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Papers by Emel Unal

Mesothelioma is a rare and aggressive tumor originating from the serosal lining of the pleural, p... more Mesothelioma is a rare and aggressive tumor originating from the serosal lining of the pleural, peritoneal and pericardial cavities. There are very few cases diagnosed with malignant peritoneal mesothelioma reported in childhood. Thanks to the developments in the field of immunotherapy, the prognosis of the disease has improved with the addition of the immune check point inhibitor, an anti-programmed death-1 monoclonal antibody, nivolumab to the treatment of MPM. In the treatment of our case who was diagnosed with diffuse malignant peritoneal mesothelioma at a very early age; cytoreductive surgery, hyperthermic intraperitoneal chemotherapy, platinum and pemetrexed combination chemotherapy and nivolumab were used. Our patient, who has been on nivolumab therapy for 14 months and has been followed up for 20 months since her diagnosis, is still in remission. This case supports the utility of nivolumab in pediatric MPM.

Turkish Journal of Medical Sciences, Aug 8, 2019

Introduction Bloodstream infections (BSIs) are the main cause of morbidity, prolonged hospitaliza... more Introduction Bloodstream infections (BSIs) are the main cause of morbidity, prolonged hospitalization, increased cost, and mortality in patients [1,2]. Underlying diseases, applied chemotherapy protocols, central venous catheter (CVC), radiation therapy, surgical procedures, and mucositis may predispose patients to infections [3]. Today, more than 80% of pediatric patients receiving cancer treatment have long-term CVCs [4]. The majority of BSIs are related to the use of these catheters in children. Early diagnosis and empirical antibiotic treatment may help improve the prognosis of BSIs. However, the choice of empirical antibiotic treatment must be based on the patient's clinical status, frequently detected isolates, and their antimicrobial susceptibility patterns in the region [5]. In some hospitals, treatment of BSIs caused by multiresistant bacteria is an important problem because of increasing antibiotic resistance [6]. Until the 1990s gram-positive microorganisms were the pathogens most often responsible for BSIs; today gram-negative pathogens are frequently isolated in many centers [7]. It is very important to know the local prevalence of responsible microorganisms for appropriate management. For this purpose, in our study we aimed to identify the microorganisms that were isolated from blood culture during the febrile period in pediatric hematology and oncology patients, their antimicrobial susceptibility patterns, and clinical outcomes. 2. Materials and methods 2.1. Study populations This was a cross-sectional study that included febrile patients with hematological and/or oncological diseases Background/aim: Bloodstream infections are the major cause of morbidity, increased cost, prolonged hospitalization, and mortality in pediatric patients. Identifying the predominant microorganisms and antimicrobial susceptibilities in centers helps to select effective empirical antimicrobials which leads to positive clinical outcomes. We aimed to identify the causative microorganisms and their antimicrobial susceptibilities in patients with bloodstream infections. Materials and methods: Data belonging to patients with hematological and/or oncological diseases admitted to our hospital with fever between January 2010 and November 2015 were analyzed. Results: In total, 71 patients who had 111 bloodstream infection episodes were included. Responsible pathogens were detected as follows: 35.1% gram-positive microorganisms, 60.5% gram-negative bacteria, and 4.4% fungi. The most common causative gram-negative pathogen was Escherichia coli and the most commonly isolated gram-positive microorganism was coagulase-negative staphylococci. Conclusion: Gram-negative microorganisms were predominant pathogens in bloodstream infections. Escherichia coli and coagulasenegative staphylococci were the most commonly isolated responsible pathogens. Beta-lactam/lactamase inhibitors were suitable for empirical treatment. However, in critical cases, colistin could have been used for empirical treatment until the culture results were available. Routine glycopeptide use was not required. By identifying the causative microorganisms and their antimicrobial resistance patterns, it will be possible to obtain positive clinical results.

Pediatric Research, May 1, 1999

Japanese Journal of Infectious Diseases

Invasive aspergillosis (IA) is a major cause of morbidity and mortality. This study aimed to pres... more Invasive aspergillosis (IA) is a major cause of morbidity and mortality. This study aimed to present our 10-year IA experience at a single center. Fifty-nine pediatric patients with IA were included in this study. The male-to-female ratio was 42/17. The median age was 8.75 years. Hematologic malignancy was present in the majority of the patients (40/59, 68%). The mean neutropenia duration was 18.5 days. Cytosine arabinoside was the most common immunosuppressive therapy directed at T cells during IA diagnosis. IA cases were categorized as proven (27%), probable (51%), or possible (22%) according to the 2008 European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) criteria. The lungs (78%) were the most common site of IA, and nodules were the most frequent radiological findings (75.5%). In 38 patients (64.4%) receiving antifungal prophylaxis, prophylactic agents included fluconazole (30.5%), liposomal amphotericin B (23.7%), posaconazole (8.5%), and voriconazole (1.7%). Initial treatment was most commonly administered as monotherapy (69.5%). The median antifungal treatment duration was 67 days. Eleven deaths (18.6%) were due to aspergillosis. With the increased use of corticosteroids, biological agents, and intensive immunosuppressive chemotherapy, IA will most likely continue to occur frequently in pediatric patients.

