted: 10/01/2018] [Indexed: 10/28/2022]
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Hazar V, Kesik V, Karasu GT, Öztürk G, Küpesiz A, Kılıç SÇ, Ataş E, Uygun V, Eker N, Erbey F, Bengoa ŞY, Emir S, Anak S, Öniz H, Daloğlu H, Aksoylar S, Koçak Ü, Karakükçü M, Elli M, Kurucu N, Yeşilipek A. Risk factors predicting the survival of pediatric patients with relapsed/refractory non-Hodgkin lymphoma who underwent hematopoietic stem cell transplantation: a retrospective study from the Turkish pediatric bone marrow transplantation registry. Leuk Lymphoma 2017; 59:85-96. [DOI: 10.1080/10428194.2017.1330472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Volkan Hazar
- Departments of Pediatric Hematology and Oncology and BMT Unit, Medical Park Göztepe Hospital, Istanbul, Turkey
| | - Vural Kesik
- Gülhane Military Medical Academy, Ankara, Turkey
| | - Gülsün Tezcan Karasu
- Faculty of Medicine, Göztepe Medical Park Hospital, Bahçeşehir University, Istanbul, Turkey
| | - Gülyüz Öztürk
- Faculty of Medicine, Acıbadem Atakent Hospital, Acıbadem University Istanbul, Turkey
| | - Alphan Küpesiz
- Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Suar Çakı Kılıç
- Faculty of Medicine, Göztepe Medical Park Hospital, Bahçeşehir University, Istanbul, Turkey
| | - Erman Ataş
- Gülhane Military Medical Academy, Ankara, Turkey
| | - Vedat Uygun
- Faculty of Medicine, Antalya Medical Park Hospital, Bahçeşehir University, Antalya, Turkey
| | - Nurşah Eker
- Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Fatih Erbey
- Faculty of Medicine, Acıbadem Atakent Hospital, Acıbadem University Istanbul, Turkey
| | | | - Suna Emir
- Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, Ankara, Turkey
| | - Sema Anak
- Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Haldun Öniz
- Tepecik Training and Research Hospital, Izmir, Turkey
| | - Hayriye Daloğlu
- Faculty of Medicine, Antalya Medical Park Hospital, Bahçeşehir University, Antalya, Turkey
| | | | - Ülker Koçak
- Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Musa Karakükçü
- Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Murat Elli
- Faculty of Medicine, On Dokuz Mayıs University, Samsun, Turkey
| | - Nilgün Kurucu
- Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Akif Yeşilipek
- Faculty of Medicine, Göztepe Medical Park Hospital, Bahçeşehir University, Istanbul, Turkey
- Turkish Pediatric BMT Study Group, Istanbul, Turkey
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17
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Kurekci E, Küpesiz A, Anak S, Öztürk G, Gürsel O, Aksoylar S, Ileri T, Kuşkonmaz B, Eker İ, Cetin M, Tezcan Karasu G, Kaya Z, Fışgın T, Ertem M, Kansoy S, Yeşilipek MA. Hematopoietic Stem Cell Transplantation Using Preimplantation Genetic Diagnosis and Human Leukocyte Antigen Typing for Human Leukocyte Antigen–Matched Sibling Donor: A Turkish Multicenter Study. Biol Blood Marrow Transplant 2017; 23:790-794. [DOI: 10.1016/j.bbmt.2017.02.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 02/07/2017] [Indexed: 11/25/2022]
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Tüfekçi Ö, Koçak Ü, Kaya Z, Yenicesu İ, Albayrak C, Albayrak D, Yılmaz Bengoa Ş, Patıroğlu T, Karakükçü M, Ünal E, Ünal İnce E, İleri T, Ertem M, Celkan T, Özdemir GN, Sarper N, Kaçar D, Yaralı N, Özbek NY, Küpesiz A, Karapınar T, Vergin C, Çalışkan Ü, Tokgöz H, Sezgin Evim M, Baytan B, Güneş AM, Yılmaz Karapınar D, Karaman S, Uygun V, Karasu G, Yeşilipek MA, Koç A, Erduran E, Atabay B, Öniz H, Ören H. Juvenile Myelomonocytic Leukemia in Turkey: A Retrospective Analysis of Sixty-five Patients. Turk J