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Çekdemir D, Güvenç S, Özdemirkıran F, Eser A, Toptaş T, Özkocaman V, Haydaroğlu Şahin H, Ermiş Turak E, Esen R, Cömert M, Sadri S, Aslaner M, Uncu Ulu B, Karakuş A, Bapur DS, Alacacıoğlu İ, Aydın D, Tekinalp A, Namdaroğlu S, Ceran F, Tarkun P, Kiper D, Çetiner M, Yenerel M, Demir AM, Yılmaz G, Terzi H, Atilla E, Malkan ÜY, Acar K, Öztürk E, Tombak A, Sunu C, Salim O, Alayvaz N, Sayan Ö, Ozan Ü, Ayer M, Gökgöz Z, Andıç N, Kızılkılıç E, Noyan F, Özen M, Pepedil Tanrıkulu F, Alanoğlu G, Özkan HA, Aslan V, Çetin G, Akyol Erikçi A, Deveci B, Ersoy Dursun F, Dermenci H, Aytan P, Gündüz M, Karakuş V, Özlü C, Demircioğlu S, Akay Yanar OM, Özatlı D, Ündar L, Tiftik EN, Türköz Sucak AG, Haznedaroğlu İ, Özcan M, Şencan M, Tombuloğlu M, Özet G, Bilgir O, Turgut B, Özcan MA, Payzın KB, Sönmez M, Ayyıldız O, Dal MS, Ertop Ş, Turgut M, Soysal T, Kaya E, Ünal A, Pehlivan M, Atagündüz I, Tuğlular Fıratlı T, Saydam G, Diz Küçükkaya R. A Multi-Center Study on the Efficacy of Eltrombopag in Management of Refractory Chronic Immune Thrombocytopenia: A Real-Life Experience. Turk J Haematol 2019; 36. [PMID: 31327186 PMCID: PMC6863031 DOI: 10.4274/tjh.galenos.2018.0307] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE The aim of the present study was to evaluate the efficacy and safety of eltrombopag, an oral thrombopoietin receptor agonist, in patients with chronic immune thrombocytopenia (ITP). MATERIALS AND METHODS A total of 285 chronic ITP patients (187 women, 65.6%; 98 men, 34.4%) followed in 55 centers were enrolled in this retrospective cohort. Response to treatment was assessed according to platelet count (/mm3) and defined as complete (platelet count of >100,000/mm3), partial (30,000-100,000/mm3 or doubling of platelet count after treatment), or unresponsive (<30,000/mm3). Clinical findings, descriptive features, response to treatment, and side effects were recorded. Correlations between descriptive, clinical, and hematological parameters were analyzed. RESULTS The median age at diagnosis was 43.9±20.6 (range: 3-95) years and the duration of follow-up was 18.0±6.4 (range: 6-28.2) months. Overall response rate was 86.7% (n=247). Complete and partial responses were observed in 182 (63.8%) and 65 (22.8%) patients, respectively. Thirty-eight patients (13.4%) did not respond to eltrombopag treatment. For patients above 60 years old (n=68), overall response rate was 89.7% (n=61), and for those above 80 years old (n=12), overall response rate was 83% (n=10). Considering thrombocyte count before treatment, eltrombopag significantly increased platelet count at the 1st, 2nd, 3rd, 4th, and 8th weeks of treatment. As the time required for partial or complete response increased, response to treatment was significantly reduced. The time to reach the maximum platelet levels after treatment was quite variable (1-202 weeks). Notably, the higher the maximum platelet count after eltrombopag treatment, the more likely that side effects would occur. The most common side effects were headache (21.6%), weakness (13.7%), hepatotoxicity (11.8%), and thrombosis (5.9%). CONCLUSION Results of the current study imply that eltrombopag is an effective therapeutic option even in elderly patients with chronic ITP. However, patients must be closely monitored for response and side effects during treatment. Since both response and side effects may be variable throughout the follow-up period, patients should be evaluated dynamically, especially in terms of thrombotic risk factors.
