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Acar SO, Tahta N, Al IO, Erdem M, Gözmen S, Karapınar TH, Kılınç B, Celkan T, Kirkiz S, Koçak Ü, Ören H, Yıldırım AT, Arslantaş E, Ayhan AC, Oymak Y. Sirolimus is effective and safe in childhood relapsed-refractory autoimmune cytopenias: A multicentre study. Scand J Immunol 2024:e13376. [PMID: 38741164 DOI: 10.1111/sji.13376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 03/24/2024] [Indexed: 05/16/2024]
Abstract
Autoimmune cytopenias are a heterogeneous group of disorders characterized by immune-mediated destruction of haematopoietic cell lines. Effective and well-tolerated treatment options for relapsed-refractory immune cytopenias are limited. In this study, the aim was to evaluate the efficacy and safety of sirolimus in this disease group within the paediatric age group. The study enrolled patients in the paediatric age group who used sirolimus with a diagnosis of immune cytopenia between December 2010 and December 2020, followed at six centres in Turkey. Of the 17 patients, five (29.4%) were treated for autoimmune haemolytic anaemia (AIHA), six (35.2%) for immune thrombocytopenic purpura (ITP) and six (35.2%) for Evans syndrome (ES). The mean response time was 2.7 months (range, 0-9 months). Complete response (CR) and partial response (PR) were obtained in 13 of 17 patients (76.4%) and nonresponse (NR) in four patients (23.5%). Among the 13 patients who achieved CR, three of them were NR in the follow-up and two of them had remission with low-dose steroid and sirolimus. Thus, overall response rate (ORR) was achieved in 12 of 17 patients (70.5%). In conclusion, sirolimus may be an effective and safe option in paediatric patients with relapsed-refractory immune cytopenia.
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Affiliation(s)
- Sultan Okur Acar
- Deparment of Hematology and Oncology, University of Health Sciences Dr. Behçet Uz Children's Hospital, Izmir, Turkey
| | - Neryal Tahta
- Deparment of Hematology and Oncology, University of Health Sciences Dr. Behçet Uz Children's Hospital, Izmir, Turkey
| | - Işık Odaman Al
- Deparment of Hematology and Oncology, University of Health Sciences Dr. Behçet Uz Children's Hospital, Izmir, Turkey
| | - Melek Erdem
- Deparment of Hematology and Oncology, University of Health Sciences Dr. Behçet Uz Children's Hospital, Izmir, Turkey
| | - Salih Gözmen
- Deparment of Hematology and Oncology, University of Health Sciences Dr. Behçet Uz Children's Hospital, Izmir, Turkey
| | - Tuba Hilkay Karapınar
- Deparment of Hematology and Oncology, University of Health Sciences Dr. Behçet Uz Children's Hospital, Izmir, Turkey
| | - Burcu Kılınç
- Faculty of Medicine Hospital, Istanbul University Cerrahpaşa, Istanbul, Turkey
| | - Tiraje Celkan
- Faculty of Medicine Hospital, Istanbul University Cerrahpaşa, Istanbul, Turkey
| | - Serap Kirkiz
- Faculty of Medicine Hospital, Ankara Gazi University, Ankara, Turkey
| | - Ülker Koçak
- Faculty of Medicine Hospital, Ankara Gazi University, Ankara, Turkey
| | - Hale Ören
- Faculty of Medicine Hospital, Dokuz Eylül University, Izmir, Turkey
| | | | - Esra Arslantaş
- Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey
| | | | - Yeşim Oymak
- Deparment of Hematology and Oncology, University of Health Sciences Dr. Behçet Uz Children's Hospital, Izmir, Turkey
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Arslantaş E, Şanlı K, Acar SO, Tekgündüz SA, Ayçiçek A. Granulocyte transfusions in life-threatening infections of children with hemato-oncological diseases. Transfus Apher Sci 2024:103897. [PMID: 38395673 DOI: 10.1016/j.transci.2024.103897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 02/04/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024]
Abstract