Haematol 2017; 35:27-34. [PMID: 28179213 PMCID: PMC5843771 DOI: 10.4274/tjh.2017.0021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE This study aimed to define the status of juvenile myelomonocytic leukemia (JMML) patients in Turkey in terms of time of diagnosis, clinical characteristics, mutational studies, clinical course, and treatment strategies. MATERIALS AND METHODS Data including clinical and laboratory characteristics and treatment strategies of JMML patients were collected retrospectively from pediatric hematology-oncology centers in Turkey. RESULTS Sixty-five children with JMML diagnosed between 2002 and 2016 in 18 institutions throughout Turkey were enrolled in the study. The median age at diagnosis was 17 months (min-max: 2-117 months). Splenomegaly was present in 92% of patients at the time of diagnosis. The median white blood cell, monocyte, and platelet counts were 32.9x109/L, 5.4x109/L, and 58.3x109/L, respectively. Monosomy 7 was present in 18% of patients. JMML mutational analysis was performed in 32 of 65 patients (49%) and PTPN11 was the most common mutation. Hematopoietic stem cell transplantation (HSCT) could only be performed in 28 patients (44%), the majority being after the year 2012. The most frequent reason for not performing HSCT was the inability to find a suitable donor. The median time from diagnosis to HSCT was 9 months (min-max: 2-63 months). The 5-year cumulative survival rate was 33% and median estimated survival time was 30±17.4 months (95% CI: 0-64.1) for all patients. Survival time was significantly better in the HSCT group (log-rank p=0.019). Older age at diagnosis (>2 years), platelet count of less than 40x109/L, and PTPN11 mutation were the factors significantly associated with shorter survival time. CONCLUSION Although there has recently been improvement in terms of definitive diagnosis and HSCT in JMML patients, the overall results are not satisfactory and it is necessary to put more effort into this issue in Turkey.
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Affiliation(s)
- Özlem Tüfekçi
- Dokuz Eylül University Faculty of Medicine, Department of Pediatric Hematology, İzmir, Turkey
| | - Ülker Koçak
- Gazi University Faculty of Medicine, Department of Pediatric Hematology, Ankara, Turkey
| | - Zühre Kaya
- Gazi University Faculty of Medicine, Department of Pediatric Hematology, Ankara, Turkey
| | - İdil Yenicesu
- Gazi University Faculty of Medicine, Department of Pediatric Hematology, Ankara, Turkey
| | - Canan Albayrak
- Ondokuz Mayıs University Faculty of Medicine, Department of Pediatric Hematology, Samsun, Turkey
| | - Davut Albayrak
- Ondokuz Mayıs University Faculty of Medicine, Department of Pediatric Hematology, Samsun, Turkey
| | - Şebnem Yılmaz Bengoa
- Dokuz Eylül University Faculty of Medicine, Department of Pediatric Hematology, İzmir, Turkey
| | - Türkan Patıroğlu
- Erciyes University Faculty of Medicine, Department of Pediatric Hematology and Oncology, Kayseri, Turkey
| | - Musa Karakükçü
- Erciyes University Faculty of Medicine, Department of Pediatric Hematology and Oncology, Kayseri, Turkey
| | - Ekrem Ünal
- Erciyes University Faculty of Medicine, Department of Pediatric Hematology and Oncology, Kayseri, Turkey
| | - Elif Ünal İnce
- Ankara University Faculty of Medicine, Department of Pediatric Hematology and Oncology, Ankara, Turkey
| | - Talia İleri
- Ankara University Faculty of Medicine, Department of Pediatric Hematology and Oncology, Ankara, Turkey
| | - Mehmet Ertem
- Ankara University Faculty of Medicine, Department of Pediatric Hematology and Oncology, Ankara, Turkey
