Person: MERAL GÜNEŞ, ADALET
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MERAL GÜNEŞ
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ADALET
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Publication Thalassemia-free and graft-versus-host-free survival: Outcomes of hematopoietic stem cell transplantation for thalassemia major, Turkish experience(Springernature, 2022-02-24) Yeşilipek, M. Akif; Uygun, Vedat; Küpesiz, Alphan; Karasu, Gülsün; Öztürk, Gülyüz; Ertem, Mehmet; Şaşmaz, İlgen; Daloğlu, Hayriye; Güler, Elif; Hazar, Volkan; Fisgin, Tunç; Sezgin, Gülay; Kansoy, Savaş; Kuşkonmaz, Barış; Akıncı, Burcu; Özbek, Namık; İnce, Elif Ünal; Öztürkmen, Seda; Küpesiz, Funda Tayfun; Yalçın, Koray; Anak, Sema; Bozkurt, Ceyhun; Karakukcu, Musa; Küpeli, Serhan; Albayrak, Davut; Oniz, Haldun; Aksoylar, Serap; Okur, Fatma Visal; Albayrak, Canan; Yenigürbüz, Fatma Demir; Bozkaya, İkbal Ok; İleri, Talia; Gürsel, Orhan; Karagün, Barbaros Şahin; Kintrup, Gülen Tuysuz; Çelen, Suna; Elli, Murat; Aksoy, Başak Adaklı; Yılmaz, Ebru; Tanyeli, Atila; Akyol, Şule Turan; SIVI, Zuhal Önder; Özek, Gülçihan; Uçkan, Duygu; Kartal, İbrahim; Atay, Didem; Akyay, Arzu; Bilir, Özlem Arman; Çakmakl, Hasan Fatih; Kürekçi, Emin; Malbora, Barış; Akbayram, Sinan; Demir, Hacı Ahmet; Kılıç, Suar Çakır; Güneş, Adalet Meral; Zengin, Emine; Özmen, Salih; Antmen, Ali Bülent; MERAL GÜNEŞ, ADALET; Tıp Fakültesi; Çocuk Hematoloji ve Onkoloji Ana Bilim Dalı; JGX-6145-2023We report the national data on the outcomes of hematopoietic stem cell transplantation (HSCT) for thalassemia major (TM) patients in Turkey on behalf of the Turkish Pediatric Stem Cell Transplantation Group. We retrospectively enrolled 1469 patients with TM who underwent their first HSCT between 1988 and 2020 in 25 pediatric centers in Turkey. The median follow-up duration and transplant ages were 62 months and 7 years, respectively; 113 patients had chronic graft versus host disease (cGVHD) and the cGVHD rate was 8.3% in surviving patients. Upon the last visit, 30 patients still had cGvHD (2.2%). The 5-year overall survival (OS), thalassemia-free survival (TFS) and thalassemia-GVHD-free survival (TGFS) rates were 92.3%, 82.1%, and 80.8%, respectively. cGVHD incidence was significantly lower in the mixed chimerism (MC) group compared to the complete chimerism (CC) group (p < 0.001). In survival analysis, OS, TFS, and TGFS rates were significantly higher for transplants after 2010. TFS and TGFS rates were better for patients under 7 years and at centers that had performed over 100 thalassemia transplants. Transplants from matched unrelated donors had significantly higher TFS rates. We recommend HSCT before 7 years old in thalassemia patients who have a matched donor for improved outcomes.Publication The evaluation of bleeding diathesis in adolescents with heavy menstrual bleeding(Galenos Yayıncılık, 2018-01-01) Evim, Melike Sezgin; Baytan, Birol; Güneş, Adalet Meral; SEZGİN EVİM, MELİKE; Baytan, Birol; MERAL GÜNEŞ, ADALET; Tıp Fakültesi; Çocuk Hematoloji Ana Bilim Dalı; 0000-0002-9375-2855; AAH-1452-2021; DVW-8108-2022; JGX-6145-2023Heavy menstrual bleeding is defined as bleeding longer than 7 days or more than 80 ml blood loss per cycle. It causes decreased quality of life with reluctance in participating in social and physical activities, school absenteeism in addition to iron deficiency anemia. As the most frequent cause is anovulatory cycles linked to the immature hypothalamic-pituitary axis, the second common cause is an underlying bleeding disorder.Publication Evaluation of micafungin use in children(Ankara Microbiology, 2020-01-01) Hacimustafaoglu, Mustafa; Yeşil, Edanur; YEŞİL, EDANUR; Çelebi, Solmaz; ÇELEBİ, SOLMAZ; Sezgin Evim, Melike; SEZGİN EVİM, MELİKE; Özer, Arife; Turan, Cansu; TURAN, CANSU; Timur, Demet; TİMUR, DEMET; Çakır, Salih Cağrı; ÇAKIR, SALİH ÇAĞRI; Bülbül, Beyhan; BÜLBÜL, BEYHAN; Ener, Beyza; ENER, BEYZA; Güneş, Adalet Meral; MERAL GÜNEŞ, ADALET; Koksal, Nilgun; Özkan, Hilal; ÖZKAN, HİLAL; Sevinir, Betul; SEVİNİR, BETÜL