Browsing by Author "Oymak, Yeşim"

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Deferasirox in children with transfusion-dependent thalassemia or sickle cell anemia: A large cohort real-life experience from turkey (reach-them)
(Wiley, 2019-02-01) Antmen, Bülent; Karakaş, Zeynep; Yeşilipek, Mehmet Akif; Küpesiz, Osman Alphan; Şaşmaz, Ilgen; Uygun, Vedat; Kurtoğlu, Erdal; Oktay, Gönül; Aydogan, Gönül; Akın, Mehmet; Salcıoğlu, Zafer; Vergin, Canan; Kazancı, Elif Güler; Ünal, Selma; Çalışkan, Ümran; Aral, Yusuf Ziya; Türkkan, Emine; Güneş, Adalet Meral; Tunc, Bahattin; Gümrük, Fatma; Ayhan, Aylin Canbolat; Söker, Murat; Koç, Ahmet; Oymak, Yeşim; Ertem, Mehmet; Timur, Çetin; Yıldırmak, Yıldız; İrken, Gülersu; Apak, Hilmi; Biner, Betül; Eren, Tuğba Gürleyen; Balcı, Yasemin Işik; Koçak, Ulker; Karasu, Gulsun; Akkaynak, Diyar; Patıroğlu, Türkan; MERAL GÜNEŞ, ADALET; Uludağ Üniversitesi/Tıp Fakültesi; JGX-6145-2023
Objectives To evaluate the long-term efficacy and safety of deferasirox therapy in a large observational cohort of children with transfusion-dependent thalassemia (TDT) and sickle cell anemia (SCA) in Turkey. Methods This was a multicenter, prospective cohort study including TDT and SCA patients aged 2-18 years with iron overload (>= 100 mL/kg of pRBC or a serum ferritin [SF] level >1000 mu g/L) receiving deferasirox. Patients were followed for up to 3 years according to standard practice. Results A total of 439 patients were evaluated (415 [94.5%] TDT, 143 [32.6%] between 2 and 6 years). Serum ferritin levels consistently and significantly decreased across 3 years of deferasirox therapy from a median of 1775.5 to 1250.5 mu g/L (P < 0.001). Serum ferritin decreases were noted in TDT (1804.9 to 1241 mu g/L), SCA (1655.5 to 1260 mu g/L), and across age groups of 2-6 years (1971.5 to 1499 mu g/L), 7-12 years (1688.5 to 1159.8 mu g/L), and 13-18 years (1496.5 to 1107 mu g/L). Serum ferritin decreases were also noted for all deferasirox dose groups but only significant in patients with doses >= 30 mg/kg/d (n = 120, -579.6 median reduction, P < 0.001). Only 9 (2%) patients had adverse events suspected to be related to deferasirox. Serum creatinine slightly increased but remained within the normal range. Conclusions Deferasirox has long-term efficacy and safety in children with TDT and SCA, although higher doses (>= 30 mg/kg/d) may be required to achieve iron balance.
Thrombolysis with systemic recombinant tissue plasminogen activator in children: A multicenter retrospective study
(Galenos Yayıncılık, 2021-08-18) Zengin, Emine; Sarper, Nazan; Erdem, Arzu Yazal; Al, Işık Odaman; Evim, Melike Sezgin; Yaralı, Neşe; Belen, Burcu; Akçay, Arzu; Yıldırım, Aysen Türedi; Karapınar, Tuba Hilkay; Güneş, Adalet Meral; Gelen, Sema Aylan; Oren, Hale; Olcay, Lale; Baytan, Birol; Gülen, Hüseyin; Öztürk, Gülyüz; Orhan, Mehmet Fatih; Oymak, Yeşim; Akpınar, Sibel; Tüfekci, Özlem; Albayrak, Meryem; Günen, Burçak Tatlı; Canpolat, Aylin; Özbek, Namık; SEZGİN EVİM, MELİKE; MERAL GÜNEŞ, ADALET; Baytan, Birol; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Sağlığı ve Hastalıkları Anabilim Dalı/Çocuk Hematoloji Bilim Dalı.; 0000-0002-4792-269X; 0000-0002-0686-7129; 0000-0002-9375-2855; JGX-6145-2023 ; AAH-1452-2021 ; DVW-8108-2022
Objective: This study aimed to evaluate systemic thrombolysis experiences with recombinant tissue plasminogen activator (rtPA). Materials and Methods: Retrospective data were collected from 13 Turkish pediatric hematology centers. The dose and duration of rtPA treatment, concomitant anticoagulant treatment, complete clot resolution (CCR), partial clot resolution (PCR), and bleeding complications were evaluated. Low-dose (LD) rtPA treatment was defined as 0.01-0.06 mg/kg/h and high-dose (HD) rtPA as 0.1-0.5 mg/kg/h. Results: Between 2005 and 2019, 55 thrombotic episodes of 54 pediatric patients with a median age of 5 years (range: 1 day to 17.75 years) were evaluated. These patients had intracardiac thrombosis (n=16), deep vein thrombosis (DVT) (n=15), non-stroke arterial thrombosis (n=14), pulmonary thromboembolism (PE) (n=6), and stroke (n=4). The duration from thrombus detection to rtPA initiation was a median of 12 h (range: 2-504 h) and it was significantly longer in cases of DVT and PE compared to stroke, non-stroke arterial thrombosis, and intracardiac thrombosis (p=0.024). In 63.6% of the episodes, heparin was initiated before rtPA treatment. LD and HD rtPA were administered in 22 and 33 of the episodes, respectively. Concomitant anticoagulation was used in 90% and 36% of the episodes with LD and HD rtPA, respectively (p=0.0001). Median total duration of LD and HD rtPA infusions was 30 h (range: 2-120 h) and 18 h (2-120 h), respectively (p=0.044). Non-fatal major and minor bleeding rates were 12.5% and 16.7% for LD and 3.2% and 25.8% for HD rtPA, respectively. At the end of the rtPA infusions, CCR and PCR were achieved in 32.7% and 49.0% of the episodes, respectively. The most successful site for thrombolysis was intracardiac thrombosis. HD versus LD rtPA administration was not correlated with CCR/PCR or bleeding (p>0.05). Conclusion: Systemic thrombolytic therapy may save lives and organs effectively if it is used at the right indications and the right times in children with high-risk thrombosis by experienced hematologists with close monitoring of recanalization and bleeding.