| | - Tiraje Celkan
- İstanbul University Cerrahpaşa Faculty of Medicine, Department of Pediatric Hematology and Oncology, İstanbul, Turkey
| | - Gül Nihal Özdemir
- İstanbul University Cerrahpaşa Faculty of Medicine, Department of Pediatric Hematology and Oncology, İstanbul, Turkey
| | - Nazan Sarper
- Kocaeli University Faculty of Medicine, Department of Pediatric Hematology, Kocaeli, Turkey
| | - Dilek Kaçar
- Ankara Children's Hematology and Oncology Training and Research Hospital, Ankara, Turkey
| | - Neşe Yaralı
- Ankara Children's Hematology and Oncology Training and Research Hospital, Ankara, Turkey
| | - Namık Yaşar Özbek
- Ankara Children's Hematology and Oncology Training and Research Hospital, Ankara, Turkey
| | - Alphan Küpesiz
- Akdeniz University Faculty of Medicine, Department of Pediatric Hematology and Oncology, Antalya, Turkey
| | - Tuba Karapınar
- Dr. Behçet Uz Children Training and Research Hospital, Clinic of Pediatric Hematology and Oncology, İzmir, Turkey
| | - Canan Vergin
- Dr. Behçet Uz Children Training and Research Hospital, Clinic of Pediatric Hematology and Oncology, İzmir, Turkey
| | - Ümran Çalışkan
- Necmettin Erbakan University Meram Faculty of Medicine, Department of Pediatric Hematology, Konya, Turkey
| | - Hüseyin Tokgöz
- Necmettin Erbakan University Meram Faculty of Medicine, Department of Pediatric Hematology, Konya, Turkey
| | - Melike Sezgin Evim
- Uludağ University Faculty of Medicine, Department of Pediatric Hematology, Bursa, Turkey
| | - Birol Baytan
- Uludağ University Faculty of Medicine, Department of Pediatric Hematology, Bursa, Turkey
| | - Adalet Meral Güneş
- Uludağ University Faculty of Medicine, Department of Pediatric Hematology, Bursa, Turkey
| | | | - Serap Karaman
- Şişli Hamidiye Etfal Training and Research Hospital, Clinic of Pediatric Hematology and Oncology, İstanbul, Turkey
| | - Vedat Uygun
- Bahçeşehir University Faculty of Medicine, Department of Pediatric Hematology and Oncology, İstanbul, Turkey
| | - Gülsun Karasu
- Bahçeşehir University Faculty of Medicine, Department of Pediatric Hematology and Oncology, İstanbul, Turkey
| | - Mehmet Akif Yeşilipek
- Bahçeşehir University Faculty of Medicine, Department of Pediatric Hematology and Oncology, İstanbul, Turkey
| | - Ahmet Koç
- Marmara University Faculty of Medicine, Department of Pediatric Hematology and Oncology, İstanbul, Turkey
| | - Erol Erduran
- Karadeniz Technical University Faculty of Medicine, Department of Pediatric Hematology and Oncology, Trabzon, Turkey
| | - Berna Atabay
- Tepecik Training and Research Hospital, Clinic of Pediatric Hematology and Oncology, İzmir, Turkey
| | - Haldun Öniz
- Tepecik Training and Research Hospital, Clinic of Pediatric Hematology and Oncology, İzmir, Turkey
| | - Hale Ören
- Dokuz Eylül University Faculty of Medicine, Department of Pediatric Hematology, İzmir, Turkey
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Kesik V, Ataş E, Karakükcü M, Aksoylar S, Erbey F, Taçyıldız N, Küpesiz A, Öniz H, Ünal E, Kansoy S, Öztürk G, Elli M, Kaya Z, Ünal E, Hazar V, Yılmaz Bengoa Ş, Karasu G, Atay D, Dağdemir A, Ören H, Koçak Ü, Yeşilipek MA. Prognostic Factors and a New Prognostic Index Model for Children and Adolescents with Hodgkin's Lymphoma Who Underwent Autologous Hematopoietic Stem Cell Transplantation: A Multicenter Study of the Turkish Pediatric Bone Marrow Transplantation Study Group. Turk J Haematol 2016; 33:265-272. [PMID: 27094103 PMCID: PMC5204179 DOI: 10.4274/tjh.2015.0280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objective: The prognostic factors and a new childhood