Journal of Pediatric Infection

Bu çalışmanın amacı, 20 aylık bir dönem içerisinde kan kültüründe Serratia marcescens üreyen hast... more Bu çalışmanın amacı, 20 aylık bir dönem içerisinde kan kültüründe Serratia marcescens üreyen hastalarda beklenmedik bir artış olması ile bu hastaların demografik, klinik ve laboratuvar sonuçlarının incelenmesi, mortaliteye yol açan özelliklerin ve dirençli suşlara tedavi yaklaşımının gözden geçirilmesidir. Gereç ve Yöntemler: Kan kültüründe S. marcescens üreyen ve bakteriyemi ile uyumlu klinik bulguları olan hastalar geriye dönük olarak incelenmiştir. Yaş, cinsiyet, altta yatan hastalıklar, beyaz küre ve nötrofil sayıları, C-reaktif protein (CRP) ve albümin düzeyleri, hastanede yatış süresi, yoğun bakımda yatış süresi, santral venöz kateter varlığı ve süresi, 28-gün mortalitesi ve antibiyogram kaydedildi. Enfeksiyonlar kan yayım veya kateter ilişkili kan yayım enfeksiyonu olarak ayrıldı. Antimikrobiyal direnci değerlendirmek için suşlar non-MDR, MDR, XDR ve PDR olarak sınıflandırıldı. Bulgular: Hastaların 12 (%26.9)'sinin altta yatan hastalığı maligniteydi. Ortalama hastanede kalış süresi 42.7 ± 41.4 (3-171) gündü. Kan yayım enfeksiyonları sırasında 43 hastada kemo-portlar ve Hickman kateterleri dahil santral venöz kateterler mevcuttu. Yirmi dört hastada kan yayım enfeksiyonu, 21 hastada kateterle ilişkili kan yayım enfeksiyonu mevcut-Abstract Objective: In this study, it was aimed to present a cohort study conducted retrospectively in order to examine the unexpected Serratia marcescens bacteremia prevalence in a children's hospital in Türkiye. Material and Methods: S. marcescens was isolated in the blood cultures of 45 patients at a 20-month period. Demographic features and clinical findings of the 45 patients including age, sex, underlying diseases, white blood cell (WBC), C-reactive protein (CRP), serum albumin level, length of hospital stay and length of pediatric intensive care unit stay, portal of entry, duration of central venous catheter, results of antimicrobial susceptibility testing and 28-day all-cause mortality were examined. Bloodstream infections (BSI) were classified as BSI or catheter-related BSI. Definitions used to characterize antimicrobial resistant bacteria were classified as multidrug-resistant (MDR), extensively drug-resistant (XDR) and pandrug-resistant (PDR). Results: Twelve patients (26.9%) had a malignancy. Mean hospitalization duration was 42.7 ± 41.4 (3-171) days. Central venous catheters (CVCs), including chemo-ports and Hickman catheters, were present in 43 patients during episodes of BSI. Twenty-four patients had primary BSI while 21 patients had catheter-related BSI. Mean length of CVC presence be

Background: The only curative therapy for many primary immunodeficiencies is HSCT. aGvHD is a ser... more Background: The only curative therapy for many primary immunodeficiencies is HSCT. aGvHD is a serious and potentially fatal complication of HSCT with an incidence of nearly %50. Furthermore, involvement of the lower gastrointestinal (LGI) tract is associated with a poor prognosis. Unfortunately, there isn’t consensus about second-line therapies for steroid-refractory (SR) aGvHD. Alpha 1 Antitrypsin (AAT) is one of the second-line therapies. There isn’t a study in pediatric population with acute SR-GvHD in the literature. Method: We retrospectively evaluated data of 3 patients that received AAT as second-line therapy for acute SR-GvHD. Results: Each patients’ response to treatment was unique. P1 had a complete response beginning with the third dose of the treatment. P2 showed a partial response to the treatment after the second dose. Despite 8 doses of the treatment, P3 did not achieve remission. Conclusion: AAT may play a promising role in the treatment of severe and refractory aGvH...

Nature Publishing Group, 2015

41st Annual Meeting of the European-Society-for-Blood-and-Marrow-Transplantation -- MAR 22-25, 20... more 41st Annual Meeting of the European-Society-for-Blood-and-Marrow-Transplantation -- MAR 22-25, 2015 -- Istanbul, TURKEYWOS: 000351632903148…European Soc Blood & Marrow Transplanta

TURKISH JOURNAL OF MEDICAL SCIENCES, 2020

The main purpose of this study is to determine the current status of long-term follow-up (LTFU) f... more The main purpose of this study is to determine the current status of long-term follow-up (LTFU) for childhood cancer survivors and the challenges of LTFU for pediatric cancer survivors at pediatric oncology institutions in Turkey. Material and methods: A questionnaire was e-mailed to the directors of 33 pediatric oncology centers (POCs) registered in the Turkish Pediatric Oncology Group (TPOG). Of these 33 active TPOG institutions, 21 participated in the study and returned their completed questionnaires. Results: Only 1 of the 21 participating centers had a separate LTFU clinic. The remaining centers provided LTFU care for childhood cancer survivors at the pediatric oncology outpatient clinic. Of these centers, 17 (80.9%) reported difficulty in transition from the pediatric clinic to the adult clinic, 14 (66.6%) reported insufficient care providers, and 12 (57.1%) reported insufficient time and transportation problems. As neglected late effects, 16 (76.1%) centers reported psychosocial and getty job problems and 11 (52.3%) reported sexual and cognitive problems. None of the centers had their own LTFU guidelines for their daily LTFU practice. Conclusion: This study was the first to gain an overview of the needs of POCs and the gaps in survivorship services in Turkey. The results from this study will help to develop a national health care system and national guidelines for pediatric cancer survivors.

Iranian Journal of Pediatrics, 2017

Background: Studies on various adult cancer types showed that there are changes in levels of prot... more Background: Studies on various adult cancer types showed that there are changes in levels of protein types that are related to iron metabolism. In our study, proteins related to iron metabolism are examined for the first time in childhood malignancies and results are presented. Methods: Between January 2013 and December 2014, 58 patients 17 healthy children were included in the study. Blood samples were taken from patients at diagnosis and in remission and serum ferritin heavy chain (FTH-1), ferritin light chain (FTL), LCN-2, soluble transferrin receptor (sTFR), transferrin receptor-2 (TFR-2), hepcidin and ferroportin levels were examined using ELISA method. Results: Levels of FTH-1 were found higher in all patient groups than in control group (P < 0.05). Levels of FTL were found higher in all patient groups than in control group, although this was not statistically significant. It was observed that these levels decreased in remission. Levels of LCN-2 were found significantly high (P = 0.001) in all patient groups. sTfR levels were found lower in acute leukemia patients (P = 0.001). Level of TFR-2 was found to be higher in all patient groups in comparison with the control group and this was statistically significant in lymphoma group (P = 0.05). In remission, levels of TFR-2 decreased. Levels of serum hepcidin were found to be higher in all patient groups in comparison with the control group and this was statistically significant (P = 0.001). Hepcidin levels decreased in remission. Although it was not statistically significant, it was observed that levels of serum ferroportin were low in sarcoma and leukemia groups at diagnosis and increased in remission. As a result, despite the fact that our patients' number was limited, we thought that investigation of the iron metabolism of tumor cells is important and additional studies will be necessary with increasing patients' number.

