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Öğe COVID-19 disease in children and adolescents following allogeneic hematopoietic stem cell transplantation: A report from the Turkish pediatric bone marrow transplantation study group(2024) Bozkurt, Ceyhun; Hazar, Volkan; Malbora, Barış; Küpesiz, Alphan; Aygüneş, Utku; Fışgın, Tunç; Karakükçü, Musa; Kuşkonmaz, Barış; Çakı Kılıç, Suar; Bayırlı, Derya; Arman Bilir, Özlem; Yalçın, Koray; Gözmen, Salih; Uygun, Vedat; Elli, Murat; Sarbay, Hakan; Küpesiz, Funda Tayfun; Şaşmaz, Hatice İlgen; Adaklı Aksoy, Başak; Yılmaz, Ebru; Okur, Fatma Visal; Tekkeşin, Funda; Demir Yenigürbüz, Fatma; Özek, Gülcihan; Atay, Abdullah Avni; Ok Bozkaya, İkbal; Çelen, Suna; Öztürkmen, Seda; Güneş, Adalet Meral; Gürsel, Orhan; Güler, Elif; Özcan, Alper; Uçkan Çetinkaya, Duygu; Aydoğdu, Selime; Özbek, Namık Yaşar; Karasu, Gülsün; Sezgin, Gülay; Doğru, Ömer; Albayrak, Davut; Öztürk, Gülyüz; Aksoylar, Serap; Daloğlu, Hayriye; Odaman Al, Işık; Sezgin Evim, Melike; Akbayram, Sinan; Öncül, Yurday; Zengin, Emine; Albayrak, Canan; Timur, Çetin; Düzenli Kar, Yeter; Çakmaklı, Hasan Fatih; Tüfekçi, Özlem; Töret, Ersin; Antmen, BülentBackground: Data on the risk factors and outcomes for pediatric patients with SARS-CoV-2 infection (COVID-19) following hematopoietic stem cell transplantation (HSCT) are limited. Objectives: The study aimed to analyze the clinical signs, risk factors, and outcomes for ICU admission and mortality in a large pediatric cohort who underwent allogeneic HSCT prior to COVID-19 infection. Method: In this nationwide study, we retrospectively reviewed the data of 184 pediatric HSCT recipients who had COVID-19 between March 2020 and August 2022. Results: The median time from HSCT to COVID-19 infection was 209.0 days (IQR, 111.7–340.8; range, 0–3845 days). The most common clinical manifestation was fever (58.7%). While most patients (78.8%) had asymptomatic/mild disease, the disease severity was moderate in 9.2% and severe and critical in 4.4% and 7.6%, respectively. The overall mortality was 10.9% (n: 20). Deaths were attributable to COVID-19 in nine (4.9%) patients. Multivariate analysis revealed that lower respiratory tract disease (LRTD) (OR, 23.20, p:.001) and lymphopenia at diagnosis (OR, 5.21, p:.006) were risk factors for ICU admission and that HSCT from a mismatched donor (OR, 54.04, p:.028), multisystem inflammatory syndrome in children (MIS-C) (OR, 31.07, p:.003), and LRTD (OR, 10.11, p:.035) were associated with a higher risk for COVID-19-related mortality. Conclusion: While COVID-19 is mostly asymptomatic or mild in pediatric transplant recipients, it can cause ICU admission in those with LRTD or lymphopenia at diagnosis and may be more fatal in those who are transplanted from a mismatched donor and those who develop MIS-C or LRTD.Öğe COVID-19 infection in children with cancer and stem cell transplant recipients in Turkey: A nationwide study(Wiley, 2021) Kebudi, Rejin; Kurucu, Nilgün; Tuğcu, Deniz; Hacısalihoğlu, Şadan; Fışgın, Tunç; Ocak, Süheyla; Tokuç, Gülnur; Özdemir, Gül Nihal; Bozkurt, Ceyhun; İnce, Dilek; Aras, Seda; Ayçiçek, Ali; Adaklı Aksoy, Başak; Karadaş, Nihal; Öztürk, Gülyüz; Orhan, Mehmet Fatih; Ataseven, Eda; Akbayram, Sinan; Yılmaz, Ebru; Tüfekçi, Özlem; Vural, Sema; Akyay, Arzu; Canbolat Ayhan, Aylin; Kılıç, Suar; Üzel, Veysiye Hülya; Düzenli, Yeter; Güler Kazancı, Elif; Acıpayam, Can; Elli, Murat; Tanyeli, Atilla; Karakaş, Zeynep; Somer, Ayper; Kara, AteşTo the Editor: Adults with cancer are reported to have a higher risk for coronavirus disease (COVID-19) infection and more severe disease and mortality than the general population.1, 2 Although children seem to be at a lower risk for COVID-19 than adults,3-5 data specifically addressing children with cancer are limited.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 Prognostic factors for survival in children who relapsed after allogeneic hematopoietic stem cell transplantation for acute leukemia(Wiley, 2021) Hazar, Volkan; Tezcan Karasu, Gülsün; Öztürk, Gülyüz; Küpesiz, Alphan; Aksoylar, Serap; Özbek, Namık; Uygun, Vedat; İleri, Talia; Visal Okur, Fatma; Koçak, Ülker; Çakı Kılıç, Suar; Akçay, Arzu; Güler, Elif; Kansoy, Savaş; Karakükcü, Musa; Bayram, İbrahim; Aksu, Tekin; Yeşilipek, Akif; Karagün, Barbaros Şahin; Yılmaz, Şebnem; Ertem, Mehmet; Uçkan, Duygu; Fışgın, Tunç; Gürsel, Orhan; Yaman, Yöntem; Bozkurt, Ceyhun; Gökçe, MügeBackground 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.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 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.