prognostic index after autologous hematopoietic stem cell transplantation (AHSCT) in patients with relapsed/refractory Hodgkin’s lymphoma (HL) were evaluated. Materials and Methods: The prognostic factors of 61 patients who underwent AHSCT between January 1990 and December 2014 were evaluated. In addition, the Age-Adjusted International Prognostic Index and the Childhood International Prognostic Index (CIPI) were evaluated for their impact on prognosis. Results: The median age of the 61 patients was 14.8 years (minimum-maximum: 5-20 years) at the time of AHSCT. There were single relapses in 28 patients, ≥2 relapses in eight patients, and refractory disease in 25 patients. The chemosensitivity/chemorefractory ratio was 36/25. No pretransplant radiotherapy, no remission at the time of transplantation, posttransplant white blood cell count over 10x103/µL, posttransplant positron emission tomography positivity at day 100, and serum albumin of <2.5 g/dL at diagnosis were correlated with progression-free survival. No remission at the time of transplantation, bone marrow positivity at diagnosis, and relapse after AHSCT were significant parameters for overall survival. Conclusion: The major factors affecting the progression-free and overall survival were clearly demonstrated. A CIPI that uses a lactate dehydrogenase level of 500 IU/L worked well for estimating the prognosis. We recommend AHSCT at first complete remission for relapsed cases, and it should also be taken into consideration for patients with high prognostic scores at diagnosis.
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Affiliation(s)
- Vural Kesik
- Gülhane Training and Research Hospital Clinic of Pediatric Oncology, Ankara, Turkey Phone: +90 312 304 43 94 E-mail:
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20
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Willmann KL, Klaver S, Doğu F, Santos-Valente E, Garncarz W, Bilic I, Mace E, Salzer E, Domínguez Conde C, Sic H, Májek P, Banerjee PP, Vladimer GI, Haskoloğlu Ş, Gökalp Bolkent M, Küpesiz A, Condino-Neto A, Colinge J, Superti-Furga G, Pickl WF, van Zelm MC, Eibel H, Orange JS, Ikincioğulları A, Boztuğ K. Biallelic loss-of-function mutation in NIK causes a primary immunodeficiency with multifaceted aberrant lymphoid immunity. Nat Commun 2014; 5:5360. [PMID: 25406581 PMCID: PMC4263125 DOI: 10.1038/ncomms6360] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 09/23/2014] [Indexed: 12/18/2022] Open
Abstract
Primary immunodeficiency disorders enable identification of genes with crucial roles in the human immune system. Here we study patients suffering from recurrent bacterial, viral and Cryptosporidium infections, and identify a biallelic mutation in the MAP3K14 gene encoding NIK (NF-κB-inducing kinase). Loss of kinase activity of mutant NIK, predicted by in silico analysis and confirmed by functional assays, leads to defective activation of both canonical and non-canonical NF-κB signalling. Patients with mutated NIK exhibit B-cell lymphopenia, decreased frequencies of class-switched memory B cells and hypogammaglobulinemia due to impaired B-cell survival, and impaired ICOSL expression. Although overall T-cell numbers are normal, both follicular helper and memory T cells are perturbed. Natural killer (NK) cells are decreased and exhibit defective activation, leading to impaired formation of NK-cell immunological synapses. Collectively, our data illustrate the non-redundant role for NIK in human immune responses, demonstrating that loss-of-function mutations in NIK can cause multiple aberrations of lymphoid immunity.
