Türkiyeden Kemik İliği Nakli İle İlgili Uluslar Arası Yayınlar

  1. Hematopoietic cell transplantation activity of Turkey in 2014: Ongoing increase in HCT rates

    Emre Tekgündüz a, İrfan Şencan b, Arif Kapuağası b,*, Doğan Ünal b, Murat Öztürk b, Eyüp Gümüş b, Hakan Göker c, Emine Betül Tavil d, Mehmet Ertem e, Mustafa Çetin f, Mutlu Arat g, Teoman Soysal h, Osman Karakaşlı b, Halil Yılmaz Sur i, Akif Yeşilipek j, Burhan Ferhanoğlu k, Duygu Uçkan d, Osman İlhan l, Fevzi Altuntaş m
    a Hematology and HCT Transplantation Clinic, Ankara Oncology Hospital, Ankara, Turkey
    b Ministry of Health, Republic of Turkey, Ankara, Turkey
    c School of Medicine, Department of Internal Medicine, Division of Hematology, Hacettepe University, Ankara, Turkey
    d School of Medicine, Department of Pediatrics, Division of Hematology, Hacettepe University, Ankara, Turkey
    e Faculty of Medicine, Department of Pediatric Hematology, Ankara University, Ankara, Turkey
    f Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Erciyes University, Kayseri, Turkey
    g HSCT Unit, Sisli Florence Nightingale Hospital, Istanbul, Turkey
    h Cerrahpasa Medical School, Department of Internal Medicine, Division of Hematology, Istanbul University, Istanbul, Turkey
    i Ankara Oncology Hospital, Ankara, Turkey
    j School of Medicine, Department of Pediatric Hematology, Oncology and BMT Unit, Akdeniz University, Antalya, Turkey
    k Medical School, Department of Hematology, Koç University, Istanbul, Turkey
    l Department of Internal Medicine, Division of Hematology, Ankara University Faculty of Medicine, Ankara, Turkey
    m Department of Internal Medicine, Division of Hematology, Yıldırım Beyazıt University Medical Faculty, Ankara, Turkey

    Hematopoietic cell transplantation is an established treatment option with curative potential for a variety of clinical conditions. The last decade especially witnessed a remarkable increase in HCT activity in Turkey. In 2014, 696 pediatric and 2631 adult (total 3327) HCT were performed in Turkey. Corresponding transplant rates per 10 million inhabitants for autologous-HCT and allogeneic-HCT were 226 and 202, respectively. Total HCT procedures in Turkey increased 177% in the last 5 years and 791% in the last 14 years. This report focuses mainly on HCT activity of Turkey in 2014 based on the national HCT registry and presents a general picture of national HCT activity.

    1. Does defibrotide prophylaxis decrease the risk of acute graft versus host disease following allogeneic hematopoietic cell transplantation?

      Emre Tekgündüz a,*, Ali Hakan Kaya a, Sinem Civriz Bozdağ b, Şerife Koçubaba a, Ömür Kayıkçı a, Sinem Namdaroğlu a, Bilge Uğur a, Seval Akpınar a, Hikmetullah Batgi a, Filiz Bekdemir a, Fevzi Altuntaş c
      a Ankara Oncology Education and Research Hospital, Hematology and Stem Cell Transplantation Clinic, Ankara, Turkey
      b Ankara University Medical Faculty, Department of Internal Medicine, Division of Hematology, Ankara, Turkey
      c Yıldırım Beyazıt University Medical Faculty, Department of Internal Medicine, Division of Hematology, Ankara, Turkey

      There is some preliminary evidence, that veno-occlusive disease prophylaxis with defibrotide (DF) may also have a role in decreasing risk of acute graft-versus-host disease (aGvHD) by preventing tissue damage. In this study, we aimed to investigate the role of DF prophylaxis on the development of aGvHD at D + 180. One hundred ninety-five consecutive adult patients receiving allogeneic HCT were retrospectively evaluated in 3 groups: no DF, DF/ post-HCT (DF D + 1 toD+ 14) and DF/pre-HCT (DF for 14 days concurrently with conditioning). The total (p: 0.057) and grades III/IV (p: 0.051) aGvHD rates at D + 180 were 46.5%, 40%, 25.5% and 15.5%, 11.2%, 0% in patients on no DF, DF/post-HCT and DF/pre-HCT. DF may have a role in decreasing incidence and severity of aGvHD, especially if used concurrently with conditioning regimen.

