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Yozgat A, Bozkaya I, Aksu T, Isik P, Kanbur M, Tiryaki T, Yarali N, Özbek N. Analysis of hemorrhagic cystitis and BK viremia in children after hematopoietic stem cell transplantation. Indian J Transplant 2022. [DOI: 10.4103/ijot.ijot_84_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Bilgin BK, Yozgat AK, Isik P, Çulha V, Kacar D, Kara A, Ozbek NY, Yarali N. The effect of deferasirox on endocrine complications in children with thalassemia. Pediatr Hematol Oncol 2020; 37:455-464. [PMID: 32131650 DOI: 10.1080/08880018.2020.1734124] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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] [Indexed: 01/19/2023]
Abstract
Endocrine system dysfunctions are the significant complications of excessive iron overload in beta thalassemia patients. The aim of this study was to evaluate the long-term effect of chelation with deferasirox on endocrine complications. The study group consisted of children with beta thalassemia who had been evaluated for the growth and pubertal development, bone metabolism, thyroid/parathyroid functions, glucose metabolism dysfunctions in the department of pediatric hematology of Ankara Dışkapı Child Health and Diseases Hematology Oncology Training And Research Hospital between 2009-2011 and reevaluated after deferasirox chelation therapy in 2018. Thirty-one transfusion dependent beta-thalassemia patients were enrolled for the study. Seventeen (54.8%) patients were male and the mean age was 16.9 ± 3.8 (9-23) years. Splenectomy was performed in 11 patients (35.5%). In the initial evaluation, 26 patients (84%) received deferoxamine and/or deferiprone and five (17%) patients received deferasirox as a chelator; in the final evaluation all patients were receiving deferasirox. The mean duration of deferasirox treatment was 5.9 ± 2.02 years (1-10 years). Of the 26 patients who had endocrine complications between 2009-2011, 18 were recovered. In the final evaluation, eight patients (25%) developed new endocrinopathies. The frequency of endocrine complications seen before the deferasirox treatment (83%) was higher than the frequency of complications while receiving deferasirox treatment (25.8%) (p < 0,05). In this study, it was determined that both existing endocrine abnormalities were reduced and recent developed problems were less likely with long-term deferasirox treatment in thalassemia patients.
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Affiliation(s)
- Burçak Kurucu Bilgin
- Department of Pediatric Hematology, Ankara Dışkapı Child Health and Diseases Hematology Oncology Training and Research Hospital, Ankara, Turkey
| | - Ayça Koca Yozgat
- Department of Pediatric Hematology, Ankara Dışkapı Child Health and Diseases Hematology Oncology Training and Research Hospital, Ankara, Turkey
| | - Pamir Isik
- Department of Pediatric Hematology, Ankara Dışkapı Child Health and Diseases Hematology Oncology Training and Research Hospital, Ankara, Turkey
| | - Vildan Çulha
- Department of Pediatric Hematology, Ankara Dışkapı Child Health and Diseases Hematology Oncology Training and Research Hospital, Ankara, Turkey
| | - Dilek Kacar
- Department of Pediatric Hematology, Ankara Dışkapı Child Health and Diseases Hematology Oncology Training and Research Hospital, Ankara, Turkey
| | - Abdurrahman Kara
- Department of Pediatric Hematology, Ankara Dışkapı Child Health and Diseases Hematology Oncology Training and Research Hospital, Ankara, Turkey
| | - Namık Yasar Ozbek
- Department of Pediatric Hematology, Ankara Dışkapı Child Health and Diseases Hematology Oncology Training and Research Hospital, Ankara, Turkey
| | - Nese Yarali
- Department of Pediatric Hematology, Ankara Dışkapı Child Health and Diseases Hematology Oncology Training and Research Hospital, Ankara, Turkey
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Donmez AD, Isik P, Cetinkaya S, Yarali N. Bone Loss in Pediatric Survivors of Acute Lymphoblastic Leukemia. Eurasian J Med 2019; 51:38-41. [PMID: 30911254 DOI: 10.5152/eurasianjmed.2018.18196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 05/21/2018] [Accepted: 08/01/2018] [Indexed: 11/22/2022] Open
Abstract
Objective Bone mineral density (BMD) in children may be negatively affected by acute lymphoblastic leukemia (ALL) or its treatment protocol. The aim of our study was to evaluate bone health by measuring BMD after ALL treatment. Materials and Methods The age, anthropometric measurements, and lumbar spine BMDs were recorded in 39 pediatric survivors of ALL, with no history of relapse, secondary malignancy, or transplantation. The lumbar spine BMD was measured by dual energy x-ray absorptiometry. The BMD risk factors, pubertal status, age at diagnosis, risk category, the time interval from the completion of the chemotherapy, and cranial radiotherapy were investigated. Serum calcium, phosphate, alkaline phosphates, magnesium, parathormone, and 25-hydroxy vitamin D levels were determined. Results The mean BMD value was calculated as 0.668±0.176 g/cm2. Osteopenia and osteoporosis were detected in nine patients (23.1%) and three patients (7.7%), respectively, according to previously published data of healthy age- and sex-related Turkish children's BMD values. The mean age at diagnosis of patients with ALL, having the Z-score above -1 was lower than in patients having bone defect (Z score <-1). Conclusion Early detection and intervention strategies to optimize bone health are essential in pediatric patients with ALL.
