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Öğe Are mesenchymal stem cells still effective in acute GvHD management?(Pergamon-Elsevier Science Ltd, 2025) Ulu, Bahar Uncu; Hindilerden, Ipek Yonal; Yigenoglu, Tugce Nur; Tiryaki, Tarik Onur; Erkurt, Mehmet Ali; Korkmaz, Gulten; Namdaroglu, SinemObjective: Graft-versus-host disease (GvHD) is a common and serious complication following allogeneic hematopoietic stem cell transplantation (allo-HSCT), significantly impacting transplant efficacy. In the treatment of GvHD, numerous therapeutic approaches have been explored, with mesenchymal stem cells (MSCs) emerging as a prominent immunomodulatory option. We aimed to evaluate efficacy and outcomes of using MSCs for steroid refractory acute GVHD (SR-aGvHD) management. Materials and Methods: We retrospectively analyzed data from 36 patients' who received MSCs for treatment of SR-aGvHD following allo-HSCT between 2018 and 2024 from nine transplantation centers in T & uuml;rkiye. The product consisted of umbilical cord-derived allogeneic MSCs, which were administered intravenously. Results: Our cohort was at the median age of 39 years (range: 19-61 years), with aGvHD diagnosed at a median of two months after allo-HSCT. More than half of the patients (58.3%) classified as high-grade aGvHD according to the Minnesota risk scoring. Cord blood-derived MSCs were administered at a median dose of 3.45 (range: 0.8-5) million MSCs/kg, with a median of 3th (range: 2-5) line treatment. The rate of responses exceeding partial response (PR) was approximately 20% at the first month, increasing to 24% at the second month. The six-month survival rate was 33%, with 46% of mortality attributed to sepsis and 12.5% related to GvHD. Multivariate analysis indicated that increasing age (>= 35 years) and lower platelet counts (<= 75 x10(9)/L) were associated with higher mortality (p<0.05). Conclusion: MSC therapy has shown promising potential in improving response rates in aGvHD treatment, with efficacy enhanced by younger age and higher platelet counts.Öğe Is there a relationship between vitamin D levels and graft versus host disease?(Pergamon-Elsevier Science Ltd, 2025) Yigenoglu, Tugce Nur; Ulu, Bahar Uncu; Namdaroglu, Sinem; Erkurt, Mehmet Ali; Sahin, Rasim; Okumus, Nazik; Yilmaz, SedaObjective: Vitamin D deficiency is common in adult patients undergoing allogenic hematopoietic stem cell transplantation (allo-HSCT). Since vitamin D is an important regulatory factor for the immune system, vitamin D deficiency may have effects on antitumor activity, relapse rates, graft versus host disease (GVHD) occurrence and infection rates in allo-HSCT. We aimed to investigate the effects of vitamin D levels on the outcome of allo-HSCT. Material and methods: This study included 211 patients who underwent allo-HSCT at seven transplant centers in T & uuml;rkiye. The impact of pretransplant vitamin D level on overall survival (OS), relapse rate, GVHD occurrence and engraftment times was analyzed retrospectively Results: Pretransplant vitamin D levels were not related to the neutrophil engraftment day (p: 0.887), relapse rate (p: 0.433) and GVHD occurrence (p: 0.391). At a median follow-up of 14 months, OS was 84.8 % and median OS was not reached. Univariate Cox Regression analysis showed that higher levels of vitamin D (>12 ng/mL) affected the survival rates (p = 0.029) (HR: 0.392: 95 % CI: 10.170-0.907). Conclusion: In our study, pretransplant vitamin D levels were not related to GVHD occurrence, relapse rate and engraftment times. However, we found that higher levels of pretransplant vitamin D levels (threshold is 12 ng/ mL) were associated with increased survival. Further studies with a larger population are necessary to reveal the role of vitamin D in patients undergoing allo-HSCT.