Juvenile Myelomonocytic Leukemia in Turkey: A Retrospective Analysis of Sixty-five Patients

Amaç: Türkiye'deki juvenil miyelomonositik lösemi (JMML) hastalarının durumunu, tanı zamanı, klinik özellikler, mutasyon çalışmaları, klinik gidiş ve tedavi stratejileri açısından ortaya koymaktır.Gereç ve Yöntemler: Ülkemizdeki pediatrik hematoloji ve onkoloji kliniklerinden veri istenerek, JMML tanısı ile takip ve tedavisi yapılan hastaların klinik ve laboratuvar bulguları geriye dönük olarak değerlendirildi.Bulgular: On sekiz merkezden, 2002-2016 tarihleri arasında JMML tanısı alan toplam 65 hasta çalışmaya dahil edildi. Ortanca tanı yaşı 17 ay idi (2-117 ay). Splenomegali tanıda %92 hastada vardı. Ortanca lökosit, monosit ve trombosit sayıları sırasıyla 32,9x109/L, 5,4x109/L ve 58,3x109/L idi. Monozomi 7, %18 hastada saptanmıştı. JMML mutasyonları 32 hastada (%49) çalışılmış olup, en sık rastlanan mutasyon PTPN11 idi. Hematopoetik kök hücre nakli (HKHN) 7 was present in 18% of patients. JMML mutational analysis was performed in 32 of 65 patients (49%) and PTPN11 was the most common mutation. Hematopoietic stem cell transplantation (HSCT) could only be performed in 28 patients (44%), the majority being after the year 2012. The most frequent reason for not performing HSCT was the inability to find a suitable donor. The median time from diagnosis to HSCT was 9 months (min-max: 2-63 months). The 5-year cumulative survival rate was 33% and median estimated survival time was 30±17.4 months (95% CI: 0-64.1) for all patients. Survival time was significantly better in the HSCT group (log-rank p=0.019). Older age at diagnosis (>2 years), platelet count of less than 40x109/L, and PTPN11 mutation were the factors significantly associated with shorter survival time. Conclusion: Although there has recently been improvement in terms of definitive diagnosis and HSCT in JMML patients, the overall results

Anahtar Kelime:

Konular: Hematoloji

Türkiye’de Juvenil Miyelomonositik Lösemi: Altmış Beş Hastanın Retrospektif Analizi

Öz:

Objective: This study aimed to define the status of juvenile myelomonocytic leukemia (JMML) patients in Turkey in terms of time of diagnosis, clinical characteristics, mutational studies, clinical course, and treatment strategies.Materials and Methods: Data including clinical and laboratory characteristics and treatment strategies of JMML patients were collected retrospectively from pediatric hematology-oncology centers in Turkey. Results: Sixty-five children with JMML diagnosed between 2002 and 2016 in 18 institutions throughout Turkey were enrolled in the study. The median age at diagnosis was 17 months (min-max: 2-117 months). Splenomegaly was present in 92% of patients at the time of diagnosis. The median white blood cell, monocyte, and platelet counts were 32.9x109/L, 5.4x109/L, and 58.3x109/L, respectively. Monosomy 7 was present in 18% of patients. JMML mutational analysis was performed in 32 of 65 patients (49%) and PTPN11 was the most common mutation. Hematopoietic stem cell transplantation (HSCT) could only be performed in 28 patients (44%), the majority being after the year 2012. The most frequent reason for not performing HSCT was the inability to find a suitable donor. The median time from diagnosis to HSCT was 9 months (min-max: 2-63 months). The 5-year cumulative survival rate was 33% and median estimated survival time was 30±17.4 months (95% CI: 0-64.1) for all patients. Survival time was significantly better in the HSCT group (log-rank p=0.019). Older age at diagnosis (>2 years), platelet count of less than 40x109/L, and PTPN11 mutation were the factors significantly associated with shorter survival time. Conclusion: Although there has recently been improvement in terms of definitive diagnosis and HSCT in JMML patients, the overall results are not satisfactory and it is necessary to put more effort into this issue in Turkey

Anahtar Kelime:

Konular: Hematoloji

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

1. Chang TY, Dvorak CC, Loh ML. Bedside to bench in juvenile myelomonocytic leukemia: insights into leukemogenesis from a rare pediatric leukemia. Blood 2014;124:2487-2497.
2. Arber DA, Orazi A, Hasserjian R, Thiele J, Borowitz MJ, Le Beau MM, Bloomfield CD, Cazzola M, Vardiman JW. The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia. Blood 2016;127:2391-2405.
3. Hasle H, Wadsworth LD, Massing BG, McBride M, Schultz KR. A populationbased study of childhood myelodysplastic syndrome in British Columbia, Canada. Br J Haematol 1999;106:1027-1032.
4. Passmore SJ, Chessells JM, Kempski H, Hann IM, Brownbill PA, Stiller CA. Paediatric myelodysplastic syndromes and juvenile myelomonocytic leukemia in the UK: a population based study of incidence and survival. Br J Haematol 2003;121:758-767.
5. Niemeyer CM, Arico M, Basso G, Biondi A, Cantu Rajnoldi A, Creutzig U, Haas O, Harbott J, Hasle H, Kerndrup G, Locatelli F, Mann G, StollmannGibbels B, van’t Veer-Korthof ET, van Wering E, Zimmermann M. Chronic myelomonocytic leukemia in childhood: a retrospective analysis of 110 cases. European Working Group on Myelodysplastic Syndromes in Childhood (EWOG-MDS). Blood 1997;89:3534-3543.
6. Loh ML. Recent advances in the pathogenesis and treatment of juvenile myelomonocytic leukaemia. Br J Haematol 2011;152:677-687.
7. Locatelli F, Nöllke P, Zecca M, Korthof E, Lanino E, Peters C, Pession A, Kabisch H, Uderzo C, Bonfim CS, Bader P, Dilloo D, Stary J, Fischer A, Révész T, Führer M, Hasle H, Trebo M, van den Heuvel-Eibrink MM, Fenu S, Strahm B, Giorgiani G, Bonora MR, Duffner U, Niemeyer CM; European Working Group on Childhood MDS; European Blood and Marrow Transplantation Group. Hematopoietic stem cell transplantation (HSCT) in children with juvenile myelomonocytic leukemia (JMML): results of the EWOG-MDS/ EBMT trial. Blood 2005;105:410-419.
8. Locatelli F, Niemeyer CM. How I treat juvenile myelomonocytic leukemia. Blood 2015;125:1083-1090.
9. Niemeyer CM, Kratz CP. Paediatric myelodysplastic syndromes and juvenile myelomonocytic leukaemia: molecular classification and treatment options. Br J Haematol 2008;140:610-624.
10. Passmore SJ, Hann IM, Stiller CA, Ramani P, Swansbury GJ, Gibbons B, Reeves BR, Chessells JM. Pediatric myelodysplasia: a study of 68 children and a new prognostic scoring system. Blood 1995;85:1742-1750.
11. Sakashita K, Matsuda K, Koike K. Diagnosis and treatment of juvenile myelomonocytic leukemia. Pediatr Int 2016;58:681-690.
12. Yoshida N, Yagasaki H, Xu Y, Matsuda K, Yoshimi A, Takahashi Y, Hama A, Nishio N, Muramatsu H, Watanabe N, Matsumoto K, Kato K, Ueyama J, Inada H, Goto H, Yabe M, Kudo K, Mimaya J, Kikuchi A, Manabe A, Koike K, Kojima S. Correlation of clinical features with the mutational status of GMCSF signaling pathway-related genes in juvenile myelomonocytic leukemia. Pediatr Res 2009;65:334-340.
13. Matsuda K, Shimada A, Yoshida N, Ogawa A, Watanabe A, Yajima S, Iizuka S, Koike K, Yanai F, Kawasaki K, Yanagimachi M, Kikuchi A, Ohtsuka Y, Hidaka E, Yamauchi K, Tanaka M, Yanagisawa R, Nakazawa Y, Shiohara M, Manabe A, Kojima S, Koike K. Spontaneous improvement of hematologic abnormalities in patients having juvenile myelomonocytic leukemia with specific RAS mutations. Blood 2007;109:5477-5480.
14. Flotho C, Kratz CP, Bergsträsser E, Hasle H, Starý J, Trebo M, van den HeuvelEibrink MM, Wójcik D, Zecca M, Locatelli F, Niemeyer CM; European Working Group of Myelodysplastic Syndromes in Childhood. Genotype-phenotype correlation in cases of juvenile myelomonocytic leukemia with clonal RAS mutations. Blood 2008;111:966-967.
15. Loh ML, Sakai DS, Flotho C, Kang M, Fliegauf M, Archambeault S, Mullighan CG, Chen L, Bergstraesser E, Bueso-Ramos CE, Emanuel PD, Hasle H, Issa JP, van den Heuvel-Eibrink MM, Locatelli F, Stary J, Trebo M, Wlodarski M, Zecca M, Shannon KM, Niemeyer CM. Mutations in CBL occur frequently in juvenile myelomonocytic leukemia. Blood 2009;114:1859-1863.
