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    An innovation in stem cell harvesting: Heparin use
    (Pergamon-Elsevier Science Ltd, 2021) Gul, Hacer Gozde; Erkurt, Mehmet Ali; Sarici, Ahmet; Kuku, Irfan; Kaya, Emin; Berber, Ilhami; Merter, Mustafa
    Background and Objectives: Stem cell transplantation is a growing treatment strategy for most malignant and nonmalignant hematological diseases. Plerixafor and granulocyte colony stimulating factor (G-CSF) are usually used in mobilization regimens to increase the CD34+ cell count in the harvest. Heparin is a sulphated glycosaminoglycated polymer with 12-15 kDa mass. Heparin inhibits the CXCR4/SDF1 axis, as does plerixafor. In this study, our aim was to investigate the effect of using heparin on stem cell mobilization and harvesting. Materials and Methods: We administered 5000 units of unfractioned heparin intravenously in 150 mL (mL) of isotonic sodium chloride solution, 15 min before the stem cell harvesting procedure to 141 patients who underwent bone marrow transplantation between the years of 2018 and 2019 at our Stem Cell Transplantation Unit. Thirty patients were included as a control group, and they were not given heparin. The study population included patients with multiple myeloma and lymphoma equally in each group. Results: In all patients hematopoeitic stem cells were successfully harvested in a single cycle of apheresis. In multiple myeloma patients who received heparin, the mean collected CD34+ cell number was 8 x 10(6)/kg, and the mean CD34+ cell number yield was 12,555/mu l. In the control group, the mean collected CD34+ cell number was 4,2 x 10(6)/kg, and mean CD34+ cell number in yield was 492/mu l. In lymphoma patients who received heparin, the mean collected CD34+ cell number was 6,8 x 10(6)/kg, and the mean CD34+ cell number was 1421/ mu l. In the control group the mean collected CD34+ cell number was 4,3 x 10(6)/kg, and the mean CD34+ cell number was 358/mu l. The effect of heparin on the collected stem cell number in both myeloma and lymphoma patients was statistically significant (p < 0.01) Conclusions: Our results have shown that heparin increases harvested stem cell numbers significantly. Heparin may be a promising agent for stem cell harvesting.
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    The effect of threosulfan-based versus busulfan-based preparation regimens on transplant outcomes
    (Pergamon-Elsevier Science Ltd, 2025) Candir, Burcu Aslan; Okumus, Nazik; Hindilerden, Ipek Yonal; Erkurt, Mehmet Ali; Namdaroglu, Sinem; Merter, Mustafa; Yilmaz, Seda
    Background: Allogeneic hematopoietic stem cell transplantation is a curative therapy for malignant and nonmalignant hematologic disorders. Conditioning regimens, such as those based on busulfan, are utilized to promote engraftment. Busulfan-based regimens are commonly employed but exhibit significant toxicity, leading to interest in alternate drugs such as treosulfan, which may offer a superior safety profile while preserving efficacy. Methods: This retrospective study examined 240 adult patients diagnosed with acute myeloid leukemia or acute lymphoblastic leukemia who received allogeneic hematopoietic stem cell transplantation at nine transplantation centers in T & uuml;rkiye from 2010 to 2024. Patients underwent either a busulfan-based or treosulfan-based conditioning regimen. Results: Engraftment was effective in both groups, with neutrophil engraftment happening earlier in the busulfan group (13 days vs. 15 days, p = 0.001). The incidence of veno-occlusive disease was significantly higher in the busulfan group (10.1 % vs. 0.9 %, p = 0.002). Cytomegalovirus infections were more prevalent in the busulfan group (51.2 % vs. 26.1 %, p < 0.001). Acute graft versus host disease occurred more frequently in the busulfan group (27.9 % vs. 18.9 %, p = 0.128); nonetheless, this difference did not reach statistical significance. No significant differences in relapse rates were detected through the groups. The overall survival was not reached in the busulfan group, while the treosulfan group demonstrated an overall survival of 40 months. Conclusion: Treosulfan-based conditioning regimens demonstrate similar efficacy to busulfan-based regimens while presenting a more acceptable toxicity profile. Treosulfan-based regimens also show a lower occurrence of veno-occlusive disease and cytomegalovirus infections.
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    The role of heparin in autologous stem cell mobilization in patients with multiple myeloma
    (Pergamon-Elsevier Science Ltd, 2025) Sarici, Ahmet; Erkurt, Mehmet Ali; Yilmaz, Seda; Demircioglu, Sinan; Berber, Ilhami; Basturk, Abdulkadir; Merter, Mustafa
    Background : Autologous hematopoietic stem cell transplantation (aHSCT) has become the standard treatment modality for eligible multiple myeloma (MM) patients. One of the most important parameters affecting the success of transplantation is the number of CD34(+) stem cells collected. The most commonly used agents to facilitate the release of CD34(+) stem cells into peripheral blood are granulocyte colony-stimulating factor and plerixafor. Heparin has also been shown to enhance the release of CD34(+) stem cells into peripheral blood. We aimed to report the effect of heparin on the number of CD34(+) stem cells in peripheral blood in MM patients who underwent aHSCT. Materials and methods : This multicenter retrospective study analyzed 138 adult patients diagnosed with MM who underwent aHSCT. Patients were divided into two groups: those who received heparin (n = 108) and those who did not receive heparin before aHSCT (n = 30). Results : The complete response, partial response, and very good partial response rates in the heparin group were 17 % (n = 18), 24 % (n = 26), and 59 % (n = 64), respectively. In the non-heparin group, 20 % of patients (n = 6) achieved complete response, while partial response and very good partial response rates were 33 % (n = 10) and 47 % (n = 14), respectively. There was no statistically significant difference between the groups regarding obesity, ECOG performance scores, and smoking status (p = 0.399, 0.578, and 0.602, respectively). The number of collected CD34(+) stem cells and the peak CD34(+) stem cell count in peripheral blood were significantly higher in the heparin group compared to the control group (both p < 0.001). Conclusion : Heparin has been shown to enhance the migration of CD34(+) stem cells into peripheral blood and facilitate the peripheral stem cell collection process.