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    COVID-19 disease in children and adolescents following allogeneic hematopoietic stem cell transplantation: A report from the Turkish pediatric bone marrow transplantation study group
    (2024) Bozkurt, Ceyhun; Hazar, Volkan; Malbora, Barış; Küpesiz, Alphan; Aygüneş, Utku; Fışgın, Tunç; Karakükçü, Musa; Kuşkonmaz, Barış; Kılıç, Suar Çakı; Bayırlı, Derya; Bilir, Özlem Arman; Yalçın, Koray; Gözmen, Salih; Uygun, Vedat; Elli, Murat; Sarbay, Hakan; Küpesiz, Funda Tayfun; Şaşmaz, Hatice İlgen; Aksoy, Başak Adaklı; Yılmaz, Ebru; Okur, Fatma Visal; Tekkeşin, Funda; Yenigürbüz, Fatma Demir; Özek, Gülcihan; Atay, Abdullah Avni; Bozkaya, İkbal Ok; Çelen, Suna; Öztürkmen, Seda; Güneş, Adalet Meral; Gürsel, Orhan; Güler, Elif; Özcan, Alper; Çetinkaya, Duygu Uçkan; Aydoğdu, Selime; Özbek, Namık Yaşar; Karasu, Gülsün; Sezgin, Gülay; Doğru, Ömer; Albayrak, Davut; Öztürk, Gülyüz; Aksoylar, Serap; Daloğlu, Hayriye; Al, Işık Odaman; Evim, Melike Sezgin; Akbayram, Sinan; Öncül, Yurday; Zengin, Emine; Albayrak, Canan; Timur, Çetin; Kar, Yeter Düzenli; Çakmaklı, Hasan Fatih; Tüfekçi, Özlem; Töret, Ersin; Antmen, Bülent
    Background: Data on the risk factors and outcomes for pediatric patients with SARS-CoV-2 infection (COVID-19) following hematopoietic stem cell transplantation (HSCT) are limited. Objectives: The study aimed to analyze the clinical signs, risk factors, and outcomes for ICU admission and mortality in a large pediatric cohort who underwent allogeneic HSCT prior to COVID-19 infection. Method: In this nationwide study, we retrospectively reviewed the data of 184 pediatric HSCT recipients who had COVID-19 between March 2020 and August 2022. Results: The median time from HSCT to COVID-19 infection was 209.0 days (IQR, 111.7-340.8; range, 0-3845 days). The most common clinical manifestation was fever (58.7%). While most patients (78.8%) had asymptomatic/mild disease, the disease severity was moderate in 9.2% and severe and critical in 4.4% and 7.6%, respectively. The overall mortality was 10.9% (n: 20). Deaths were attributable to COVID-19 in nine (4.9%) patients. Multivariate analysis revealed that lower respiratory tract disease (LRTD) (OR, 23.20, p: .001) and lymphopenia at diagnosis (OR, 5.21, p: .006) were risk factors for ICU admission and that HSCT from a mismatched donor (OR, 54.04, p: .028), multisystem inflammatory syndrome in children (MIS-C) (OR, 31.07, p: .003), and LRTD (OR, 10.11, p: .035) were associated with a higher risk for COVID-19-related mortality. Conclusion: While COVID-19 is mostly asymptomatic or mild in pediatric transplant recipients, it can cause ICU admission in those with LRTD or lymphopenia at diagnosis and may be more fatal in those who are transplanted from a mismatched donor and those who develop MIS-C or LRTD.
  • [ X ]
    Öğe
    Tandem high-dose chemotherapy followed by autologous stem cell transplantation: An infant with trilateral retinoblastoma
    (2023) Töret, Ersin; Özdemir, Zeynep Canan; Zengin Ersoy, Gizem; Öztunalı, Çiğdem; Bozkurt, Ceyhun; Kebudi, Rejin
    Background: Retinoblastoma (RB) is the most common intraocular malignancy in childhood. Advanced RB, associated with exceedingly poor prognosis, requires more intensive multiagent chemotherapy than conventional regimens. Rescue of the bone marrow after intensive chemotherapy is achieved with stem cell transplantation. The sequential courses (tandem transplantation) of high-dose chemotherapy followed by autologous stem cell transplantation allow for even greater dose intensity in consolidation with the potential to use different active chemotherapeutics at each transplant and have proven feasible and successful in treating children with recurrent/refractory solid tumors. Case description: We report an infant with trilateral high-risk RB who received tandem high-dose chemotherapy (HDC) followed by autologous stem cell transplantation after the conventional chemotherapy. A 5-month-old female patient presented with strabismus, and the ophthalmoscopic examination showed intraocular tumoral lesions in both eyes. Magnetic resonance imaging (MRI) concluded the trilateral retinoblastoma diagnosis due to a tumoral mass in the optic chiasm. The follow-up ophthalmologic examinations and the MRI detected stable disease after six cycles of multiagent chemotherapy. Conclusions: Rescue with autologous stem cell transplantation after HDC allows for an increase in chemotherapy intensity. Tandem transplantation provides the chance to perform different chemotherapeutics at each transplant and enables an increase in the chemotherapy intensity, thus providing a positive effect on disease-free survival.

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