16. Niemeyer CM, Kang MW, Shin DH, Furlan I, Erlacher M, Bunin NJ, Bunda S, Finklestein JZ, Gorr TA, Mehta P, Schmid I, Kropshofer G, Corbacioglu S, Lang PJ, Klein C, Schlegel PG, Heinzmann A, Schneider M, Starý J, van den Heuvel-Eibrink MM, Hasle H, Locatelli F, Sakai D, Archambeault S, Chen L, Russell RC, Sybingco SS, Ohh M, Braun BS, Flotho C, Loh ML. Germline CBL mutations cause developmental abnormalities and predispose to juvenile myelomonocytic leukemia. Nat Genet 2010;42:794-800.
17. Matsuda K, Taira C, Sakashita K, Saito S, Tanaka-Yanagisawa M, Yanagisawa R, Nakazawa Y, Shiohara M, Fukushima K, Oda M, Honda T, Nakahata T, Koike K. Long-term survival after nonintensive chemotherapy in some juvenile myelomonocytic leukemia patients with CBL mutations, and the possible presence of healthy persons with the mutations. Blood 2010;115:5429- 5431.
18. Pinkel D. Differentiating juvenile myelomonocytic leukemia from infectious disease. Blood 1998;91:365-367.
19. Hasle H, Niemeyer CM, Chessells JM, Baumann I, Bennett JM, Kerndrup G, Head DR. A pediatric approach to the WHO classification of myelodysplastic and myeloproliferative diseases. Leukemia 2003;17:277-282.
20. Chan RJ, Cooper T, Kratz CP, Weiss B, Loh ML. Juvenile myelomonocytic leukemia: a report from the 2nd International JMML Symposium. Leuk Res 2009;33:355-362.
21. Yoshida N, Hirabayashi S, Watanabe S, Zaike Y, Tsuchida M, Yoshimi A, Masunaga A, Otsuka Y, Ito M, Kojima S, Nakahata T, Manabe A. Prognosis of 75 patients with juvenile myelomonocytic leukemia: prospective study by MDS committee in the Japanese Society of Pediatric Hematology. Rinsho Ketsueki 2011;52:1853-1858.
22. Bader JL, Miller RW. Neurofibromatosis and childhood leukemia. J Pediatr 1978;92:925-929.
23. Stiller CA, Chessells JM, Fitchett M. Neurofibromatosis and childhood leukaemia/lymphoma: a population-based UKCCSG study. Br J Cancer 1994;70:969-972.
24. Side L, Taylor B, Cayouette M, Conner E, Thompson P, Luce M, Shannon K. Homozygous inactivation of the NF1 gene in bone marrow cells from children with neurofibromatosis type 1 and malignant myeloid disorders. N Engl J Med 1997;336:1713-1720.
25. Tartaglia M, Niemeyer CM, Fragale A, Song X, Buechner J, Jung A, Hählen K, Hasle H, Licht JD, Gelb BD. Somatic mutations in PTPN11 in juvenile myelomonocytic leukemia, myelodysplastic syndromes and acute myeloid leukemia. Nat Genet 2003;34:148-150.
26. Park HD, Lee SH, Sung KW, Koo HH, Jung NG, Cho B, Kim HK, Park IA, Lee KO, Ki CS, Kim SH, Yoo KH, Kim HJ. Gene mutations in the Ras pathway and the prognostic implication in Korean patients with juvenile myelomonocytic leukemia. Ann Hematol 2012;91:511-517.
27. Manabe A, Okamura J, Yumura-Yagi K, Akiyama Y, Sako M, Uchiyama H, Kojima S, Koike K, Saito T, Nakahata T; MDS Committee of the Japanese Society of Pediatric Hematology. Allogeneic hematopoietic stem cell transplantation for 27 children with juvenile myelomonocytic leukemia diagnosed based on the criteria of the International JMML Working Group. Leukemia 2002;16:645-649.
28. Smith FO, King R, Nelson G, Wagner JE, Robertson KA, Sanders JE, Bunin N, Emaunel PD, Davies SM; National Marrow Donor Program. Unrelated donor bone marrow transplantation for children with juvenile myelomonocytic leukaemia. Br J Haematol 2002;116:716-724.
29. Locatelli F, Niemeyer C, Angelucci E, Bender-Götze C, Burdach S, Ebell W, Friedrich W, Hasle H, Hermann J, Jacobsen N, Klingebiel T, Kremens B, Mann G, Pession A, Peters C, Schmid HJ, Stary J, Suttorp M, Uderzo C, van’t VeerKorthof ET, Vossen J, Zecca M, Zimmermann M. Allogeneic bone marrow transplantation for chronic myelomonocytic leukemia in childhood: a report from the European Working Group on Myelodysplastic Syndrome in Childhood. J Clin Oncol 1997;15:566-573.
30. Türk Kızılay. Kök Hücre Bağış. Available online at http://www.kanver.org/ sayfa/kan-hizmetleri/kok-hucre-bagisi/53