Infectious Diseases, 2021

Abstract Background Invasive aspergillosis (IA) is an important cause of morbidity and mortality ... more Abstract Background Invasive aspergillosis (IA) is an important cause of morbidity and mortality in immunosuppressed children. Early detection of the infection can improve prognosis in this patient population. Objectives To investigate the utility of Aspergillus galactomannan antigen assay (GM-EIA) as a diagnostic tool for IA in at-risk paediatric patients. Patients/Methods For the study, 659 GM-EIA results from 59 patients diagnosed with IA and 3368 GM-EIA results from 351 subjects without evidence for IA (controls) were reviewed retrospectively. Three cut-off values (i.e. ≥0.5, ≥1, ≥1.5) were specified to determine GM-EIA positivity. Results The median age was 6.3 years for boys and 14.5 years for girls. There was a significant difference between the girls and boys in terms of age (p < 0.01). For proven/probable/possible IA patients, sensitivity of 67.8% and specificity of 59.8% were detected when the ≥0.5 cut-off value was used for GM-EIA-positivity. The specificity increased to 80% at the cut-off of ≥1 and to 88% at the cut-off of ≥1.5. False positivity rates were 9.14, 3, and 1.45% at the ≥0.5, ≥1 and ≥1.5 cut-offs respectively. In the proven/probable IA group, sensitivity and negative predictive values were 86.9 and 97.2% at the ≥0.5 cut-off, 85.7 and 97.9%, at the ≥1 cut-off and 84.2 and 98.1% at ≥1.5 cut-off respectively. The positive likelihood ratio was 7.57 and the odds ratio was 42.67 at ≥1.5 cut-off. Conclusion The GM-EIA may be used for both screening and diagnostic purposes in paediatric patients using a cut-off value of ≥1.5 for GM-EIA positivity.

Turkish Journal of Pediatric Disease, Jul 12, 2018

Amaç: Optik gliomlar histolojik olarak benign özelliklidirler ve iyi yönde farklılaşma gösteren p... more Amaç: Optik gliomlar histolojik olarak benign özelliklidirler ve iyi yönde farklılaşma gösteren pilositik astrositom sınıfında yer alırlar. Tümörün histopatolojik özelliği, yerleşim yeri, hastanın yaşı, Nörofibromatozis tip-1 ile birlikteliği sağkalım oranlarını etkileyen önemli prognostik belirteçlerdir. Kemoterapi tedavide en önemli seçenektir ve klinisyenlerin hedefi radyoterapiden olabildiğince uzak durmaktır. Radyoterapi ve cerrahiden uzak kalınmasına zemin hazırlayan, uzun döneme yayılan güvenli bir tedavi planı olan vinkristin ve karboplatin kombinasyonu ilk seçenek standart tedavi yaklaşımlarından biridir. Ancak bu tedaviler altında refrakter seyreden hastalara sistemik yan etkisi az ve bir multi tirozin kinaz inhibitörü olan imatinib mesilat önemli bir seçenek olarak eklenebilir. Çocuk hastalarda güvenli bir şekilde kullanılabilir. Bu alanda bildirilmiş az sayıda çalışma olması nedeni ile imatinib mesilat kullanımına ait olumlu sonuçlarımızı klinisyenlerle paylaşmak istedik. Gereç ve Yöntemler: Çocuk Onkoloji kliniğimizde 2007-2017 yılları arasında tanı alan toplam 16 optik gliom hastası çalışmaya dahil edildi. Bulgular: İki kür vinkristin, karboplatin kombinasyonu sonrası klinik ve radyolojik olarak progresif seyreden hastalara stabil hastalık veya regresyon bulguları elde edilene kadar 1-2 yıl süre ile imatinib (270 mg/m² oral) tedavisi eklenildi. Tedavi alan hastaların median izlem süresi 7 yıl (5-10)'di. Dört hastada tam yanıt, iki hastada stabil hastalık bulguları sağlanıldı. Hastalarımızda imatinib ilişkili bir yan etki görülmedi. Sonuç: İmatinib tümörün kapiller endotellerinden özellikle PDGFR-α ve β'nın ekspresyonunu inhibe ederek etki eder. Akıllı hedef moleküllerin tedaviye eklenilmesinin progresif hastalarda geç dönemde yan etkileri fazla olan radyoterapiye olan ihtiyacı azaltacağını düşünüyoruz. Gelecekte uygulanabilecek birçok moleküler hedef ajan refrakter optik gliomların tedavisinde gündeme gelebilir ve çocuk hastalar cerrahi ve radyoterapinin yaratacağı komplikasyonlardan korunabilirler.

Eye, 2020

Objectives To evaluate the long-term treatment outcomes in intraocular retinoblastoma (RB) includ... more Objectives To evaluate the long-term treatment outcomes in intraocular retinoblastoma (RB) including the associated factors for eventual treatment with external beam radiotherapy (EBRT) and enucleation as well as to analyse the risk factors for metastasis and death in extraocular RB. Methods Retrospective analysis of 390 eyes from 256 (89.8%) intraocular RB and 29 (10.2%) extraocular RB cases diagnosed and treated between October 1998 and May 2018 at one of the largest tertiary care centers in Turkey. Results Of 351 intraocular RB eyes, 53.3% had group D/E disease at presentation. 75 (21.4%) of 351 eyes underwent primary enucleation. Of the remaining 276 eyes undergoing eye-conserving treatments, 201 (72.8%) were salvaged. Most of these eyes were treated using intravenous chemotherapy and/or focal treatments [transpupillary thermotherapy (TTT) and cryotherapy] initially. EBRT was eventually required in 48 (17.4%) eyes and secondary enucleation in 75 (27.2%) eyes. At mean follow-ups of 76.7 and 39.7 months for intraocular and extraocular RB cohorts, respectively, 180 (46.2%) eyes underwent primary/secondary enucleation and exenteration. Overall, 13 cases developed metastasis and 9 died. Two patients with trilateral RB also expired. Multivariable risk factors for enucleation were the presence of vitreous seeds (p < 0.001), absence of EBRT administration (p = 0.033), 5-9 TTT applications compared with no TTT (p = 0.031), and each 1 mm increase in tumour base diameter (p < 0.001). Univariate factors predictive of metastasis were the presence of extraocular RB detected by imaging methods (p < 0.001) and extrascleral/optic nerve cut end involvement at histopathological examination (p < 0.001). Conclusions In our series, 72.8% of the intraocular RB eyes undergoing eye-conserving treatments were saved. The globe salvage rate for all intraocular and extraocular RB eyes was 53.8% and the overall survival rate was 96.1%.

