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Öğe Allogeneic Hematopoietic Stem Cell Transplantation in Adult Patients with Thalassemia: A Single-Center Experience and Literature Review(2023) Uysal, Ayşe; Erkurt, Mehmet Ali; Sarıcı, Ahmet; Kuku, İrfan; Biçim, Soykan; Hidayet, Emine; Kaya, AhmetObjective: Allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains the only curative treatment modality in thalassemia. Its use has been limited by age, transplant-related mortality (TRM), graft rejection, and graft versus host disease (GvHD), especially in adult patients. We aimed to present our allo-HSCT experience in adult patients with thalassemia major. Material and Method: Patients’ demographic and clinical features, donor types, resource of stem cells, conditioning regimens, GvHD prophylaxis, time to neutrophil and platelet engraftments, acute and chronic GvHD, thalassemia -free survival (TFS) and overall survival were examined. Results: The study included six patients. The median age was 21.5 (20-26) years. The median ferritin levels were 1498.4 (347.4-6992.3) pg/ml. The matched sibling donor (MSD) was used in 4 patients while matched unrelated donor (MUD) was used in 2 patients. The median time to neutrophil and platelet engraftments were 17 (15-35) and 18 (15-40) days, respectively. Acute and chronic GvHD were detected in 2 and 1 patients, respectively. The TRM was detected in 2 patients (33.3%), due to infection and acute GVHD. At a median follow-up of 28 months after transplantation, 4 (66.6%) patients were alive and TFS was achieved in 2 (33.3%) patients. Graft failure was detected in 3 (50%) patients. Conclusion: Graft rejection, TRM and GvHD limited the use of allo-HSCT, especially in adult patients. These complications were reduced by re- duced-intensity conditioning regimens and allo-HSCT should be done primarily in patients under the age of 20 years and without organ damage due to iron overload.Öğe BK virus incidence, risk factors and its effect on mortality in hematopoietic stem cell transplant patients-single center experience(2021) Deviren, Mehmet Veysi; Sarıcı, Ahmet; Erkurt, Mehmet Ali; Bahçecioğlu, Ömer Faruk; Biçim, Soykan; Berber, İlhami; Kaya, EminThe aim of this trial is to investigate the risk factors of BK viruria and the effect of BK viruria on mortality in patients undergoing hematopoietic stem cell transplantation (HSCT). The data of 247 patients who underwent HSCT between 01.01.2011-01.12.2017 in Inonu University Faculty of Medicine Department of Hematology were retrospectively analyzed. BK viruria was defined as positive at any copy level in the urine. Of 247 patients, 97 patients (39.2%) were detected to have BK virus-posi- tive. Patients with positive BK virus in urine were younger than BK virus negative patients, and patients with multiple myeloma had a lower rate of BK virus positivity than other patients (p<0.05). The rate of BK viruria was found to be higher in patients who received busulfan and cyclophosphamide-containing conditioning regimens compared to patients who received other conditioning regimens (46% vs 28.9%, p=0.007). In addition, BK virus positivity was found to be lower in those receiving mel- phalan-based conditioning regimens than those receiving other conditioning regimes (28.6% vs 47.2%, p=0.008). BK virus positivity in urine was detected median 20 days after HSCT. BK virus positivity was detected in 80.4% (78/97) of the patients within the first 30 days. Patients with BK viruria had a higher first 100-day mortality than patients without BK viruria (17.5% vs 8%, p=0.023). In this series, BK viruria is a factor associated with mortality in the early period after HSCT and should be closely monitored in these patients.Öğe The effect of CD 34+ stem cell dose on both short-term and long-term outcomes of autologous stem cell transplantation in multiple myeloma(2023) Uysal, Ayşe; Erkurt, Mehmet Ali; Kuku, İrfan; Kaya, Emin; Berber, İlhami; Sarıcı, Ahmet; Biçim, SoykanAim: In this single-center, retrospective study, we aimed to evaluate the effect of CD34+ stem cell dose on hematologic recovery and long-term outcomes such as progression-free survival and overall survival after autologous stem cell transplantation (ASCT). Materials and Methods: In this study, 282 patients with MM, who underwent ASCT between January 2014 and October 2021 were evaluated. The patients were divided into 2 groups according to the infused cell dose. Patients who received ?5x106/kg CD34+ cells were defined as group A. Patients who received >5x106/kg CD34+ cells were group B. The outcome of ASCT including the time of neutrophil/platelet engraftment, febrile neutropenia status, transplant-related mortality (TRM) at 100 days, duration of hospital- ization and survival status were examined in both groups. Results: There were 118 (41.8%) patients in group A and 164 patients (58.2%) in group B. The median neutrophil engraftment was 12 (7-26) days in A group, 11 (6-28) days in B group. The median platelet engraftment was 12 (6-40) and 11 (6-29) days in group B. There were statically significant different in both group for neutrophil and platelet engraftment time (p=.001 and .002, respectively). The median hospitalization time was 16 (10-53) days and 15 (6-83) days in group A and B, respectively. The hospitalization time was statistically significantly different in two groups (p<.012). The mean OS was 53.1±4.2 months in group A and 58.2±3.5 in group B which was not statistically significant difference (p=.841). The mean PFS was 11.8±1.3 months in group A and 19.1±1.4 months in group B which was statistically significant difference in 2 groups (p<0.001). Conclusion: Infusion of >5x106/kg CD34+ stem cells (median dose 9,6 x106/kg) may have a favorable effect on short-term outcomes of transplantation, including short-term neutrophil engraftment, short-term platelet engraftment, and short-term hospitalization. Additionally, progression-free survival may be positively affected by high dose, but upper limit should be defined by new study.Öğe Efficacy and safety of ruxolitinib plus extracorporeal photopheresis in acute and chronic graft versus host disease: A single center experience(2021) Sarici, Ahmet; Erkurt, Mehmet Ali; Bahcecioglu, Omer Faruk; Tanriverdi, Lokman Hekim; Berber, İlhami; Kaya, Emin; Biçim, Soykan; Gok, Selim; Özgül, Mustafa; Kuku, İrfanAbstract: Aim: There is no standard treatment for corticosteroid refractory acute and chronic graft versus host disease (GVHD). Ruxolitinib and extracorporeal phopheresis (ECP) are promising treatment options in GVHD. In this study, we aimed to share our clinical experience in steroid refractory GVHD patients treated with ruxolitinib plus ECP. Materials and Methods: The data of patients receiving ruxolitinib plus ECP for corticosteroid refractory acute and chronic GVHD patients were analyzed retrospectively. Results: A total of 11 cases, 6 of which were acute, were included in this retrospective, observational and single-center study. Acute GVHD developed in the 6 patients after allogeneic HSCT (median onset of GVHD=27, between 20 and 60 days ). Chronic GVHD developed in the 5 patients after allogeneic HSCT (median onset of GVHD= 159 between 60 and 380 days. The overall response rate of acute GVHD patients to ruxolitinib ECP combination therapy was 16.7% (complete response: 16.7%, partial response: 0%). The overall response rate of chronic GVHD patients to combination therapy was 60% (complete response: 20%, partial response: 40%). As a result of combination therapy, thrombocytopenia occurred in 36% (4/11) of patients, neutropenia in 27% (3/11) of patients, and CMV reactivation in 9% (1/11) of patients. Conclusion: We observed a low rate of overall response to ruxolitinib plus ECP treatment in acute GVHD patients but a high rate in chronic GVHD patients. According to our trial, ruxolitinib ECP combination may be beneficial in GVHD, especially in chronic GVHD, but prospective trials comparing its efficacy with other agents are needed.Öğe Etiological evaluation and the role of plasma exchange treatment in tromboticmicroangiopathies: A retrospective analysis from Eastern Anatolia(2022) Hidayet, Emine; Erkurt, Mehmet Ali; Sarıcı, Ahmet; Biçim, Soykan; Kuku, İrfan; Berber, İlhami; Kaya, EminThe aim is this study was to make the etiological classification of patients diagnosed with TMA in our region and to statistically evaluate the effect of therapeutic plasma exchange, which we use in treatment, on laboratory recovery and mortality. In our study, between 2009-2017, 85 patients diagnosed with TMA in our center evaluated retrospectively. Thirty- one (36.5%) of our patients were followed up with HELLP, 23 with thrombotic thrombocytopenic purpura (TTP) (27.1%), 20 (23.5%) snake bites, and 11 (12.9%) with atypical hemolytic uremic syndrome (aHUS). TPE treatment was performed in all patients. TPE treatment was found effective in patients with HELLP syndrome, TTP and snake bite and statistically significant improvement was obtained in laboratory parameters (p<0.05). However, TPE