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Affiliation(s)
| | - Pamir Isik
- Ankara Children's Hematology and Oncology Hospital, Ankara, Turkey
| | - Semra Cetinkaya
- Department of Pediatric Endocrinology, Dr. Sami Ulus Obstetrics and Gynecology, Children's Health and Disease Training and Research Hospital, Ankara, Turkey
| | - Nese Yarali
- Ankara Children's Hematology and Oncology Hospital, Ankara, Turkey
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Gokcebay DG, Azik F, Bayram C, Erdem AY, Fettah A, Isik P, Yarali N, Demirel F, Tunc B, Ozbek N. Evaluation of endocrine and metabolic dysfunctions after hematopoietic stem cell transplantation in children: a study from Turkey. J Pediatr Endocrinol Metab 2017; 30:683-691. [PMID: 28525352 DOI: 10.1515/jpem-2016-0306] [Citation(s) in RCA: 5] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 04/03/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Endocrine organs are highly susceptible to effects of high-dose chemotherapy. The objective of the study was to evaluate endocrine and metabolic complications after hematopoietic stem cell transplantation (HSCT) in children. METHODS The patients who underwent HSCT in our center from April 2010 to October 2014 with at least 1 year follow-up were analyzed retrospectively. RESULTS One-hundred children (M/F:59/41; mean age 8.9±4.8 years, mean follow-up time 3.4±1.2 years) were included in the study. Female hypogonadism was the most common endocrine dysfunction (35.7%), followed by growth impairment (29.4%), malnutrition (27.4%), dyslipidemia (26%), low bone mineral density (BMD) (25%), hypothyroidism (13%) and insulin resistance (12%). Patients who underwent HSCT >10 years of age were significantly at risk for hypogonadism, metabolic syndrome, growth impairment and malnutrition (p<0.05). CONCLUSIONS Endocrine or metabolic dysfunctions are more prevalent in children who are older than 10 years of age at HSCT. Children who underwent HSCT should be followed-up by a multidisciplinary team during puberty and adolescence.
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Gürlek Gökçebay D, Ozbek N, Yazal Erdem A, Culha V, Yarali N, Isik P, Avci Z, Azik F, Demirel F, Tunc B. Effects of stem cell transplantation on bone mineral density and vitamin D status in children with thalassemia major. Pediatr Transplant 2017; 21. [PMID: 28078791 DOI: 10.1111/petr.12876] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/23/2016] [Indexed: 11/30/2022]
Abstract
HSCT is a curative treatment in TM, but conditioning and immunosuppressive treatment may affect bone metabolism. In this retrospective study, we aimed to compare BMD, vitamin D status, and growth in children with TM who underwent HSCT to those in children with TD TM. Twenty-three children with TM who underwent HSCT (mean age 7.1 years [1.03-14.7]) and 24 children with TD thalassemia (mean age 9.8 years [1.6-14]) were recruited. Lumbar spine BMD of TD thalassemia patients was higher than those in patients who had HSCT at both baseline and second-year assessments (P=.009, P<.001, respectively). However, BMD Z scores or serum 25-OH vitamin D levels were not different in two groups. Being >10 years of age was a significant risk factor for low BMD, height, and weight Z score for both groups. Patients who underwent HSCT with Pesaro risk class II or III had higher risk for low BMD compared to those risk class I patients (P=.044). In conclusion, children with TM who were >10 years at HSCT are at risk for low BMD and growth retardation. HSCT had no effect on BMD deficit in children with TM.
