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Birtas Atesoglu E, Gulbas Z, Uzay A, Ozcan M, Ozkalemkas F, Dal MS, Kalyon H, Akay OM, Deveci B, Bekoz H, Sevindik OG, Toptas T, Yilmaz F, Koyun D, Alkis N, Alacacioglu I, Sonmez M, Yavasoglu I, Tombak A, Mehtap O, Kurnaz F, Yuce OK, Karakus V, Turgut M, Kurekci DD, Ayer M, Keklik M, Buyuktas D, Ozbalak M, Ferhanoglu B. Glofitamab in relapsed/refractory diffuse large B-cell lymphoma: Real-world data. Hematol Oncol 2023; 41:663-673. [PMID: 37211991 DOI: 10.1002/hon.3174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 03/24/2023] [Accepted: 05/02/2023] [Indexed: 05/23/2023]
Abstract
Glofitamab is a CD3xCD20 bi-specific antibody with two fragments directed to the CD20 antigen and a single CD3-binding fragment. Encouraging response and survival rates were recently reported in a pivotal phase II expansion trial conducted in patients with relapsed/refractory (R/R) B-cell lymphoma. However, the real-world data of patients of all ages with no strict selection criteria are still lacking. Herein, this retrospective study aimed to evaluate the outcomes of diffuse large B-cell lymphoma (DLBCL) patients who received glofitamab via compassionate use in Turkey. Forty-three patients from 20 centers who received at least one dose of the treatment were included in this study. The median age was 54 years. The median number of previous therapies was 4, and 23 patients were refractory to first-line treatment. Twenty patients had previously undergone autologous stem cell transplantation. The median follow-up time was 5.7 months. In efficacy-evaluable patients, 21% and 16% of them achieved complete response and partial response, respectively. The median response duration was 6.3 months. The median progression-free survival (PFS) and overall survival (OS) was 3.3 and 8.8 months, respectively. None of the treatment-responsive patients progressed during the study period, and their estimated 1-year PFS and OS rate was 83%. The most frequently reported toxicity was hematological toxicity. Sixteen patients survived, while 27 died at the time of the analysis. The most common cause of death was disease progression. One patient died of cytokine release syndrome during the first cycle after receiving the first dose of glofitamab. Meanwhile, two patients died due to glofitamab-related febrile neutropenia. This is the largest real-world study on the effectiveness and toxicity of glofitamab treatment in R/R DLBCL patients. The median OS of 9 months seems promising in this heavily pretreated group. The toxicity related mortality rates were the primary concerns in this study.
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Affiliation(s)
- Elif Birtas Atesoglu
- Department of Internal Medicine, Division of Hematology, Koc University School of Medicine, Istanbul, Turkey
| | - Zafer Gulbas
- Division of Hematology, Anadolu Medical Center, Kocaeli, Turkey
| | - Ant Uzay
- Division of Hematology, Acibadem Atakent Hospital, Istanbul, Turkey
| | - Muhit Ozcan
- Department of Internal Medicine, Division of Hematology, Ankara University Medical Faculty, Ankara, Turkey
| | - Fahir Ozkalemkas
- Department of Internal Medicine, Division of Hematology, Uludag University Medical Faculty, Bursa, Turkey
| | - Mehmet Sinan Dal
- Division of Hematology, Dr. Abdurrahman Yurtaslan Ankara Oncology Hospital, Ankara, Turkey
| | - Hakan Kalyon
- Department of Internal Medicine, Division of Hematology, Koc University School of Medicine, Istanbul, Turkey
| | - Olga Meltem Akay
- Department of Internal Medicine, Division of Hematology, Koc University School of Medicine, Istanbul, Turkey
| | - Burak Deveci
- Division of Hematology, Medstar Hospital, Antalya, Turkey
| | - Huseyin Bekoz
- Department of Internal Medicine, Division of Hematology, Medipol University Medical Faculty, Istanbul, Turkey
| | - Omur Gokmen Sevindik
- Department of Internal Medicine, Division of Hematology, Medipol University Medical Faculty, Istanbul, Turkey
| | - Tayfur Toptas
- Department of Internal Medicine, Division of Hematology, Marmara University Medical Faculty, Istanbul, Turkey
| | - Fergun Yilmaz
- Department of Internal Medicine, Division of Hematology, Marmara University Medical Faculty, Istanbul, Turkey
| | - Derya Koyun
- Department of Internal Medicine, Division of Hematology, Ankara University Medical Faculty, Ankara, Turkey
| | - Nihan Alkis
- Division of Hematology, Bursa City Hospital, Bursa, Turkey
| | - Inci Alacacioglu
- Department of Internal Medicine, Division of Hematology, Dokuz Eylul University Medical Faculty, Izmir, Turkey
| | - Mehmet Sonmez
- Department of Internal Medicine, Division of Hematology, Karadeniz Technical University Medical Faculty, Trabzon, Turkey
| | - Irfan Yavasoglu
- Department of Internal Medicine, Division of Hematology, Adnan Menderes University Medical Faculty, Aydin, Turkey
| | - Anil Tombak
- Department of Internal Medicine, Division of Hematology, Mersin University Medical Faculty, Mersin, Turkey
| | - Ozgur Mehtap
- Department of Internal Medicine, Division of Hematology, Kocaeli University Medical Faculty, Kocaeli, Turkey
| | - Fatih Kurnaz
- Division of Hematology, Kocaeli Medicalpark Hospital, Kocaeli, Turkey
| | - Orhan Kemal Yuce
- Department of Internal Medicine, Division of Hematology, Akdeniz University Medical Faculty, Antalya, Turkey
| | - Volkan Karakus
- Division of Hematology, Antalya Research and Training Hospital, Antalya, Turkey
| | - Mehmet Turgut
- Department of Internal Medicine, Division of Hematology, Ondokuzmayıs University Medical Faculty, Samsun, Turkey
| | - Derya Deniz Kurekci
- Department of Internal Medicine, Division of Hematology, Ondokuzmayıs University Medical Faculty, Samsun, Turkey
| | - Mesut Ayer
- Division of Hematology, Basaksehir Cam ve Sakura City Hospital, Istanbul, Turkey
| | - Muzaffer Keklik
- Department of Internal Medicine, Division of Hematology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Deram Buyuktas
- Division of Hematology, V.K.V. American Hospital, Istanbul, Turkey
| | - Murat Ozbalak
- Division of Hematology, Basaksehir Cam ve Sakura City Hospital, Istanbul, Turkey
| | - Burhan Ferhanoglu
- Department of Internal Medicine, Division of Hematology, Koc University School of Medicine, Istanbul, Turkey
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Baysal M, Gürsoy V, Hunutlu FC, Erkan B, Demirci U, Bas V, Gulsaran SK, Pinar IE, Ersal T, Kirkizlar TA, Atli EI, Kirkizlar HO, Ümit EG, Gürkan H, Ozkocaman V, Ozkalemkas F, Demir AM, Ali R. The evaluation of risk factors leading to early deaths in patients with acute promyelocytic leukemia: a retrospective study. Ann Hematol 2022; 101:1049-1057. [PMID: 35190843 DOI: 10.1007/s00277-022-04798-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 02/14/2022] [Indexed: 11/28/2022]
Abstract
Acute promyelocytic leukemia (APL) differs from other forms of acute myeloid leukemia (AML), including coagulopathy, hemorrhage, disseminated intravascular coagulation (DIC), and treatment success with all-trans retinoic acid (ATRA). Despite ATRA, early deaths (ED) are still common in APL. Here, we evaluated factors associated with ED and applicability of scoring systems used to diagnose DIC. Ninety-one APL patients (55 females, 36 males, and median age 40 years) were included. ED was defined as deaths attributable to any cause between day of diagnosis and following 30th day. DIC was assessed based on DIC scoring system released by the International Society of Thrombosis and Hemostasis (ISTH) and Chinese Diagnostic Scoring System (CDSS). Patients' median follow-up time was 49.2 months, and ED developed in 14 (15.4% of) cases. Patients succumbing to ED had higher levels of the Eastern Cooperative Oncology Group Performance Status (ECOG PS), lactate dehydrogenase (LDH), and ISTH DIC, and lower fibrinogen levels (p <0.05). In multivariate Cox regression analysis, age >55 and ECOG PS ≥2 rates were revealed to be associated with ED. Based on ISTH and CDSS scores, DIC was reported in 47.3 and 58.2% of the patients, respectively. Despite advances in APL, ED is still a major obstacle. Besides the prompt recognition and correction of coagulopathy, those at high ED risk are recommended to be detected rapidly. Implementation of local treatment plans and creating awareness should be achieved in hematological centers. Common utilization of ATRA and arsenic trioxide (ATO) may be beneficial to overcome ED and coagulopathy in APL patients.
