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Öğe Different kinetics and risk factors for isolated extramedullary relapse after allogeneic hematopoietic stem cell transplantation in children with acute leukemia(Elsevier Science Inc., 2021) Hazar, Volkan; Öztürk, Gülyüz; Yalçın, Koray; Uygun, Vedat; Aksoylar, Serap; Küpesiz, Alphan; Ok Bozkaya, İkbal; Karagün, Barbaros Şahin; Bozkurt, Ceyhun; İleri, Talia; Atay, Didem; Koçak, Ülker; Tezcan Karasu, Gülsün; Yeşilipek, Akif; Gökçe, Müge; Kansoy, Savaş; Tüysüz Kintrup, Gülen; Karakükcü, Musa; Okur, Fatma Visal; Ertem, Mehmet; Kaya, Zühre; Gürsel, Orhan; Yaman, Yöntem; Özbek, Namık; Antmen, Bülent; Tüfekçi, Özlem; Albayrak, Canan; Adaklı Aksoy, Başak; Sezgin, Gülay; Albayrak, Davut; Sezgin Evim, Melike; Zengin, Emine; Pekpak, EsraRelapse after allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains the most frequent cause of post-transplantation mortality. Isolated extramedullary (EM) relapse (iEMR) after HSCT is relatively rare and not well characterized, particularly in pediatric patients. We retrospectively analyzed 1527 consecutive pediatric patients with acute leukemia after allo-HSCT to study the incidence, risk factors, and outcome of iEMR compared with systemic relapse. The 5 -year cumulative incidence of systemic relapse (either bone marrow [BM] only or BM combined with EMR) was 24.8%, and that of iEMR was 5.5%. The onset of relapse after allo-HSCT was significantly longer in EM sites than in BM sites (7.19 and 5.58 months, respectively; P =.013). Complete response (CR) 2 +/active disease at transplantation (hazard ratio [HR], 3.1; P <.001) and prior EM disease (HR, 2.3; P =.007) were independent risk factors for iEMR. Chronic graft-versus-host disease reduced the risk of systemic relapse (HR, 0.5; P=.043) but did not protect against iEMR. The prognosis of patients who developed iEMR remained poor but was slightly better than that of patients who developed systemic relapse (3 -year overall survival, 16.5% versus 15.3%; P =.089). Patients experiencing their first systemic relapse continued to have further systemic relapse, but only a minority progressed to iEMR, whereas those experiencing their iEMR at first relapse developed further systemic relapse and iEMR at approximately similar frequencies. A second iEMR was more common after a first iEMR than after a first systemic relapse (58.8% versus 13.0%; P =.001) and was associated with poor outcome. iEMR has a poor prognosis, particularly after a second relapse, and effective strategies are needed to improve outcomes.Öğe Evaluation of risk factors and outcomes of invasive fungal infections in the first six months after allogeneic hematopoietic stem cell transplantation in pediatric acute leukemia: A Turkish multicenter study(Nature Publishing Group, 2015) Hazar, Volkan; Karasu, Gülsün; Öztürk, Gülyüz; Çakı Kılıç, Suar; Uygun, Vedat; Karakükçü, Musa; Özbek, Namık Yaşar; Gürsel, Orhan; Atay, Didem; Küpesiz, Alphan; Aksoylar, Serap; Özyürek, Emel; Koçak, Ülker; Daloğlu, Hayriye; Ünal, Emel; Yılmaz, S.; Ünal, Ekrem; Eker, İbrahim; Tunç, B.; Erbey, Fatih; Eker, Nurşah; Kansoy, Savaş; Fışgın, Tunç; Kaya, Zühre; Ören, Hale; Sezgin, Gülay; Ertem, Mehmet; Kürekçi, Emin; Tanyeli, Atila; Ünal, Emine İlknur; Yeşilipek, Akif[Abstract Not Available]Öğe Hematopoietic stem cell transplantation in refractory or recurrent lymphomas of children and adolescents: a multicenter survey of Turkish pediatric BTM study group(Nature Publishing Group, 2014) Hazar, Volkan; Kesik, Vural; Aksoylar, Serap; Küpesiz, Osman Alphan; Kartal Öztürk, Gökçen; Ataş, Erman; Karakükçü, Musa; Karasu, Gülsün; Kansoy, Savaş; Yeşilipek, Akif; Erbey, Fatih; Anak, Sema; Uygun, Vedat; Ünal, Ekrem; Yılmaz, S.; Tanyeli, Atila; Elli, Mauro; Atay, Didem; Taçyıldız, Nurdan; Kaya, Zühre; Kurucu, Nilgün; Ünal, Emel; Koçak, Ülker[Abstract Not Available]Öğe Interleukin-8 in febrile neutropenic children with cancers: Its diagnostic value for bacteremia/sepsis is superior to that of interleukin-6, mannose binding lectin, procalcitonin and C-reactive protein(Akad