1
|
Tor YB, Habibov I, Altinkaynak M, Aydogan M, Baykiz D, Tayfur M, Gonenli MG, Onur I, Kalayoglu-Besisik S, Saka B, Erten SN, Akpinar TS. Assessment of Tp-Te interval in patients with cardiac AL amyloidosis. Cardiovasc J Afr 2024; 34:1-5. [PMID: 38270525 DOI: 10.5830/cvja-2023-059] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 11/07/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Prolonged Tp-Te interval is strongly associated with fatal ventricular arrhythmias and mortality. This association has been demonstrated in various diseases. However, the current literature does not give any information on Tp-Te interval in cardiac amyloid light-chain (AL) amyloidosis. METHODS We retrospectively screened 116 cardiac AL amyloidosis patients and 35 patients were included in the study. Demographic, laboratory, 12-lead electrocardiographic (QTc, Tp-Te V1-V6) and transthoracic echocardiographic data of the patients were analysed and compared with 35 healthy controls. RESULTS QTc and Tp-Te V2-V5 were significantly prolonged in the cardiac AL amyloidosis group (p < 0.05). Also, there was a positive and statistically significant correlation between the parameters of QTc and Tp-Te V3-V6, and also between the parameters of interventricular septum thickness at enddiastole and Tp-Te V2-V5. CONCLUSION We present the first strong evidence of prolonged Tp-Te intervals in patients with cardiac AL amyloidosis. There may also be a relationship between prolonged Tp-Te interval and the development of arrhythmia in this patient group, as in some other groups. There is a need for prospective studies examining the relationship of prolonged Tp-Te interval with arrhythmias and its prognostic significance in cardiac AL amyloidosis.
Collapse
Affiliation(s)
- Yavuz B Tor
- Department of Internal Medicine, Memorial Bahcelievler Hospital, Istanbul, Turkey.
| | - Ismat Habibov
- Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Mustafa Altinkaynak
- Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Mehmet Aydogan
- Department of Cardiology, Bitlis Tatvan State Hospital, Bitlis, Turkey
| | - Derya Baykiz
- Department of Cardiology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Mehmet Tayfur
- Department of Internal Medicine, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Mehmet G Gonenli
- Department of Internal Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Imran Onur
- Department of Internal Medicine, Memorial Bahcelievler Hospital, Istanbul, Turkey
| | - Sevgi Kalayoglu-Besisik
- Division of Haematology, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Bulent Saka
- Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Sebile N Erten
- Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Timur S Akpinar
- Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| |
Collapse
|
2
|
Tor YB, Ozbalak M, Kalayoglu-Besisik S, Aksoy E, Cagatay AA, Gul A, Erelel M, Senkal N, Medetalibeyoglu A, Kose M, Tukek T. Independent risk factors for COVID-19-associated coagulopathy. Eur Rev Med Pharmacol Sci 2023; 27:7851-7860. [PMID: 37667962 DOI: 10.26355/eurrev_202308_33440] [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] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Abstract
OBJECTIVE Past three years since the beginning of the outbreak, we have obtained satisfactory data on COVID-19. However, data on risk factors of COVID-19-associated coagulopathy (CAC) are extremely limited. Prediction of CAC might be a game changer since it is related to poor prognosis. Seeking independent risk factors for CAC was the main aim of the study. PATIENTS AND METHODS 510 hospitalized COVID-19 patients were retrospectively screened. Forty-eight of them were excluded due to irrelevant D-dimer or ferritin elevation. The remaining patients were stratified into three groups as overt coagulopathy, significant pulmonary microthrombosis, and patients without coagulopathy. The overt coagulopathy group included cases with macrothrombosis or disseminated intravascular coagulation (DIC). The significant pulmonary microthrombosis group covered the cases that had clinical deterioration with simultaneous marked D-dimer elevation. The group of patients without coagulopathy included the asymptomatic patients with normal or elevated D-dimer levels. RESULTS Overt coagulopathy developed in 3.2% and significant pulmonary microthrombosis in 10.1% of the patients. In the multivariate analysis, not receiving low molecular weight heparin (LMWH) (p=0.002), a level of D-dimer >15,000 U/ml (p=0.013) were associated with overt coagulopathy. In addition, levels of initial LDH >480 IU/L (p=0.022) and initial ferritin >1,000 ng/ml (p=0.036) were associated with significant pulmonary microthrombosis. Not receiving LMWH (p=0.001) was also associated with significant pulmonary microthrombosis, when multivariate analysis was performed by the parameters with a p-value <0.1 in the univariate analysis. Furthermore, all cases with DIC had Gram-negative bacterial sepsis. CONCLUSIONS Not receiving LMWH, high levels of D-dimer, initial LDH, and initial ferritin are independent risk factors for CAC. DIC does not appear to develop based on COVID-19.