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Affiliation(s)
- Demet Çekdemir
- Anadolu Medical Center, Bone Marrow Transplantation Center, Department of Hematology, Kocaeli, Turkey,* Address for Correspondence: Anadolu Medical Center, Bone Marrow Transplantation Center, Department of Hematology, Kocaeli, Turkey Phone: +90 542 484 87 47 E-mail:
| | - Serkan Güvenç
- Yeni Yüzyıl University Gaziosmanpaşa Hospital, Department of Hematology, İstanbul, Turkey
| | - Füsun Özdemirkıran
- İzmir Atatürk Training and Research Hospital, Clinic of Hematology, İzmir, Turkey
| | - Ali Eser
- Marmara University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
| | - Tayfur Toptaş
- Marmara University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
| | - Vildan Özkocaman
- Uludağ University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Bursa, Turkey
| | - Handan Haydaroğlu Şahin
- Gaziantep University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Gaziantep, Turkey
| | - Esra Ermiş Turak
- Erciyes University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Kayseri, Turkey
| | - Ramazan Esen
- Van Yüzüncü Yıl University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Van, Turkey
| | - Melda Cömert
- İnönü University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Malatya, Turkey
| | - Sevil Sadri
- İstanbul University-Cerrahpaşa Cerrahpaşa Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
| | - Müzeyyen Aslaner
- Bülent Ecevit University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Zonguldak, Turkey
| | - Bahar Uncu Ulu
- Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Clinic of Hematology, Ankara, Turkey
| | - Abdullah Karakuş
- Dicle University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Diyarbakır, Turkey
| | - Derya Selim Bapur
- Karadeniz Teknik University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Trabzon, Turkey
| | - İnci Alacacıoğlu
- Dokuz Eylül University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İzmir, Turkey
| | - Demet Aydın
- Okmeydanı Training and Research Hospital, Clinic of Hematology, İstanbul, Turkey
| | - Atakan Tekinalp
- Namık Kemal University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Tekirdağ, Turkey
| | - Sinem Namdaroğlu
- İzmir Bozyaka Training and Research Hospital, Clinic of Hematology, İzmir, Turkey
| | - Funda Ceran
- Ankara Numune Training and Research Hospital, Clinic of Hematology, Ankara, Turkey
| | - Pınar Tarkun
- Kocaeli University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Kocaeli, Turkey
| | - Demet Kiper
- Ege University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İzmir, Turkey
| | - Mustafa Çetiner
- Koç University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
| | - Mustafa Yenerel
- İstanbul University İstanbul Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
| | - Ahmet Muzaffer Demir
- Trakya University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Edirne, Turkey
| | - Güven Yılmaz
- Dr. Lütfi Kırdar Kartal Training and Research Hospital, Clinic of Hematology, İstanbul, Turkey
| | - Hatice Terzi
- Cumhuriyet University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Sivas, Turkey
| | - Erden Atilla
- Ankara University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Turkey
| | - Ümit Yavuz Malkan
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Turkey
| | - Kadir Acar
- Gazi University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Turkey
| | - Erman Öztürk
- Koç University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
| | - Anıl Tombak
- Mersin University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Mersin, Turkey
| | - Cenk Sunu
- Sakarya University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Sakarya, Turkey
| | - Ozan Salim
- Akdeniz University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Antalya, Turkey
| | - Nevin Alayvaz
- Ondokuz Mayıs University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Samsun, Turkey
| | - Özkan Sayan
- Medicana Çamlıca Hospital, Clinic of Hematology, İstanbul, Turkey
| | - Ülkü Ozan
- Medical Park Hospital, Clinic of Hematology, Bursa, Turkey
| | - Mesut Ayer
- Haseki Training and Research Hospital, Clinic of Hematology, İstanbul, Turkey
| | - Zafer Gökgöz