Doktorlar Yayinevi, 2021) Akçay, Arzu; Ağaoğlu, Leyla; Ekmekçi, Hakan; Balcı Ekmekçi, Özlem; Sarıbeyoğlu, Ebru; Atay, Didem; Tuğcu, Deniz; Karakaş, Zeynep; Ünüvar, Ayşegül; Anak, Sema; Öztürk, Gülyüz; Devecioğlu, ÖmerThe aim of this study was to determine the predictive value of serum interleukin-6 (IL-6), interleukin-8 (IL-8), mannose binding lectin (MBL), procalcitonin (PCT) and C-reactive protein (CRP) levels for bacteremia/sepsis (B/S) at the beginning of a febrile episode in children with chemotherapy-induced febril neutropenia (FN). In a prospective study, 54 febrile neutropenic episodes from 30 pediatric cancer patients were analysed. Samples were obtained in two different clinical periods: afebrile neutropenic (AFN) period after chemotherapy and FN period (on the first day of fever). The highest levels of IL-6, IL-8, MBL and PCT were observed in cases of B/S group. However, only IL-8 levels were significantly higher in patients with B/S than those with clinically or microbiologically documented infection and those with fever of unknown origin (p<0.05). While sensitivity was high for IL-6 and IL-8, specificity value was found to be quite low. The marker with the highest specificity values was PCT. While positive predictive values of all markers were generally low, their negative predictive values were higher. The high levels of IL-8 are more reliable than the levels of IL-6, MBL, CRP and PCT for prediction of B/S in pediatric cancer patients with FN. With the combined use of inflammatory markers and cytokines, the low-risk group for B/S can be determined more clearly in patients with FN at the beginning of the febrile episode.Öğe National pediatric hematopoietic stem cell transplantation activity in Turkey(Nature Publishing Group, 2015) Kansoy, Savaş; Hazar, Volkan; Küpesiz, Alphan; Uçkan, Duygu; Kuşkonmaz, Barış; Tezcan, İlhan; Aksoylar, Serap; Tezcan, Gülsun; Çakı Kılıç, Suar; Ertem, Mehmet; Ünal, Emine İlknur; İkincioğulları, Aydan; Uygun, Vedat; Öztürk, Gülyüz; Erbey, Fatih; Gedikoğlu, Gökhan; Kürekçi, Emin; Kesik, Vural; Karakükçü, Musa; Albayrak, Davut; Öniz, Haldun; Azık, Fatih Mehmet; Tanyeli, Atila; Anak, Sema; Koçak, Ülker; Ören, Hale; Antmen, Bülent; Fışgın, Tunç; Özyürek, Emel; Atay, Didem; Gözmen, Salih; Yeşilipek, Akif[Abstract Not Available]Öğe Outcome of autologous hematopoietic stem cell transplantation in children and adolescents with relapsed or refractory Hodgkin's lymphoma(Blackwell Publishing, 2015) Hazar, Volkan; Kesik, Vural; Aksoylar, Serap; Karakükçü, Musa; Öztürk, Gülyüz; Küpesiz, Alphan; Ataş, Erman; Öniz, Haldun; Kansoy, Savaş; Ünal, Ekrem; Tanyeli, Atila; Erbey, Fatih; Elli, Murat; Taçyıldız, Nurdan; Karasu, Gülsün Tezcan; Koçak, Ülker; Anak, Şema Sema; Yılmaz Bengoa, Şebnem; Sezgin, Gülay; Atay, Didem; Ünal, Emel; Uygun, Vedat; Kurucu, Nilgün; Kaya, Zühre; Yeşilipek, AkifThis study evaluates the outcome of 66 pediatric patients with rrHL who underwent autoHSCT. Twenty-nine patients experienced early relapse, and 19 patients experienced late relapse. Of 18 newly diagnosed with HL, 13 were primary refractory disease and five had late responsive disease. At the time of transplantation, only 68% of the patients were chemosensitive. The majority of patients received BCNU+etoposide+ara-C+melphalan for conditioning (45/66), and peripheral blood (56/66) was used as a source of stem cells. After a median follow-up period of 39months, 46 patients were alive. At fiveyr, the probabilities of OS, EFS, the relapse rate, and the non-relapse mortality rate were 63.1%, 54.3%, 36.4%, and 9.1%, respectively. The probability of EFS in chemosensitive and chemoresistant patients at fiveyr was 72.3% and 19%, respectively (p<0.001). Multivariate analysis showed that chemoresistant disease at the time of transplantation was the only factor predicting limited both OS (hazard ratio=4.073) and EFS (hazard ratio=4.599). AutoHSCT plays an important role for the treatment of rrHL in children and adolescents, and survival rates are better for patients with chemosensitive disease at the time of transplantation.