Collapse
Affiliation(s)
- Y B Tor
- Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
3
|
Amikishiyev S, Gunver MG, Bektas M, Aghamuradov S, Ince B, Koca N, Torun ES, Aliyeva N, Sari S, Cetin C, Yalcin-Dulundu BC, Deniz R, Kemik F, Agargun BF, Gulseren UA, Besisik B, Alkan O, Bagriacik C, Tor YB, Senkal N, Catma Y, Durak G, Mese S, Agacfidan A, Kose M, Erelel M, Cagatay AA, Simsek-Yavuz S, Kalayoglu-Besisik S, Esen F, Gül A. Criteria for Hyperinflammation Developing in COVID-19: Analysis of 2 Cohorts From Different Periods of the Pandemic. Arthritis Rheumatol 2022; 75:664-672. [PMID: 36508470 PMCID: PMC9878117 DOI: 10.1002/art.42417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 11/15/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Hyperinflammation (HI) that develops in week 2 of COVID-19 contributes to a worse outcome. Because week 2 laboratory findings can be relatively mild, the available criteria for classification of hemophagocytic lymphohistiocytosis or macrophage activation syndrome are not helpful. METHODS Our study included a discovery cohort of patients from Turkey with symptomatic COVID-19 who were followed up while hospitalized during the initial wave and a replication cohort of hospitalized patients from a later period, all of whom required oxygen support and received glucocorticoids. Diagnosis of HI was made by an expert panel; most patients with COVID-19-associated HI (HIC) received tocilizumab or anakinra. Clinical and laboratory data from start day of treatment with tocilizumab or anakinra in HIC patients were compared with the data from day 5-6 in patients without HIC. Values maximizing the sensitivity and specificity of each parameter were calculated to determine criteria items. RESULTS The discovery cohort included 685 patients, and the replication cohort included 156 patients, with 150 and 61 patients receiving treatment for HI, respectively. Mortality rate in HI patients in the discovery cohort (23.3%) was higher than the rate in patients without HI (3.7%) and the rate in patients in the overall replication cohort (10.3%). The 12-item criteria that we developed for HIC showed that a score of 35 provided 85.3% sensitivity and 81.7% specificity for identification of HIC. In the replication cohort, the same criteria resulted in 90.0% sensitivity for HIC; however, lower specificity values were observed because of the inclusion of milder cases of HIC responding only to glucocorticoids. CONCLUSION The use of the 12-item criteria for HIC can better define patients with HIC with reasonable sensitivity and specificity and enables an earlier treatment start.