Granulocytes are the most important cells for host defense during infections. Granulocyte suspension transfusions (GTx) may be given as additional treatment in severely neutropenic patients with life-threatening infections when antimicrobial therapy is inadequate. The aim of this study was to evaluate the effectiveness and safety of GTx for the treatment of children with hemato-oncological disease, febrile neutropenia and serious life-threatening infections. Patients who underwent GTx between July 2020 and September 2022 were evaluated retrospectively. Hematologic and clinical response rates, adverse effects, characteristics of infection episodes and survival data of the patients were analyzed. During the study period, 60 patients received a total of 313 GTx for 81 infection episodes with a median number of GTx/infection episode of 3 (range 1-29). The median neutrophil count per bag was 20.8 (range 7.9-68.3) × 109 and the median neutrophil count per kg body weight was 0.82 (range 0.17-9.2) × 109. Clinical response was 85 %. Clinical response decreased significantly as the duration of neutropenia increased (p = 0.002). Hematologic response was calculated in 198 GTx (GTx given with pre-transfusion neutrophil count ≤ 0.5 × 109/L); hematologic response rate was 34 %. The infection-related mortality was 15 % and overall survival rate was 87 % and 70 % on days 30 and 90, respectively. No serious side effects were observed in any patient. Granulocyte transfusions appear to be safe and effective supportive treatment in neutropenic children with hematologic/oncologic diseases and severe infections.
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Affiliation(s)
- Esra Arslantaş
- Department of Pediatric Hematology and Oncology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey.
| | - Kamuran Şanlı
- Department of Clinical Microbiology, Head of Blood Center, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Sultan Okur Acar
- Department of Pediatric Hematology and Oncology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Sibel Akpınar Tekgündüz
- Department of Pediatric Hematology and Oncology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Ali Ayçiçek
- Department of Pediatric Hematology and Oncology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
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Arslantaş E, Ayçiçek A, Esen Akkas B, Tahtakesen Güçer TN, Okur Acar S, Özkan Karagenc A, Akpınar Tekgündüz S, Bayram C. The Role of FDG- PET/CT in Detecting Bone Marrow Involvement in Childhood Solid Tumors. Nuklearmedizin 2024. [PMID: 38190995 DOI: 10.1055/a-2224-9441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
PURPOSE To compare the results of 18F-Fluorodeoxy positron emission tomography/computed tomography (18 F-FDG-PET/CT) and bone marrow biopsy (BMB) procedures in the initial evaluation of bone marrow involvement (BMI) in pediatric solid tumors. METHODS We conducted a retrospective analysis of newly diagnosed pediatric cases with lymphoma, neuroblastoma, Ewing sarcoma, rhabdomyosarcoma. Each case underwent both PET-CT imaging and BMB. Presence of tumor infiltration in BMB specimens and/or positive FDG-PET/CT findings indicate as BMI were regarded as true positive results. RESULTS Sixty-four patients were included in the study. BMI was detected in 23/64 (36%) patients, FDG-PET/CT imaging and BMB results were concordant in 54/64 patients. In 9/64 patients the finding was FDG-PET/CT (+), BMB (-) indicating a false negative BMB result. In only 1/64 patients FDG- PET/CT (-), BMB (+), indicating a false negative FDG-PET/CT result. In the whole patient group, the sensitivity, specificity, positive predictive value and negative predictive value of PET/CT and BMB in detecting bone marrow involvement were 95.6%, 100%, 100% and 97.6% and 60.8 %, 100%, 100% and 82%, respectively. CONCLUSION PET/CT has a high sensitivity and specificity for the assessing marrow involvement in pediatric solid tumors. We believe that PET/CT imaging should be performed as the first step in diagnostic staging, and BMB may not be necessary in every patient, only in patients with suspicious PET/CT results for bone marrow involvement. Additionally, for a more precise determination of bone marrow involvement, it is reasonable to perform BMB from FDG-retaining areas, using PET/CT as a guide tool.