Öğe Relapse after allogeneic hematopoietic stem cell transplantation for acute leukemia in children: A survey by the Turkish Pediatric Bone Marrow Study Group of 255 cases(Nature Publishing Group, 2018) Hazar, Volkan; Tezcan Karasu, Gülsün; Öztürk, Gülyüz; Küpesiz, Alphan; Kansoy, Savaş; Özbek, Namık; Uygun, Vedat; İleri, Talia; Okur, Fatma Visal; Koçak, Ülker; Çakı Kılıç, Suar; Akçay, Arzu; Güler, Elif; Gözmen, Salih; Karakükçü, Musa; Bayram, İbrahim; Aksu, Tekin; Yeşilipek, Akif; Karagün, Barboros Şahin; Yılmaz Bengoa, Şebnem; Ertem, Mehmet; Uçkan, Duygu; Kaya, Zühre; Fışkın, Tunç; Atay, Didem; Tayfun Küpesiz, Funda; Gürsel, Orhan; Yaman, Yöntem; Bozkurt, Ceyhun; Gökçe, Müge; Aksoylar, Serap[Abstract Not Available]Öğe Risks and outcomes of invasive fungal infections in the first six months after allogeneic hematopoietic stem cell transplantation in pediatric patients: A multicenter cohort study by the Turkish pediatric bone marrow transplantation study group (tpbmt-sg)(Nature Publishing Group, 2015) Hazar, Volkan; Karasu, Gülsün; Uygun, Vedat; Öztürk, Gülyüz; Çakı Kılıç, Suar; Küpesiz, Alphan; Daloğlu, Hayriye; Aksoylar, Serap; Atay, Didem; Karakükçü, Musa; Özbek, Namık Yaşar; Eker, Nurşah; Kansoy, Savaş; Özyürek, Emel; Akçay, Arzu; Ünal, Emine İlknur; Koçak, Ülker; Ünal, Ekrem; Gürsel, Orhan; Tunç, B.; Tayfun, Funda; İkincioğulları, Aydan; Gözmen, Salih; Fışgın, Tunç; Erbey, Fatih; Ertem, Mehmet; Sezgin, Gülay; Yılmaz, S.; Kaya, Zühre; Kürekçi, Emin; Doğu, Figen; Kesik, Vural; Tanyeli, Atila; Ören, Hale; Ataş, Erman; Ünal, Emel; Taçyıldız, Nurdan; Yeşilipek, Akif[Abstract Not Available]Öğe Thalassemia-free and graft-versus-host-free survival: Outcomes of hematopoietic stem cell transplantation for thalassemia major, Turkish experience(Springer Nature, 2022) Yeşilipek, Mehmet Akif; Uygun, Vedat; Küpesiz, Alphan; Karasu, Gülsün; Öztürk, Gülyüz; Ertem, Mehmet; Şaşmaz, İlgen; Daloğlu, Hayriye; Güler, Elif; Hazar, Volkan; Fışgın, Tunç; Sezgin, Gülay; Kansoy, Savaş; Kuşkonmaz, Barışl; Akıncı, Burcu; Özbek, Namık; Ünal İnce, Elif; Öztürkmen, Seda; Tayfun Küpesiz, Funda; Yalçın, Koray; Anak, Sema; Bozkurt, Ceyhun; Karakükçü, Musa; Küpeli, Serhan; Albayrak, Davut; Öniz, Haldun; Aksoylar, Serap; Okur, Fatma Visal; Albayrak, Canan; Demir Yenigürbüz, Fatma; Ok Bozkaya, İkbal; İleri, Talia; Gürsel, Orhan; Karagün, Barbaros Şahin; Tüysüz Kintrup, Gülen; Çelen, Suna; Elli, Murat; Adaklı Aksoy, Başak; Yılmaz, Ebru; Tanyeli, Atila; Turan Akyol, Şule; Önder Siviş, Zühal; Özek, Gülcihan; Uçkan, Duygu; Kartal, İbrahim; Atay, Didem; Akyay, Arzu; Arman Bilir, Özlem; Çakmaklı, Hasan Fatih; Kürekçi, Emin; Malbora, Barış; Akbayram, Sinan; Demir, Hacı Ahmet; Çakı Kılıç, Suar; Güneş, Adalet Meral; Zengin, Emine; Özmen, Salih; Antmen, Ali BülentWe report the national data on the outcomes of hematopoietic stem cell transplantation (HSCT) for thalassemia major (TM) patients in Turkey on behalf of the Turkish Pediatric Stem Cell Transplantation Group. We retrospectively enrolled 1469 patients with TM who underwent their first HSCT between 1988 and 2020 in 25 pediatric centers in Turkey. The median follow-up duration and transplant ages were 62 months and 7 years, respectively; 113 patients had chronic graft versus host disease (cGVHD) and the cGVHD rate was 8.3% in surviving patients. Upon the last visit, 30 patients still had cGvHD (2.2%). The 5-year overall survival (OS), thalassemia-free survival (TFS) and thalassemia-GVHD-free survival (TGFS) rates were 92.3%, 82.1%, and 80.8%, respectively. cGVHD incidence was significantly lower in the mixed chimerism (MC) group compared to the complete chimerism (CC) group (p < 0.001). In survival analysis, OS, TFS, and TGFS rates were significantly higher for transplants after 2010. TFS and TGFS rates were better for patients under 7 years and at centers that had performed over 100 thalassemia transplants. Transplants from matched unrelated donors had significantly higher TFS rates. We recommend HSCT before 7 years old in thalassemia patients who have a matched donor for improved outcomes.