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Affiliation(s)
- Dilek Gürlek Gökçebay
- Department of Pediatric Hematology, Ankara Children's Hematology and Oncology Hospital, Ankara, Turkey
| | - Namik Ozbek
- Department of Pediatric Hematology, Ankara Children's Hematology and Oncology Hospital, Ankara, Turkey
| | - Arzu Yazal Erdem
- Department of Pediatric Hematology, Ankara Children's Hematology and Oncology Hospital, Ankara, Turkey
| | - Vildan Culha
- Department of Pediatric Hematology, Ankara Children's Hematology and Oncology Hospital, Ankara, Turkey
| | - Nese Yarali
- Department of Pediatric Hematology, Ankara Children's Hematology and Oncology Hospital, Ankara, Turkey
| | - Pamir Isik
- Department of Pediatric Hematology, Ankara Children's Hematology and Oncology Hospital, Ankara, Turkey
| | - Zekai Avci
- Department of Pediatric Hematology, Ankara Children's Hematology and Oncology Hospital, Ankara, Turkey
| | - Fatih Azik
- Department of Pediatric Hematology, Ankara Children's Hematology and Oncology Hospital, Ankara, Turkey
| | - Fatma Demirel
- Department of Pediatric Endocrinology and Metabolism, Ankara Children's Hematology and Oncology Hospital, Ankara, Turkey
| | - Bahattin Tunc
- Department of Pediatric Hematology, Ankara Children's Hematology and Oncology Hospital, Ankara, Turkey
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Isik P, Yarali N, Ozkasap S, Kara A, Tunc B, Bay A. Urinary retention in acute lymphoblastic leukemia induction therapy: Two distinct pathologies. J Pediatr Neurol 2015. [DOI: 10.3233/jpn-2009-0321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Pamir Isik
- Department of Pediatrics, Dr. Sami Ulus Children's Hospital, Ankara, Turkiye
| | - Nese Yarali
- Department of Pediatrics, Dr. Sami Ulus Children's Hospital, Ankara, Turkiye
| | - Serdar Ozkasap
- Department of Pediatrics, Dr. Sami Ulus Children's Hospital, Ankara, Turkiye
| | - Abdurrahman Kara
- Department of Pediatrics, Dr. Sami Ulus Children's Hospital, Ankara, Turkiye
| | - Bahattin Tunc
- Department of Pediatrics, Dr. Sami Ulus Children's Hospital, Ankara, Turkiye
| | - Ali Bay
- Department of Pediatrics, Dr. Sami Ulus Children's Hospital, Ankara, Turkiye
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Gürlek Gökçebay D, Azik F, Ozbek N, Isik P, Avci Z, Tavil B, Kara A, Tunc B. Clinical comparison of weight- and age-based strategy of dose administration in children receiving intravenous busulfan for hematopoietic stem cell transplantation. Pediatr Transplant 2015; 19:307-15. [PMID: 25661259 DOI: 10.1111/petr.12430] [Citation(s) in RCA: 7] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/18/2014] [Indexed: 11/28/2022]
Abstract
Bu, combined with TDM-guided dosing, is associated with fewer graft failures/relapses and lower toxicity in pediatric HSCT. We aimed this retrospective study for comparison of weight- and age-based dosing in terms of clinical outcomes such as time to engraftment, early complications, EFS, OS, and toxicity profiles in children receiving iv Bu. Sixty-one children who underwent HSCT from April 2010 to February 2013 by means of a Bu-based conditioning regimen and completed 100 days after transplantation at Ankara Children?s Hematology and Oncology Hospital Bone Marrow Transplantation Unit were enrolled in this study. SOS and neutropenic fever occurred more frequently in the weight-based dosing group. We found a statistically significant correlation between Bu dose and the incidence of SOS (r = 0.26, p = 0.04). Multivariate analysis showed only weight-based dosing of Bu was a significant predictor of SOS (HR = 9.46; p = 0.009). However, no relationship was found between two groups in terms of hemorrhagic cystitis, engraftment syndrome, acute or chronic GvHD, time to engraftment, chimerism, TRM, OS, and EFS rates. Weight-based dosing of Bu may cause higher incidence of SOS and early infectious complications at the places where TDM of Bu cannot be performed.
