N Ustael

Ankara Numune Training and Research Hospital, Engüri, Ankara, Turkey

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Publications (4)15.42 Total impact

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    ABSTRACT: This study was conducted to evaluate the efficacy of high-dose thiotepa, melphalan and carboplatin (TMCb) regimen in 27 patients undergoing autologous stem cell transplantation (ASCT) for metastatic breast cancer. A total of 27 patients with stage IV breast cancer underwent ASCT following thiotepa (500 mg/m(2)), melphalan (100 mg/m(2)) and carboplatin (1200-1350 mg/m(2)). Of 27 patients, 17 had refractory relapse, eight had responding relapse, and two had no evidence of disease (NED) at the time of transplant. In all, 11 patients had only bone disease, nine had bone plus visceral disease, three had only visceral disease, and two had locoregional recurrent disease. The median time from diagnosis to transplant was 1081 days (range 180-2341). Staging for evaluation of response was performed 4-6 months after transplantation. Five patients were not evaluable (NE) for response because of NED at transplant (n=2) or early death due to transplant-related complications (n=3) (two of viral pneumonia and one of regimen-related toxicity) occurring at a median of 4 days (range 11-46) post-transplant. One of the two patients who was NED at the time of transplant is still NED on day 760 post-transplant. Seven of 15 refractory (47%) and 5/7 (71%) responsive patients with evaluable disease achieved a complete response of all measurable disease or all soft-tissue disease with at least improvement in bone lesions. Of 27 patients (37%),(10) are alive and progression-free, a median of 582 days (range 410-1380) after treatment, 6/17 (35%) with refractory disease and 4/10 (40%) with responsive disease. The probability of progression-free survival (PFS) for all patients was 0.50. The probabilities of PFS at 2 years for patients with refractory (n=17) and responsive (n=10) disease were 0.42 and 0.60, respectively. PFS at 2 years for the 14 patients who were NED or achieved CR/PR(*) following-HDC was 0.67. PFS at 2 years for patients who did not achieve CR/PR(*) following-DHC was 0.33. These preliminary data suggest that high-dose TMCb followed by autologous stem cell transplantation is an effective regimen for patients with advanced breast cancer and may be comparable to some previously used regimens.
    No preview · Article · Jun 2003 · Bone Marrow Transplantation
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    T Demirer · M Ayli · M Dagli · T Fen · R Haznedar · N Ustael · T Ustun · A Oymak · O Ozdel · O Muftuoglu

    Full-text · Article · Dec 2002 · Bone Marrow Transplantation
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    ABSTRACT: This study evaluated of the effect of post-transplant recombinant human granulocyte colony-stimulating factor (rhG-CSF) administration on the parameters of peritransplant morbidity. Three sequential and consecutive cohorts of 20 patients each received either post-transplant rhG-CSF at a dose of 5 micro g/kg/d i.v. in the morning, starting on d 0, d 5, or no rhG-CSF. Patients who received rhG-CSF starting on d 0 and 5 recovered granulocytes more rapidly than those not receiving rhG-CSF (P < 0.001 for ANC >or= 0.5 and 1 x 10(9)/l). RhG-CSF administration was not significantly associated with more rapid platelet engraftment. RhG-CSF administration starting on d 0 and 5 was significantly associated with a decreased duration of fever (P = 0.002 and 0.001 respectively), antibiotic administration (P < 0.001 and 0.006 respectively) and shorter hospitalization (P < 0.001 and 0.001 respectively) compared with the reference group. There was no difference between the d 0 and d 5 arms regarding the parameters of peritransplant morbidity. In conclusion, rhG-CSF administration was associated with a faster granulocyte recovery, shorter hospitalization, and shorter period of fever and non-prophylactic antibiotic administration. This study also showed that starting rhG-CSF administration on d 5 may be as effective as d 0 on the clinical outcome and may be an economical approach in routine clinical practice in this cost-conscious era.
    Full-text · Article · Sep 2002 · British Journal of Haematology
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    ABSTRACT: It is logical to expect that large-volume leukapheresis may be able to collect adequate numbers of PBSC with fewer procedures. To date, there is no agreement on the optimal volume of leukapheresis. Therefore, in this study we compared 81 volume with 121 and assessed whether a 50% increase in the blood volume processed would decrease the number of leukaphereses each patient needed to collect ≥2.5 × 106 CD34+ cells/kg in normal mobilizers. PBSC mobilization was done with cyclophosphamide etoposide followed by rhG-CSF in all patients. Forty patients were randomized to undergo 81 leukaphereses (n = 20 patients) or 121 leukaphereses (n = 20). The median numbers of leukaphereses required in order to collect ≥ 2.5 × 106 CD34+ cells/kg in patients processed with 81 and 121 were 1 (range 1-5) and 1 (1-4), respectively (P = 0.50). The median number of total nucleated cells (TNC) collected per patient was greater for the 121 group (7.47 × 108/kg vs 3.90 × 108/kg, P < 0.001), as was the median number of total mononuclear cells (TMNC) (4.26 × 108/kg vs 2.16 × 108/kg, P < 0.001), whereas there was no difference between the two groups for the median number of CD34+ cells collected per patient (8.94 × 106/kg vs 8.60 × 106/kg, P = 0.85). The TNCs and TMNCs collected per leukapheresis were again greater for the 121 group (3.64 × 108/kg vs 1.91 × 108/kg, P = 0.001 and 2.17 × 108/kg vs 0.88 × 108/kg, P < 0.001), whereas there was no difference between the two groups for the median number of CD34+ cells collected per leukapheresis (3.98 × 106/kg vs 3.26 × 106/kg, P = 0.90). This study showed that there is no difference between 81 and 121 volumes in regard to collected CD34+ cells/kg and also the use of a 121 leukapheresis volume did not decrease the number of leukaphereses performed compared with a 81 leukapheresis volume. In fact, the use of the larger leukapheresis volume had the disadvantage of adding 60 min to the time the patient was on the machine.
    Full-text · Article · Jun 2002 · Bone Marrow Transplantation