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Affiliation(s)
- Mehmet Baysal
- Division of Hematology Edirne, Department of Internal Medicine, Trakya University School of Medicine, Balkan Campus, 22030, Edirne, Turkey.
| | - Vildan Gürsoy
- Division of Hematology, Department of Internal Medicine, Uludag University School of Medicine, Bursa, Turkey
| | - Fazil Cagri Hunutlu
- Department of Internal Medicine, Uludag University School of Medicine, Bursa, Turkey
| | - Buket Erkan
- Department of Internal Medicine, Uludag University School of Medicine, Bursa, Turkey
| | - Ufuk Demirci
- Division of Hematology Edirne, Department of Internal Medicine, Trakya University School of Medicine, Balkan Campus, 22030, Edirne, Turkey
| | - Volkan Bas
- Division of Hematology Edirne, Department of Internal Medicine, Trakya University School of Medicine, Balkan Campus, 22030, Edirne, Turkey
| | - Sedanur Karaman Gulsaran
- Division of Hematology Edirne, Department of Internal Medicine, Trakya University School of Medicine, Balkan Campus, 22030, Edirne, Turkey
| | - Ibrahim Ethem Pinar
- Division of Hematology, Department of Internal Medicine, Uludag University School of Medicine, Bursa, Turkey
| | - Tuba Ersal
- Division of Hematology, Department of Internal Medicine, Uludag University School of Medicine, Bursa, Turkey
| | - Tugcan Alp Kirkizlar
- Division of Hematology Edirne, Department of Internal Medicine, Trakya University School of Medicine, Balkan Campus, 22030, Edirne, Turkey
| | - Emine Ikbal Atli
- Department of Medical Genetics, Trakya University School of Medicine, Edirne, Turkey
| | - Hakki Onur Kirkizlar
- Division of Hematology Edirne, Department of Internal Medicine, Trakya University School of Medicine, Balkan Campus, 22030, Edirne, Turkey
| | - Elif G Ümit
- Division of Hematology Edirne, Department of Internal Medicine, Trakya University School of Medicine, Balkan Campus, 22030, Edirne, Turkey
| | - Hakan Gürkan
- Department of Medical Genetics, Trakya University School of Medicine, Edirne, Turkey
| | - Vildan Ozkocaman
- Division of Hematology, Department of Internal Medicine, Uludag University School of Medicine, Bursa, Turkey
| | - Fahir Ozkalemkas
- Division of Hematology, Department of Internal Medicine, Uludag University School of Medicine, Bursa, Turkey
| | - Ahmet Muzaffer Demir
- Division of Hematology Edirne, Department of Internal Medicine, Trakya University School of Medicine, Balkan Campus, 22030, Edirne, Turkey
| | - Ridvan Ali
- Division of Hematology, Department of Internal Medicine, Uludag University School of Medicine, Bursa, Turkey
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Gursoy V, Ozkalemkas F, Ozkocaman V, Serenli Yegen Z, Ethem Pinar I, Ener B, Akalın H, Kazak E, Ali R, Ersoy A. Conventional Amphotericin B Associated Nephrotoxicity in Patients With Hematologic Malignancies. Cureus 2021; 13:e16445. [PMID: 34422476 PMCID: PMC8367387 DOI: 10.7759/cureus.16445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2021] [Indexed: 12/05/2022] Open
Abstract
Introduction: Amphotericin B (AmB-d) is one of the most effective therapeutic options against frequently life-threatening systemic fungal infections in patients with hematologic malignancies. However, significant adverse effects including nephrotoxicity associated with its use limit its more widespread use. The objectives of our study were to determine the incidence of AmB-d associated nephrotoxicity, to evaluate clinical and epidemiological characteristics of patients, and to support the notion that conventional amphotericin B remains a valid therapeutic option among hematologic patients with proper patient selection. Materials and methods: A total of 110 patients with hematologic malignancies were admitted to our Hematology Unit between January 2014 and November 2017 who required anti-fungal therapy during intensive systemic chemotherapy. The incidence of AmB-d associated nephrotoxicity, side effect profile, time to nephrotoxicity, and clinical and epidemiological characteristics associated with treatment success were assessed retrospectively. Results: Of the 110 patients receiving AmB-d, 70 (63.6%) were male and 40 (36.4%) were female. The mean age of participants was 44 years. The most common diagnosis was acute myeloid leukemia (n=53, 48.2%), and the most common chemotherapy protocol was 7 + 3 remission-induction (cytarabine 100 mg/m² days 1-7, Idarubicin 12 mg/m² days 1-3; n=24, 21.8%). In 56.4% of the patients, antifungal therapy was given empirically. In 40 patients (36.4%), nephrotoxicity was observed following antifungal treatment, and only four patients had stage 3 renal failure. The mean duration of time to nephrotoxicity from initiation of amphotericin B was four days (min: 2, max: 31). All patients were found to receive at least one additional potential nephrotoxic treatment during the antifungal treatment process. Conclusion: AmB-d is associated with a significant risk of nephrotoxicity. In most hematological patients, antifungal treatment is initiated empirically, and patients received prolonged courses of treatment. Therefore, it is plausible to initiate such treatment with AmB-d, when one considers the already high treatment costs in this patient group as well as the fact that AmB-d offers similar efficacy to antifungal agents at a lower cost. AmB-d may be recommended as a first-line agent in this patient group with the introduction of newer and more costly antifungal agents when needed, on the basis of the fact that these patients can be closely monitored in a hospital setting, reversible nature of nephrotoxicity upon discontinuation, and rare occurrence of severe renal failure requiring dialysis.