- Medicana International Ankara Hospital, Clinic of Hematology, Ankara, Turkey
| | - Neslihan Andıç
- Eskişehir Osmangazi University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Eskişehir, Turkey
| | - Ebru Kızılkılıç
- Acıbadem Kozyatağı Hospital, Clinic of Hematology, İstanbul, Turkey
| | - Figen Noyan
- Başkent University İstanbul Hospital, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
| | - Mehmet Özen
- Tokat Gaziosmanpaşa University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Tokat, Turkey
| | | | - Güçhan Alanoğlu
- Süleyman Demirel University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Isparta, Turkey
| | - Hasan Atilla Özkan
- Yeditepe University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
| | - Vahap Aslan
- Ümit Hospital, Clinic of Hematology, Eskişehir, Turkey
| | - Güven Çetin
- Bezmialem Vakıf University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
| | - Alev Akyol Erikçi
- İstanbul Yeni Yüzyıl University Gaziosmanpaşa Hospital Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
| | - Burak Deveci
- Medstar Antalya Hospital, Clinic of Hematology, Antalya, Turkey
| | - Fadime Ersoy Dursun
- Göztepe Training and Research Hospital, Clinic of Hematology, İstanbul, Turkey
| | - Hasan Dermenci
- Haydarpaşa Numune Training and Research Hospital, Clinic of Hematology, İstanbul, Turkey
| | - Pelin Aytan
- Başkent University Training and Research Hospital, Bone Marrow and Stem Cell Transplantation Center, Department of Hematology, Adana, Turkey
| | - Mehmet Gündüz
- Atatürk Training and Research Hospital, Clinic of Hematology, Ankara, Turkey
| | - Volkan Karakuş
- Muğla Sıtkı Koçman University Training and Research Hospital, Department of Hematology, Muğla, Turkey
| | - Can Özlü
- Ministry of Health Erzurum Regional Training and Research Hospital, Clinic of Hematology, Erzurum, Turkey
| | - Sinan Demircioğlu
- Van Yüzüncü Yıl University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Van, Turkey
| | - Olga Meltem Akay Yanar
- Eskişehir Osmangazi University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Eskişehir, Turkey
| | - Düzgün Özatlı
- Ondokuz Mayıs University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Samsun, Turkey
| | - Levent Ündar
- Akdeniz University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Antalya, Turkey
| | - Eyüp Naci Tiftik
- Mersin University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Mersin, Turkey
| | - Ayhan Gülsan Türköz Sucak
- Gazi University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Turkey
| | - İbrahim Haznedaroğlu
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Turkey
| | - Muhit Özcan
- Ankara University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Turkey
| | - Mehmet Şencan
- Cumhuriyet University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Sivas, Turkey
| | - Murat Tombuloğlu
- Ege University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İzmir, Turkey
| | - Gülsüm Özet
- Ankara Numune Training and Research Hospital, Clinic of Hematology, Ankara, Turkey
| | - Oktay Bilgir
- İzmir Bozyaka Training and Research Hospital, Clinic of Hematology, İzmir, Turkey
| | - Burhan Turgut
- Namık Kemal University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Tekirdağ, Turkey
| | - Mehmet Ali Özcan
- Dokuz Eylül University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İzmir, Turkey
| | - Kadriye Bahriye Payzın
- Yeni Yüzyıl University Gaziosmanpaşa Hospital, Department of Hematology, İstanbul, Turkey
| | - Mehmet Sönmez
- Karadeniz Teknik University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Trabzon, Turkey
| | - Orhan Ayyıldız
- Dicle University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Diyarbakır, Turkey
| | - Mehmet Sinan Dal
- Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Clinic of Hematology, Ankara, Turkey
| | - Şehmus Ertop
- Bülent Ecevit University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Zonguldak, Turkey
| | - Mehmet Turgut
- Ondokuz Mayıs University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Samsun, Turkey
| | - Teoman Soysal
- İstanbul University-Cerrahpaşa Cerrahpaşa Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
| | - Emin Kaya
- İnönü University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Malatya, Turkey