The Turkish Journal of Pediatrics, 2019

A targeted salvage therapy with Brentuximab vedotin in heavily treated refractory or relapsed ped... more A targeted salvage therapy with Brentuximab vedotin in heavily treated refractory or relapsed pediatric Hodgkin lymphoma patients before and after stem cell transplantation. Turk J Pediatr 2019; 61: 671-676. Hodgkin's lymphoma (HL) is highly curable disease in its early stages, but in advanced stages, it presents a dilemma when it becomes refractory or relapses after several rounds of chemotherapy. Brentuximab vedotin (BV) is an antibody-drug conjugate that targets the tumor necrosis receptor family protein member CD30 positive malignancies via an anti-CD30 monoclonal antibody linked to monomethyl auristatin-E. In adult and pediatric studies, it has been shown to be an effective salvage therapy for primary refractory HL or relapse after autologous stem cell transplant (ASCT). Between July 2012 and August 2017, we administered BV (1.8 mg/m 2 every three weeks; 12 cycles totally) with doxorubucin, vinblastin, dacarbazine (AVD), rituximab + ifosfamide + carboplatin + etoposide (RICE), or bendamustine combination treatment in pediatric HL patients, who were previosuly treated for refractory or relapsed advanced stage HL before (seven patients) or after (one patient) ASCT in our center. After eight BV courses, one patient was able to undergo match unrelated donor (MUD) SCT. Another seven pediatric HL patients, who were not able to go into remission with any other classical HL chemotherapy protocols, received 4-6 courses of BV-AVD and/or RICE/bendamustine. All were able to undergo ASCT after negative positron emission tomography (PET) imaging results. After ASCT, we switched to BV as consolidation therapy until a total of 12 cycles was completed. Patients went into remission after a median 34 (range: 12-42) months from the start of BV treatment. BV is an encouraging, well-tolerated, and effective targeted therapy especially when combined with AVD or when alternated with another targeted therapy combination, including RICE, when needed.

The Turkish Journal of Pediatrics, 2019

Is antibiotic lock therapy effective for the implantable long-term catheter-related bloodstream i... more Is antibiotic lock therapy effective for the implantable long-term catheter-related bloodstream infections in children? Turk J Pediatr 2019; 61: 895-904. Catheter-related bloodstream infections (CRBSIs) are an important problem in pediatric patients with central venous catheters. This study aimed to determine the incidence of CRBSIs, responsible pathogens and outcomes of antibiotic lock treatment (ALT) in pediatric patients. Between January 2010 and November 2015 all hospitalized pediatric hematology, oncology and immunology patients diagnosed with CRBSIs were retrospectively analyzed. Seventy-eight CRBSI episodes were detected in 60 pediatric patients. The incidence of CRBSIs was 4.20/1000 catheter days. The most frequently detected pathogen was methicillin-resistant coagulase-negative Staphylococcus. Pseudomonas aeruginosa, Klebsiella spp., and Escherichia coli were other commonly isolated microorganisms. ALT was administered in 42 patients. The success rate of ALT was 81% (34/42). Catheter was removed without ALT in 36 episodes. Common reasons for catheter removal were sepsis and causative microorganisms which had high probability of biofilm formation. CRBSIs are an important cause of morbidity and mortality in pediatric patients. ALT is safe and effective. It is possible to obtain satisfactory results when ALT is used with intravenous systemic antibiotics for CRBSIs, though in some cases catheter removal is necessary. ALT helps to prevent unnecessary catheter removal in pediatric patients.

Posters, 2017

Background and aims Bloodstream infections are the major cause of morbidity, increased cost, prol... more Background and aims Bloodstream infections are the major cause of morbidity, increased cost, prolonged hospitalisation and mortality in paediatric haematology and oncology patients. We aimed to identify causative microorganisms and their antimicrobial susceptibilities in paediatric immunocompromised patients. Methods Patients with haematological and/or oncological diseases who admitted to our hospital with fever between January 2010 and November 2015 were included in this study. Patients’ demografic and clinical findings were collected from hospital information systems and microbiology laboratory records retrospectively. Results Totally 71 paediatric patients who had 111 bloodstream infection episodes were included in this study. The median age of patients was 90 (3-247) months. The most underlying disease was acute lymphoblastic leukaemia. While 31 patients had only peripheral blood culture positivity, 80 patients had catheter related blood stream infections. Of 80.2% blood stream infections occurred in neutropenic period. Responsible pathogens were detected as follows: 35.1% gram-positive microorganisms, 60.5% gram-negative bacteria and 4.4% fungi. The most causative gram negative pathogen was Escherichia coli and the most isolated gram positive microorganism was meticillin resistant coagulase negative Staphylococci. Extended spectrum beta lactamase was produced by 60% of Klebsiella spp. and 42.1% of E. coli. In addition carbapenemase producing E. coli and Klebsiella spp. were 15.8% and 26.7% respectively. Enterococcus spp. had 88.9% ampicillin resistance and%33.3 vancomycin resistance. Bloodstream infection related mortality rate was 2.7%. Conclusion Gram negative microorganisms were predominant pathogens in bloodstream infections. Extended spectrum beta lactamase and carbapenem resistance were increasingly important and they limited treatment options. The choice of empiric antimicrobial drug in immunosuppressed patients is life-saving. For all these reasons, the choice of empirical antibiotics should be made according to the clinical condition of the patient and the prevalent microorganisms in the current clinic, as favourable antimicrobial therapy will be able to achieve positive clinical outcomes.

Journal of Clinical Oncology, 2010

e20008 Background: Genistein, a soy isoflavone, has been shown to induce apoptosis and sensitize ... more e20008 Background: Genistein, a soy isoflavone, has been shown to induce apoptosis and sensitize cancer cells to chemotherapy and radiotherapy in a variety of cancer cell types. However, there is n...

Turkish journal of haematology : official journal of Turkish Society of Haematology, Jan 5, 2002

This study intends to describe growth and endocrine disorders secondary to chemotherapy among lon... more This study intends to describe growth and endocrine disorders secondary to chemotherapy among long-term survivors of pediatric acute leukemia. Sixteen patients including 14 ALL and 2 AML entered the study. Four were females and 12 were males with the mean age of 17.38 ± 3.81 years. Following the completion of their therapy, the mean follow up period of the patients was 62.43 ± 41.11 months. Somatic growth, sexual maturation, hypothalamic- pituitary-thyroid axis and hypothalamic-pituitary-gonadal axis were evaluated in all the patients. Two out of 16 had pathologic short stature (12.5%) and 3 patients had enuchoid status (18.75%) with antrophometric measurements. Eleven patients had normal thyroid gland dimensions and homogeneous thyroid tissue on ultrasonographic examination. One patient had Ia and another four patients had Ib diffuse goitre according to WHO criteria. Two out of 16 patients were diagnosed as subclinic primary hypothyroidism (12.5%), and three of them were diagnosed ...