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Affiliation(s)
- Vildan Gursoy
- Division of Hematology, Department of Internal Medicine, Medical School of Usak University, Usak, TUR
| | - Fahir Ozkalemkas
- Division of Hematology, Department of Internal Medicine, Uludag University Medical Faculty, Bursa, TUR
| | - Vildan Ozkocaman
- Division of Hematology, Department of Internal Medicine, Uludag University Medical Faculty, Bursa, TUR
| | | | - Ibrahim Ethem Pinar
- Division of Hematology, Department of Internal Medicine, Uludag University Medical Faculty, Bursa, TUR
| | - Beyza Ener
- Department of Microbiology, Uludag University Medical Faculty, Bursa, TUR
| | - Halis Akalın
- Department of Infectious Diseases and Clinical Microbiology, Uludag University Medical Faculty, Bursa, TUR
| | - Esra Kazak
- Department of Infectious Diseases and Clinical Microbiology, Uludag University Medical Faculty, Bursa, TUR
| | - Ridvan Ali
- Division of Hematology, Department of Internal Medicine, Uludag University Medical Faculty, Bursa, TUR
| | - Alparslan Ersoy
- Division of Nephrology, Department of Internal Medicine, Uludag University Medical Faculty, Bursa, TUR
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Gemici A, Ozkalemkas F, Dogu MH, Tekinalp A, Alacacioglu I, Guney T, Ince I, Geduk A, Cagliyan GA, Maral S, Serin I, Gunduz E, Karakus V, Bekoz HS, Eren R, Pinar IE, Gunes AK, Sargın FD, Sevindik OG. A Real-life Turkish Experience of Venetoclax Treatment in High-risk Myelodysplastic Syndrome and Acute Myeloid Leukemia. Clin Lymphoma Myeloma Leuk 2021; 21:e686-e692. [PMID: 34059487 DOI: 10.1016/j.clml.2021.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 04/05/2021] [Accepted: 04/06/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Venetoclax is a selective B-cell lymphoma 2 (BCL2) inhibitor, which is approved to treat elderly patients with newly diagnosed acute myeloid leukemia (AML) and high-risk myelodysplastic syndrome (MDS) in combination with either low-dose cytarabine (ARA-C) or hypomethylating agents. We aimed to collect and share data among the efficacy and safety of venetoclax both as a monotherapy or in combination with other drugs used to treat high-risk MDS or AML. MATERIALS AND METHODS A total of 60 patients with a median age of 67 (30-83) years from 14 different centers were included in the final analysis. Thirty (50%) of the patients were women; 6 (10%) of the 60 patients were diagnosed with high-risk MDS and the remaining were diagnosed with AML. RESULTS The best objective response rate (complete remission [CR], complete remission with incomplete hematological recovery (CRi), morphological leukemia-free state [MLFS], partial response [PR]) was 35% in the entire cohort. Best responses achieved during venetoclax per patient number were as follows: 7 CR, 1 CRi, 8 MLFS, 5 PR, and stable disease. Median overall survival achieved with venetoclax was 5 months in patients who relapsed and not achieved in patients who were initially treated with venetoclax. Nearly all patients (86.7%) had experienced a grade 2 or more hematologic toxicity. Some 36.7% of these patients had received granulocyte colony stimulating factor (GCSF) support. Infection, mainly pneumonia (26.7%), was the leading nonhematologic toxicity, and fatigue, diarrhea, and skin reactions were the others reported. CONCLUSION Our real-life data support the use of venetoclax in patients with both newly diagnosed and relapsed high-risk MDS and AML.
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Affiliation(s)
- Aliihsan Gemici
- Department of Hematology, Medipol University, Istanbul, Turkey.
| | | | | | - Atakan Tekinalp
- Department of Hematology, Necmettin Erbakan University, Konya, Turkey
| | | | - Tekin Guney
- Department of Hematology, University of Medical Sciences, Ankara City Hospital, Ankara, Turkey
| | - Idris Ince
- Division of Hematology, Dr. Ersin Arslan Training and Research Hospital, Gaziantep, Turkey
| | - Ayfer Geduk
- Department of Hematology, Kocaeli University, Kocaeli, Turkey
| | | | - Senem Maral
- Division of Hematology, Diskapi Training and Research Hospital, Ankara, Turkey
| | - Istemi Serin
- Division of Hematology, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Eren Gunduz
- Department of Hematology, Osman Gazi University, Eskisehir, Turkey
| | - Volkan Karakus
- Department of Hematology, Alaaddin Keykubat University, Alanya, Turkey
| | | | - Rafet Eren
- Division of Hematology, Bozyaka Training and Research Hospital, Izmir, Turkey
| | | | - Ahmet Kursad Gunes
- Department of Hematology, University of Medical Sciences, Ankara City Hospital, Ankara, Turkey
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Kirkizlar TA, Akalin H, Kirkizlar O, Ozkalemkas F, Ozkocaman V, Kazak E, Ozakin C, Bulbul EN, Ozboz ES, Ali R. Vancomycin-resistant enterococci infection and predisposing factors for infection and mortality in patients with acute leukaemia and febrile neutropenia. Leuk Res 2020; 99:106463. [PMID: 33130331 DOI: 10.1016/j.leukres.2020.106463] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/09/2020] [Accepted: 10/13/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Vancomycin-resistant enterococcus (VRE) is an infectious agent that can increase morbidity and mortality, especially in patients with neutropenia in haematology departments. We analysed VRE infections and mortality rates among VRE colonized patients with acute leukaemia, defined predisposing risk factors for infection and mortality, and investigated the influence of daptomycin or linezolid treatment on mortality. PATIENTS-METHODS We included 200 VRE colonized adult acute leukaemia patients with febrile neutropenia between January 2010 and January 2016. Data were collected from electronic files. RESULTS There were 179 patients in the colonized group, and 21 patients in the infected group. Enterococcus faecium (van A) was isolated from all patients. The infection rate was 10.5 %, and the types of infections noted were as follows: bloodstream (n = 14; 66.7 %), skin and soft tissue (n = 3; 14.3 %), urinary (n = 2; 9.5 %), and others (9.5 %). In the multivariate logistic regression analysis, exposure to invasive procedures, coinfection status, and >15 days of VRE positivity were independent risk factors for VRE infections. In hospital mortality rates were 57.1 % in the infected group, and 9.5 % in the colonized group (p < 0.001). Older age, female gender, absolute neutropenia, and coinfection status were statistically significant predictor of survival. CONCLUSION Vancomycin-resistant enterococcus infections are associated with high morbidity and mortality in haematology patients with neutropenia. Clinicians should be aware of predisposing risk factors for VRE infection to avoid unfavourable outcomes. We believe that larger studies are necessary regarding the influence of treatment with daptomycin and linezolid.
