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    Anti-T lymphocyte globulin plus posttransplant cyclophosphamide 25 mg/kg versus posttransplant cyclophosphamide 50 mg/kg in patients with acute leukemias
    (Springernature, 2025) Karakus, Abdullah; Toptas, Tayfur; Dal, Mehmet Sinan; Durdu, Ali; Hatipoglu, Ugur; Kayer, Merve Apaydin; Hindilerden, Ipek Yonal
    In this study, we aimed to compare the engraftment days, graft-versus-host disease (GVHD) development, relapse and overall survival rates in patients using myeloablative/reduced intensity conditioning regimens with posttransplant cyclophosphamide (PTCy) 25 mg/kg x2 with Anti-T lymphocyte Globulin (ATLG) (n = 29) and PTCy 50 mg/kg x2 doses (n = 41) in patients with acute leukemias. Matched related, matched unrelated, 1 mismatched unrelated, and haploidentical donors were selected for the patients. Platelet (median 11 vs 17 days) and neutrophil (median 14 vs 15 days) engraftment times were shorter in ATLG+ PTCy25 treated patients (both p < 0.05); veno-occlusive disease rates, graft failure and poor graft functions were similar between the two approaches (all p > 0.05); cumulative incidences of grade II-IV aGVHD at +100 days, grade III-IV aGVHD at +100 days, and grade II-IV cGVHD at 1-year were comparable between ATLG+PTCy25 and PTCy50 groups (all p > 0.05). Cumulative incidences of relapse and non-relapse mortality at 1-year were similar in two cohorts (both p > 0.05). PTCy50 was associated with a statistically significant benefit in terms of GVHD-free/relapse-free survival (GRFS) at 1-year (p = 0.03). Median GRFS was 115 (95% CI: 42-214) days and 248 (95% CI: 151-not reached) days, respectively [HR was 0.51 (0.28-0.95), p = 0.03; GRFS at 1-year was 20.7% vs 44.3%, respectively]. However, the groups were comparable in terms of PFS and OS. Median PFS was 332 days (95% CI: 182 days-not reached) for ATLG+PTCy25 group. It was not reached (95% CI: 210 days-not reached) for the patients who received PTCy50. Median OS was not reached in either ATLG+PTCy25 (95% CI: 191 days-not reached) or PTCy50 groups (Log rank = 0.42). Our study showed that lowering PTCy dose with ATLG seems to accelerate platelet and neutrophil engraftment rates; confers similar survival and relapse rates, similar acute and chronic GVHD frequency despite increased GRFS at 1-year.
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    Clinical characteristics and therapeutic outcomes of paroxysmal nocturnal hemoglobinuria patients in Turkey: a multicenter experience
    (Springer, 2021) Goren Sahin, Deniz; Akay, Olga Meltem; Keklik, Muzaffer; Okan, Vahap; Karakus, Abdullah; Demir, Cengiz; Erkurt, Mehmet Ali
    The aim of this study is to collect paroxysmal nocturnal hemoglobinuria (PNH) patient data from hematology centers all over Turkey in order to identify clinical features and management of PNH patients. Patients with PNH were evaluated by a retrospective review of medical records from 19 different institutions around Turkey. Patient demographics, medical history, laboratory findings, and PNH-specific information, including symptoms at the diagnosis, complications, erythrocyte, and granulocyte clone size, treatment, and causes of death were recorded. Sixty patients (28 males, 32 females) were identified. The median age was 33 (range; 17-77) years. Forty-six patients were diagnosed as classic PNH and 14 as secondary PNH. Fatigue and abdominal pain were the most frequent presenting symptoms. After eculizumab became available in Turkey, most of the patients (n = 31/46, 67.4%) were switched to eculizumab. Three patients with classic PNH underwent stem cell transplantation. The median survival time was 42 (range; 7-183 months) months. This study is the first and most comprehensive review of PNH cases in Turkey. It provided us useful information to find out the differences between our patients and literature, which may help us understand the disease.
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    The comparison of cyclophosphamide at different dose levels for stem cell mobilization in multiple myeloma
    (Pergamon-Elsevier Science Ltd, 2025) Karakus, Abdullah; Hatipoglu, Ugur; Katircilar, Yavuz; Erkurt, Mehmet Ali; Yilmaz, Seda; Cagliyan, Gulsum Akgun; Ozturk, Fahir
    Background: We conducted a multi-center retrospective non-randomized study to clarify roles of 2 and 3 gr/m2 doses of Cyclophosphamide (Cy) for stem cell mobilization in Multiple Myeloma. Material and methods: This study analyzed 169 adult patients who received Cy-based mobilization regimen at doses 2 and 3 gr/m2 between 2018 and 2024. All patients included in this study were 18 years old and older. Patients divided into two groups; group 1 represents 2 gr/m2 treated patients, and group 2 represents 3 gr/m2 dosing. These two groups then compared in terms of CD34+ cell number collected by apheresis, apheresis days, peak peripheral blood CD34+ value and rates of mobilization failures. Results: Higher doses of Cy yielded more hematopoietic stem cells compared to the lower dose Cy [10.00 (3.00-28.90) vs 9.01 (5.00-14.90), p = 0.002]; while mobilization failures and apheresis days were comparable across groups (p = 0.112 and p = 0.648, respectively). Apheresis days required for adequate stem cell harvest among groups was found statistically similar (p = 0.648). Conclusion: This study indicated the superior efficacy of 3 gr/m2 dose of Cy in terms of stem cell yield. However, mobilization failure and prolonged apheresis sessions were not issues with lower doses.