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Affiliation(s)
- D Gürlek Gökçebay
- Department of Pediatric Hematology, Ankara Children's Hematology and Oncology Hospital, Ankara, Turkey
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Isik P, Özbek N, Azik F, Arman Bilir Ö, Baylan B, Tunç B. Successful treatment of hemorrhagic cystitis after hematopoietic stem cell transplantation with intravesical hyaluronic acid. Pediatr Transplant 2014; 18:780-1. [PMID: 25195630 DOI: 10.1111/petr.12354] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Pamir Isik
- BMT Unit, Pediatric Hematology, Ankara Children's Hematology and Oncology Hospital, Ankara, Turkey.
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Isik P, Yarali N, Tavil B, Demirel F, Karacam GB, Sac RU, Fettah A, Ozkasap S, Kara A, Tunc B. Endocrinopathies in Turkish children with Beta thalassemia major: results from a single center study. Pediatr Hematol Oncol 2014; 31:607-15. [PMID: 24854890 DOI: 10.3109/08880018.2014.898724] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [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] [Indexed: 11/13/2022]
Abstract
The endocrinological complications in β-thalassemia major patients do affect the life quality to a large extend. In this study, the endocrinological complications of 47 β-thalassemia patients, who have been followed-up at our hospital's pediatric hematology department, were evaluated. Out of β-thalassemia major cases included to this study, the 55.3% was male and 44.7% was female. The patients' mean levels of ferritin, whose mean age was 10.0 ± 4.5 years (2-20 years), were 2497 ± 1469 ng/mL (472-8558 ng/mL). At least one endocrinological pathology in 27 out of 47 (57.4%) and more than one endocrinological pathology in 14 out of 47 (29.7%) thalassemia patients were observed. The most frequently observed complication in followed-up cases was vitamin D insufficiency and deficiency (78.2%). The other complications in decreasing order were pubertal failure (41.6%), growth retardation (25.5%), decreased bone-mineral density (22.2%), secondary hyperparathyroidism (11.5%), overt hypothyroidism (4.25%), subclinical hypothyroidism (2.12%), and impaired glucose tolerance (2.12%). There was no statistically significant difference between serum mean ferritin level and endocrin complications (P > .05). Four patients (8.5%) had decreased signal intensity in pituitary magnetic resonance imaging (MRI) but this finding was not associated with ferritin levels (P = .87). MRI parameters were similar between patients with and without gonadal dysfunction. Mean height of the pituitary gland was 4.98 ± 1.1 mm (3-9 mm) and this was similar to those normal values in the literature. Ferritin levels were not correlated with pituitary height (P > .05). Beta thalassemia major, having the potential of leading to multisystemic complications, is a chronic disease that should be treated and followed-up by a multidisciplinary approach. Due to frequently encountered endocrinological complications, beta thalassemic patients should be followed-up regularly by hematology and endocrinology departments in coordination.
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Affiliation(s)
- Pamir Isik
- 1Department of Pediatric Hematology, Ankara Children's Hematology and Oncology Hospital, Ankara, Turkey
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Tavil B, Erdem AY, Azik F, Isik P, Metin A, Emir S, Uckan D, Tunc B. Successful allogeneic hemopoietic stem cell transplantation in a case of Wiskott-Aldrich syndrome and non-Hodgkin lymphoma. Pediatr Transplant 2013; 17:E146-8. [PMID: 23773507 DOI: 10.1111/petr.12114] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [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] [Accepted: 05/21/2013] [Indexed: 11/28/2022]
Abstract
WAS is a severe X-linked recessive disorder characterized by microthrombocytopenia, eczema, and immunodeficiency. A six-yr-old boy with WAS diagnosed as B-cell NHL (Stage III) localized in the liver who underwent successful HSCT from HLA-one antigen mismatch sibling donor has been presented here. His conditioning regimen included ATG, busulfan, and fludarabine. He received 2.3 × 10(6) /kg CD 34+ stem cells and 11 × 10(8) /kg nucleated cells at day 0. Neutrophil engraftment was achieved at day +14 and platelet engraftment at day +20. He has been in CR for more than two yr after transplantation. Thus, HSCT is an effective treatment for children with WAS even after development of lymphoma.
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Affiliation(s)
- Betul Tavil
- Department of Pediatric Hematology, Ankara Children's Hematology and Oncology Hospital, Diskapi, Ankara, Turkey.