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Affiliation(s)
- Tugcan Alp Kirkizlar
- Uludag University Medical Faculty, Department of Haematology, 16059, Gorukle, Bursa, Turkey.
| | - Halis Akalin
- Uludag University Medical Faculty, Department of Infectious Diseases and Clinical Microbiology, 16059, Gorukle, Bursa, Turkey.
| | - Onur Kirkizlar
- Trakya University Medical Faculty, Department of Haematology, 22030, Edirne, Turkey.
| | - Fahir Ozkalemkas
- Uludag University Medical Faculty, Department of Haematology, 16059, Gorukle, Bursa, Turkey.
| | - Vildan Ozkocaman
- Uludag University Medical Faculty, Department of Haematology, 16059, Gorukle, Bursa, Turkey.
| | - Esra Kazak
- Uludag University Medical Faculty, Department of Infectious Diseases and Clinical Microbiology, 16059, Gorukle, Bursa, Turkey.
| | - Cuneyt Ozakin
- Uludag University Medical Faculty, Department of Clinical Microbiology, 16059, Gorukle, Bursa, Turkey.
| | - Esra Nur Bulbul
- Uludag University Medical Faculty, Department of Internal Medicine, 16059, Gorukle, Bursa, Turkey.
| | - Ezgi Sezen Ozboz
- Uludag University Medical Faculty, Department of Internal Medicine, 16059, Gorukle, Bursa, Turkey.
| | - Rıdvan Ali
- Uludag University Medical Faculty, Department of Haematology, 16059, Gorukle, Bursa, Turkey.
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Okuturlar Y, Ozkalemkas F, Ener B, Serin SO, Kazak E, Ozcelik T, Ozkocaman V, Ozkan HA, Akalin H, Gunaldi M, Ali R. Serum galactomannan levels in the diagnosis of invasive aspergillosis. Korean J Intern Med 2015; 30:899-905. [PMID: 26552466 PMCID: PMC4642020 DOI: 10.3904/kjim.2015.30.6.899] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Revised: 05/18/2015] [Accepted: 06/20/2015] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND/AIMS In this study, the sensitivity-specificity of galactomannan-enzyme immunoassay (GM-EIA) with a cut-off value of 0.5 for a single, two, or three consecutive positivity in the diagnosis of invasive pulmonary aspergillosis (IPA) in neutropenic patients with hematological malignancy was investigated. METHODS IPA was classified as "proven," "probable," or "possible" as described in the guidelines prepared by the European Organization for Research and Treatment of Cancer and Mycoses Study Group." Serum samples were collected from the patients twice a week throughout their hospitalization. A total of 1,385 serum samples, with an average of 8.3 samples per episode, were examined. RESULTS Based on the 165 febrile episodes in 106 patients, 80 (48.5%) were classified as IPA (4 proven, 11 probable, 65 possible) and 85 (51.5%) as non-IPA. The sensitivity/ specificity was 100%/27.1% for a single proven/probable IPA with the cut of value of GM-EIA ≥ 0.5, 86.7%/71.8% for two consecutive positive results, and 73.3%/85.9% for three consecutive positive results. CONCLUSIONS With the galactomannan levels measured twice a week, consecutive sensitivity decreased and specificity increased. Therefore, an increase may be obtained in sensitivity-specificity by more frequent monitoring of GM-EIA starting from the first day of positivity is detected.
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Affiliation(s)
- Yildiz Okuturlar
- Department of Internal Medicine, Bakirkoy Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey
- Correspondence to Yildiz Okuturlar, M.D. Department of Internal Medicine, Bakirkoy Dr. Sadi Konuk Education and Research Hospital, Atakent mah. 1203. sok. 26/B D:15 Kucukcekmece, Istanbul, Turkey Tel: +90-532-120-0893 Fax: +90-212-542-4491 E-mail:
| | - Fahir Ozkalemkas
- Department of Hematology, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Beyza Ener
- Departments of Medical Mycology and Microbiology, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Sibel Ocak Serin
- Department of Internal Medicine, Umraniye Education and Research Hospital, Istanbul, Turkey
| | - Esra Kazak
- Department of Infectious Diseases and Clinical Microbiology, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Tulay Ozcelik
- Bone Marrow Transplantation Center, Florence Nightingale Hospital, Istanbul, Turkey
| | - Vildan Ozkocaman
- Department of Hematology, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Hasan Atilla Ozkan
- Department of Hematology, Yeditepe University Faculty of Medicine, Istanbul, Turkey
| | - Halis Akalin
- Department of Infectious Diseases and Clinical Microbiology, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Meral Gunaldi
- Department of Oncology, Bakirkoy Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Ridvan Ali
- Department of Hematology, Uludag University Faculty of Medicine, Bursa, Turkey
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Dizdar OS, Ozkocaman V, Sahbazlar M, Pesen E, Kurt E, Ozkalemkas F, Ali R, Tunali A. Severe Hemorrhagic Diathesis in a Patient with Prostat Adenocarsinoma and Diagnostic Approach. Erciyes Med J 2015. [DOI: 10.5152/etd.2015.5076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Yakut T, Ali R, Egeli U, Ozkalemkas F, Ercan I, Ozçelik T, Ozkocaman V, Yigit B, Tunali A. Comparison of genetic changes between interphase and metaphase nuclei in monitoring CML and APL treatment using DC-FISH technique. Cancer Biol Ther 2014; 3:858-63. [PMID: 15254420 DOI: 10.4161/cbt.3.9.1039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
In leukemias, the monitoring techniques on the response after the treatment have clinical importance for evaluating new therapeutic approaches and identifying the risk of relapse. In this study, genetic changes before and after chemotherapy in interphase and metaphase nuclei of bone morrow of adults with provisional diagnosis of leukemia were compared to understand the molecular characterization and pathogenesis of the leukemia for the classification of diagnosis and prognosis. We examined bone morrow cells of 47 chronic myeloid leukemia (CML) cases (29 of 47 at the time of diagnosis, 31 of 47 after chemotherapy) with the bcr/abl translocation probes and of 10 acute promyelocytic leukemia (APL) cases (7 of 10 at the time of diagnosis, 4 of 10 after chemotherapy) with the PML/RARalpha translocation probes by using dual color-flourescence in situ hybridization (DC-FISH). For each case, 400 interphase nuclei and 11 to 25 metaphases nuclei were analysed. The ratios of translocations before and after chemotherapy were compared between interphase and metaphase nuclei. After chemotherapy, though, translocations were detected in interphase nuclei of 29 of the 31 CML and 4 of the 4 APL cases, these translocations were determined in metaphase nuclei of only 14 of the 31 CML and 1 of the 4 APL cases with very low ratios (p < 0.01). The results showed that the rates of translocation positive interphase nuclei were higher than the rates of translocation positive metaphase nuclei (p < 0.01) after chemotherapy, so there may be some factors effecting proliferative activity of metaphase formation in leukemias.