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Affiliation(s)
- Katharina L. Willmann
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna 1090, Austria
| | - Stefanie Klaver
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna 1090, Austria
- Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo 05508-900, Brazil
| | - Figen Doğu
- Department of Pediatric Immunology and Allergy, Ankara University Medical School, Ankara 06100, Turkey
| | - Elisangela Santos-Valente
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna 1090, Austria
| | - Wojciech Garncarz
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna 1090, Austria
| | - Ivan Bilic
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna 1090, Austria
| | - Emily Mace
- Center for Human Immunobiology, Baylor College of Medicine and Texas Children’s Hospital, Houston, Texas 77030, USA
| | - Elisabeth Salzer
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna 1090, Austria
| | - Cecilia Domínguez Conde
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna 1090, Austria
| | - Heiko Sic
- Centre of Chronic Immunodeficiency, University Medical Centre Freiburg, Freiburg 79180, Germany
| | - Peter Májek
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna 1090, Austria
| | - Pinaki P. Banerjee
- Center for Human Immunobiology, Baylor College of Medicine and Texas Children’s Hospital, Houston, Texas 77030, USA
| | - Gregory I. Vladimer
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna 1090, Austria
| | - Şule Haskoloğlu
- Department of Pediatric Immunology and Allergy, Ankara University Medical School, Ankara 06100, Turkey
| | - Musa Gökalp Bolkent
- Department of Pediatric Immunology and Allergy, Ankara University Medical School, Ankara 06100, Turkey
| | - Alphan Küpesiz
- Department of Pediatric Hematology, Akdeniz University Medical School, Antalya 07985, Turkey
| | - Antonio Condino-Neto
- Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo 05508-900, Brazil
| | - Jacques Colinge
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna 1090, Austria
| | - Giulio Superti-Furga
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna 1090, Austria
| | - Winfried F. Pickl
- Christian Doppler Laboratory for Immunomodulation and Institute of Immunology, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna 1090, Austria
| | - Menno C. van Zelm
- Department of Immunology, Erasmus MC, University Medical Center, Rotterdam 3015GE, The Netherlands
| | - Hermann Eibel
- Centre of Chronic Immunodeficiency, University Medical Centre Freiburg, Freiburg 79180, Germany
| | - Jordan S. Orange
- Center for Human Immunobiology, Baylor College of Medicine and Texas Children’s Hospital, Houston, Texas 77030, USA
| | - Aydan Ikincioğulları
- Department of Pediatric Immunology and Allergy, Ankara University Medical School, Ankara 06100, Turkey
| | - Kaan Boztuğ
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna 1090, Austria
- Department of Paediatrics and Adolescent Medicine, Medical University of Vienna, Vienna 1090, Austria
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Hazar V, Karasu G, Uygun V, Akcan M, Küpesiz A, Yeşilipek A. Hematopoietic stem cell transplantation activity and trends at a pediatric transplantation center in Turkey during 1998-2008. Turk J Haematol 2012; 29:143-9. [PMID: 24744645 PMCID: PMC3986952 DOI: 10.5505/tjh.2012.78300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Accepted: 06/29/2011] [Indexed: 11/15/2022] Open
Abstract
Objective: The aim of this study was to document hematopoietic stem cell transplantation (HSCT) activity and trends at our treatment center. Material and Methods: Data collected over a 10-year period were retrospectively analyzed, concentrating primarily on types of HSCT, transplant-related mortality (TRM), stem cell sources, indications for HSCT, and causes of death following HSCT. Results: In total, 222 allogeneic (allo)-HSCT (87.4%) and 32 autologous (auto)-HSCT (12.6%) procedures were performed between 1998 and 2008. Stem cells obtained from unrelated donors were used in 22.6% (50/222) of the allo- HSCTs. Cord blood was the source of hematopoietic stem cells (HSC) in 12.2% of all transplants. The most common indication for allo-HSCT was hemoglobinopathy (43.2%), versus neuroblastoma (53.1%) for auto-HSCT. The TRM rate 1 year post transplantation was 18.3% ± 2.5% for all transplants, but differed according to transplantation type (23.5% ± 7.9% for auto-HSCT and 17.5% ± 2.6% for allo-HSCT). The most common cause of death 1 year post HSCT was infection (35.9%). Conclusion: The TRM rate in the patients that underwent allo-HSCT was similar to that which has been previously reported; however, the TRM rate in the patients that underwent auto-HSCT was higher than previously reported in developed countries. The selection of these patients to be transplanted must be made attentively.