APA	Tüfekçi Ö, Kocak U, Kaya Z, YENİCESU I, albayrak c, Albayrak D, BENGOA Ş, Patıroglu T, Karakukcu M, UNAL E, ince e, İLERİ D, ERTEM M, CELKAN T, ÖZDEMİR G, Sarper N, kaçar d, YARALI H, ozbek n, KÜPESİZ O, KARAPINAR T, Vergin C, ÇALISKAN Ü, Tokgöz H, EVİM M, BAYTAN B, meral gunes a, YILMAZ KARAPINAR D, KARAMAN S, UYGUN V, Karasu G, YEŞİLİPEK M, KOÇ A, ERDURAN E, Atabay B, Öniz H, ÖREN H (2018). Juvenile Myelomonocytic Leukemia in Turkey: A Retrospective Analysis of Sixty-five Patients. , 27 - 34.
Chicago	Tüfekçi Özlem,Kocak Ulker,Kaya Zuhre,YENİCESU IDIL,albayrak canan,Albayrak Davut,BENGOA Şebnem Yılmaz,Patıroglu Türkan,Karakukcu Musa,UNAL Ekrem,ince elif,İLERİ Dilber Talia,ERTEM Mehmet,CELKAN TÜLIN TIRAJE,ÖZDEMİR Gül Nihal,Sarper Nazan,kaçar dilek,YARALI HÜSNİYE NEŞE,ozbek namik yasar,KÜPESİZ Osman Alphan,KARAPINAR Tuba,Vergin Canan,ÇALISKAN ÜMRAN,Tokgöz Hüseyin,EVİM Melike Sezgin,BAYTAN Birol,meral gunes adalet,YILMAZ KARAPINAR Deniz,KARAMAN SERAP,UYGUN Vedat Uygun,Karasu Gulsun,YEŞİLİPEK Mehmet Akif,KOÇ Ahmet,ERDURAN Erol,Atabay Berna,Öniz Haldun,ÖREN Hale Juvenile Myelomonocytic Leukemia in Turkey: A Retrospective Analysis of Sixty-five Patients. (2018): 27 - 34.
MLA	Tüfekçi Özlem,Kocak Ulker,Kaya Zuhre,YENİCESU IDIL,albayrak canan,Albayrak Davut,BENGOA Şebnem Yılmaz,Patıroglu Türkan,Karakukcu Musa,UNAL Ekrem,ince elif,İLERİ Dilber Talia,ERTEM Mehmet,CELKAN TÜLIN TIRAJE,ÖZDEMİR Gül Nihal,Sarper Nazan,kaçar dilek,YARALI HÜSNİYE NEŞE,ozbek namik yasar,KÜPESİZ Osman Alphan,KARAPINAR Tuba,Vergin Canan,ÇALISKAN ÜMRAN,Tokgöz Hüseyin,EVİM Melike Sezgin,BAYTAN Birol,meral gunes adalet,YILMAZ KARAPINAR Deniz,KARAMAN SERAP,UYGUN Vedat Uygun,Karasu Gulsun,YEŞİLİPEK Mehmet Akif,KOÇ Ahmet,ERDURAN Erol,Atabay Berna,Öniz Haldun,ÖREN Hale Juvenile Myelomonocytic Leukemia in Turkey: A Retrospective Analysis of Sixty-five Patients. , 2018, ss.27 - 34.
AMA	Tüfekçi Ö,Kocak U,Kaya Z,YENİCESU I,albayrak c,Albayrak D,BENGOA Ş,Patıroglu T,Karakukcu M,UNAL E,ince e,İLERİ D,ERTEM M,CELKAN T,ÖZDEMİR G,Sarper N,kaçar d,YARALI H,ozbek n,KÜPESİZ O,KARAPINAR T,Vergin C,ÇALISKAN Ü,Tokgöz H,EVİM M,BAYTAN B,meral gunes a,YILMAZ KARAPINAR D,KARAMAN S,UYGUN V,Karasu G,YEŞİLİPEK M,KOÇ A,ERDURAN E,Atabay B,Öniz H,ÖREN H Juvenile Myelomonocytic Leukemia in Turkey: A Retrospective Analysis of Sixty-five Patients. . 2018; 27 - 34.
Vancouver	Tüfekçi Ö,Kocak U,Kaya Z,YENİCESU I,albayrak c,Albayrak D,BENGOA Ş,Patıroglu T,Karakukcu M,UNAL E,ince e,İLERİ D,ERTEM M,CELKAN T,ÖZDEMİR G,Sarper N,kaçar d,YARALI H,ozbek n,KÜPESİZ O,KARAPINAR T,Vergin C,ÇALISKAN Ü,Tokgöz H,EVİM M,BAYTAN B,meral gunes a,YILMAZ KARAPINAR D,KARAMAN S,UYGUN V,Karasu G,YEŞİLİPEK M,KOÇ A,ERDURAN E,Atabay B,Öniz H,ÖREN H Juvenile Myelomonocytic Leukemia in Turkey: A Retrospective Analysis of Sixty-five Patients. . 2018; 27 - 34.
IEEE	Tüfekçi Ö,Kocak U,Kaya Z,YENİCESU I,albayrak c,Albayrak D,BENGOA Ş,Patıroglu T,Karakukcu M,UNAL E,ince e,İLERİ D,ERTEM M,CELKAN T,ÖZDEMİR G,Sarper N,kaçar d,YARALI H,ozbek n,KÜPESİZ O,KARAPINAR T,Vergin C,ÇALISKAN Ü,Tokgöz H,EVİM M,BAYTAN B,meral gunes a,YILMAZ KARAPINAR D,KARAMAN S,UYGUN V,Karasu G,YEŞİLİPEK M,KOÇ A,ERDURAN E,Atabay B,Öniz H,ÖREN H "Juvenile Myelomonocytic Leukemia in Turkey: A Retrospective Analysis of Sixty-five Patients." , ss.27 - 34, 2018.
ISNAD	Tüfekçi, Özlem vd. "Juvenile Myelomonocytic Leukemia in Turkey: A Retrospective Analysis of Sixty-five Patients". (2018), 27-34.