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Affiliation(s)
- Esra Arslantaş
- Pediatric Hematology Oncology, Başakşehir Çam ve Sakura Şehir Hastanesi, Istanbul, Turkey
| | - Ali Ayçiçek
- Pediatric Hematology Oncology, Başakşehir Çam ve Sakura Şehir Hastanesi, Istanbul, Turkey
| | - Burcu Esen Akkas
- Department of Nuclear Medicine, Başakşehir Çam ve Sakura Şehir Hastanesi, Istanbul, Turkey
| | | | - Sultan Okur Acar
- Pediatric Hematology Oncology, Başakşehir Çam ve Sakura Şehir Hastanesi, Istanbul, Turkey
| | - Ayse Özkan Karagenc
- Pediatric Hematology Oncology, Başakşehir Çam ve Sakura Şehir Hastanesi, Istanbul, Turkey
| | | | - Cengiz Bayram
- Pediatric Hematology Oncology, Başakşehir Çam ve Sakura Şehir Hastanesi, Istanbul, Turkey
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Devrim İ, Celebi MY, Karakaya N, Sahinkaya S, Acar SO, Cem E, Demirağ B, Oruc Y, Kara AA, Oymak Y, Karapınar TH, Bayram N. The evaluation of Candida-related central line-related bloodstream infections in pediatric cancer patients: A pre- and post-intervention study. J Infect Prev 2023; 24:219-222. [PMID: 37736125 PMCID: PMC10510660 DOI: 10.1177/17571774231191334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 03/28/2023] [Indexed: 09/23/2023] Open
Abstract
Aim/Objections The purpose of this study was to assess the efficacy of a central line maintenance bundle in preventing catheter-related (implanted venous access devices, port) Candida bloodstream infections. Methods The study encompassed two distinct time periods, namely, pre-bundle and bundle. The number of catheter-related bloodstream infections (CRBSI) episodes per catheter days for each timeframe was determined. Findings/Results Upon implementation of the central line bundle, the rate of CRBSI reduced significantly from 4.27 per 1000 central line days in the pre-bundle period to 1.0 per 1000 central line days in the bundle period (p < .001). Discussion Using a central line bundle to avoid CRBSIs in pediatric cancer patients with ports led to a significant decrease in Candida species-related CRBSIs.
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Affiliation(s)
- İlker Devrim
- Department of Pediatric Hematology and Oncology, Dr Behcet Uz Child Disease and Surgery Training and Research Hospital, Izmir, Turkey
| | - Miray Yılmaz Celebi
- Department of Pediatric Infectious Diseases, Dr Behcet Uz Child Disease and Surgery Training and Research Hospital, Izmir, Turkey
| | - Nurgul Karakaya
- Department of Pediatric Hematology and Oncology, Dr Behcet Uz Child Disease and Surgery Training and Research Hospital, Izmir, Turkey
| | - Sahika Sahinkaya
- Department of Pediatric Infectious Diseases, Dr Behcet Uz Child Disease and Surgery Training and Research Hospital, Izmir, Turkey
| | - Sultan Okur Acar
- Department of Pediatric Hematology and Oncology, Dr Behcet Uz Child Disease and Surgery Training and Research Hospital, Izmir, Turkey
| | - Ela Cem
- Department of Pediatric Infectious Diseases, Dr Behcet Uz Child Disease and Surgery Training and Research Hospital, Izmir, Turkey
| | - Bengü Demirağ
- Department of Pediatric Hematology and Oncology, Dr Behcet Uz Child Disease and Surgery Training and Research Hospital, Izmir, Turkey
| | - Yeliz Oruc
- Department of Pediatric Infectious Diseases, Dr Behcet Uz Child Disease and Surgery Training and Research Hospital, Izmir, Turkey
| | - Aybuke Akaslan Kara