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MESH Headings
- Bone Marrow Cells
- Cell Proliferation
- Endpoint Determination
- Humans
- In Situ Hybridization, Fluorescence
- Interphase
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Leukemia, Promyelocytic, Acute/drug therapy
- Leukemia, Promyelocytic, Acute/genetics
- Leukemia, Promyelocytic, Acute/pathology
- Metaphase
- Prognosis
- Translocation, Genetic
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Affiliation(s)
- Tahsin Yakut
- Department of Medical Biology and Genetics, Faculty of Medicine, University of Uludag, Bursa, Turkey.
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Kaderli AA, Baran I, Aydin O, Bicer M, Akpinar T, Ozkalemkas F, Yesilbursa D, Gullulu S. Diffuse involvement of the heart and great vessels in primary cardiac lymphoma. Eur J Echocardiogr 2009; 11:74-6. [PMID: 19759028 DOI: 10.1093/ejechocard/jep111] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Primary cardiac lymphoma (PCL) is an extremely rare disorder. In this report, a 57-year-old male with diffuse large B-cell lymphoma involving the heart and great vessels is presented. Trans-thoracic echocardiography was the first modality used to establish the diagnosis. Fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) showed diffuse increased metabolic activity of the heart walls and hypermetabolic lesions occupying cardiac chambers in some areas. The patient underwent systemic chemotherapy, and after 13 days, a marked regression of the tumour mass was evident based on echocardiographic examination. After completing six R-CHOP chemotherapy treatments, PET imaging was planned to control the residual mass, but the patient was intubated due to pneumonia that developed after the sixth chemotherapy session and subsequently died due to sepsis.
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Affiliation(s)
- Aysel Aydin Kaderli
- Department of Cardiology, Uludag University Faculty of Medicine, 16059 Gorukle, Bursa, Turkey.
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Ali R, Beksac M, Ozkalemkas F, Ozkocaman V, Ozkan A, Ozcelik T, Tunali A. Efficacy of bortezomib in combination chemotherapy on secondary plasma cell leukemia. Leuk Lymphoma 2009; 48:1426-8. [PMID: 17613776 DOI: 10.1080/10428190701370597] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Ozkan A, Taskapilioglu O, Bican A, Ozkocaman V, Ozturk H, Ozkalemkas F, Ali R. Hairy cell leukemia presenting with Guillain-Barre syndrome. Leuk Lymphoma 2009; 48:1048-9. [PMID: 17487755 DOI: 10.1080/10428190701253850] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Ali R, Ozkalemkas F, Kimya Y, Koksal N, Ozkocaman V, Yorulmaz H, Eroglu A, Ozcelik T, Tunali A. Pregnancy in chronic lymphocytic leukemia: Experience with fetal exposure to chlorambucil. Leuk Res 2009; 33:567-9. [DOI: 10.1016/j.leukres.2008.05.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2008] [Revised: 05/27/2008] [Accepted: 05/27/2008] [Indexed: 10/21/2022]
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Ali R, Ozkalemkas F, Kimya Y, Koksal N, Ozkan H, Ozkocaman V, Hoyrazli A, Cetinkaya M, Tunali A. Acute leukemia and pregnancy. Leuk Res 2009; 33:e26-8. [DOI: 10.1016/j.leukres.2008.07.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2008] [Revised: 07/09/2008] [Accepted: 07/11/2008] [Indexed: 11/26/2022]
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Ali R, Ozkalemkas F, Ozcelik T, Ozkan A, Ozkocaman V, Ozturk H, Kurt M, Sadikoglu Y, Elbuken-Ozer G, Tunali A. Extramedullary plasmacytoma involving the abdominal vessels and pancreas. Dig Dis Sci 2007; 52:3199-201. [PMID: 17909974 DOI: 10.1007/s10620-005-9044-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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Ali R, Ozkalemkas F, Ozkan A, Ozkocaman V, Ozcelik T, Ozan U, Kurt M, Tunali A. Bortezomib and extramedullary disease in multiple myeloma: The shine and dark side of the moon. Leuk Res 2007; 31:1153-5. [PMID: 16945413 DOI: 10.1016/j.leukres.2006.07.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2006] [Revised: 07/15/2006] [Accepted: 07/17/2006] [Indexed: 11/21/2022]
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Ozcelik T, Ozkocaman V, Ozkalemkas F, Ali R, Altundal Y, Ozkan A, Tunali A. Use of recombinant activated factor VII in a patient with severe thrombocytopenia due to myelodysplastic syndrome with uncontrolled gastrointestinal bleeding. Blood Coagul Fibrinolysis 2007; 18:385-6. [PMID: 17473584 DOI: 10.1097/mbc.0b013e32809cc96c] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Affiliation(s)
- Atilla Ozkan
- Division of Haematology, Department of Internal Medicine, Uludag University School of Medicine, Bursa, Turkey.
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Ali R, Ozkalemkas F, Ozkan A, Ozcelik T, Ozkocaman V, Akdag I, Ozan U, Tunali A. Tumour lysis syndrome with acute renal failure during imatinib therapy. Leuk Res 2007; 31:573-4. [PMID: 16782190 DOI: 10.1016/j.leukres.2006.05.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2006] [Revised: 04/29/2006] [Accepted: 05/07/2006] [Indexed: 11/24/2022]
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Ozkan A, Baskan EB, Ali R, Ozkalemkas F, Turan H, Adim SB, Oz O. Profuse erythema multiforme induced by chlorambucil. Ann Hematol 2007; 86:539-40. [PMID: 17333187 DOI: 10.1007/s00277-007-0273-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2007] [Accepted: 02/09/2007] [Indexed: 10/23/2022]
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Ozkalemkas F, Ali R, Ozkocaman V, Ozcelik T, Ozkan A, Tunali A. Therapeutic plasma exchange plus corticosteroid for the treatment of the thrombotic thrombocytopenic purpura: a single institutional experience in the southern Marmara region of Turkey. Transfus Apher Sci 2007; 36:109-15. [PMID: 17291831 DOI: 10.1016/j.transci.2006.05.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2006] [Accepted: 05/15/2006] [Indexed: 11/24/2022]
Abstract
Thrombotic thrombocytopenic purpura (TTP) is a classic, but not a common disorder of hematology. Plasma exchange (PE) was shown to nearly reverse its 90% mortality rate. However, there are still some fatal outcomes in this dramatic disease. We present our experience of plasma exchange plus corticosteroids for the treatment of TTP in our hospital. Patients with TTP diagnosed between January 1996 and January 2005 were identified by a retrospective review of records of the Uludag University Hospital, Bursa (the largest referral center for adults with this disorder in this region with an estimated 2.2 million residents), which performs all therapeutic PE in the southern Marmara region in Turkey. A total of 11 (6 male, 5 female) patients were treated for TTP during this period. The median age was 39 years (range 18-49). One plasma volume exchange daily plus steroid was the principle treatment in all patients. A total of 295 PE sessions were performed. We have obtained six complete responses (CR) and three partial responses (PR) with daily PE and steroid (response rate 9/11). One of our primary refractory patients was saved with pulse steroid+cyclosporine+vincristine. Now, he is disease free for over one year. The other refractory patient did not develop any response to salvage therapy and expired on day 15 with status epilepticus and ventilator related pneumonia (mortality rate 1/11). A CR was obtained with adjuvant treatments in all three PR patients. Only one CR patient developed an early relapse (early relapse rate in CR patients 1/6). She was treated successfully with daily PE plus vincristine. Our median follow up period was 25 months (range 9-108). Considering our local population, our annual incidence is only about 0.63 new cases per one million people. This figure is considerably less than the data from US, which indicated an incidence of 3.7 cases per 1,000,000. To our knowledge, there is no high variability in the incidence of TTP in the different geographical regions of the world. It suggests that considerable number of patients escaped notice. We hope that, demonstrating the successful outcome, this article serves to urge primary physicians to keep in mind the diagnosis of TTP and refer suspected cases quickly.