  2. Retrospective analysis of adult patients with acute lymphoblastic leukemia undergoing allogeneic hematopoietic cell transplantation: A multicenter experience of daily practice

    Emre Tekgündüz a,*, Leylagül Kaynar b, Hakan Göker c, Ali Hakan Kaya a, Esra Ermiş Turak b, Eylem Eliaçık c, Ömür Kayıkçı a, Mustafa Çetin b, Yahya Büyükaşık c, Bülent Eser b, Fevzi Altuntaş a,d
    a Hematology and Stem Cell Transplantation Clinic, Ankara Oncology Education and Research Hospital, Ankara, Turkey
    b Division of Hematology, Department of Internal Medicine, Erciyes University Medical Faculty, Kayseri, Turkey
    c Division of Hematology, Department of Internal Medicine, Hacettepe University Medical Faculty, Ankara, Turkey
    d Division of Hematology, Department of Internal Medicine, Yıldırım Beyazıt University Medical Faculty, Ankara, Turkey

    Compared to pediatric age group, the prognosis of adult acute lymphoblastic leukemia (ALL) is still dismal even in patients receiving allogeneic hematopoietic cell transplantation (AHCT). We retrospectively analyzed 205 adults (male: 122; female: 83) with ALL who underwent AHCT. Median age of patientswas 28 (18–59). Fifty-two patients had Ph+ ALL. The estimated relapsefree and overall survival (OS) of the study cohort at 1, 2 and 3 yearswere 52.3%/63.9%, 42.9%/49.5% and 39.9%/45.6%, respectively. On multivariate analysis, first complete remission at the time of AHCT, TBI-based conditioning and development of chronic graft-versus-host disease were only factors, which were significantly associated with prolonged OS.

  3. Chimeric antigen receptor T cell treatment in hematologic malignancies

    Hakan Goker *, Umit Yavuz Malkan, Haluk Demiroglu, Yahya Buyukasik
    School of Medicine, Department of Internal Medicine, Division of Hematology, Hacettepe University, Ankara, Turkey

    Adoptive transfer of T cells that have genetically engineered chimeric antigen receptors (CARs) is an encouraging treatment modality in the hematological malignancies. These T cells are capable of selectively recognizing tumor-associated antigens. There are a variety of reported, as well as ongoing studies on the utilization of CAR-T cells in the treatment of leukemia, myeloma, as well as B and T cell lymphomas. In this review, we aimed to highlight current understanding of this promising treatment modality, including its efficacy and adverse effects.

  4. DHAP plus filgrastim as an effective peripheral stem cell mobilization regimen for autologous stem-cell transplantation in patients with relapsed/refractory lymphoma: A single center experience

    Ilhami Berber a,*, Mehmet Ali Erkurt a, Irfan Kuku a, Emin Kaya a, Harika Gozukara Bag b, Ilknur Nizam a, Mustafa Koroglu a, Mustafa Ozgul a
    a Department of Hematology, Faculty of Medicine, Inonu University, Malatya, Turkey
    b Department of Biostatistics and Medical Informatics, Inonu University School of Medicine, Malatya, Turkey

    This study aimed to evaluate the efficiency of DHAP regimen plus filgrastim for mobilization of stem cells in patients with recurrent and/or refractory lymphoma. Thirty-four patients who took DHAP as salvage therapy prior to autologous stem cell transplantation were included. After chemotherapies, 2 cycles of DHAP plus filgrastim were administered to the patients. Stem cells from 32 patients (94%) were collected on median 11th day (8–12), and the median collected CD34+ cell dose was 9.7 × 106/kg (range 3.8–41.6). DHAP plus filgrastim was found to be an effective chemotherapy regimen in mobilizing CD34+ stem cells into the peripheral.