BERRİN; Düzcan Kilimci, Duygu; Tıp Fakültesi; Pediatri Onkoloji Ana Bilim Dalı; 0000-0002-8926-9959; 0000-0003-3146-6391; 0000-0001-5761-4757; 0000-0002-5720-1212; 0000-0002-3232-7652; 0000-0003-4646-660X; AAG-8523-2021; AEZ-2469-2022; GSO-3630-2022; AAH-1570-2021; HJZ-4508-2023; AAE-6201-2021; AAG-8393-2021; JCD-9679-2023Micafungin is recommended especially in patients with liver and kidney failure and in the presence of other side effects due to antifungals apart from its known priority indications such as invasive candidiasis. The aim of this study was to evaluate the children who have received micafungin treatment. In the study, 125 children who were hospitalized in the pediatric wards and intensive care units of our hospital and had used micafungin between November 2016 and January 2019 were analyzed retrospectively. Clinical data, micafungin indication, blood values on the first and fourth days of the treatment, side effects of the drug and efficacy were evaluated. Sixty percent (75/125) of the patients were male and the mean age of all the patients were 58 +/- 67 (0-215, 30) months. Approximately half of the cases (48%) had malignancy and 13% of them were premature. Sixty-two percent (n= 37) of the malignencies were hematological (27 acute lymphocytic leukemia, nine acute myeloid leukemia, one myelodysplastic syndrome) and 38% (n= 23) were oncological (six neuroblastoma, four Hodgkin lymphoma, two Non-Hodgkin's lymphoma, five sarcomas, one hepatoblastoma, five others) malignencies. The major cause of hospitalization was sepsis (53%). The patients had several risk factors like immunosuppressive therapy (n= 68, 54%), neutropenia (n= 61, 49%), central venous catheter (n= 102, 82%), nasogastric tube (n= 63, 50%), endotracheal intubation tube (n= 49, 39%), urinary catheter (n= 14, 11%) and total parenteral nutrition (n= 81, 65%). Thirteen percent (n= 16) of the cases were post-operative patients. Candida species were cultivated in 97 clinical specimens (blood, endotracheal aspirate, sputum, urine, etc.) among 23 (18%) of the patients. Thirteen (10%) of the patients had candidemia and 62% of them were non-albicans strains. In all candidemias, strains were echinocandin susceptible, and blood cultures were negative within four days. When all the patients (n= 125) were evaluated, a significant decrease in C-reactive protein, an increase in sodium, and a decrease in alanine aminotransferase were observed on the fourth day of micafungin treatment (p< 0.05). A total of 39 (31%) patients underwent various antifungal treatments for median seven (1-60) days prior to micafungin treatment. Fourteen (36%) of these 39 patients, had elevated liver function tests (LFT), 10 (26%) of them had hypokalemia, and five (13%) of them had elevated renal function tests. Ten (26%) patients had antifungal-induced hypokalemia previously; and potassium levels were normalized after micafungin treatment (p= 0.0001). The patients for which micafungin treatment was chosen due to elevated liver function tests (n= 47, 38%), whether the antifungalinduced or not; alanine aminotransferase and aspartate aminotransferase levels were decreased after micafungin treatment (p= 0.0001 and p= 0.0001, respectively). Nineteen (15%) of the patients have died within the first 30 days of micafungin treatment and one of them had candidemia. No micafungin treatment related significant side effects were observed in any of the patients. Our study showed that micafungin could be a safe and effective option in pediatric cases including newborns with high liver and kidney function tests.Publication Treatment of severe bleeding and prophylaxis with rFVIIA in a child with FVIII inhibitor(Wiley, 2015-06-01) Güneş, Adalet Meral; Evim, Melike Sezgin; Baytan, Birol; MERAL GÜNEŞ, ADALET; SEZGİN EVİM, MELİKE; Baytan, Birol; Tıp Fakültesi; Pediatri Hematoloji Bölümü; 0000-0002-9375-2855; AAH-1452-2021; EXD-8400-2022; DVW-8108-2022Publication Incidence and management of thromboembolism in patients with acute