Collapse
Affiliation(s)
- Shirkhan Amikishiyev
- Division of Rheumatology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - M Guven Gunver
- Department of Medical Statistics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Murat Bektas
- Division of Rheumatology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sarvan Aghamuradov
- Division of Rheumatology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Burak Ince
- Division of Rheumatology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Nevzat Koca
- Division of Rheumatology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ege Sinan Torun
- Division of Rheumatology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Numune Aliyeva
- Division of Rheumatology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Selma Sari
- Division of Rheumatology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Cigdem Cetin
- Division of Rheumatology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Banu C Yalcin-Dulundu
- Division of Rheumatology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Rabia Deniz
- Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Fatih Kemik
- Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Besim Fazil Agargun
- Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ubeyde Ayse Gulseren
- Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Beliz Besisik
- Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Onur Alkan
- Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ceren Bagriacik
- Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Yavuz B Tor
- Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Naci Senkal
- Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Yunus Catma
- Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Gorkem Durak
- Department of Radiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sevim Mese
- Division of Virology and Fundamental Immunology, Department of Medical Microbiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ali Agacfidan
- Division of Virology and Fundamental Immunology, Department of Medical Microbiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Murat Kose
- Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mustafa Erelel
- Department of Chest Diseases, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - A Atahan Cagatay
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Serap Simsek-Yavuz
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sevgi Kalayoglu-Besisik
- Division of Hematology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Figen Esen
- Department of Anesthesiology and Reanimation, Intensive Care Unit, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ahmet Gül
- Division of Rheumatology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| |
Collapse
|
4
|
Dirim AB, Demir E, Guller N, Safak S, Artan AS, Oto OA, Ozluk Y, Ozturk S, Yazici H, Kalayoglu-Besisik S, Turkmen A. Efficacy of intravenous combined immunosuppression with plasmapheresis in adult patients with refractory primary focal segmental glomerulosclerosis. J Clin Apher 2022; 37:376-387. [PMID: 35535432 DOI: 10.1002/jca.21985] [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: 12/08/2021] [Revised: 04/17/2022] [Accepted: 04/18/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Primary focal segmental glomerulosclerosis (FSGS) treatment is based on immunosuppressive therapies. Since refractory disease is common, alternative methods are emerging. One of these methods is plasmapheresis with intravenous cyclosporine and corticosteroids, and it could be an option in post-transplant recurrent FSGS. We retrospectively investigated the efficacy of this combined treatment in adult patients with refractory primary FSGS. METHODS Seven refractory primary FSGS patients were included. Demographics, estimated glomerular filtration rates, serum albumin levels, urine protein/creatinine ratios, and previous treatments were evaluated. Also, complications and remission rates were assessed. RESULTS Median patient age was 23 years. Median duration of diagnosis was 2 years. Median number of plasmapheresis sessions was 14. Five of seven patients (71.4%, one complete, four partial remissions) were responders after the protocol. Changes in serum albumin levels and proteinuria after protocol were statistically significant (P = 0.018 and P = 0.018, respectively). eGFR levels did not change statistically (P = 0.753). Median follow-up duration after the treatment was 17 months. However, two patients experienced disease relapse (28.5%). End-stage kidney disease was developed in two patients. Sustained remission rate was 42.8% during follow-up (One complete and two partial remissions). Also, 42.8% of patients experienced catheter infections. Catheter-associated thrombosis that required surgery was observed in a patient. CONCLUSIONS Plasmapheresis combined with intravenous cyclosporine and corticosteroids could be an option in refractory primary FSGS. High response rates after this protocol were encouraging. However, the relapsing disease was observed after the cessation of apheresis. Also, complications of the protocol could limit the applicability.
Collapse
Affiliation(s)
- Ahmet Burak Dirim