Mesothelioma is a rare and aggressive tumor originating from the serosal lining of the pleural, p... more Mesothelioma is a rare and aggressive tumor originating from the serosal lining of the pleural, peritoneal and pericardial cavities. There are very few cases diagnosed with malignant peritoneal mesothelioma reported in childhood. Thanks to the developments in the field of immunotherapy, the prognosis of the disease has improved with the addition of the immune check point inhibitor, an anti-programmed death-1 monoclonal antibody, nivolumab to the treatment of MPM. In the treatment of our case who was diagnosed with diffuse malignant peritoneal mesothelioma at a very early age; cytoreductive surgery, hyperthermic intraperitoneal chemotherapy, platinum and pemetrexed combination chemotherapy and nivolumab were used. Our patient, who has been on nivolumab therapy for 14 months and has been followed up for 20 months since her diagnosis, is still in remission. This case supports the utility of nivolumab in pediatric MPM.

Turkish Journal of Medical Sciences, Aug 8, 2019

Introduction Bloodstream infections (BSIs) are the main cause of morbidity, prolonged hospitaliza... more Introduction Bloodstream infections (BSIs) are the main cause of morbidity, prolonged hospitalization, increased cost, and mortality in patients [1,2]. Underlying diseases, applied chemotherapy protocols, central venous catheter (CVC), radiation therapy, surgical procedures, and mucositis may predispose patients to infections [3]. Today, more than 80% of pediatric patients receiving cancer treatment have long-term CVCs [4]. The majority of BSIs are related to the use of these catheters in children. Early diagnosis and empirical antibiotic treatment may help improve the prognosis of BSIs. However, the choice of empirical antibiotic treatment must be based on the patient's clinical status, frequently detected isolates, and their antimicrobial susceptibility patterns in the region [5]. In some hospitals, treatment of BSIs caused by multiresistant bacteria is an important problem because of increasing antibiotic resistance [6]. Until the 1990s gram-positive microorganisms were the pathogens most often responsible for BSIs; today gram-negative pathogens are frequently isolated in many centers [7]. It is very important to know the local prevalence of responsible microorganisms for appropriate management. For this purpose, in our study we aimed to identify the microorganisms that were isolated from blood culture during the febrile period in pediatric hematology and oncology patients, their antimicrobial susceptibility patterns, and clinical outcomes. 2. Materials and methods 2.1. Study populations This was a cross-sectional study that included febrile patients with hematological and/or oncological diseases Background/aim: Bloodstream infections are the major cause of morbidity, increased cost, prolonged hospitalization, and mortality in pediatric patients. Identifying the predominant microorganisms and antimicrobial susceptibilities in centers helps to select effective empirical antimicrobials which leads to positive clinical outcomes. We aimed to identify the causative microorganisms and their antimicrobial susceptibilities in patients with bloodstream infections. Materials and methods: Data belonging to patients with hematological and/or oncological diseases admitted to our hospital with fever between January 2010 and November 2015 were analyzed. Results: In total, 71 patients who had 111 bloodstream infection episodes were included. Responsible pathogens were detected as follows: 35.1% gram-positive microorganisms, 60.5% gram-negative bacteria, and 4.4% fungi. The most common causative gram-negative pathogen was Escherichia coli and the most commonly isolated gram-positive microorganism was coagulase-negative staphylococci. Conclusion: Gram-negative microorganisms were predominant pathogens in bloodstream infections. Escherichia coli and coagulasenegative staphylococci were the most commonly isolated responsible pathogens. Beta-lactam/lactamase inhibitors were suitable for empirical treatment. However, in critical cases, colistin could have been used for empirical treatment until the culture results were available. Routine glycopeptide use was not required. By identifying the causative microorganisms and their antimicrobial resistance patterns, it will be possible to obtain positive clinical results.

Pediatric Research, May 1, 1999

Japanese Journal of Infectious Diseases

Invasive aspergillosis (IA) is a major cause of morbidity and mortality. This study aimed to pres... more Invasive aspergillosis (IA) is a major cause of morbidity and mortality. This study aimed to present our 10-year IA experience at a single center. Fifty-nine pediatric patients with IA were included in this study. The male-to-female ratio was 42/17. The median age was 8.75 years. Hematologic malignancy was present in the majority of the patients (40/59, 68%). The mean neutropenia duration was 18.5 days. Cytosine arabinoside was the most common immunosuppressive therapy directed at T cells during IA diagnosis. IA cases were categorized as proven (27%), probable (51%), or possible (22%) according to the 2008 European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) criteria. The lungs (78%) were the most common site of IA, and nodules were the most frequent radiological findings (75.5%). In 38 patients (64.4%) receiving antifungal prophylaxis, prophylactic agents included fluconazole (30.5%), liposomal amphotericin B (23.7%), posaconazole (8.5%), and voriconazole (1.7%). Initial treatment was most commonly administered as monotherapy (69.5%). The median antifungal treatment duration was 67 days. Eleven deaths (18.6%) were due to aspergillosis. With the increased use of corticosteroids, biological agents, and intensive immunosuppressive chemotherapy, IA will most likely continue to occur frequently in pediatric patients.