treatment was not found to be effective in the treatment of atipical HUS (p>0.05). Mortality rates were found 9.7%, 21.7%, 27.3%, and 0% in patients with HELLP Syndrome, TTP, aHUS, and snake bite, respectively. The primary treatment in HELLP syndrome was termination of pregnancy, it was observed in our study that TPE was effective in TTP, HELLP syndrome and snake bites and treatment should be started without delayÖğe How are the Results of Allogeneic Stem Cell Transplantation in Elderly Patients? A Single-center Experience(2023) Uysal, Ayse; Erkurt, Mehmet Ali; Kuku, İrfan; Kaya, Emin; Berber, İlhami; Sarıcı, Ahmet; Biçim, SoykanINTRODUCTION: In this study, we aimed to present allogeneic hematopoietic stem cell transplantation (allo-HCT) experience in elderly patients with hematological malignancy. METHODS: Thirty-five patients aged 60 years and older who underwent allo-HSCT between 2017 and 2021 were retrospectively analyzed. Patient's demographic/clinical features, and the outcomes of transplantation were reviewed. RESULTS: The median age was 63 (range, 60-74) years and 25 (77,1%) were male. Twenty-seven (60%) were diagnosed with AML, followed by MDS (n: 7, 20%). Twenty-three (65,8%) patients had intermediate, and 6 (17,1%) patients had a high hematopoietic cell transplantation-specific comorbidity index score. Karnofsky performance status of ? 90% was detected in 15 (42,9%) patients. Busulfan plus fludarabine plus anti-thymocyte globulin was used mainly as a reduced-intensity conditioning regimen, which was used in 18 (51,4%) patients. The median duration of neutrophil and platelet engraftments were 18 (range, 11-27) and 18 (range, 11-33) days, respectively. The median follow-up time was 4 months (range, 0-51), with the OS rate %14,2. The transplant-related mortality rate within the first 30 days after allo-HSCT was detected in 10 patients (28,6%) due to infection and/or GvHD. Response assessment could be performed in 25 (71,4%) patients after transplantation. The duration of PFS was 6 (range, 1-51) months in patients with response evaluation. The rate of PFS was 72% in 1 years and 5 (14,2%) patients were still alive with complete response at the last visit. DISCUSSION AND CONCLUSION: Reduced-intensity conditioning regimen has provided the important advantage in allo-HSCT, for elderly patients with hematological malignancies such as AML and MDS.Öğe The impact of laboratory features and comorbidities on the prognosis of patients with COVID-19(2021) Sarıcı, Ahmet; Berber, Nurcan; Çağasar, Özlem; Biçim, Soykan; Cagin, Yasir Furkan; Ulutaş, Özkan; Gözükara Bağ, Harika; Berber, İlhamiAbstract: Objective: Demographic and laboratory values predicting clinical severity in coronavirus disease 2019 (COVID-19) patients havebeen a matter of curiosity since the beginning of the disease. We aimed to show the relationship between the severity of COVID-19disease and comorbidities, clinical and laboratory features of the patients.Material and Method: The data of COVID-19 patients diagnosed with polymerase chain reaction (PCR), were analyzed retrospectively.The patients were divided into 3 groups according to their clinical severity as mild, moderate and severe. Comorbidities and theCharlson comorbidity index (CCI) at the time of diagnosis were calculated for each patient from the patients’ records. Demographicdata, laboratory values, comorbidity and CCI scores were compared between the patient groups. The effect of CCI on survival andlength of hospital stay was examined.Results: One hundred and four patients were included in the trial. The most common comorbid disease in the patients included in thetrial was hypertension. The moderate-severe stage patients were statistically significantly older (p<0.001). The CCI was found to bestatistically significantly different between mild, moderate and severe groups (p<0.001). When CCI increases by one unit, the risk ofdeath increases by 1.193 times (p=0.017). The neutrophil-to-lymphocyte ratio (NLR) was statistically significantly different betweenthe mild, moderate and severe patient groups. It was observed that as the severity of the disease increased, the NLR increased. Olderage, WBC, neutrophil count, NLR, BUN, creatinine, AST, potassium level, C-reactive protein (CRP), procalcitonin, aPTT, fibrinogen,d-dimer, and ferritin levels were found to be higher in the clinically severe patient group. Lymphocyte and eosinophil counts, totalprotein, albumin and sodium levels were found to be lower in the clinically severe patient group.Conclusion: This trial showed that calculating the CCI score in COVID-19 patients can be useful in predicting the severity of thedisease. Examination of CCI, age, WBC, neutrophil, lymphocyte, eosinophil counts, BUN, creatinine, AST, total protein, albumin,sodium, potassium level, CRP, procalcitonin, aPTT, fibrinogen, d-dimer and ferritin levels at the time of diagnosis can be suggested.