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Erol Demir
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Nurane Guller
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Seda Safak
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ayse Serra Artan
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ozgur Akin Oto
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Yasemin Ozluk
- Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Savas Ozturk
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Halil Yazici
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sevgi Kalayoglu-Besisik
- Division of Hematology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Aydin Turkmen
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| |
Collapse
|
5
|
Kuyumcu S, Isik EG, Tiryaki TO, Has-Simsek D, Sanli Y, Buyukkaya F, Özkan ZG, Kalayoglu-Besisik S, Unal SN. Prognostic significance of 68Ga-Pentixafor PET/CT in multiple myeloma recurrence: a comparison to 18F-FDG PET/CT and laboratory results. Ann Nucl Med 2021; 35:1147-1156. [PMID: 34185263 DOI: 10.1007/s12149-021-01652-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 04/03/2021] [Accepted: 06/28/2021] [Indexed: 12/23/2022]
Abstract
PURPOSE This study investigates the prognostic value of 68Ga-Pentixafor PET/CT using PET-derived quantitative in multiple myeloma (MM) patients with suspected recurrence in comparison to 18F-FDG PET/CT and clinical data. METHODS Twenty-four MM patients with suspicion for relapse who underwent 68Ga-Pentixafor and 18F-FDG PET/CT were retrospectively evaluated. Total bone marrow glycolysis for 18F-FDG (TBMFDG) and total bone marrow uptake for 68Ga-Pentixafor PET/CT (TBMCXCR4) were calculated using whole-body metabolic tumor burden obtained by dedicated software (MIM 7.0.6). The patients were followed for 19-24 months, and the association of PET-derived quantitative data with overall survival (OS) was analyzed. RESULTS 68Ga-Pentixafor PET/CT was positive in 17 patients, of which 13 were also positive on 18F-FDG PET/CT, whereas 7 patients were negative on both scans. The positive rate of 68Ga-Pentixafor and 18F-FDG PET/CT on a patient-based approach was 70.8% and 54.1%, respectively. 68Ga-Pentixafor positivity was significantly associated with OS (p = 0.009), and 18F-FDG positivity was at the margin of statistical significance (p = 0.056). TBMCXCR4 and TBMFDG were negatively correlated with OS (r = -0.457, p = 0.025 and r = -0.617, p = 0.001, respectively). The OS was negatively correlated with beta-2-microglobulin levels (r = -0.511, p = 0.01) and CRAB score (r = -0.592, p = 0.002) as an indicator of the end-organ disease, which confirmed these results. Serum beta-2-microglobulin levels and CRAB score were also correlated with TBMCXCR4 (r = 0.442, p = 0.039 and r = 0.573, p = 0.003, respectively) and TBMFDG (r = 0.543, p = 0.009 and r = -0.424, p = 0.003, respectively). CONCLUSION 68Ga-Pentixafor PET/CT positivity is a negative prognostic factor in the survival outcome of MM patients. Complementary 68Ga-Pentixafor PET/CT has the potential to overcome 18F-FDG PET/CT limitations and helps a more precise risk stratification.
Collapse
Affiliation(s)
- Serkan Kuyumcu
- Istanbul Medical Faculty, Department of Nuclear Medicine, Istanbul, Turkey.
| | - Emine Goknur Isik
- Istanbul Medical Faculty, Department of Nuclear Medicine, Istanbul, Turkey
| | - Tarik Onur Tiryaki
- Istanbul Medical Faculty, Department of Internal Medicine, Division of Hematology, Istanbul, Turkey
| | - Duygu Has-Simsek
- Istanbul Medical Faculty, Department of Nuclear Medicine, Istanbul, Turkey
| | - Yasemin Sanli
- Istanbul Medical Faculty, Department of Nuclear Medicine, Istanbul, Turkey
| | - Fikret Buyukkaya
- Istanbul Medical Faculty, Department of Nuclear Medicine, Istanbul, Turkey
| | - Zeynep Gözde Özkan
- Istanbul Medical Faculty, Department of Nuclear Medicine, Istanbul, Turkey
| | - Sevgi Kalayoglu-Besisik
- Istanbul Medical Faculty, Department of Internal Medicine, Division of Hematology, Istanbul, Turkey
| | - Seher Nilgun Unal
- Istanbul Medical Faculty, Department of Nuclear Medicine, Istanbul, Turkey
| |
Collapse
|
6
|
Alkan O, Tiryaki TO, Kalayoglu-Besisik S. Myelomatous Pleural Effusion: A Rare Involvement in Myeloma. J Med Cases 2020; 11:55-56. [PMID: 34434362 PMCID: PMC8383523 DOI: 10.14740/jmc3428] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 02/26/2020] [Indexed: 11/11/2022] Open
Abstract
Extramedullary disease (EMD) incidence is between 7% and 18% in multiple myeloma. Overall survival of patients who develop EMD is significantly shorter than that of patients without EMD. Malignant myelomatous pleural effusions (MPEs) are rarely observed, occurring in less than 1% of cases. The diagnosis of MPE was confirmed by the detection of myeloma cells in the pleural fluid using flow cytometric analyses. We present a case of a 67-year-old male patient with IgG-kappa myelom. After a few line treatment regimens, he was admitted to hospital with back pain and blurred consciousness, and pleural effusion was detected. Pleural fluid analysis showed malignant plasma cells. It is a rare presentation of multiple myeloma, but important in diagnosis.