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Affiliation(s)
- Volkan Hazar
- Akdeniz University, School of Medicine, Department of Pediatric Hematology, Oncology and BMT Unit, Antalya, Turkey
| | - Gülsün Karasu
- Akdeniz University, School of Medicine, Department of Pediatric Hematology, Oncology and BMT Unit, Antalya, Turkey
| | - Vedat Uygun
- Akdeniz University, School of Medicine, Department of Pediatric Hematology, Oncology and BMT Unit, Antalya, Turkey
| | - Mediha Akcan
- Akdeniz University, School of Medicine, Department of Pediatric Hematology, Oncology and BMT Unit, Antalya, Turkey
| | - Alphan Küpesiz
- Akdeniz University, School of Medicine, Department of Pediatric Hematology, Oncology and BMT Unit, Antalya, Turkey
| | - Akif Yeşilipek
- Akdeniz University, School of Medicine, Department of Pediatric Hematology, Oncology and BMT Unit, Antalya, Turkey
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Fışgın T, Balkan C, Celkan T, Kılınç Y, Türker M, Timur C, Gürsel T, Kürekçi E, Duru F, Küpesiz A, Olcay L, Yılmaz S, Ozgen U, Unüvar A, Oren H, Kavaklı K. Rare coagulation disorders: a retrospective analysis of 156 patients in Turkey. Turk J Haematol 2012; 29:48-54. [PMID: 24744623 PMCID: PMC3986768 DOI: 10.5505/tjh.2012.02418] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Accepted: 01/12/2011] [Indexed: 11/25/2022] Open
Abstract
Objective: To retrospectively evaluate the clinical findings, laboratory data, management, and outcome in a group ofTurkish children diagnosed with rare coagulation deficiencies (RCDs) between January 1999 and June 2009. Material and Methods: The Turkish Society of Pediatric Hematology-Hemophilia-Thrombosis-Hemostasissubcommittee designed a Microsoft Excel-based questionnaire for standardized data collection and sent it to participatinginstitutions. Results: In total, 156 patients from 12 pediatric referral centers were included in the study. The cost common RCDswere as follows: FVII (n = 53 [34%]), FV (n = 24 [15.4%]), and FX (n = 23 [14.7%]) deficiency. The most common initialfinding in the patients was epistaxis, followed by ecchymosis, and gingival bleeding. Conclusion: Initial symptoms were mucosal bleeding, and fresh frozen plasma (FFP) and tranexamic acid werethe most commonly used treatments. We think that prophylactic treatment used for hemophilia patients should beconsidered as an initial therapeutic option for patients with rare factor deficiencies and a severe clinical course, and forthose with a factor deficiency that can lead to severe bleeding.