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Affiliation(s)
- Fahir Ozkalemkas
- Department of Hematology, Uludag University, 16059 Gorukle, Bursa, Turkey.
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Ozkalemkas F, Ozcelik T, Ozkocaman V. Treatment with piperacillin-tazobactam and Aspergillus galactomannan test results for patients with hematological malignancies. Eur J Intern Med 2007; 18:79. [PMID: 17223052 DOI: 10.1016/j.ejim.2006.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2006] [Accepted: 05/11/2006] [Indexed: 11/21/2022]
Affiliation(s)
- Fahir Ozkalemkas
- Department of Internal Medicine, Division of Hematology, Uludag University School of Medicine, 16059, Gorukle, Bursa, Turkey
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Ozkan A, Hakyemez B, Ozkalemkas F, Ali R, Ozkocaman V, Ozcelik T, Taskapilioglu O, Altundal Y, Tunali A. Tumor lysis syndrome as a contributory factor to the development of reversible posterior leukoencephalopathy. Neuroradiology 2006; 48:887-92. [PMID: 16983525 DOI: 10.1007/s00234-006-0142-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2006] [Accepted: 07/22/2006] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Reversible posterior leukoencephalopathy syndrome (RPLS) is a recently described clinical and radiological entity comprising headache, seizures, altered level of consciousness and visual disturbances in association with transient posterior cerebral white-matter abnormalities. METHOD We report a young woman with Burkitt's lymphoma who developed RPLS after combined chemotherapy administered during the tumor lysis syndrome. RESULTS The symptoms in this patient fitted well with those of RPLS; they included abrupt alterations in mental status, seizures, headache, visual changes and characteristic neuroradiological findings. She was given further combination chemotherapy without any neurological complications, at which time she had already recovered from both RPLS and tumor lysis syndrome. CONCLUSION Although many etiological factors have been reported in the development of RPLS, the underlying mechanism is not yet well understood. With prompt and appropriate management, RPLS is usually reversible, and chemotherapy can be continued after complete recovery from RPLS. We suggest that tumor lysis syndrome should be considered as a contributory factor to the development of RPLS in patients for whom treatment with combined chemotherapy for hematological malignancies is planned.
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Affiliation(s)
- A Ozkan
- Division of Hematology, Department of Internal Medicine, Uludag University Hospital, Uludag University School of Medicine, 16059 Bursa, Turkey.
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Ozkocaman V, Ozcelik T, Ali R, Ozkalemkas F, Ozkan A, Ozakin C, Akalin H, Ursavas A, Coskun F, Ener B, Tunali A. Bacillus spp. among hospitalized patients with haematological malignancies: clinical features, epidemics and outcomes. J Hosp Infect 2006; 64:169-76. [PMID: 16891037 DOI: 10.1016/j.jhin.2006.05.014] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2006] [Accepted: 05/17/2006] [Indexed: 11/22/2022]
Abstract
Between April 2000 and May 2005, 350 bacteraemic episodes occurred among patients treated in our haematology unit. Two hundred and twenty-eight of these episodes were caused by Gram-positive pathogens, most commonly coagulase-negative staphylococci and Staphylococcus aureus. One hundred and twenty-two episodes were due to Gram-negative pathogens, with a predominance of Escherichia coli, Acinetobacter baumannii and Pseudomonas aeruginosa. Bacillus bacteraemias constituted 12 of these episodes occurring in 12 patients, and accounted for 3.4% of all bacteraemic episodes. Of the 12 strains evaluated, seven were Bacillus licheniformis, three were Bacillus cereus and two were Bacillus pumilus. Seven episodes presented with bloodstream infection, three with pneumonia, one with severe abdominal pain and deterioration of liver function, and one with a catheter-related bloodstream infection. B. licheniformis was isolated from five patients who had been hospitalized at the same time. This outbreak was related to non-sterile cotton wool used during skin disinfection. B. cereus and B. licheniformis isolates were susceptible to cefepime, carbapenems, aminoglycosides and vancomycin, but B. pumilus isolates were resistant to all antibiotics except for quinolones and vancomycin. Two deaths were observed. In conclusion, Bacillus spp. may cause serious infections, diagnostic and therapeutic dilemmas, and high morbidity and mortality in patients with haematological malignancies. Both B. cereus and B. licheniformis may be among the 'new' Gram-positive pathogens to cause serious infection in patients with neutropenia.
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Affiliation(s)
- V Ozkocaman
- Division of Haematology, Department of Internal Medicine, Uludag University School of Medicine, Uludag University Hospital, Bursa, Turkey
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Ozkan A, Ozkalemkas F, Ali R, Karadogan S, Ozkocaman V, Ozcelik T, Tunali A. Mediterranean spotted fever: presentation with pancytopenia. Am J Hematol 2006; 81:646-7. [PMID: 16823824 DOI: 10.1002/ajh.20628] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Ali R, Ozkalemkas F, Ozcelik T, Ozkocaman V, Ozkan A, Bayram S, Ener B, Ursavas A, Ozal G, Tunali A. Invasive pulmonary aspergillosis: role of early diagnosis and surgical treatment in patients with acute leukemia. Ann Clin Microbiol Antimicrob 2006; 5:17. [PMID: 16872530 PMCID: PMC1550418 DOI: 10.1186/1476-0711-5-17] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2006] [Accepted: 07/27/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Aspergillus is a ubiquitous soil-dwelling fungus known to cause significant pulmonary infection in immunocompromised patients. The incidence of aspergillosis has increased during the past two decades and is a frequently lethal complication of acute leukemia patients that occurs following both chemotherapy and bone marrow transplantation. The diagnosis of invasive pulmonary aspergillosis (IPA) according to the criteria that are established by European Organization for the Research and Treatment of Cancer and Mycoses Study Group raise difficulties in severely ill patients. Despite established improvements in field of diagnosis (galactomannan antigen, quantitative PCR, real-time PCR for Aspergillus spp., and findings of computed tomography) and treatment with new antifungals, it is still a major problem in patients with acute leukemia. However, prompt and effective treatment of IPA is crucial because most patients will need subsequent chemotherapy for underlying hematologic disease as soon as possible. CASE PRESENTATION We report a 33-year-old male patient with acute promyelocytic leukemia diagnosed in 1993 that developed invasive pulmonary aspergillosis due to A. flavus at relapse in 2003. The patient was successfully treated with liposomal amphotericin B and underwent surgical pulmonary resection. The operative course was uneventful. CONCLUSION This report emphasizes the clinical picture, applicability of recent advances in diagnostic and therapeutic approaches for IPA. For early identification of a patient infected with IPA, a high index of suspicion and careful clinical and radiological examinations with serial screening for galactomannan should be established. If aspergillosis is suspected, anti-aspergillosis drug should be administered immediately, and if a unique pulmonary lesion remains, surgical resection should be considered to prevent reactivation during consecutive chemotherapy courses and to improve the outcome.