Journal of Pediatric Infection

Bu çalışmanın amacı, 20 aylık bir dönem içerisinde kan kültüründe Serratia marcescens üreyen hast... more Bu çalışmanın amacı, 20 aylık bir dönem içerisinde kan kültüründe Serratia marcescens üreyen hastalarda beklenmedik bir artış olması ile bu hastaların demografik, klinik ve laboratuvar sonuçlarının incelenmesi, mortaliteye yol açan özelliklerin ve dirençli suşlara tedavi yaklaşımının gözden geçirilmesidir. Gereç ve Yöntemler: Kan kültüründe S. marcescens üreyen ve bakteriyemi ile uyumlu klinik bulguları olan hastalar geriye dönük olarak incelenmiştir. Yaş, cinsiyet, altta yatan hastalıklar, beyaz küre ve nötrofil sayıları, C-reaktif protein (CRP) ve albümin düzeyleri, hastanede yatış süresi, yoğun bakımda yatış süresi, santral venöz kateter varlığı ve süresi, 28-gün mortalitesi ve antibiyogram kaydedildi. Enfeksiyonlar kan yayım veya kateter ilişkili kan yayım enfeksiyonu olarak ayrıldı. Antimikrobiyal direnci değerlendirmek için suşlar non-MDR, MDR, XDR ve PDR olarak sınıflandırıldı. Bulgular: Hastaların 12 (%26.9)'sinin altta yatan hastalığı maligniteydi. Ortalama hastanede kalış süresi 42.7 ± 41.4 (3-171) gündü. Kan yayım enfeksiyonları sırasında 43 hastada kemo-portlar ve Hickman kateterleri dahil santral venöz kateterler mevcuttu. Yirmi dört hastada kan yayım enfeksiyonu, 21 hastada kateterle ilişkili kan yayım enfeksiyonu mevcut-Abstract Objective: In this study, it was aimed to present a cohort study conducted retrospectively in order to examine the unexpected Serratia marcescens bacteremia prevalence in a children's hospital in Türkiye. Material and Methods: S. marcescens was isolated in the blood cultures of 45 patients at a 20-month period. Demographic features and clinical findings of the 45 patients including age, sex, underlying diseases, white blood cell (WBC), C-reactive protein (CRP), serum albumin level, length of hospital stay and length of pediatric intensive care unit stay, portal of entry, duration of central venous catheter, results of antimicrobial susceptibility testing and 28-day all-cause mortality were examined. Bloodstream infections (BSI) were classified as BSI or catheter-related BSI. Definitions used to characterize antimicrobial resistant bacteria were classified as multidrug-resistant (MDR), extensively drug-resistant (XDR) and pandrug-resistant (PDR). Results: Twelve patients (26.9%) had a malignancy. Mean hospitalization duration was 42.7 ± 41.4 (3-171) days. Central venous catheters (CVCs), including chemo-ports and Hickman catheters, were present in 43 patients during episodes of BSI. Twenty-four patients had primary BSI while 21 patients had catheter-related BSI. Mean length of CVC presence be

Background: The only curative therapy for many primary immunodeficiencies is HSCT. aGvHD is a ser... more Background: The only curative therapy for many primary immunodeficiencies is HSCT. aGvHD is a serious and potentially fatal complication of HSCT with an incidence of nearly %50. Furthermore, involvement of the lower gastrointestinal (LGI) tract is associated with a poor prognosis. Unfortunately, there isn’t consensus about second-line therapies for steroid-refractory (SR) aGvHD. Alpha 1 Antitrypsin (AAT) is one of the second-line therapies. There isn’t a study in pediatric population with acute SR-GvHD in the literature. Method: We retrospectively evaluated data of 3 patients that received AAT as second-line therapy for acute SR-GvHD. Results: Each patients’ response to treatment was unique. P1 had a complete response beginning with the third dose of the treatment. P2 showed a partial response to the treatment after the second dose. Despite 8 doses of the treatment, P3 did not achieve remission. Conclusion: AAT may play a promising role in the treatment of severe and refractory aGvH...

Nature Publishing Group, 2015

41st Annual Meeting of the European-Society-for-Blood-and-Marrow-Transplantation -- MAR 22-25, 20... more 41st Annual Meeting of the European-Society-for-Blood-and-Marrow-Transplantation -- MAR 22-25, 2015 -- Istanbul, TURKEYWOS: 000351632903148…European Soc Blood & Marrow Transplanta

TURKISH JOURNAL OF MEDICAL SCIENCES, 2020

The main purpose of this study is to determine the current status of long-term follow-up (LTFU) f... more The main purpose of this study is to determine the current status of long-term follow-up (LTFU) for childhood cancer survivors and the challenges of LTFU for pediatric cancer survivors at pediatric oncology institutions in Turkey. Material and methods: A questionnaire was e-mailed to the directors of 33 pediatric oncology centers (POCs) registered in the Turkish Pediatric Oncology Group (TPOG). Of these 33 active TPOG institutions, 21 participated in the study and returned their completed questionnaires. Results: Only 1 of the 21 participating centers had a separate LTFU clinic. The remaining centers provided LTFU care for childhood cancer survivors at the pediatric oncology outpatient clinic. Of these centers, 17 (80.9%) reported difficulty in transition from the pediatric clinic to the adult clinic, 14 (66.6%) reported insufficient care providers, and 12 (57.1%) reported insufficient time and transportation problems. As neglected late effects, 16 (76.1%) centers reported psychosocial and getty job problems and 11 (52.3%) reported sexual and cognitive problems. None of the centers had their own LTFU guidelines for their daily LTFU practice. Conclusion: This study was the first to gain an overview of the needs of POCs and the gaps in survivorship services in Turkey. The results from this study will help to develop a national health care system and national guidelines for pediatric cancer survivors.

Iranian Journal of Pediatrics, 2017

Background: Studies on various adult cancer types showed that there are changes in levels of prot... more Background: Studies on various adult cancer types showed that there are changes in levels of protein types that are related to iron metabolism. In our study, proteins related to iron metabolism are examined for the first time in childhood malignancies and results are presented. Methods: Between January 2013 and December 2014, 58 patients 17 healthy children were included in the study. Blood samples were taken from patients at diagnosis and in remission and serum ferritin heavy chain (FTH-1), ferritin light chain (FTL), LCN-2, soluble transferrin receptor (sTFR), transferrin receptor-2 (TFR-2), hepcidin and ferroportin levels were examined using ELISA method. Results: Levels of FTH-1 were found higher in all patient groups than in control group (P < 0.05). Levels of FTL were found higher in all patient groups than in control group, although this was not statistically significant. It was observed that these levels decreased in remission. Levels of LCN-2 were found significantly high (P = 0.001) in all patient groups. sTfR levels were found lower in acute leukemia patients (P = 0.001). Level of TFR-2 was found to be higher in all patient groups in comparison with the control group and this was statistically significant in lymphoma group (P = 0.05). In remission, levels of TFR-2 decreased. Levels of serum hepcidin were found to be higher in all patient groups in comparison with the control group and this was statistically significant (P = 0.001). Hepcidin levels decreased in remission. Although it was not statistically significant, it was observed that levels of serum ferroportin were low in sarcoma and leukemia groups at diagnosis and increased in remission. As a result, despite the fact that our patients' number was limited, we thought that investigation of the iron metabolism of tumor cells is important and additional studies will be necessary with increasing patients' number.