- Department of Pediatric Infectious Diseases, Dr Behcet Uz Child Disease and Surgery Training and Research Hospital, Izmir, Turkey
| | - Yesim Oymak
- Department of Pediatric Hematology and Oncology, Dr Behcet Uz Child Disease and Surgery Training and Research Hospital, Izmir, Turkey
| | - Tuba Hilkay Karapınar
- Department of Pediatric Hematology and Oncology, Dr Behcet Uz Child Disease and Surgery Training and Research Hospital, Izmir, Turkey
| | - Nuri Bayram
- Department of Pediatric Hematology and Oncology, Dr Behcet Uz Child Disease and Surgery Training and Research Hospital, Izmir, Turkey
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Odaman Al I, Oymak Y, Erdem M, Tahta N, Okur Acar S, Mese T, Yilmazer MM, Gözmen S, Zihni C, Calkavur S, Karapinar TH. Assessment of clinical characteristics and treatment outcomes of pediatric patients with intracardiac thrombosis: a single-center experience. Blood Coagul Fibrinolysis 2022; 33:34-41. [PMID: 34799505 DOI: 10.1097/mbc.0000000000001100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The prevalence of intracardiac thrombus (ICT) is gradually increasing, though it is rare among children. Data related to the occurrence of ICT among children are limited, and treatment recommendations have been made utilizing adult guidelines. The primary objective of this study is to determine associated factors, management, and outcomes of intracardiac thrombosis in children. Between January 2013 and January 2020, patients diagnosed with ICT at the Pediatric Hematology-Oncology and Pediatric Cardiology departments in our hospital were included in the study. Demographic characteristics, clinical and laboratory findings, treatment protocols, and outcomes were analyzed retrospectively. The median age at diagnosis was 10.5 months (2 days to 14.5 years), and the median follow-up period was 6.5 months (1 month to 3.1 years). The most common primary diagnoses of the patients, in order of frequency, were heart disease (n: 8), metabolic disease (n: 3), prematurity and RDS (n: 3), burns (n: 2), pneumonia (n: 2), and asphyxia (n: 2). CVC was present in 19/23 of the patients. The reasons for CVC insertion were the need for plasmapheresis in one patient with a diagnosis of HUS and the need for well tolerated vascular access because of long-term hospitalization in others. LMWH was administered to all patients as first-line therapy. Complete response was achieved in 19 (79%) of 24 patients and 4 patients (16.6%) were unresponsive to medical treatment. It was found out that the thrombus location, type, sepsis, and hemoculture positivity, as well as the presence of CVC, had no impact on treatment response (chi-square P = 0.16, 0.12, 0.3, 0.49, 0.56). Moreover, no correlation was determined between thrombus size and treatment response (Mann Whitney U test P = 0.47). The mortality rate was determined to be 12.5% (3/24). Spontaneous occurrence of ICT is rare in childhood, without any underlying primary disease or associated factor. The presence of CVC, sepsis, and heart disease are factors associated with ICT. The success rate is increased with medical treatment. There was no significant difference in treatment response between the newborn and 1 month to 18-year-old patient group. It has been demonstrated that thrombus size, type, localization; sepsis, and hemoculture positivity had no impact on the treatment response.
