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    A Case of Gonadotropin-independent precocious puberty due to germ cell tumor in the frontal lobe
    (Karger, 2019) Hacıhamdioğlu, Bülent; Yalçın, Koray; Çelen, Safiye Suna; Hazar, Volkan
    It is known that gonadotropin-independent or peripheral precocious puberty (PPP) may develop due to tumors that secrete beta human chorionic gonadotropin (Beta-HCG)
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    Central line-associated bloodstream infection outbreak related to Ralstonia pickettii-contaminated saline in a pediatric hematopoietic stem cell transplant center
    (Hacettepe Üniversitesi Çocuk Sağlığı Enstitüsü Müdürlüğü, 17.10.2024) Çelen, Safiye Suna; Zhumatayev, Suleimen; Yalçın, Koray; Kara, Emine Manolya; Sutcu, Murat; Karasu, Gulsun; Yesilipek, M.Akif
    Background. Ralstonia pickettii is an aerobic Gram-negative non-fermentative bacillus. It is an opportunistic pathogen that has recently prompted nosocomial outbreaks. Although it has low virulence, it can cause a wide range of invasive diseases in immunosuppressive patients. The characteristics of R. pickettii-related central line-associated bloodstream infection (CLABSI) outbreak in pediatric hematopoietic stem cell transplant (HSCT) recipients are presented in this study. Materials and Methods. This was a single-center, retrospective analysis conducted at Bahcesehir University Goztepe Medicalpark Hospital . The clinical and laboratory characteristics of twelve children with Ralstonia-related CLABSIs were analyzed. Results. Of the twelve patients with R. pickettii growth, seven were female. The median age was 12.1 (2-17) years. Autologous HSCT was performed in two of the patients and allogeneic HSCT was performed in ten patients for both malignant and non-malignant diseases. In the conditioning regimens, all patients were given myeloablative therapy. Clinical sepsis was the most common presentation. As a result of the investigations, R. pickettii growth was observed in saline solutions. All cases were successfully treated with the appropriate antibiotic regimen and the bacteria was not found in repeat cultures. Catheter removal was required in two patients. Mortality was not observed in any patient as the outcome of the infection episode. Conclusion. The detection and control of the infectious source are critical in pediatric HSCT patients with severe immunosuppression, as medical equipment-related outbreaks can be life-threatening.
  • Küçük Resim Yok
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    Hematopoetic stem cell transplantation in CD40 ligand deficiency
    (SPRINGERNATURE, 2020) Uygun, Vedat; Uygun, Dilara Fatma Kocacık; Daloğlu, Hayriye; Öztürkmen, Seda; Kılıç, Suar Çakı; Bingöl, Aysen; Yalçın, Koray; Çelen, Safiye Suna; Hazar, Volkan; Tezcan Karasu, Gülsun; Yeşilipek, Akif
    [No Abstract Available]
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    Ruxolitinib salvage therapy is effective for steroid-refractory graft-versus-host disease in children: a single-center experience
    (Wiley, 2020) Uygun, Vedat; Tezcan Karasu, Gülsün; Daloğlu, Hayriye; Öztürkmen, Seda; Kılıç, Suar Çakı; Yalçın, Koray; Çelen, Safiye Suna; Hazar, Volkan; Yeşilipek, Akif
    Background Despite the increasing performance of allogeneic hematopoietic cell transplantation over the last decades, graft-versus-host disease (GVHD) remains the main cause of morbidity and mortality. The efficacy of ruxolitinib against GVHD has been demonstrated in adult studies; however, very few studies have been conducted in children. Procedure This study aimed to evaluate the efficacy of ruxolitinib in 29 children with steroid-refractory acute or chronic GVHD. Twenty-five (87%) patients received at least three different immune modulator agents, including methylprednisolone, before initiating ruxolitinib. Results All grade 2 acute GVHD patients completely responded to ruxolitinib treatment; 82% of high-grade (3-4) acute GVHD patients and 80% of chronic GVHD (moderate-severe) patients had at least a partial response. Of seven patients with bronchiolitis obliterans, five had a partial response after ruxolitinib. Of 29 patients, 22 were administered steroids at any time in the first month of acute GVHD or the first three months of chronic GVHD during ruxolitinib usage, which was significantly tapered by the end of the observation period. Conclusion Steroid-refractory acute and chronic pediatric GVHD patients treated with ruxolitinib had a high overall response rate, with the additional benefit of steroid sparing.
  • Küçük Resim Yok
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    Timing of initiation of calcineurin inhibitors in pediatric haploidentical transplantation with post-transplantation cyclophosphamide: Effects on survival, relapse, and cytokine release syndrome
    (Karger, 2022) Uygun, Vedat; Karasu, Gülsüm; Yalçın, Koray; Öztürkmen, Seda; Daloğlu, Hayriye; Çelen, Safiye Suna; Hazar, Volkan; Yeşilipek, Akif
    Background: The use of unmanipulated haploidentical hematopoietic stem cell transplantations (haplo-HSCT) with post-transplant cyclophosphamide (PTCY) in children has emerged as an acceptable alternative to the patients without a matched donor. However, the timing of calcineurin inhibitors (CNIs) used in combination with PTCY is increasingly becoming a topic of controversy. Method: We evaluated 49 children with acute leukemia who underwent unmanipulated haplo-HSCT with PTCY according to the initiation day of CNIs (pre- or post-cyclophosphamide [CY]). Results: There were no significant differences in the overall survival analysis between the 2 groups. The cumulative incidence of relapse at 2 years was 21.2% in the pre-CY group and 38.9% in the post-CY group (p = 0.33). Cytokine release syndrome (CRS) was observed more frequently in the post-CY group (p = 0.04). The overall survival and event-free survival at 2 years in patients with and without CRS in the pre-CY group were 42.9% versus 87.5% (p = 0.04) and 38.1% versus 87.5% (p = 0.04), respectively. Conclusion: Our study shows that the argument for starting CNI administration after CY is tenuous, and the rationale for not starting CNIs before CY needs to be reconsidered.
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    Use of low cell dose for unmanipulated donor lymphocyte for management of cytomegalovirus infection: a single-center experience
    (2020) Uygun, Vedat; Tezcan Karasu, Gülsün; Daloğlu, Hayriye; Öztürkmen, Seda; Yalçın, Koray; Çelen, Safiye Suna; Yeşilipek, Akif
    Although advancements have been made in monitoring and preventing viral infections in HSCT patients, CMV reactivation still remains a critical post-transplant complication. Adoptive cell therapy is an alternative to pharmacotherapy of CMV infection in refractory patients. We retrospectively reviewed CMV infection cases after allogeneic HSCT who received U-DLI as treatment. In total, five pediatric patients between the ages of 0.5-16 years that received U-DLI for a post-HSCT CMV infection were evaluated. The dose of CD3+ lymphocytes administered in DLI was 5 × 104 /kg, except in one patient transplanted from his sibling. One patient, who was transplanted from an unrelated donor, received U-DLI from his haploidentical mother. CMV titers dramatically reduced after U-DLI. If the availability of CMV-specific CTL is an issue, we propose that one should consider using the U-DLI therapy with low cell dose from a seropositive donor. In case the stem cell donor is seronegative and a seropositive donor is unavailable, using the U-DLI therapy from seropositive, haploidentical donors is a promising way of treatment. More studies need to be conducted to further confirm the safety and efficacy of this treatment procedure.