Infectious Diseases, 2021

Abstract Background Invasive aspergillosis (IA) is an important cause of morbidity and mortality ... more Abstract Background Invasive aspergillosis (IA) is an important cause of morbidity and mortality in immunosuppressed children. Early detection of the infection can improve prognosis in this patient population. Objectives To investigate the utility of Aspergillus galactomannan antigen assay (GM-EIA) as a diagnostic tool for IA in at-risk paediatric patients. Patients/Methods For the study, 659 GM-EIA results from 59 patients diagnosed with IA and 3368 GM-EIA results from 351 subjects without evidence for IA (controls) were reviewed retrospectively. Three cut-off values (i.e. ≥0.5, ≥1, ≥1.5) were specified to determine GM-EIA positivity. Results The median age was 6.3 years for boys and 14.5 years for girls. There was a significant difference between the girls and boys in terms of age (p < 0.01). For proven/probable/possible IA patients, sensitivity of 67.8% and specificity of 59.8% were detected when the ≥0.5 cut-off value was used for GM-EIA-positivity. The specificity increased to 80% at the cut-off of ≥1 and to 88% at the cut-off of ≥1.5. False positivity rates were 9.14, 3, and 1.45% at the ≥0.5, ≥1 and ≥1.5 cut-offs respectively. In the proven/probable IA group, sensitivity and negative predictive values were 86.9 and 97.2% at the ≥0.5 cut-off, 85.7 and 97.9%, at the ≥1 cut-off and 84.2 and 98.1% at ≥1.5 cut-off respectively. The positive likelihood ratio was 7.57 and the odds ratio was 42.67 at ≥1.5 cut-off. Conclusion The GM-EIA may be used for both screening and diagnostic purposes in paediatric patients using a cut-off value of ≥1.5 for GM-EIA positivity.

Turkish Journal of Pediatric Disease, Jul 12, 2018

Amaç: Optik gliomlar histolojik olarak benign özelliklidirler ve iyi yönde farklılaşma gösteren p... more Amaç: Optik gliomlar histolojik olarak benign özelliklidirler ve iyi yönde farklılaşma gösteren pilositik astrositom sınıfında yer alırlar. Tümörün histopatolojik özelliği, yerleşim yeri, hastanın yaşı, Nörofibromatozis tip-1 ile birlikteliği sağkalım oranlarını etkileyen önemli prognostik belirteçlerdir. Kemoterapi tedavide en önemli seçenektir ve klinisyenlerin hedefi radyoterapiden olabildiğince uzak durmaktır. Radyoterapi ve cerrahiden uzak kalınmasına zemin hazırlayan, uzun döneme yayılan güvenli bir tedavi planı olan vinkristin ve karboplatin kombinasyonu ilk seçenek standart tedavi yaklaşımlarından biridir. Ancak bu tedaviler altında refrakter seyreden hastalara sistemik yan etkisi az ve bir multi tirozin kinaz inhibitörü olan imatinib mesilat önemli bir seçenek olarak eklenebilir. Çocuk hastalarda güvenli bir şekilde kullanılabilir. Bu alanda bildirilmiş az sayıda çalışma olması nedeni ile imatinib mesilat kullanımına ait olumlu sonuçlarımızı klinisyenlerle paylaşmak istedik. Gereç ve Yöntemler: Çocuk Onkoloji kliniğimizde 2007-2017 yılları arasında tanı alan toplam 16 optik gliom hastası çalışmaya dahil edildi. Bulgular: İki kür vinkristin, karboplatin kombinasyonu sonrası klinik ve radyolojik olarak progresif seyreden hastalara stabil hastalık veya regresyon bulguları elde edilene kadar 1-2 yıl süre ile imatinib (270 mg/m² oral) tedavisi eklenildi. Tedavi alan hastaların median izlem süresi 7 yıl (5-10)'di. Dört hastada tam yanıt, iki hastada stabil hastalık bulguları sağlanıldı. Hastalarımızda imatinib ilişkili bir yan etki görülmedi. Sonuç: İmatinib tümörün kapiller endotellerinden özellikle PDGFR-α ve β'nın ekspresyonunu inhibe ederek etki eder. Akıllı hedef moleküllerin tedaviye eklenilmesinin progresif hastalarda geç dönemde yan etkileri fazla olan radyoterapiye olan ihtiyacı azaltacağını düşünüyoruz. Gelecekte uygulanabilecek birçok moleküler hedef ajan refrakter optik gliomların tedavisinde gündeme gelebilir ve çocuk hastalar cerrahi ve radyoterapinin yaratacağı komplikasyonlardan korunabilirler.

Eye, 2020

Objectives To evaluate the long-term treatment outcomes in intraocular retinoblastoma (RB) includ... more Objectives To evaluate the long-term treatment outcomes in intraocular retinoblastoma (RB) including the associated factors for eventual treatment with external beam radiotherapy (EBRT) and enucleation as well as to analyse the risk factors for metastasis and death in extraocular RB. Methods Retrospective analysis of 390 eyes from 256 (89.8%) intraocular RB and 29 (10.2%) extraocular RB cases diagnosed and treated between October 1998 and May 2018 at one of the largest tertiary care centers in Turkey. Results Of 351 intraocular RB eyes, 53.3% had group D/E disease at presentation. 75 (21.4%) of 351 eyes underwent primary enucleation. Of the remaining 276 eyes undergoing eye-conserving treatments, 201 (72.8%) were salvaged. Most of these eyes were treated using intravenous chemotherapy and/or focal treatments [transpupillary thermotherapy (TTT) and cryotherapy] initially. EBRT was eventually required in 48 (17.4%) eyes and secondary enucleation in 75 (27.2%) eyes. At mean follow-ups of 76.7 and 39.7 months for intraocular and extraocular RB cohorts, respectively, 180 (46.2%) eyes underwent primary/secondary enucleation and exenteration. Overall, 13 cases developed metastasis and 9 died. Two patients with trilateral RB also expired. Multivariable risk factors for enucleation were the presence of vitreous seeds (p < 0.001), absence of EBRT administration (p = 0.033), 5-9 TTT applications compared with no TTT (p = 0.031), and each 1 mm increase in tumour base diameter (p < 0.001). Univariate factors predictive of metastasis were the presence of extraocular RB detected by imaging methods (p < 0.001) and extrascleral/optic nerve cut end involvement at histopathological examination (p < 0.001). Conclusions In our series, 72.8% of the intraocular RB eyes undergoing eye-conserving treatments were saved. The globe salvage rate for all intraocular and extraocular RB eyes was 53.8% and the overall survival rate was 96.1%.