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Affiliation(s)
- Ridvan Ali
- Department of Internal Medicine, Division of Hematology, Uludag University School of Medicine, Bursa, Turkey
| | - Fahir Ozkalemkas
- Department of Internal Medicine, Division of Hematology, Uludag University School of Medicine, Bursa, Turkey
| | - Tulay Ozcelik
- Department of Internal Medicine, Division of Hematology, Uludag University School of Medicine, Bursa, Turkey
| | - Vildan Ozkocaman
- Department of Internal Medicine, Division of Hematology, Uludag University School of Medicine, Bursa, Turkey
| | - Atilla Ozkan
- Department of Internal Medicine, Division of Hematology, Uludag University School of Medicine, Bursa, Turkey
| | - Sami Bayram
- Department of Thoracic Surgery, Uludag University School of Medicine, Bursa, Turkey
| | - Beyza Ener
- Department of Microbiology and Infectious Diseases, Uludag University School of Medicine, Bursa, Turkey
| | - Ahmet Ursavas
- Department of Chest and Tuberculosis, Uludag University School of Medicine, Bursa, Turkey
| | - Guze Ozal
- Department of Internal Medicine, Division of Hematology, Uludag University School of Medicine, Bursa, Turkey
| | - Ahmet Tunali
- Department of Internal Medicine, Division of Hematology, Uludag University School of Medicine, Bursa, Turkey
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Ali R, Ozan U, Ozkalemkas F, Ozcelik T, Ozkocaman V, Ozturk H, Tunali S, Tunali A. Leukaemia cutis in T-cell acute lymphoblastic leukaemia. Cytopathology 2006; 17:158-61. [PMID: 16719862 DOI: 10.1111/j.1365-2303.2006.00289.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ozcelik T, Ozkocaman V, Ali R, Ozkalemkas F, Bulbul-Baskan E, Yazici B, Ozkan A, Tunali A. Sweet's syndrome: dilemma in febrile neutropenic patient with acute myeloid leukemia. Leuk Res 2006; 30:1466-8. [PMID: 16540169 DOI: 10.1016/j.leukres.2006.01.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2006] [Revised: 01/21/2006] [Accepted: 01/30/2006] [Indexed: 11/30/2022]
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Ali R, Ozkalemkas F, Ozkocaman V, Ozcelik T, Akalin H, Ozkan A, Altundal Y, Tunali A. Hydatid disease in acute leukemia: effect of anticancer treatment on echinococcosis. Microbes Infect 2006; 7:1073-6. [PMID: 15996888 DOI: 10.1016/j.micinf.2005.02.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2004] [Revised: 01/31/2005] [Accepted: 02/02/2005] [Indexed: 11/20/2022]
Abstract
Echinococcosis, also known as hydatid disease or hydatidosis, is a zoonotic illness caused by the larval form of Echinococcus spp. It is highly prevalent in areas where the parasite is endemic such as the Mediterranean region. However, occurrence of echinococcosis and cancer together is rare. We treated and followed approximately 1200 patients with different hematologic neoplastic diseases between 1985 and 2003, and only one of these individuals had concomitant acute leukemia and liver hydatidosis. This report describes the case of a 19-year-old man who had both primary refractoriness of acute leukemia (AML-M4) and liver hydatidosis. Management is discussed. The patient had cystic echinococcosis (CE) of the liver that was classified as CE1 according to the system established by the World Health Organization's Informal Working Group on Echinococcosis. The patient underwent 3 months of treatment with agents that targeted the leukemia (daunorubicin, idarubicin, cytarabine, fludarabine) and its complications (amphotericin B, amphotericin B lipid complex, liposomal amphotericin B). Throughout this period, the size and the contents of the cyst did not change, Echinococcus titers remained unchanged, and the cyst classification remained CE1.
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Affiliation(s)
- Ridvan Ali
- Division of Hematology, Department of Internal Medicine, Uludag University School of Medicine, Uludag University Hospital, Bursa, Turkey.
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Ali R, Ozkalemkas F, Yerci O, Ozcelik T, Gebitekin C, Ozkocaman V, Ozkan A, Budak F, Gulten T, Cetintas S, Tunali A. Superior vena cava syndrome: Initial presentation of acute myeloid leukemia (AML-M 0) with near-tetraploidy +/TdT +/CD7 +/CD34 +/HLA-DR +. Leuk Lymphoma 2006; 47:937-40. [PMID: 16753886 DOI: 10.1080/10428190500398963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Ozkalemkas F, Ali R, Ozkocaman V, Ozcelik T, Ozan U, Ozturk H, Kurt E, Evrensel T, Yerci O, Tunali A. The bone marrow aspirate and biopsy in the diagnosis of unsuspected nonhematologic malignancy: a clinical study of 19 cases. BMC Cancer 2005; 5:144. [PMID: 16262899 PMCID: PMC1310632 DOI: 10.1186/1471-2407-5-144] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2005] [Accepted: 11/01/2005] [Indexed: 11/10/2022] Open
Abstract
Background Although bone marrow metastases can be found commonly in some malignant tumors, diagnosing a nonhematologic malignancy from marrow is not a usual event. Methods To underscore the value of bone marrow aspiration and biopsy as a short cut in establishing a diagnosis for disseminated tumors, we reviewed 19 patients with nonhematologic malignancies who initially had diagnosis from bone marrow. Results The main indications for bone marrow examination were microangiopathic hemolytic anemia (MAHA), leukoerythroblastosis (LEB) and unexplained cytopenias. Bone marrow aspiration was not diagnostic due to dry tap or inadequate material in 6 cases. Biopsy results were parallel to the cytological ones in all cases except one; however a meticulous second examination of the biopsy confirmed the cytologic diagnosis in this patient too. The most common histologic subtype was adenocarcinoma, and after all the clinical and laboratory evaluations, the primary focus was disclosed definitively in ten patients (5 stomach, 3 prostate, 1 lung, 1 muscle) and probably in four patients (3 gastrointestinal tract, 1 lung). All work up failed in five patients and these cases were classified as tumor of unknown origin (TUO). Conclusion Our series showed that anemia, thrombocytopenia, elevated red cell distribution width (RDW) and hypoproteinemia formed a uniform tetrad in patients with disseminated tumors that were diagnosed via bone marrow examination. The prognosis of patients was very poor and survivals were only a few days or weeks (except for 4 patients whose survivals were longer). We concluded that MAHA, LEB and unexplained cytopenias are strong indicators of the necessity of bone marrow examination. Because of the very short survival of many patients, all investigational procedures should be judged in view of their rationality, and should be focused on treatable primary tumors.