Collapse
Affiliation(s)
- Onur Alkan
- Department of Internal Medicine, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Tarik Onur Tiryaki
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sevgi Kalayoglu-Besisik
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| |
Collapse
|
7
|
Istemihan Z, Ozkan S, Dogan O, Yonal-Hindilerden I, Kalayoglu-Besisik S, Kalayoglu-Besısık S. Long-time overlooked blastic plasmacytoid dendritic cell neoplasm evolving into multiple organ involvement presentation. Leuk Res 2019. [DOI: 10.1016/s0145-2126(19)30315-7] [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: 11/30/2022]
|
8
|
Abatay-Sel F, Savran-Oguz F, Kalayoglu-Besisik S, Mastanzade M, Duvarci-Ogret Y, Yonal-Hindilerden I, Aydin F. Short Tandem Repeat-Polymerase Chain Reaction (STR-PCR) with Quantitative Real Time-Polymerase Chain Reaction (qRT-PCR) Method Using for Chimerism Analysis. Clin Lab 2019; 65. [PMID: 31532093 DOI: 10.7754/clin.lab.2019.190221] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Recently molecular chimerism analysis after allogeneic hematopoietic stem cell transplantation (AHSCT) has become more important. The use of quantitative chimerism methods aims to assess the kinetics of engraftment to determine graft rejection and failure or relapse of the underlying disease after AHSCT. An accurate and sensitive determination of chimerism status is mandatory after AHSCT. This study aimed to compare two chimerism methods: Multiplex Short Tandem Repeat-Polymerase Chain Reaction (STR-PCR) and quantitative Real Time-PCR (qRT-PCR). METHODS Thirty-nine blood samples at +28 day were used to extract DNA. Most patients had been diagnosed with acute leukemia (74.3 %) and other hematological diseases. For Multiplex STR-PCR method, PCR products were separated on an ABI 3130 Genetic Analyzer (Applied Biosystem, USA) and for qRT-PCR, an ABI 7500 (Applied Biosystem, USA) Plate System Real Time Analyzer was used to determine the quantification of chimerism per-centage. RESULTS Of the 39 analyzed samples, 82% concordant chimerism results were detected for both STR-PCR and qRT-PCR methods. Ten mixed chimerisms (MC) were found by qRT-PCR whereas of only 3 MC cases were detected by STR-PCR. In the discordant group of 7 by qRT-PCR, we observed Acute Graft versus Host Disease (aGVHD). Three MC cases that were detected by both STR- and qRT-PCR methods died because of relapse. CONCLUSIONS The quantitative chimerism method along with multiplex STR-PCR method is important for early detection of MC. qRT-PCR methods can be valuable options in the prevention of graft failure and assisting with fast and early treatment strategies for patients undergoing AHSCT.
Collapse
|
9
|
Demir S, Gelincik A, Coskun R, Ozkan G, Demir N, Paksoy N, Beyaz S, Colakoglu B, Kalayoglu-Besisik S, Nalcacı M, Buyukozturk S. A practical 16-day desensitization protocol in lenalidomide-induced non-immediate hypersensitivity reactions. Ann Allergy Asthma Immunol 2019; 123:394-397. [PMID: 31400463 DOI: 10.1016/j.anai.2019.07.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 07/29/2019] [Accepted: 07/31/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Desensitization in immediate-type hypersensitivity reactions (HRs) caused by chemotherapeutics is well described and standardized for many drugs. However, there are no standardized protocols in non-immediate HRs. OBJECTIVE To evaluate the effectiveness of a 16-day desensitization protocol in the non-immediate HRs induced by lenalidomide. METHODS According to our previously published slow desensitization protocol, we desensitized patients who had experienced non-immediate HRs attributable to lenalidomide. The protocol was started with the 1/100 of the daily-prescribed dose in milligrams of the culprit drug; then the doses were slowly increased to complete the procedure in 16 days. Demographic and clinical features of the patients were further appraised. RESULTS Ten patients (mean age was 64.7 ± 10.8 years; 7 male) were successfully desensitized to lenalidomide. The mean reaction time was 7.3 ± 3.9 days in the history, and the reaction types were delayed urticaria (n = 4), eczematous rash (n = 3), and maculopapular eruptions (n = 3). The desensitization was successfully completed in 16 days in 9 patients. In 1 patient, maculopapular eruptions developed on the 11th day, and the patient was treated with corticosteroids. We repeated the previous tolerated dose longer and completed with a slower dose increasement, and the targeted dose was achieved in 35 days. CONCLUSION The 16-day desensitization protocol seemed to be safe and effective in the non-immediate type drug HRs caused by lenalidomide.