| | - Ali Ünal
- Erciyes University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Kayseri, Turkey
| | - Mustafa Pehlivan
- Gaziantep University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Gaziantep, Turkey
| | - Işık Atagündüz
- Marmara University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
| | - Tülin Tuğlular Fıratlı
- Marmara University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
| | - Güray Saydam
- Ege University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İzmir, Turkey
| | - Reyhan Diz Küçükkaya
- İstanbul University Science Faculty, Department of Molecular Biology and Genetics, İstanbul, Turkey
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2
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Çekdemir D, Güvenç S, Özdemirkıran F, Eser A, Toptaş T, Özkocaman V, Haydaroğlu Şahin H, Ermiş Turak E, Esen R, Cömert M, Sadri S, Aslaner M, Uncu Ulu B, Karakuş A, Selim Bapur D, Alacacıoğlu İ, Aydın D, Tekinalp A, Namdaroğlu S, Ceran F, Tarkun P, Kiper D, Çetiner M, Yenerel M, Demir AM, Yılmaz G, Terzi H, Atilla E, Malkan ÜY, Acar K, Öztürk E, Tombak A, Sunu C, Salim O, Alayvaz N, Sayan Ö, Ozan Ü, Ayer M, Gökgöz Z, Andıç N, Kızılkılıç E, Noyan F, Özen M, Pepedil Tanrıkulu F, Alanoğlu G, Özkan HA, Aslan V, Çetin G, Akyol Erikçi A, Deveci B, Ersoy Dursun F, Dermenci H, Aytan P, Gündüz M, Karakuş V, Özlü C, Demircioğlu S, Akay Yanar OM, Özatlı D, Ündar L, Tiftik EN, Türköz Sucak AG, Haznedaroğlu İ, Özcan M, Şencan M, Tombuloğlu M, Özet G, Bilgir O, Turgut B, Özcan MA, Payzın KB, Sönmez M, Ayyıldız O, Dal MS, Ertop Ş, Turgut M, Soysal T, Kaya E, Ünal A, Pehlivan M, Atagündüz I, Tuğlular Fıratlı T, Saydam G, Diz Küçükkaya R. A Multi-Center Study on the Efficacy of Eltrombopag in Management of Refractory Chronic Immune Thrombocytopenia: A Real-Life Experience. Turk J Haematol 2019; 36:230-237. [PMID: 31327186 DOI: 10.4274/tjh.galenos.2019.2018.0307] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective The aim of the present study was to evaluate the efficacy and safety of eltrombopag, an oral thrombopoietin receptor agonist, in patients with chronic immune thrombocytopenia (ITP). Materials and Methods A total of 285 chronic ITP patients (187 women, 65.6%; 98 men, 34.4%) followed in 55 centers were enrolled in this retrospective cohort. Response to treatment was assessed according to platelet count (/mm3) and defined as complete (platelet count of >100,000/mm3), partial (30,000-100,000/mm3 or doubling of platelet count after treatment), or unresponsive (<30,000/mm3). Clinical findings, descriptive features, response to treatment, and side effects were recorded. Correlations between descriptive, clinical, and hematological parameters were analyzed. Results The median age at diagnosis was 43.9±20.6 (range: 3-95) years and the duration of follow-up was 18.0±6.4 (range: 6-28.2) months. Overall response rate was 86.7% (n=247). Complete and partial responses were observed in 182 (63.8%) and 65 (22.8%) patients, respectively. Thirty-eight patients (13.4%) did not respond to eltrombopag treatment. For patients above 60 years old (n=68), overall response rate was 89.7% (n=61), and for those above 80 years old (n=12), overall response rate was 83% (n=10). Considering thrombocyte count before treatment, eltrombopag significantly increased platelet count at the 1st, 2nd, 3rd, 4th, and 8th weeks of treatment. As the time required for partial or complete response increased, response to treatment was significantly reduced. The time to reach the maximum platelet levels after treatment was quite variable (1-202 weeks). Notably, the higher the maximum platelet count after eltrombopag treatment, the more likely that side effects would occur. The most common side effects were headache (21.6%), weakness (13.7%), hepatotoxicity (11.8%), and thrombosis (5.9%). Conclusion Results of the current study imply that eltrombopag is an effective therapeutic option even in elderly patients with chronic ITP. However, patients must be closely monitored for response and side effects during treatment. Since both response and side effects may be variable throughout the follow-up period, patients should be evaluated dynamically, especially in terms of thrombotic risk factors.