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Affiliation(s)
| | - Yeşim Oymak
- Department of Pediatric Hematology and Oncology
| | - Melek Erdem
- Department of Pediatric Hematology and Oncology
| | | | | | | | | | | | | | - Sebnem Calkavur
- Department of Neonatology, Dr Behçet Uz Traning and Research Hospital, İzmir, Turkey
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Devrim F, Çağlar İ, Acar SO, Akkuş Ş, Dinçel N, Yılmaz E, Tahta N, Demirağ B, Karapınar TH, Gözmen S, Oymak Y, Vergin C, Bayram N, Devrim İ. Evaluation of renal effects of liposomal amphotericin B in children with malignancies with KDIGO and RIFLE criteria. Nephrol Ther 2021; 17:507-511. [PMID: 34535406 DOI: 10.1016/j.nephro.2021.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/23/2021] [Accepted: 06/27/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Amphotericin B is a broad-spectrum antifungal agent and is the backbone of the treatment for medically important opportunistic fungal pathogens in children. This study aimed to compare the nephrotoxicity associated with L-AmB in children with acute lymphoblastic leukemia and acute myeloid leukemia. MATERIALS AND METHODS A total of 112 pediatric acute lymphoblastic leukemia or acute myeloid leukemia patients who received treatment with L-AmB (Ambisome®) at the University of Health Sciences Dr Behcet Uz Children's Hospital over 7 years were included. The incidence of hypokalemia, decreased estimated glomerular filtration rate and presence of acute kidney injury was recorded. RESULTS The average L-AmB treatment duration was 17.1±15.0 days. Five patients (4.4%) of the patients had grade I acute renal injury according to KDIGO criteria and 16 patients (14.2%) had increased risk for kidney injury according to RIFLE criteria. There were no patients with eGFR decrease above 50% and no renal injury and failure were observed during L-AmB treatment. The rate of patients with hypokalemia in the pre-treatment was 17.9% and the post-L-AmB group was 50.0%. The rate of hypokalemia was higher in the post-treatment group (P=0.0015). Among the 112 patients, only two patients (1.7%) required cessation of L-AmB treatment due to resistant hypokalemia despite supplementation. CONCLUSIONS Hypokalemia was more common compared to glomerulotoxicity and acute renal injury (according to KDIGO and RIFLE criteria) in pediatric leukemia patients treated with L-AmB. Hypokalemia developed in nearly half of the patients and the study shows the need for randomized controlled trials and strategies for hypokalemia associated with L-AmB treatment.
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Affiliation(s)
- Fatma Devrim
- Department of pediatric nephrology, Dr Behçet Uz child disease and pediatric surgery training and research hospital, İzmir, Turkey.
| | - İlknur Çağlar
- Department of pediatric infectious diseases, Dr Behçet Uz children's diseases and surgery training and research hospital, İzmir, Turkey
| | - Sultan Okur Acar
- Department of pediatric hematology and oncology, Dr Behçet Uz children's diseases and surgery training and research hospital, İzmir, Turkey
| | - Şeyma Akkuş
- Department of pediatrics, Dr Behçet Uz children's diseases and surgery training and research hospital, İzmir, Turkey
| | - Nida Dinçel
- Department of pediatric nephrology, Dr Behçet Uz child disease and pediatric surgery training and research hospital, İzmir, Turkey
| | - Ebru Yılmaz
- Department of pediatric nephrology, Dr Behçet Uz child disease and pediatric surgery training and research hospital, İzmir, Turkey
| | - Neryal Tahta
- Department of pediatric hematology and oncology, Dr Behçet Uz children's diseases and surgery training and research hospital, İzmir, Turkey
| | - Bengü Demirağ
- Department of pediatric hematology and oncology, Dr Behçet Uz children's diseases and surgery training and research hospital, İzmir, Turkey
| | - Tuba Hilkay Karapınar
- Department of pediatric hematology and oncology, Dr Behçet Uz children's diseases and surgery training and research hospital, İzmir, Turkey
| | - Salih Gözmen
- Department of pediatric hematology and oncology, Dr Behçet Uz children's diseases and surgery training and research hospital, İzmir, Turkey
| | - Yeşim Oymak
- Department of pediatric hematology and oncology, Dr Behçet Uz children's diseases and surgery training and research hospital, İzmir, Turkey
| | - Canan Vergin
- Department of pediatric hematology and oncology, Dr Behçet Uz children's diseases and surgery training and research hospital, İzmir, Turkey
| | - Nuri Bayram
- Department of pediatric infectious diseases, Dr Behçet Uz children's diseases and surgery training and research hospital, İzmir, Turkey
| | - İlker Devrim
- Department of pediatric infectious diseases, Dr Behçet Uz children's diseases and surgery training and research hospital, İzmir, Turkey
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