Collapse
Affiliation(s)
- Semra Demir
- Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine, Turkey.
| | - Asli Gelincik
- Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine, Turkey
| | - Raif Coskun
- Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine, Turkey
| | - Gulkan Ozkan
- Hematology, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine, Turkey
| | - Nazli Demir
- Hematology, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine, Turkey
| | - Nail Paksoy
- Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine, Turkey
| | - Sengul Beyaz
- Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine, Turkey
| | - Bahauddin Colakoglu
- Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine, Turkey
| | - Sevgi Kalayoglu-Besisik
- Hematology, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine, Turkey
| | - Meliha Nalcacı
- Hematology, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine, Turkey
| | - Suna Buyukozturk
- Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine, Turkey
| |
Collapse
|
10
|
Yonal-Hindilerden I, Kalayoglu-Besisik S, Gurses-Koc N, Hindilerden F, Sargin D. Allogeneic Hematopoietic Stem Cell Transplantation for Adult Acute Lymphoblastic Leukemia: Results from a Single Center, 1993-2011. Int J Hematol Oncol Stem Cell Res 2017; 11:58-62. [PMID: 28286617 PMCID: PMC5338284] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: For adult ALL patients, the indications and appropriate timing of allogeneic hematopoietic stem cell transplantation (AHSCT) continue to be debated. The primary aim of this single-institution study was to compare the results of our adult ALL patients that had been allografted with those reported in the current literature. Subjects and Methods: This study included 53 consecutive adults with acute lymphoblastic leukemia (ALL) who underwent allogeneic hematopoietic stem cell transplantation (AHSCT) with myeloablative (92%) and reduced-intensity (8%) conditioning between 1993 and 2011. Results: Mean patient age was 27 years (SD:8.62) and donor age was 33.7 years (SD:9.47). Fourteen patients were in first remission; 21 in ≥2nd remission, 15 in relapse and 3 had primary refractory leukemia. Thirty-four, 15 and 4 patients received busulfan plus cyclophosphamide, cyclophosphamide/total body irradiation and fludarabine-based regimens, respectively. For graft-versus-host disease (GVHD) prophylaxis, cyclosporine plus methotrexate were used. Forty-six donors were related and 7 were unrelated. Thirty patients received granulocyte-colony stimulating factor (G-CSF) mobilized peripheral blood and 23 received bone marrow as stem cell source. Twenty-six patients relapsed at a mean duration of 11.3 months (SD:19.1). Forty-four patients succumbed to their disease after a mean follow-up of 13.6 months (SD:19.5). The cause of mortality was relapse (n=24; 54.5%) and transplant-related etiologies (n=20; 45.5%). The estimated five year probabilities of overall survival (OS) and progression-free survival (PFS) were 37% and 12%, respectively. Conclusion: By multivariate analyses, transplantation in first remission was the most important predictor of transplant success.