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Affiliation(s)
- Tunç Fışgın
- Ondokuz Mayıs University, School of Medicine, Department of Pediatric Hematology, Samsun, Turkey
| | - Can Balkan
- Ege University, School of Medicine, Department of Pediatric Hematology, İzmir, Turkey
| | - Tiraje Celkan
- İstanbul University, Cerrahpaşa School of Medicine, Department of Pediatric Hematology and Oncology, İstanbul, Turkey
| | - Yurdanur Kılınç
- Çukurova University, School of Medicine, Department of Pediatric Hematology, Adana, Turkey
| | - Meral Türker
- Tepecik Research and Education Hospital, Department of Pediatric Hematology, İzmir, Turkey
| | - Cetin Timur
- Göztepe Training and Research Hospital, Department of Pediatric Hematology, İstanbul, Turkey
| | - Türkiz Gürsel
- Gazi University, School of Medicine, Department of Pediatric Hematology, Ankara, Turkey
| | - Emin Kürekçi
- Gülhane Military Medical Academy, Department of Pediatric Hematology, Ankara, Turkey
| | - Feride Duru
- Ondokuz Mayıs University, School of Medicine, Department of Pediatric Hematology, Samsun, Turkey
| | - Alphan Küpesiz
- Akdeniz University, School of Medicine, Department of Pediatric Hematology, Antalya, Turkey
| | - Lale Olcay
- Dr. Abdurahman Yurtarslan Oncology Training and Research Hospital, Department of Pediatric Hematology, Ankara, Turkey
| | - Sebnem Yılmaz
- Dokuz Eylül University, School of Medicine, Department of Pediatric Hematology, İzmir, Turkey
| | - Unsal Ozgen
- İnönü University, School of Medicine, Department of Pediatric Hematology, Malatya, Turkey
| | - Ayşegül Unüvar
- Istanbul University, İstanbul School of Medicine, Department of Pediatric Hematology and Oncology, İstanbul, Turkey
| | - Hale Oren
- Dokuz Eylül University, School of Medicine, Department of Pediatric Hematology, İzmir, Turkey
| | - Kaan Kavaklı
- Ege University, School of Medicine, Department of Pediatric Hematology, İzmir, Turkey
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Tezcan G, Küpesiz A, Yesilipek A, Hazar V, Aksu GD, Ozkaynak C, Ozbilim G. Embryonic rhabdomyosarcoma presenting as endobronchial tumor in an adolescent. Pediatr Blood Cancer 2005; 44:689-90. [PMID: 15702484 DOI: 10.1002/pbc.20324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Manguoğlu E, Sargin CF, Nal N, Keser I, Küpesiz A, Yeşilipek A, Lüleci G. combination of IVS2.849 A-G witH IVS1.1 G-A: a mutation of beta-globin gene in a Turkish beta-thalessemia major patient. Pediatr Hematol Oncol 2005; 22:291-5. [PMID: 16020116 DOI: 10.1080/08880010590935185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Beta-thalassemia, which is an autosomal recessive disease, is among the most common hemoglobinopathies in Antalya, Turkey. Mutations found in Turkish beta-thalassemia patients constitute a heterogeneous group, which is mostly composed of point mutations and, only in very rare cases, a deletion or an insertion causes affected or carrier phenotypes. Reverse dot blot hybridization (RDBH) method is used for screening common mutations, and sequence analysis and silver staining were performed consecutively to detect any uncommon mutation. The authors report a first Turkish family with a rare variant--intervening sequence 2 (IVS2) 849 (A-G). The proband's mother and father were determined as carriers of IVS2.849 (A-G) and IVS1.1 (G-A) mutations, respectively. Proband is the first child of the family and she has an IVS2.849 (A-G)/IVS1.1 (G-A) genotype with ss-thalassemia major phenotype. Prenatal diagnosis was performed for the second child, and genotype of the fetus was determined as IVS2.849 (A-G)/Normal. This first report of IVS2.849 (A-G) mutation in Turkish population shows that there are many more mutations contributing the heterogeneity of the mutation spectrum of beta-globin gene in the Turkish population, which indicates migrations of different ethnic origins.