APA	Tüfekçi Ö, Kocak U, Kaya Z, YENİCESU I, albayrak c, Albayrak D, BENGOA Ş, Patıroglu T, Karakukcu M, UNAL E, ince e, İLERİ D, ERTEM M, CELKAN T, ÖZDEMİR G, Sarper N, kaçar d, YARALI H, ozbek n, KÜPESİZ O, KARAPINAR T, Vergin C, ÇALISKAN Ü, Tokgöz H, EVİM M, BAYTAN B, meral gunes a, YILMAZ KARAPINAR D, KARAMAN S, UYGUN V, Karasu G, YEŞİLİPEK M, KOÇ A, ERDURAN E, Atabay B, Öniz H, ÖREN H (2018). Juvenile Myelomonocytic Leukemia in Turkey: A Retrospective Analysis of Sixty-five Patients. Turkish Journal of Hematology, 35(1), 27 - 34.
Chicago	Tüfekçi Özlem,Kocak Ulker,Kaya Zuhre,YENİCESU IDIL,albayrak canan,Albayrak Davut,BENGOA Şebnem Yılmaz,Patıroglu Türkan,Karakukcu Musa,UNAL Ekrem,ince elif,İLERİ Dilber Talia,ERTEM Mehmet,CELKAN TÜLIN TIRAJE,ÖZDEMİR Gül Nihal,Sarper Nazan,kaçar dilek,YARALI HÜSNİYE NEŞE,ozbek namik yasar,KÜPESİZ Osman Alphan,KARAPINAR Tuba,Vergin Canan,ÇALISKAN ÜMRAN,Tokgöz Hüseyin,EVİM Melike Sezgin,BAYTAN Birol,meral gunes adalet,YILMAZ KARAPINAR Deniz,KARAMAN SERAP,UYGUN Vedat Uygun,Karasu Gulsun,YEŞİLİPEK Mehmet Akif,KOÇ Ahmet,ERDURAN Erol,Atabay Berna,Öniz Haldun,ÖREN Hale Juvenile Myelomonocytic Leukemia in Turkey: A Retrospective Analysis of Sixty-five Patients. Turkish Journal of Hematology 35, no.1 (2018): 27 - 34.
MLA	Tüfekçi Özlem,Kocak Ulker,Kaya Zuhre,YENİCESU IDIL,albayrak canan,Albayrak Davut,BENGOA Şebnem Yılmaz,Patıroglu Türkan,Karakukcu Musa,UNAL Ekrem,ince elif,İLERİ Dilber Talia,ERTEM Mehmet,CELKAN TÜLIN TIRAJE,ÖZDEMİR Gül Nihal,Sarper Nazan,kaçar dilek,YARALI HÜSNİYE NEŞE,ozbek namik yasar,KÜPESİZ Osman Alphan,KARAPINAR Tuba,Vergin Canan,ÇALISKAN ÜMRAN,Tokgöz Hüseyin,EVİM Melike Sezgin,BAYTAN Birol,meral gunes adalet,YILMAZ KARAPINAR Deniz,KARAMAN SERAP,UYGUN Vedat Uygun,Karasu Gulsun,YEŞİLİPEK Mehmet Akif,KOÇ Ahmet,ERDURAN Erol,Atabay Berna,Öniz Haldun,ÖREN Hale Juvenile Myelomonocytic Leukemia in Turkey: A Retrospective Analysis of Sixty-five Patients. Turkish Journal of Hematology, vol.35, no.1, 2018, ss.27 - 34.