leukemia(Springer India, 2023-03-29) Temuroğlu, Aytuel; Güler, Salih; GÜLER, SALİH; Evim, Melike Sezgin; SEZGİN EVİM, MELİKE; Güneş, Adalet Meral; MERAL GÜNEŞ, ADALET; Tıp Fakültesi; Pediatri Hemotoloji Ana Bilim DalıThromboembolic events (TE) in childhood are relatively rare but, serious complications of acute leukemia. The aim was to define the incidence and risk factors of thrombosis in children with leukemias. The electronic files of pediatric denovo/relapsed acute leukemia patients aged below 18 years, treated between 2011 and 2021 were retrospectively evaluated for thrombotic attacks. Thirty out of 469 patients developed 35 thrombotic events. The median age at the time of the TE was 11.8 (2-17.6) years, and the median time from diagnosis to TE was 9 (0-58) months. The frequency of TE was found at 7.4% ( n = 35/469). When catheter related (n = 13) events, superficial venous events (n = 10), and arterial central nervous system thrombosis (n = 1) were excluded, the frequency of TE was decreased to 2.3% (n = 11/469). Children older than 10 years old (13.8%; n = 21/152) had significantly higher thromboembolic events than the others (4.4%; n = 14/317) (p = 0.03). The majority of attacks were symptomatic 66% (n = 23/35). The most common complaints were local pain, swelling, and redness 52% (n = 12/23). The majority of attacks in patients with relapsed (75%; 6/8) and newly diagnosed acute lymphoblastic leukemia (40%; 10/25%) developed during the induction phase. Thrombosis recurred in 13.3% (n = 4/30) of cases more than once. Thrombotic attacks were successfully treated with low molecular weight heparin 60% (n = 21/35), and recombinant tissue plasminogen activator 17% (n = 6/35). None of the children were lost due to thrombosis. Thrombosis is an important complication during acute leukemia treatment.Successful results are obtained with early diagnosis and treatment attempts by creating awareness.Publication Characteristics, treatment and outcome of 15 to 18 years-old adolescents with Chronic Myeloid Leukemia (CML): The experience of the International Registry of Childhood CML (I-CML-Ped Study)(American Society of Hematology, 2021-11-23) Froment, Morgane; Suttorp, Meinolf; Ragot, Stephanie; Deutsch, Helene; Goyeau, Violaine; De Moerloose, Barbara; Brandalise, Silvia Regina; Borisevich, Marina; Sedlacek, Petr; Gunes, Adalet Meral; Lausen, Birgitte; Molines Honrubia, Antonio; Jakovljevic, Gordana; Versluys, Birgitta; Kalwak, Krzysztof; Hraskova, Andrea; Millot, Frederic; MERAL GÜNEŞ, ADALET; Tıp Fakültesi; EXD-8400-2022Publication Single center experience: Intracranial hemorrhage in children with hemophilia(Wiley, 2019-02-01) SEZGİN EVİM, MELİKE; Evim, Melike; Guneş, Adalet Meral; MERAL GÜNEŞ, ADALET; Baytan, Birol; Ertekin, M.; Tıp Fakültesi; Hematoloji Ana Bilim Dalı; 0000-0002-9375-2855; 0000-0002-5492-7982; AAH-1452-2021Publication A rare case of recurrence presenting with bilateral exudative retinal detachment in a child with acute lymphoblastic leukemia(Wiley, 2021-08-16) Yalçınbayır, Özgür; Sezgin Evim, Melike; Uçan Gündüz, Gamze; Güler, Salih; Meral Güneş, Adalet; YALÇINBAYIR, ÖZGÜR; SEZGİN EVİM, MELİKE; UÇAN GÜNDÜZ, GAMZE; GÜLER, SALİH; MERAL GÜNEŞ, ADALET; Tıp Fakültesi; Göz Hastalıkları Ana Bilim Dalı; 0000-0002-7311-5277; 0000-0002-1219-8304; 0000-0002-5458-1686; 0000-0002-4792-269X; 0000-0002-0686-7129; IYJ-9408-2023; AAH-1452-2021; AAH-6661-2021; DWH-8632-2022; EXD-8400-2022Publication Assessment of minimal residual disease in childhood acute lymphoblastic leukemia: A multicenter study from Turkey(Lippincott Williams & Wilkins, 2022-03-01) Tüfekci, Özlem; Evim, Melike Sezgin; Güneş, Adalet Meral; Çelkan, Tiraje; Karapınar, Deniz Yılmaz; Kaya, Zühre; Baysal, Birsen; Baytan, Birol; Koçak, Ülker; Yılmaz, Şebnem; Çınar, Suzan; Ören, Hale; SEZGİN EVİM, MELİKE; MERAL GÜNEŞ, ADALET; Baytan, Birol; Tıp Fakültesi; Çocuk Hematoloji Ana Bilim Dalı; AAH-1452-2021; EXD-8400-2022; DVW-8108-2022Assestment of minimal residual disease (MRD) in childhood acute lymphoblastic