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Affiliation(s)
- Demet Çekdemir
- Anadolu Medical Center, Bone Marrow Transplantation Center, Department of Hematology, Kocaeli, Turkey
| | - Serkan Güvenç
- Yeni Yüzyıl University Gaziosmanpaşa Hospital, Department of Hematology, İstanbul, Turkey
| | - Füsun Özdemirkıran
- İzmir Atatürk Training and Research Hospital, Clinic of Hematology, İzmir, Turkey
| | - Ali Eser
- Marmara University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
| | - Tayfur Toptaş
- Marmara University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
| | - Vildan Özkocaman
- Uludağ University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Bursa, Turkey
| | - Handan Haydaroğlu Şahin
- Gaziantep University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Gaziantep, Turkey
| | - Esra Ermiş Turak
- Erciyes University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Kayseri, Turkey
| | - Ramazan Esen
- Van Yüzüncü Yıl University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Van, Turkey
| | - Melda Cömert
- İnönü University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Malatya, Turkey
| | - Sevil Sadri
- İstanbul University-Cerrahpaşa Cerrahpaşa Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
| | - Müzeyyen Aslaner
- Bülent Ecevit University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Zonguldak, Turkey
| | - Bahar Uncu Ulu
- Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Clinic of Hematology, Ankara, Turkey
| | - Abdullah Karakuş
- Dicle University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Diyarbakır, Turkey
| | - Derya Selim Bapur
- Karadeniz Teknik University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Trabzon, Turkey
| | - İnci Alacacıoğlu
- Dokuz Eylül University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İzmir, Turkey
| | - Demet Aydın
- Okmeydanı Training and Research Hospital, Clinic of Hematology, İstanbul, Turkey
| | - Atakan Tekinalp
- Namık Kemal University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Tekirdağ, Turkey
| | - Sinem Namdaroğlu
- İzmir Bozyaka Training and Research Hospital, Clinic of Hematology, İzmir, Turkey
| | - Funda Ceran
- Ankara Numune Training and Research Hospital, Clinic of Hematology, Ankara, Turkey
| | - Pınar Tarkun
- Kocaeli University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Kocaeli, Turkey
| | - Demet Kiper
- Ege University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İzmir, Turkey
| | - Mustafa Çetiner
- Koç University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
| | - Mustafa Yenerel
- İstanbul University İstanbul Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
| | - Ahmet Muzaffer Demir
- Trakya University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Edirne, Turkey
| | - Güven Yılmaz
- Dr. Lütfi Kırdar Kartal Training and Research Hospital, Clinic of Hematology, İstanbul, Turkey
| | - Hatice Terzi
- Cumhuriyet University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Sivas, Turkey
| | - Erden Atilla
- Ankara University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Turkey
| | - Ümit Yavuz Malkan
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Turkey
| | - Kadir Acar
- Gazi University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Turkey
| | - Erman Öztürk
- Koç University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
| | - Anıl Tombak
- Mersin University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Mersin, Turkey
| | - Cenk Sunu
- Sakarya University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Sakarya, Turkey
| | - Ozan Salim
- Akdeniz University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Antalya, Turkey
| | - Nevin Alayvaz
- Ondokuz Mayıs University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Samsun, Turkey
| | - Özkan Sayan
- Medicana Çamlıca Hospital, Clinic of Hematology, İstanbul, Turkey
| | - Ülkü Ozan
- Medical Park Hospital, Clinic of Hematology, Bursa, Turkey
| | - Mesut Ayer
- Haseki Training and Research Hospital, Clinic of Hematology, İstanbul, Turkey
| | - Zafer Gökgöz
- Medicana International Ankara Hospital, Clinic of Hematology, Ankara, Turkey
| | - Neslihan Andıç