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Abstract
BACKGROUND Hepcidin, a key regulator of iron homeostasis, increases when inflammation and some infections occur. It plays a critical role in macrophage iron retention, which underlies inflammation/infection caused anemia. It is known that Helicobacter pylori (HP) may lead to iron deficiency (ID) due to occult blood loss or reduced iron absorption. This study investigates the role of prohepcidin, hepcidin's precursor, in ID and ID anemia (IDA) with a concurrent HP infection. METHODS In this prospectively designed study, 15 patients with IDA and a concurrent HP infection (group 1), 11 patients with an ID and a concurrent HP infection (group 2), and 18 patients with HP infection (group 3) were observed. All groups received only HP eradication therapy. Twenty-five age- and sex-matched children without ID/IDA and HP infection were included in the study as the control group. In all groups and control group, measurements were taken for pre- and posttreatment hemoglobin, serum prohepcidin, serum ferritin, serum iron (SI), transferrin saturation, erythrocyte sedimentation rate, fibrinogen, and C-reactive protein levels. RESULTS The pretreatment prohepcidin levels were significantly higher only in group 1 compared to the control group (P < .05). In group 1, a significant increase in hemoglobin and SI levels and a significant reduction in prohepcidin levels were additionally observed following HP eradication treatment (P < .05). However, in groups 2 and 3, significant differences in hemoglobin, iron, and prohepcidin levels between pre- and posttreatment were not observed. CONCLUSION Elevated serum prohepcidin might indicate the role of inflammation in the etiology of anemia concurrent with HP.
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Affiliation(s)
- Serdar Ozkasap
- Division of Pediatric Hematology and Oncology, Rize University Education and Research Hospital, Rize, Turkey.
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Gokcebay DG, Azik FM, Isik P, Bozkaya IO, Kara A, Tavil EB, Yarali N, Tunc B. Complete blood count using VCS (volume, conductivity, light scatter) technology is affected by hyperlipidemia in a child with acute leukemia. Int J Lab Hematol 2011; 33:651-5. [PMID: 21645281 DOI: 10.1111/j.1751-553x.2011.01333.x] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Asparaginase, an effective drug in the treatment of childhood acute lymphoblastic leukemia (ALL), has become an important component of most childhood ALL regimens during the remission induction or intensification phases of treatment. The incidence range of asparaginase-associated lipid abnormalities that are seen in children is 67-72%. Lipemia causes erroneous results, which uses photometric methods to analyze blood samples. We describe a case of l-asparaginase-associated severe hyperlipidemia with complete blood count abnormalities. Complete blood count analysis was performed with Beckman COULTER(®) GEN·S™ system, which uses the Coulter Volume, Conductivity, Scatter technology to probe hydrodynamically focused cells. Although an expected significant inaccuracy in hemoglobin determination occurred starting from a lipid value of 3450 mg/dl, we observed that triglyceride level was 1466 mg/dl. Complete blood count analysis revealed that exceptionally high hemoglobin, mean corpuscular hemoglobin, and mean corpuscular hemoglobin concentration levels vs. discordant with red blood cell count, mean corpuscular volume, and hematocrit levels. Total leukocyte count altered spontaneously in a wide range, and was checked with blood smear. Platelet count was in expected range (Table 1). Thus, we thought it was a laboratory error, and the patient's follow-up especially for red cell parameters was made by red blood cell and hematocrit values.
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Affiliation(s)
- D G Gokcebay
- Department of Pediatric Hematology, Ankara Children's Hematology and Oncology Hospital, Ankara, Turkey.
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Isik P, Tavil B, Tunç B, Yarali N, Demir A, Cetin M. Extramedullary orbital granulocytic sarcoma without bone marrow involvement: a report of two cases. Pediatr Hematol Oncol 2011; 28:65-70. [PMID: 20863164 DOI: 10.3109/08880018.2010.511439] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The authors present herein 2 extramedullary orbital granulocytic sarcoma (GS) cases without bone marrow involvement in view of their rarity and also to reevaluate the treatment approach in this disease. Seven days of high-dose methyl prednisolone (HDMP) treatment (3 days 30 mg/kg/day and 4 days 20 mg/kg/day) was administered initially, and subsequently Acute Myeloid Leukaemia-Berlin Frankfurt Münster (AML-BFM) 2004 treatment protocol was continued for 2 cases. Eye findings of the cases resolved considerably with HDMP treatment. They have still been under systemic chemotherapy without any complication for 1 year. Thus, early diagnosis and AML-targeted intensive chemotherapy improve the prognosis of GS even if there is no bone marrow involvement.
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Affiliation(s)
- Pamir Isik
- Department of Pediatric Hematology, Ankara Children's Hematology and Oncology Hospital, Ankara, Turkey
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