Öğe Outcomes of Brentuximab Vedotin Monotherapy in Refractory/Relapsed Classical Hodgkin's Lymphoma: A Multi-Center Retrospective Study on Survival and Safety(Springer India, 2025) Bakirtas, Mehmet; Hindilerden, Ipek Yonal; Ulu, Bahar Uncu; Ekinci, Omer; Dogu, Mehmet Hilmi; Aydogdu, Ismet; Berber, IlhamiBackground Refractory/relapsed classical Hodgkin's lymphoma (R/RcHL) poses significant treatment challenges, with limited success rates in achieving long-term remission. Brentuximab Vedotin (BV), an anti-CD30 monoclonal antibody-drug conjugate, has emerged as a promising therapeutic option. This study aims to evaluate the efficacy and safety of BV monotherapy in R/RcHL patients, particularly regarding survival outcomes and adverse events. Methods This multi-center retrospective study included 82 R/RcHL patients aged 18 and over, treated with BV monotherapy across 14 institutions in Turkey from June 2012 to June 2020. Data on demographics, clinical characteristics, treatment response, adverse events, and overall survival (OS) rates were collected and analyzed. Primary outcomes were overall treatment response rate and OS, while the secondary outcome focused on the adverse event profile of BV treatment. Results Among the patients (56.1% female, median age 33.5 years), the overall treatment response rate was 76.8%. The median OS was 13.6 months, with patients undergoing hematopoietic stem cell transplantation (HSCT) post-BV treatment exhibiting significantly longer survival (19.6 months) compared to those who did not receive HSCT (7.8 months, p < 0.001). Grade 3 to 5 adverse events were observed in 32.9% of patients, with neutropenia being the most common. Conclusion BV monotherapy demonstrates substantial efficacy in treating R/RcHL, offering a favorable balance between treatment response and manageable adverse events. Particularly effective as a bridging therapy to HSCT, BV significantly extends survival in R/RcHL patients. These findings underscore the need for prospective studies to further delineate patient subsets most likely to benefit from BV monotherapy.Öğe What is the role of alpha-1 antitrypsin in the management of acute graft versus host disease?(Pergamon-Elsevier Science Ltd, 2025) Yigenoglu, Tugce Nur; Erkurt, Mehmet Ali; Dagdas, Simten; Ulu, Bahar Uncu; Kuku, Irfan; Durdu, Ali; Pepeler, Mehmet SezginObjective: Acute graft versus host disease (GVHD) occurs in 20-80 % of patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT). Of these patients, 40 % will be resistant to steroids, which is the standard first-line approach. There is no standard second line treatment approach for patients with steroid refractory acute GVHD (SR-aGVHD). Alpha-1 antitrypsin is a protease inhibitor and has anti-inflammatory and immune regulatory properties. Here we report the outcomes and safety data of 17 patients treated with alpha-1 antitrypsin for SR-aGVHD. Material and methods: Patients who received at least 2 lines of alpha-1 antitrypsin treatment for SR-aGVHD at five transplant centers in T & uuml;rkiye were included in this retrospective study. Results: The median number of alpha-1 antitrypsin treatment line patients received was 4 (range, 2-5). The median time between alpha-1 antitrypsin administration and response was 65 days (range, 10-138 days). Overall response rate was 70.6 %. When the first- and second-month response rates were compared according to GVHD organ involvement, we found that the response rates were similar in skin, liver and gastrointestinal system involvement (p = 0.281 and p = 0.305, respectively). No grade 3-4 anemia, thrombocytopenia or neutropenia was observed after alpha-1 antitrypsin treatment. Two patients had cytomegalovirus infection and 1 patient had pneumonia. At a median follow-up of 7 months, overall survival was 70.6 % and median overall survival was not reached. Conclusion: In conclusion, alpha-1 antitrypsin is an effective and safe treatment option in patients with SRaGVHD, with response rates of up to 70 % in patients with skin, liver and gastrointestinal system involvement. Larger studies are needed to establish a standard second and subsequent treatment approach in patients with SR-aGVHD.