leukemia (ALL) is of utmost importance both for risk classification and tailoring of the therapy. The data of pediatric ALL patients that received treatment with Berlin-Frankfurt-Munster (BFM) protocols were retrospectively collected from 5 university hospitals in Turkey. Of the 1388 patients enrolled in the study 390 were treated according to MRD-based protocols. MRD assestment was with real time quantitative polymerase chain reaction (qPCR) in 283 patients and with multiparametric flow cytometry (MFC)-MRD in 107 patients. MRD monitoring had upstaged a total of 8 patients (2%) from intermediate risk group to high-risk group. Univariate analysis revealed age 10 years or above, prednisone poor response, PCR-MRD >= 10(-3) on day 33 and on day 78 as poor prognostic factors affecting event-free survival (EFS). Detection of >10% blasts on day 15 with MFC (MFC-high-risk group) was not shown to affect EFS and/or overall survival (log-rank P=0.339). Multiple logistic regression analysis revealed PCR-MRD >= 10(-3) on day 78 as the only poor prognostic factor affecting EFS (odds ratio: 8.03; 95% confidence interval: 2.5-25; P=0.000). It is very important to establish the infrastructure and ensure necessary standardization for both MRD methods for optimal management of children with ALL.Publication Invasive fungal infections in children with leukemia: Clinical features and prognosis(Galenos Yayıncılık, 2022-01-01) Evim, Melike Sezgin; Tüfekci, Özlem; Baytan, Birol; Ören, Hale; Çelebi, Solmaz; Ener, Beyza; Elmas, Kevser Üstün; Yılmaz, Şebnem; Erdem, Melek; Hacımustafaoğlu, Mustafa Kemal; Güneş, Adalet Meral; SEZGİN EVİM, MELİKE; Baytan, Birol; ÇELEBİ, SOLMAZ; ENER, BEYZA; ÜSTÜN ELMAS, KEVSER; HACIMUSTAFAOĞLU, MUSTAFA KEMAL; MERAL GÜNEŞ, ADALET; Tıp Fakültesi; Çocuk Sağlığı ve Hastalıkları Ana Bilim Dalı; 0000-0002-4803-8206 ; AAH-1452-2021; DVW-8108-2022; JHN-1091-2023; AAG-8523-2021; JLB-6134-2023; CTG-5805-2022; JGX-6145-2023Objective: The incidence of invasive fungal infections (IFIs) has increased due to intensive chemotherapy in childhood leukemia. The aim of this study was to evaluate the incidence, risk factors, causative pathogens, and impact on survival of IFIs among pediatric leukemia patients. Materials and Methods: The hospital records of 307 children with acute lymphoblastic leukemia (ALL, n=238), acute myeloid leukemia (AML, n=51), and relapsed leukemia (n=18) between January 2010 and December 2015 were retrospectively evaluated. Results: A total of 1213 febrile neutropenia episodes were recorded and 127 (10.4%) of them were related to an IFI. Of 307 children, 121 (39.4%) developed IFIs. The mean age was significantly older in the IFI group compared to children without IFIs (p<0.001). IFIs were defined as possible, probable, and proven in 73.2%, 11.9%, and 14.9% of the attacks, respectively. Invasive aspergillosis (81.9%) was the most frequent infection, followed by invasive candidiasis (13.4%) and rare fungal diseases (4.8%). The majority of IFI attacks in both ALL and AML occurred during the induction phase. In total, the death rate was 24% and the IFI-related mortality rate was 18%. The mortality rate among children with IFIs was found to be significantly higher than that of children without IFIs (p<0.001). Overall and event-free survival rates at 5 years were also found to be significantly lower in the IFI group (p<0.001). Relapse (odds ratio: 8.49) was the most effective risk factor for mortality, followed by developing an IFI episode (odds ratio: 3.2) and AML (odds ratio: 2.33) according to multivariate regression analysis. Conclusion: Our data showed that IFIs were more common in older children. Although proven and probable IFI episodes were more frequently diagnosed in cases of relapse and AML, children with ALL and AML had similar frequencies of experiencing at least one episode of IFI. Rare fungal diseases were also identified as a major problem. Despite success in treatment, IFIs increased the rate of mortality in children with acute leukemia.