- Eskişehir Osmangazi University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Eskişehir, Turkey
| | - Ebru Kızılkılıç
- Acıbadem Kozyatağı Hospital, Clinic of Hematology, İstanbul, Turkey
| | - Figen Noyan
- Başkent University İstanbul Hospital, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
| | - Mehmet Özen
- Tokat Gaziosmanpaşa University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Tokat, Turkey
| | | | - Güçhan Alanoğlu
- Süleyman Demirel University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Isparta, Turkey
| | - Hasan Atilla Özkan
- Yeditepe University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
| | - Vahap Aslan
- Ümit Hospital, Clinic of Hematology, Eskişehir, Turkey
| | - Güven Çetin
- Bezmialem Vakıf University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
| | - Alev Akyol Erikçi
- İstanbul Yeni Yüzyıl University Gaziosmanpaşa Hospital Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
| | - Burak Deveci
- Medstar Antalya Hospital, Clinic of Hematology, Antalya, Turkey
| | - Fadime Ersoy Dursun
- Göztepe Training and Research Hospital, Clinic of Hematology, İstanbul, Turkey
| | - Hasan Dermenci
- Haydarpaşa Numune Training and Research Hospital, Clinic of Hematology, İstanbul, Turkey
| | - Pelin Aytan
- Başkent University Training and Research Hospital, Bone Marrow and Stem Cell Transplantation Center, Department of Hematology, Adana, Turkey
| | - Mehmet Gündüz
- Atatürk Training and Research Hospital, Clinic of Hematology, Ankara, Turkey
| | - Volkan Karakuş
- Muğla Sıtkı Koçman University Training and Research Hospital, Department of Hematology, Muğla, Turkey
| | - Can Özlü
- Ministry of Health Erzurum Regional Training and Research Hospital, Clinic of Hematology, Erzurum, Turkey
| | - Sinan Demircioğlu
- Van Yüzüncü Yıl University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Van, Turkey
| | - Olga Meltem Akay Yanar
- Eskişehir Osmangazi University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Eskişehir, Turkey
| | - Düzgün Özatlı
- Ondokuz Mayıs University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Samsun, Turkey
| | - Levent Ündar
- Akdeniz University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Antalya, Turkey
| | - Eyüp Naci Tiftik
- Mersin University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Mersin, Turkey
| | - Ayhan Gülsan Türköz Sucak
- Gazi University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Turkey
| | - İbrahim Haznedaroğlu
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Turkey
| | - Muhit Özcan
- Ankara University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Turkey
| | - Mehmet Şencan
- Cumhuriyet University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Sivas, Turkey
| | - Murat Tombuloğlu
- Ege University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İzmir, Turkey
| | - Gülsüm Özet
- Ankara Numune Training and Research Hospital, Clinic of Hematology, Ankara, Turkey
| | - Oktay Bilgir
- İzmir Bozyaka Training and Research Hospital, Clinic of Hematology, İzmir, Turkey
| | - Burhan Turgut
- Namık Kemal University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Tekirdağ, Turkey
| | - Mehmet Ali Özcan
- Dokuz Eylül University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İzmir, Turkey
| | - Kadriye Bahriye Payzın
- Yeni Yüzyıl University Gaziosmanpaşa Hospital, Department of Hematology, İstanbul, Turkey
| | - Mehmet Sönmez
- Karadeniz Teknik University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Trabzon, Turkey
| | - Orhan Ayyıldız
- Dicle University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Diyarbakır, Turkey
| | - Mehmet Sinan Dal
- Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Clinic of Hematology, Ankara, Turkey
| | - Şehmus Ertop
- Bülent Ecevit University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Zonguldak, Turkey
| | - Mehmet Turgut
- Ondokuz Mayıs University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Samsun, Turkey
| | - Teoman Soysal
- İstanbul University-Cerrahpaşa Cerrahpaşa Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
| | - Emin Kaya
- İnönü University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Malatya, Turkey
| | - Ali Ünal