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Affiliation(s)
- Esra Manguoğlu
- Akdeniz University, Faculty of Medicine, Department of Medical Biology and Genetics, 07070 Antalya, Turkey
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Hazar V, Kansoy S, Küpesiz A, Aksoylar S, Kantar M, Yeşilipek A. High-dose acyclovir and pre-emptive ganciclovir in prevention of cytomegalovirus disease in pediatric patients following peripheral blood stem cell transplantation. Bone Marrow Transplant 2004; 33:931-5. [PMID: 15034541 DOI: 10.1038/sj.bmt.1704463] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Cytomegalovirus (CMV) disease remains an important cause of morbidity and mortality in patients undergoing hematopoietic stem cell transplantation (HSCT). We evaluated high-dose acyclovir (HDACV) and pre-emptive ganciclovir to prevent CMV disease in 76 children who underwent peripheral blood stem cell transplantation (PBSCT) and were at risk for CMV reactivation and disease (both recipient and donor seropositive) from May 1998 to April 2003. All received HDACV from day -9 to 6 months post transplant in conjunction with weekly CMV pp65 antigenemia monitoring. The incidence of antigenemia in this cohort was 19.7%, at a median of 22 days post-PBSCT. The frequencies were 26.4 and 4.4% in allogeneic and autologous groups, respectively (P=0.03). Patients with nonmalignant disease had higher CMV antigenemia than those with malignant disease (30.8 vs 8.1%, P=0.02). Age at PBSCT, sex, graft-versus-host disease (GVHD) prophylaxis regimen and presence of acute GVHD did not affect the risk of CMV antigenemia. None of the patients who had positive pp65 antigenemia developed CMV disease during the study period. We conclude that pp65 antigenemia-guided HDACV and pre-emptive ganciclovir may prevent CMV disease in children undergoing PBSCT.
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Affiliation(s)
- V Hazar
- Department of Pediatric Hematology & Oncology, Akdeniz University Medical Faculty, Antalya, Turkey.
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Yesilipek MA, Hazar V, Küpesiz A, Kizilörs A, Uguz A, Yegin O. Peripheral blood stem cell transplantation in children with beta-thalassemia. Bone Marrow Transplant 2001; 28:1037-40. [PMID: 11781613 DOI: 10.1038/sj.bmt.1703284] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2001] [Accepted: 08/23/2001] [Indexed: 11/09/2022]
Abstract
Fifteen patients with beta-thalassemia received an allogeneic peripheral blood stem cell transplant. Median age was 3.5 years (1-15 years). Six were class I, four class II and five class III according to the Pesaro criteria. All of the donors were HLA-phenotypically identical (13 siblings and two parents). Nine patients were given BU + CY and six BU + CY plus ATG as conditioning. All patients received MTX (+1, +3, +6) and CsA (9-12 months) post transplant for GVHD prophylaxis. The median neutrophil and platelet engraftment times were day 12 and day 16, respectively. cGVHD was observed in three patients. Two patients died. Thirteen patients are well, and transfusion-independent 2-30 months after PSCT. No recurrences of thalassemia have been seen. Overall and event-free survival were 86.6%. In conclusion, we suggest that PSCT can be considered a safe and effective treatment for children with beta- thalassemia.
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Affiliation(s)
- M A Yesilipek
- Akdeniz University School of Medicine, Department of Pediatric Haematology and Immunology, Antalya, Turkey
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Abstract
Congenital amegakaryocytic thrombocytopenia (CAMT) is an unusual cause of thrombocytopenia without radial or other congenital anomalies in the newborn. Generalized bone marrow dysfunction developing later in life has been reported. We present a 13-month-old girl who was diagnosed as having congenital amegakaryocytic thrombocytopenia and was successfully treated with allogeneic peripheral stem cell transplantation (PSCT) from her fully matched sibling donor. The neutrophil engraftment was on post transplant day 12 and platelet engraftment was on day 14. Her last hemogram revealed platelets of 168 x 10(9)/l 20 months post transplant.
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