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Affiliation(s)
- Fahir Ozkalemkas
- Division of Hematology, Department of Internal Medicine Uludag University School of Medicine, Uludag University Hospital, Bursa, Turkey
| | - Rıdvan Ali
- Division of Hematology, Department of Internal Medicine Uludag University School of Medicine, Uludag University Hospital, Bursa, Turkey
| | - Vildan Ozkocaman
- Division of Hematology, Department of Internal Medicine Uludag University School of Medicine, Uludag University Hospital, Bursa, Turkey
| | - Tulay Ozcelik
- Division of Hematology, Department of Internal Medicine Uludag University School of Medicine, Uludag University Hospital, Bursa, Turkey
| | - Ulku Ozan
- Division of Hematology, Department of Internal Medicine Uludag University School of Medicine, Uludag University Hospital, Bursa, Turkey
| | - Hulya Ozturk
- Department of Pathology, Uludag University School of Medicine, Uludag University Hospital, Bursa, Turkey
| | - Ender Kurt
- Division of Medical Oncology, Department of Internal Medicine Uludag University School of Medicine, Uludag University Hospital, Bursa, Turkey
| | - Turkkan Evrensel
- Division of Medical Oncology, Department of Internal Medicine Uludag University School of Medicine, Uludag University Hospital, Bursa, Turkey
| | - Omer Yerci
- Department of Pathology, Uludag University School of Medicine, Uludag University Hospital, Bursa, Turkey
| | - Ahmet Tunali
- Division of Hematology, Department of Internal Medicine Uludag University School of Medicine, Uludag University Hospital, Bursa, Turkey
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Ozkan HA, Ozkalemkas F, Ali R, Ozkocaman V, Ozcelik T. Propylthiouracil-induced lupus-like syndrome: successful management with oral corticosteroids. Thyroid 2005; 15:1203-4. [PMID: 16425441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
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Ozkalemkas F, Ali R, Ozkan A, Ozcelik T, Ozkocaman V, Kunt-Uzaslan E, Bahadir-Erdogan B, Akalin H. Tuberculosis presenting as immune thrombocytopenic purpura. Ann Clin Microbiol Antimicrob 2004; 3:16. [PMID: 15350205 PMCID: PMC517508 DOI: 10.1186/1476-0711-3-16] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2004] [Accepted: 09/06/2004] [Indexed: 12/20/2022] Open
Abstract
Background Although various hematologic abnormalities are seen in tuberculosis, immune thrombocytopenic purpura is a rare event. Case Presentation We report a case of a 29 year-old male who was presented with immune thrombocytopenia-induced hemoptysis, macroscopic hematuria and generalized petechiae. The patient was found to have clinical, microbiological and radiological evidence of active pulmonary tuberculosis. The immune thrombocytopenic purpura was successfully treated with anti-tuberculous drugs combined with corticosteroids and high dose immune globulin therapy. Conclusion Immune thrombocytopenic purpura can be one of the hematological manifestations of tuberculosis which has a global prevalence with increasing incidence secondary to HIV infection.
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Affiliation(s)
- Fahir Ozkalemkas
- Division of Hematology, Department of Internal Medicine, Uludag University School of Medicine, Uludag University Hospital, 16059, Bursa, Turkey
| | - Ridvan Ali
- Division of Hematology, Department of Internal Medicine, Uludag University School of Medicine, Uludag University Hospital, 16059, Bursa, Turkey
| | - Atilla Ozkan
- Division of Hematology, Department of Internal Medicine, Uludag University School of Medicine, Uludag University Hospital, 16059, Bursa, Turkey
| | - Tulay Ozcelik
- Division of Hematology, Department of Internal Medicine, Uludag University School of Medicine, Uludag University Hospital, 16059, Bursa, Turkey
| | - Vildan Ozkocaman
- Division of Hematology, Department of Internal Medicine, Uludag University School of Medicine, Uludag University Hospital, 16059, Bursa, Turkey
| | - Esra Kunt-Uzaslan
- Department of Chest and Tuberculosis, Uludag University School of Medicine, Uludag University Hospital, 16059, Bursa, Turkey
| | - Beril Bahadir-Erdogan
- Department of Chest and Tuberculosis, Uludag University School of Medicine, Uludag University Hospital, 16059, Bursa, Turkey
| | - Halis Akalin
- Department of Microbiology and Infectious Diseases, Uludag University School of Medicine, Uludag University Hospital, 16059, Bursa, Turkey
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Ali R, Ozçelik T, Ozkalemkas F, Ozkocaman V, Ozan U, Yalçin M, Saricaoğlu H, Tunali A. Successful treatment of acquired haemophilia with prednisolone therapy. Haemophilia 2003; 9:741-3. [PMID: 14750942 DOI: 10.1046/j.1351-8216.2003.00830.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Acquired hemophilia is a rare, life threatening coagulopathy in adults caused by the development of autoantibodies against to factor VIII. No general consensus exists on the best therapeutic approach. We report here a case that presented with extensive cutaneous and mucosal bleedings due to factor VIII inhibitors and treated successfully with steroid therapy alone but complicated with a life threatening thromboembolic attack during her follow up. In conclusion, corticosteroids are "cost effective therapy" associated with high inhibitor elimination rates and although recurrence of inhibitor in a patient with factor VIII inhibitor is an expected clinical situation thrombosis risk should also be considered.
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Affiliation(s)
- R Ali
- Department of Internal Medicine, Division of Hematology, Uludağ University School of Medicine, Uludağ University Hospital, Bursa, Turkey.
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Ozan H, Ozkalemkas F, Ozan U, Ozerkan K, Bilgin T, Küçükyildiz F. Effect of prechemotherapy filgrastim on the bone marrow toxicity of topotecan. EUR J GYNAECOL ONCOL 2002; 22:463-5. [PMID: 11874084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
PURPOSE To investigate the efficacy and safety of single-dose filgrastim administered 24 hours prior to chemotherapy in the prevention of topotecan-related myeloid suppression. METHODS No medication was given to 21 rats in group 1; 1.5 mg/m2/day topotecan was administered intraperitoneally for five days every three weeks to 21 rats in group II; a single dose of 5 microg/kg filgrastim was injected intraperitoneally 24 hours before the intraperitoneal administration of the same dose of topotecan to 21 rats in group III. After completion of six cycles of chemotherapy. the rats were decapitated and blood samples were immediately collected into citrated tubes for complete blood counts. RESULTS White blood cell and lymphocyte counts in the control and the filgrastim + topotecan groups were similar (p > 0.05) and significantly higher than the counts in the topotecan group (p < 0.05). There was no difference in means of neutrophil, monocyte, eosinophil, basophil and erythrocyte counts among the groups (p > 0.05). CONCLUSION Filgrastim administration prior to chemotherapy seems to be beneficial and further investigations are needed.
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Affiliation(s)
- H Ozan
- Uludağ University Medical Faculty, Department of Obstetrics and Gynaecology, Bursa, Turkey
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