- Erciyes University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Kayseri, Turkey
| | - Mustafa Pehlivan
- Gaziantep University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Gaziantep, Turkey
| | - Işık Atagündüz
- Marmara University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
| | - Tülin Tuğlular Fıratlı
- Marmara University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
| | - Güray Saydam
- Ege University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İzmir, Turkey
| | - Reyhan Diz Küçükkaya
- İstanbul University Science Faculty, Department of Molecular Biology and Genetics, İstanbul, Turkey
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Kaynar L, Demir K, Turak EE, Öztürk ÇP, Zararsız G, Gönen ZB, Gökahmetoğlu S, Şıvgın S, Eser B, Köker Y, Solmaz M, Ünal A, Çetin M. TcRαβ-depleted haploidentical transplantation results in adult acute leukemia patients. Hematology 2017; 22:136-144. [PMID: 27724812 DOI: 10.1080/10245332.2016.1238182] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [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] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION The use of αβ+ T-cell-depleted grafts is a novel approach to prevent graft failure, graft-versus-host disease (GVHD), and non-relapse mortality (NRM) in patients undergoing haploidentical hematopoietic stem cell transplantation. PATIENT AND METHOD Thirty-four patients with acute leukemia and lacking a match donor were treated with αβ T-cell-depleted allografts from haploidentical family donors. A total of 24 patients had acute myeloid leukemia (AML) and 10 had acute lymphoblastic leukemia. 84.4% of patients were in the high-risk group, and 55.9% were not in remission. The preparative regimen included thiotepa, melphalan, fludarabine, and anti-thymocyte globulin-Fresenius. Grafts were peripheral blood stem cells engineered by TcR-alpha/beta depletion. RESULTS Neutrophil and platelet engraftment was achieved on days +12 (range, 10.5-15) and +11 (range, 10-12). All but three patients were engrafted with full donor chimerism. Grade III-IV acute GVHD occurred in two (5.9%) patients and chronic GVHD in two (6.1%). Disease-free survival and overall survival were 42 and 54% at 1 year, respectively. AML as disease type (HR: 4.87, 95% CI: 1.50-15.87) and mother as donor (HR: 1.05, 95% CI: 1.00-1.11) were found to be independent risk factors on patient survival. Mortality and NRM in the first 100 days were 5 of 34 (14.7%) and 4 of 34 (11.7%). Relapse was the main cause of death (56.3%). T-cell reconstitution appears to be faster than that reported in published data with CD3/CD19-depleted grafts. CONCLUSION αβ T-cell-depleted haploidentical transplantation may be a good alternative for high-risk patients if there are no human leukocyte antigen matched donors.
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MESH Headings
- Acute Disease
- Adult
- Female
- Graft Survival
- Graft vs Host Disease/etiology
- Graft vs Host Disease/prevention & control
- HLA Antigens/genetics
- HLA Antigens/immunology
- Haplotypes
- Hematopoietic Stem Cell Mobilization/methods
- Hematopoietic Stem Cell Transplantation/adverse effects
- Hematopoietic Stem Cell Transplantation/methods
- Humans
- Leukemia/genetics
- Leukemia/immunology
- Leukemia/mortality
- Leukemia/therapy
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/immunology
- Leukemia, Myeloid, Acute/mortality
- Leukemia, Myeloid, Acute/therapy
- Lymphocyte Depletion/methods
- Male
- Middle Aged
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/genetics
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/immunology
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/mortality
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/therapy
- Receptors, Antigen, T-Cell, alpha-beta/metabolism
- Retrospective Studies
- Survival Analysis
- T-Lymphocyte Subsets/immunology
- T-Lymphocyte Subsets/metabolism
- Transplantation Conditioning/methods
- Transplantation, Homologous
- Treatment Outcome
- Young Adult
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Affiliation(s)
- Leylagul Kaynar
- a Hematology Department, Medical Faculty , Erciyes University , Kayseri , Turkey
| | - Koray Demir
- a Hematology Department, Medical Faculty , Erciyes University , Kayseri , Turkey