The Turkish Journal of Pediatrics, 2019

A targeted salvage therapy with Brentuximab vedotin in heavily treated refractory or relapsed ped... more A targeted salvage therapy with Brentuximab vedotin in heavily treated refractory or relapsed pediatric Hodgkin lymphoma patients before and after stem cell transplantation. Turk J Pediatr 2019; 61: 671-676. Hodgkin's lymphoma (HL) is highly curable disease in its early stages, but in advanced stages, it presents a dilemma when it becomes refractory or relapses after several rounds of chemotherapy. Brentuximab vedotin (BV) is an antibody-drug conjugate that targets the tumor necrosis receptor family protein member CD30 positive malignancies via an anti-CD30 monoclonal antibody linked to monomethyl auristatin-E. In adult and pediatric studies, it has been shown to be an effective salvage therapy for primary refractory HL or relapse after autologous stem cell transplant (ASCT). Between July 2012 and August 2017, we administered BV (1.8 mg/m 2 every three weeks; 12 cycles totally) with doxorubucin, vinblastin, dacarbazine (AVD), rituximab + ifosfamide + carboplatin + etoposide (RICE), or bendamustine combination treatment in pediatric HL patients, who were previosuly treated for refractory or relapsed advanced stage HL before (seven patients) or after (one patient) ASCT in our center. After eight BV courses, one patient was able to undergo match unrelated donor (MUD) SCT. Another seven pediatric HL patients, who were not able to go into remission with any other classical HL chemotherapy protocols, received 4-6 courses of BV-AVD and/or RICE/bendamustine. All were able to undergo ASCT after negative positron emission tomography (PET) imaging results. After ASCT, we switched to BV as consolidation therapy until a total of 12 cycles was completed. Patients went into remission after a median 34 (range: 12-42) months from the start of BV treatment. BV is an encouraging, well-tolerated, and effective targeted therapy especially when combined with AVD or when alternated with another targeted therapy combination, including RICE, when needed.

The Turkish Journal of Pediatrics, 2019

Is antibiotic lock therapy effective for the implantable long-term catheter-related bloodstream i... more Is antibiotic lock therapy effective for the implantable long-term catheter-related bloodstream infections in children? Turk J Pediatr 2019; 61: 895-904. Catheter-related bloodstream infections (CRBSIs) are an important problem in pediatric patients with central venous catheters. This study aimed to determine the incidence of CRBSIs, responsible pathogens and outcomes of antibiotic lock treatment (ALT) in pediatric patients. Between January 2010 and November 2015 all hospitalized pediatric hematology, oncology and immunology patients diagnosed with CRBSIs were retrospectively analyzed. Seventy-eight CRBSI episodes were detected in 60 pediatric patients. The incidence of CRBSIs was 4.20/1000 catheter days. The most frequently detected pathogen was methicillin-resistant coagulase-negative Staphylococcus. Pseudomonas aeruginosa, Klebsiella spp., and Escherichia coli were other commonly isolated microorganisms. ALT was administered in 42 patients. The success rate of ALT was 81% (34/42). Catheter was removed without ALT in 36 episodes. Common reasons for catheter removal were sepsis and causative microorganisms which had high probability of biofilm formation. CRBSIs are an important cause of morbidity and mortality in pediatric patients. ALT is safe and effective. It is possible to obtain satisfactory results when ALT is used with intravenous systemic antibiotics for CRBSIs, though in some cases catheter removal is necessary. ALT helps to prevent unnecessary catheter removal in pediatric patients.

Posters, 2017

Background and aims Bloodstream infections are the major cause of morbidity, increased cost, prol... more Background and aims Bloodstream infections are the major cause of morbidity, increased cost, prolonged hospitalisation and mortality in paediatric haematology and oncology patients. We aimed to identify causative microorganisms and their antimicrobial susceptibilities in paediatric immunocompromised patients. Methods Patients with haematological and/or oncological diseases who admitted to our hospital with fever between January 2010 and November 2015 were included in this study. Patients’ demografic and clinical findings were collected from hospital information systems and microbiology laboratory records retrospectively. Results Totally 71 paediatric patients who had 111 bloodstream infection episodes were included in this study. The median age of patients was 90 (3-247) months. The most underlying disease was acute lymphoblastic leukaemia. While 31 patients had only peripheral blood culture positivity, 80 patients had catheter related blood stream infections. Of 80.2% blood stream infections occurred in neutropenic period. Responsible pathogens were detected as follows: 35.1% gram-positive microorganisms, 60.5% gram-negative bacteria and 4.4% fungi. The most causative gram negative pathogen was Escherichia coli and the most isolated gram positive microorganism was meticillin resistant coagulase negative Staphylococci. Extended spectrum beta lactamase was produced by 60% of Klebsiella spp. and 42.1% of E. coli. In addition carbapenemase producing E. coli and Klebsiella spp. were 15.8% and 26.7% respectively. Enterococcus spp. had 88.9% ampicillin resistance and%33.3 vancomycin resistance. Bloodstream infection related mortality rate was 2.7%. Conclusion Gram negative microorganisms were predominant pathogens in bloodstream infections. Extended spectrum beta lactamase and carbapenem resistance were increasingly important and they limited treatment options. The choice of empiric antimicrobial drug in immunosuppressed patients is life-saving. For all these reasons, the choice of empirical antibiotics should be made according to the clinical condition of the patient and the prevalent microorganisms in the current clinic, as favourable antimicrobial therapy will be able to achieve positive clinical outcomes.

Journal of Clinical Oncology, 2010

e20008 Background: Genistein, a soy isoflavone, has been shown to induce apoptosis and sensitize ... more e20008 Background: Genistein, a soy isoflavone, has been shown to induce apoptosis and sensitize cancer cells to chemotherapy and radiotherapy in a variety of cancer cell types. However, there is n...

Turkish journal of haematology : official journal of Turkish Society of Haematology, Jan 5, 2002

This study intends to describe growth and endocrine disorders secondary to chemotherapy among lon... more This study intends to describe growth and endocrine disorders secondary to chemotherapy among long-term survivors of pediatric acute leukemia. Sixteen patients including 14 ALL and 2 AML entered the study. Four were females and 12 were males with the mean age of 17.38 ± 3.81 years. Following the completion of their therapy, the mean follow up period of the patients was 62.43 ± 41.11 months. Somatic growth, sexual maturation, hypothalamic- pituitary-thyroid axis and hypothalamic-pituitary-gonadal axis were evaluated in all the patients. Two out of 16 had pathologic short stature (12.5%) and 3 patients had enuchoid status (18.75%) with antrophometric measurements. Eleven patients had normal thyroid gland dimensions and homogeneous thyroid tissue on ultrasonographic examination. One patient had Ia and another four patients had Ib diffuse goitre according to WHO criteria. Two out of 16 patients were diagnosed as subclinic primary hypothyroidism (12.5%), and three of them were diagnosed ...