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TOKUÇ, AYŞE GÜLNUR

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TOKUÇ

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AYŞE GÜLNUR

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2022 - 20232
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    PublicationOpen Access
    Successful treatment of refractory graft-versus-host disease with ruxolitinib in a child after autologous stem cell transplantation
    (2022-06-01) TRUE, ÖMER; TOKUÇ, AYŞE GÜLNUR; KOÇ, AHMET; EKER, NURŞAH; Eker N., Tas B. T., Doğru Ö., Senay E., Tokuç A. G., Koç A.
    Autologous hematopoietic stem cell transplantation (AHSCT) is an increasingly used curative treatment for some solid tumors in children. Instead of allogeneic transplantation, the risk of developing graft-versus-host disease (GvHD) is much lower after AHSCT. Although the clinical findings of auto-GVHD are mild and self-limited in most cases, rare cases may be severe and need intensive immunosuppressive treatment. Here, we present a case who underwent autologous HSCT due to relapsed neuroblastoma, developed steroid-refractory GvHD after AHSCT, and achieved remission using ruxolitinib. A 12 years old female patient was diagnosed with relapsed neuroblastoma. After metaiodobenzylguanidine treatment, AHSCT was performed, and the status of the disease was a very good partial response at the time of transplantation. Our patient was diagnosed with severe and steroid-refractory GvHD with skin involvement after AHSCT. We used ruxolitinib with extracorporeal photopheresis because of the essential side effects of the other drugs and got a very good response. Over the following five months, there was no recurrence of GvHD. She was in complete remission of neuroblastoma after two years of AHSCT. It is crucial to keep in mind that GvHD may develop after AHSCT. Ruxolitinib is an effective treatment for GvHD also after AHSCT. Further studies and case reports are needed to understand the disease\"s pathogenesis and regulate appropriate treatment.
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    PublicationOpen Access
    Single-center experience in vaccination of children in special risk groups: A multidisciplinary institutional consensus protocol
    (2023-09-01) BARIŞ, HATİCE EZGİ; KEPENEKLİ KADAYİFCİ, EDA; ÜTÜK, BURAK; ŞAHİN, PINAR; TOKUÇ, AYŞE GÜLNUR; KOÇ, AHMET; AYDINER, ELİF; BORAN, PERRAN; BARIŞ H. E., Kepenekli E., Sakar F. İ. A., ÜTÜK B., ŞAHİN P., Ergenç Z., TOKUÇ A. G., KOÇ A., Karakoç-Aydıner E., BORAN P.
    Objective: Despite marked improvements in the accessibility of childhood vaccines, knowledge gaps remain about the vaccination of children in special risk groups (SRG). This study aimed to analyze the clinical data of children vaccinated in SRG in a single-center unit to contribute to the clinical evidence for the specific planning of immunization of children in SRG. The secondary aim is to present institutional consensus on the vaccination of children in SRG. Materials and Methods: This retrospective study was conducted at a single-center pediatric vaccination clinic. Patient charts between 2018 and 2021 were retrospectively reviewed, and clinical and laboratory data were extracted. Serial joint meetings with multiple healthcare pro-fessionals were performed to develop an institutional protocol for vaccination. Results: There were 479 children vaccinated between 2018 and 2021 for reasons such as post-chemotherapy, after hematopoietic stem cell transplantation, before/after solid organ trans-plantation, allergies, and chronic diseases. Of these, 298 (62.2%) children vaccinated in the unit due to a history of food or vaccine allergies were excluded. One hundred eighty-one children were vaccinated at a median age of 11 [7-15] years. Most children were vaccinated after treatment for malignancies. Solid tumors were the most frequent malignancy (67%), followed by acute lymphoblastic leukemia (29.0%) and acute myeloid leukemia (4.0%). Institutional vaccination protocols for cancer survivors, hematopoietic stem cells, and solid organ recipient children were developed and presented. Conclusion: There is a need to prepare national guidelines for vaccinating children with altered immunocompetence. Sharing vaccination practices by multidisciplinary vaccination units might increase and provide knowledge to develop national policies.