AMA	Tüfekçi Ö,Kocak U,Kaya Z,YENİCESU I,albayrak c,Albayrak D,BENGOA Ş,Patıroglu T,Karakukcu M,UNAL E,ince e,İLERİ D,ERTEM M,CELKAN T,ÖZDEMİR G,Sarper N,kaçar d,YARALI H,ozbek n,KÜPESİZ O,KARAPINAR T,Vergin C,ÇALISKAN Ü,Tokgöz H,EVİM M,BAYTAN B,meral gunes a,YILMAZ KARAPINAR D,KARAMAN S,UYGUN V,Karasu G,YEŞİLİPEK M,KOÇ A,ERDURAN E,Atabay B,Öniz H,ÖREN H Juvenile Myelomonocytic Leukemia in Turkey: A Retrospective Analysis of Sixty-five Patients. Turkish Journal of Hematology. 2018; 35(1): 27 - 34.
Vancouver	Tüfekçi Ö,Kocak U,Kaya Z,YENİCESU I,albayrak c,Albayrak D,BENGOA Ş,Patıroglu T,Karakukcu M,UNAL E,ince e,İLERİ D,ERTEM M,CELKAN T,ÖZDEMİR G,Sarper N,kaçar d,YARALI H,ozbek n,KÜPESİZ O,KARAPINAR T,Vergin C,ÇALISKAN Ü,Tokgöz H,EVİM M,BAYTAN B,meral gunes a,YILMAZ KARAPINAR D,KARAMAN S,UYGUN V,Karasu G,YEŞİLİPEK M,KOÇ A,ERDURAN E,Atabay B,Öniz H,ÖREN H Juvenile Myelomonocytic Leukemia in Turkey: A Retrospective Analysis of Sixty-five Patients. Turkish Journal of Hematology. 2018; 35(1): 27 - 34.
IEEE	Tüfekçi Ö,Kocak U,Kaya Z,YENİCESU I,albayrak c,Albayrak D,BENGOA Ş,Patıroglu T,Karakukcu M,UNAL E,ince e,İLERİ D,ERTEM M,CELKAN T,ÖZDEMİR G,Sarper N,kaçar d,YARALI H,ozbek n,KÜPESİZ O,KARAPINAR T,Vergin C,ÇALISKAN Ü,Tokgöz H,EVİM M,BAYTAN B,meral gunes a,YILMAZ KARAPINAR D,KARAMAN S,UYGUN V,Karasu G,YEŞİLİPEK M,KOÇ A,ERDURAN E,Atabay B,Öniz H,ÖREN H "Juvenile Myelomonocytic Leukemia in Turkey: A Retrospective Analysis of Sixty-five Patients." Turkish Journal of Hematology, 35, ss.27 - 34, 2018.
ISNAD	Tüfekçi, Özlem vd. "Juvenile Myelomonocytic Leukemia in Turkey: A Retrospective Analysis of Sixty-five Patients". Turkish Journal of Hematology 35/1 (2018), 27-34.