  5. First hematopoietic cell transplantation in Uzbekistan: Progress through education and cooperation

    Khamid Karimov a, Emre Tekgündüz b,*, Alonur Saidov a, Ömür Kayıkçı b, Kodirzhon Boboev a, Şerife Koçubaba b, Abdurakhmon Kayumov a, Ali Kılınç c, Gülşen Adıbelli c, Abdumannon Isroilov a, Tuğçe Nur Türközü b, Halil Yılmaz Sur d, Nurullah Zengin e, Fevzi Altuntaş f
    a Scientific Research Institute of Hematology and Blood Transfusion, Tashkent, Uzbekistan
    b Hematology and HCT Clinic, Ankara Oncology Education and Research Hospital, Ankara, Turkey
    c Therapeutic Apheresis Center, Ankara Oncology Education and Research Hospital, Ankara, Turkey
    d Ankara Oncology Education and Research Hospital, Ankara, Turkey
    e Yıldırım Beyazıt University Medical Faculty, Department of Internal Medicine, Division of Oncology, Ankara, Turkey
    f Yıldırım Beyazıt University Medical Faculty, Department of Internal Medicine, Division of Hematology, Ankara, Turkey

    HCT rates are one of the important parameters defining developmental stage of a given country. There is a steady increase in HCT activity on both sides of Atlantic. But in certain parts of the world, HCT activities have yet to begin. Here we report the history of the establishment of the first HCT center and its preliminary activity in Tashkent-Uzbekistan through close cooperation between Turkish Cooperation and Coordination Agency (TIKA) and Uzbekistan Ministry of Health. As of 2014, a total of 10 multiple myeloma patients successfully underwent autologous HCT in Uzbekistan. This encouraging project may be seen as a good example for other developing countries.

  6. Does the preference of peripheral versus central venous access in peripheral blood stem cell collection/yield change stem cell kinetics in autologous stem cell transplantation?

    Mehmet Hilmi Dogu a,*, Ali Hakan Kaya b, Ilhami Berber c, İsmail Sari a, Emre Tekgündüz b, Mehmet Ali Erkurt c, Dicle Iskender b, Ömur Kayıkçı b, Irfan Kuku c, Emin Kaya c, Ali Keskin a, Fevzi Altuntaş d
    a Department of Hematology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
    b Hematology and Stem Cell Transplantation Clinic, Ankara Oncology Education and Research Hospital, Ankara, Turkey
    c Department of Hematology, Faculty of Medicine, İnönü University, Malatya, Turkey
    d Medical Faculty, Department of Internal Medicine, Division of Hematology, Yıldırım Beyazıt University, Ankara, Turkey

    Central venous access is often used during apheresis procedure in stem cell collection. The aim of the present study was to evaluate whether central or peripheral venous access has an effect on stem cell yield and the kinetics of the procedure and the product in patients undergoing ASCT after high dose therapy. A total of 327 patients were retrospectively reviewed. The use of peripheral venous access for stem cell yield was significantly more frequent in males compared to females (p = 0.005). Total volume of the product was significantly lower in central venous access group (p = 0.046). As being a less invasive procedure, peripheral venous access can be used for stem cell yield in eligible selected patients.

  7. Primary central nervous system lymphoma in daily practice and the role of autologous stem cell transplantation in relapsed disease: A retrospective multicenter study

    Mehmet Ali Erkurt a,*, Ilhami Berber a, Emre Tekgündüz b, Mehmet Hilmi Dogu c, Serdal Korkmaz d, Cengiz Demir e, Mehmet Yilmaz f, Olga Meltem Akay g, Ciğdem Pala h, Yusuf Bilen i, Emin Kaya a, Ismail Sari c, Mehmet Sencan j, Irfan Kuku a, Fevzi Altuntaş b,k, Mehmet Sinan Dal b, Ismet Aydogdu l
    a Department of Hematology, Inönü University Medical Faculty, Malatya, Turkey
    b Hematology and HCT Clinic, Ankara Oncology Hospital, Ankara, Turkey
    c Department of Hematology, Pamukkale University Medical Faculty, Denizli, Turkey
    d Hematology Division, Kayseri Trainer and Research Hospital, Kayseri, Turkey
    e Department of Hematology, Yüzüncü Yıl University Medical Faculty, Van, Turkey
    f Department of Hematology, Antep University Medical Faculty, Gaziantep, Turkey
    g Department of Hematology, Osmangazi University Medical Faculty, Eskişehir, Turkey
    h Department of Hematology, Erciyes University Medical Faculty, Kayseri, Turkey
    i Department of Hematology, Atatürk University Medical Faculty, Erzurum, Turkey
    j Department of Hematology, Cumhuriyet University Medical Faculty, Sivas, Turkey
    k Department of Internal Medicine, Division of Hematology, Yıldırım Beyazıt University Medical Faculty, Ankara, Turkey
    l Department of Hematology, Celal Bayar University Medical Faculty, Manisa, Turkey

    We investigated the course of 54 patients presenting with primary central nervous system lymphoma, who were treated in daily practice. The patients were treated with chemotherapy and/or radiotherapy and/or intrathecal chemotherapy. At amedian follow-up period of 23 months (range 1–71), median relapse-free survival (RFS) and overall survival (OS) were not reached. Estimated 2-year RFS and OS rates were 42% and 48%, respectively. Ten relapsed PCNSL patients underwent ASCT. Complete remission rate of these patients was 40%, with 20% treatment-related mortality. Estimated 2-year RFS and OS rates were 37% and 40%, respectively. The prognosis of patients with PCNSL, who received off-study treatment, is still dismal.