Öğe Life saving effect of early use of convalescent plasma inCovid-19 treatment(2021) Sarıcı, Ahmet; Erkurt, Mehmet Ali; Kuku, İrfan; Biçim, Soykan; Berber, İlhami; Kaya, Emin; Ozgul, MustafaAcute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) virus, which is detected by the transmission from bat to person in Wuhan Province of China, has shown its effect all over the world in a very short time. There is no treatment method proven effective in Coronavirus disease 2019 (COVID-19) pandemics. The whole world is still working on it. Convalescent Plasma (CP) treatment is a passive antibody treatment that has been shown to be effective during periods of epidemic disease in history. CP treatment is interesting in the treatment of virus infection without vaccine or specific treatment, such as SARSCoV-2, which causes COVID-19. The mechanisms of action of CP include neutralizing the virus by direct binding, initiating virus elimination by complement activation, antibody-dependent cellular cytotoxicity and / or phagocytosis. Neutralizing antibodies are the most important mechanisms of action. The most important point in recovery is the inactivation of the virus and the prevention of viral replication. It was demonstrated for the first time that CP significantly reduced mortality in COVID-19 disease. Our results of CP treatment in COVID-19 patients have been published. We have shown that CP is effective and safe in COVID-19 disease. We aimed to gather CP experiences up to date in COVID-19.Öğe Non-Infectious Complications in Patients with Allogeneic Hematopoietic Stem Cell Transplantation- Single Center Experience from Eastern Anatolia(2022) Karaman, Sevtap; Sarıcı, Ahmet; Erkurt, Mehmet Ali; Biçim, Soykan; Hidayet, Emine; Kaya, Ahmet; Kuku, İrfanIntroduction: The aim of this study was to investigate late non-infectious complications in patients with allogeneic hematopoietic stem cell transplantation (HSCT). Materials and Methods: The records of 143 patients who underwent allogeneic HSCT between 01.02.2011 and 31.12.2018 in Inonu University Turgut Özal Medical Center Department of Hematology were retrospectively reviewed. Results: In our study, late non-infectious complications were seen in 68 % of the patients. Graft Versus Host Disease (GVHD) was observed in 43 patients (33%) %. The most common GVHD involvement sites were skin and liver. It was determined that the number of CD 34 (+) cells had a significant effect on the development of chronic GVHD (p=0,01) and late stage complications (p=0,016). Chronic GVHD and late complication rates were found to be lower in the group given high CD 34 (+) cell count. When the patients were grouped according to the preparation regimens, statistically significantly more complications were observed at the rate of 78.8% in the patients in the myeloablative regimen group (p=0.005). It was observed that the rate of recurrence of the primary disease, renal complications and neurological complications was higher in the 90-120th days after transplantation. Ocular and GVHD complications were more likely to develop later. It was observed that endocrine complications were encountered equally in both early and late periods. Discussion: It was seen that, late complications were common in patients who underwent allogeneic HSCT and these complications were mostly related to GVHD and GVHD treatment.Öğe Successful treatment with convalescent plasma inCovid-19 disease in relaps/refractory multiple myeloma(2021) Sarıcı, Ahmet; Biçim, Soykan; Erkurt, Mehmet Ali; Berber, İlhami; Kaya, Emin; Kuku, İrfan; Ozgul, MustafaThe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) virus detected in the Wuhan Province of the People's Republic of China caused a pandemic in a very short time all over the world. Convalescent plasma (CP) therapy is a passive antibody therapy that has been shown to be effective in epidemic periods. CP therapy has been of interest in the treatment of infection with no vaccine or specific treatment, such as the Sars-CoV-2 infection that causes COVID-19. We aimed to report our CP experience in Sars-Cov-2 infection in our relapsed / refractory Multiple myeloma (MM) patient.