| | - Esra Ermiş Turak
- a Hematology Department, Medical Faculty , Erciyes University , Kayseri , Turkey
| | - Çiğdem Pala Öztürk
- a Hematology Department, Medical Faculty , Erciyes University , Kayseri , Turkey
- b Dışkapı Yıldırım Beyazıt Training and Research Hospital , Ankara , Turkey
| | - Gökmen Zararsız
- c Biostatistics Department, Medical Faculty , Erciyes University , Kayseri , Turkey
| | - Zeynep Burçin Gönen
- d Genome and Stem Cell Center (GENKOK) , Erciyes University , Kayseri , Turkey
| | - Selma Gökahmetoğlu
- e Microbiology Department, Medical Faculty , Erciyes University , Kayseri , Turkey
| | - Serdar Şıvgın
- a Hematology Department, Medical Faculty , Erciyes University , Kayseri , Turkey
| | - Bülent Eser
- a Hematology Department, Medical Faculty , Erciyes University , Kayseri , Turkey
| | - Yavuz Köker
- f Immunology Department, Medical Faculty , Erciyes University , Kayseri , Turkey
| | - Musa Solmaz
- a Hematology Department, Medical Faculty , Erciyes University , Kayseri , Turkey
| | - Ali Ünal
- a Hematology Department, Medical Faculty , Erciyes University , Kayseri , Turkey
| | - Mustafa Çetin
- a Hematology Department, Medical Faculty , Erciyes University , Kayseri , Turkey
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Tekgündüz E, Kaynar L, Göker H, Kaya AH, Turak EE, Eliaçık E, Kayıkçı Ö, Çetin M, Büyükaşık Y, Eser B, Altuntaş F. Retrospective analysis of adult patients with acute lymphoblastic leukemia undergoing allogeneic hematopoietic cell transplantation: A multicenter experience of daily practice. Transfus Apher Sci 2016; 54:41-7. [PMID: 26810140 DOI: 10.1016/j.transci.2016.01.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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] [Indexed: 02/05/2023]
Abstract
Compared to pediatric age group, the prognosis of adult acute lymphoblastic leukemia (ALL) is still dismal even in patients receiving allogeneic hematopoietic cell transplantation (AHCT). We retrospectively analyzed 205 adults (male: 122; female: 83) with ALL who underwent AHCT. Median age of patients was 28 (18-59). Fifty-two patients had Ph(+) ALL. The estimated relapse-free and overall survival (OS) of the study cohort at 1, 2 and 3 years were 52.3%/63.9%, 42.9%/49.5% and 39.9%/45.6%, respectively. On multivariate analysis, first complete remission at the time of AHCT, TBI-based conditioning and development of chronic graft-versus-host disease were only factors, which were significantly associated with prolonged OS.
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Affiliation(s)
- Emre Tekgündüz
- Hematology and Stem Cell Transplantation Clinic, Ankara Oncology Education and Research Hospital, Ankara, Turkey.
| | - Leylagül Kaynar
- Division of Hematology, Department of Internal Medicine, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Hakan Göker
- Division of Hematology, Department of Internal Medicine, Hacettepe University Medical Faculty, Ankara, Turkey
| | - Ali Hakan Kaya
- Hematology and Stem Cell Transplantation Clinic, Ankara Oncology Education and Research Hospital, Ankara, Turkey
| | - Esra Ermiş Turak
- Division of Hematology, Department of Internal Medicine, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Eylem Eliaçık
- Division of Hematology, Department of Internal Medicine, Hacettepe University Medical Faculty, Ankara, Turkey
| | - Ömür Kayıkçı
- Hematology and Stem Cell Transplantation Clinic, Ankara Oncology Education and Research Hospital, Ankara, Turkey
| | - Mustafa Çetin
- Division of Hematology, Department of Internal Medicine, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Yahya Büyükaşık
- Division of Hematology, Department of Internal Medicine, Hacettepe University Medical Faculty, Ankara, Turkey
| | - Bülent Eser
- Division of Hematology, Department of Internal Medicine, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Fevzi Altuntaş
- Hematology and Stem Cell Transplantation Clinic, Ankara Oncology Education and Research Hospital, Ankara, Turkey; Division of Hematology, Department of Internal Medicine, Yıldırım Beyazıt University Medical Faculty, Ankara, Turkey
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