  8. Could psychiatric assessment before hematopoietic stem cell transplantation predict the need for psychiatric consultation during transplantation period?

    Hayriye Dilek Yalvaç a,*, Zeynep Kotan a, Emre Tekgündüz b, Ali Çayköylü c, Fevzi Altuntaş b
    a Ankara Oncology Education and Research Hospital, Psychiatry Clinic, Ankara, Turkey
    b Ankara Oncology Education and Research Hospital, Hematology and Stem Cell Transplantation Clinic, Ankara, Turkey
    c Yıldırım Beyazıt University Medical Faculty, Department of Internal Medicine, Division of Hematology, Ankara, Turkey

    Psychiatric morbidity seems to be a significant concern associated with all stages of hematopoietic stem cell transplantation (HSCT).We aimed to understand whether psychiatric consultation before HSCT procedure could predict the need for psychiatric support during isolation period. Seventy-eight patients undergoing HSCT were included in the study. Patients were diagnosed according to the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV). Standard anxiety and depression scores were performed. Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) and State and Trait Anxiety Inventory (STAI) were performed. Psychiatric consultation was required for 45 (58%) patients during hospitalization. Only pre-HSCT STAI trait scores were higher in patients who were found to have psychopathology at consultation during hospitalization compared to patients without established psychopathology. Sixteen (76%) and 29 (51%) patients needed consultation with and without pre-HSCT psychopathology, respectively. Our study showed that the psychiatric consultation request rate during the transplantation process was higher for cases previously diagnosed with psychopathology and who had high trait anxiety scale scores before HSCT.

  9. The use of second allogeneic hematopoietic stem cell transplantation for hematologic malignancies relapsed after the first: Does it worth to do?

    Hasan Sami Göksoy a, Mutlu Arat b,*
    a Istanbul Bilim University, Medical Faculty Hematology Department, Istanbul, Turkey
    b Istanbul Florence Nightingale Hospital Group, Hematopoietic Stem Cell Transplantation Unit, Istanbul, Turkey

    Allogeneic (allo) hematopoietic stem cell transplantation (HSCT) is the only curative option for many malignant and benign hematological disorders. It seems hopeless for patients who relapse after this strategy. In the era of developing breakthrough therapies, we can hope for better, but for patients relapsed after the first allo HSCT probably the best therapy option for long term survival is still another allo HSCT. Interval between first allo HSCT and relapse of primary disease and achievement of complete response after the relapse are the most prominent factors for long time survival for patient after second all HSCT.

  10. Optimizing mobilization strategies in difficult-to-mobilize patients: The role of plerixafor

    Hakan Goker *, Sezgin Etgul, Yahya Buyukasik
    Hematology Department, Hacettepe University School of Medicine, Ankara, Turkey

    Peripheral blood stem cell collection is currently the most widely used source for hematopoietic autologous transplantation. Several factors such as advanced age, previous chemotherapy, disease and marrow infiltration at the time of mobilization influence the efficacy of CD34+ progenitor cell mobilization. Despite the safety and efficiency of the standard mobilization protocols (G-CSF ± chemotherapy), there is still a significant amount of mobilization failure rate (10–40%), which necessitate novel agents for effective mobilization. Plerixafor, is a novel agent, has been recently approved for mobilization of hematopoietic stem cells (HSCs). The combination of Plerixafor with G-CSF provides the collection of large numbers of stem cells in fewer apheresis sessions and can salvage those who fail with standard mobilization regimens. The development and optimization of practical algorithms for the use Plerixafor is crucial to make hematopoietic stem cell mobilization more efficient in a cost-effective way. This review is aimed at summarizing how to identify poor mobilizers, and define rational use of Plerixafor for planning mobilization in hard-to-mobilize patients.