Collapse
Affiliation(s)
- Ipek Yonal-Hindilerden
- Department of Internal Medicine, Division of Hematology, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
| | - Sevgi Kalayoglu-Besisik
- Department of Internal Medicine, Division of Hematology, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
| | - Nuray Gurses-Koc
- Department of Internal Medicine, Division of Hematology, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
| | - Fehmi Hindilerden
- Hematology Clinic, Istanbul Bakırkoy Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Deniz Sargin
- Department of Internal Medicine, Division of Hematology, Istanbul Medipol University, Istanbul, Turkey
| |
Collapse
|
11
|
Yonal I, Kayar Y, Nazligul E, Yenerel MN, Kalayoglu-Besisik S. Leukemic ascites as an initial presentation of acute myelomonocytic leukemia with inversion of chromosome 16. Ann Saudi Med 2013; 33:197-8. [PMID: 23563011 PMCID: PMC6078620 DOI: 10.5144/0256-4947.2013.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Ipek Yonal
- Department of Internal Medicine, Division of Hematolgy, Istanbul, Turkey
- Correspondence: Dr. Ipek Yonal Department of Internal Medicine, Division of Hematolgy, Istanbul Universitesi Istanbul Tip Fakultesi, Ic Hastaliktari ABD, Hematolji BD Istanbul 34104 Turkey
| | - Yusuf Kayar
- Department of Internal Medicine, Division of Hematolgy, Istanbul, Turkey
| | - Esra Nazligul
- Department of Internal Medicine, Division of Hematolgy, Istanbul, Turkey
| | | | | |
Collapse
|
12
|
Yonal I, Ciftcibasi A, Gokturk S, Yenerel MN, Akyuz F, Karaca C, Demir K, Besisik F, Kalayoglu-Besisik S. Massive ascites as the initial manifestation of mantle cell lymphoma: a challenge for the gastroenterologist. Case Rep Gastroenterol 2013; 6:803-9. [PMID: 23341805 PMCID: PMC3551400 DOI: 10.1159/000346290] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Involvement of the serosa may be the presenting feature in a wide and complex variety of lymphoproliferative diseases, with differing clinical outcomes covering a spectrum of benign and malignant conditions. Effusions involving peritoneal and pericardial cavities are uncommon during the course of hematological malignancies. Obstructive and/or infiltrative tumor mass or vascular leakage due to stimulation by vascular endothelial growth factor contribute to the pathogenesis. In addition to clinical findings, cytomorphology and flow cytometric immunophenotyping of the serosal fluid yield valuable information in the differential diagnosis of lymphocytic infiltrates. Herein, we describe the case of primary mantle cell lymphoma in a 75-year-old man presenting with abdominal fullness and weight loss, suggesting a gastrointestinal pathology.
Collapse
Affiliation(s)
- Ipek Yonal
- Division of Hematology, Department of Internal Medicine, Istanbul University Medical Faculty, Istanbul, Turkey
| | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Kalayoglu-Besisik S, Yonal I, Hindilerden F, Agan M, Sargin D. Plasmacytoma of the nasolacrimal duct simulating dacryocystitis: an uncommon presentation for extramedullary relapse of multiple myeloma. Case Rep Oncol 2012; 5:119-24. [PMID: 22666199 PMCID: PMC3364047 DOI: 10.1159/000337431] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The most common site for localized forms of plasma cell neoplasms (extramedullary plasmacytoma; EMP) is the upper respiratory tract, including the oropharynx, nasal cavities, sinuses and larynx. A 50-year-old woman with a history of myeloma in complete remission after autologous stem cell transplantation complained of two weeks of epiphora of the left eye with subsequent diplopia, bloody nasal discharge and progressive swelling around the nasolacrimal sac. A solitary mass in the left sinonasal area, extending to the nasolacrimal duct (NLD) was detected on MRI, whose histopathological examination was consistent with plasmacytoma. Further clinical investigation ruled out multiple myeloma (MM). The patient underwent debulking surgery and adjuvant chemotherapy followed by local radiotherapy in an attempt to achieve complete response. Despite being a rare entity, EMP of the NLD should be considered in the differential diagnosis of epiphora and dacryocystitis. To our knowledge, this is the first case of a plasmacytoma of the NLD presenting as isolated extramedullary relapse of MM. The follow-up in EMPs should include appropriate imaging studies, a systemic workup to rule out MM.
Collapse
|
14
|
Kalayoglu-Besisik S, Oguz FS, Aydin F, Duvarci Y, Sargin D, Carin M. Tissue chimerism analysis after donor lymphocyte infusion: a case of deceptive evidence. Hematology 2008; 13:92-4. [PMID: 18616875 DOI: 10.1179/102453308x315889] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
A 31-year-old female with refractory extramedullary myeloid leukemia relapse underwent peripheral blood stem-cell transplantation from her HLA-identical brother. Hematopoietic recovery followed disappearance of the lesions. Studies three-months post-transplant showed complete chimerism (CC). Fourteen months after transplantation, the patient presented with an increasing number of extramedullary sites of biopsy-proven disease relapse (as nodular skin lesions). Bone marrow was in remission with maintenance of CC. However, tissue chimerism analysis showed full recipient-cell population. After one course of conventional dose chemotherapy followed by mobilized donor-lymphocyte infusions (DLI), a complete response was achieved. DLI continued monthly but she developed new skin lesions accompanied by multiple cervical masses. Bone marrow and tissue chimerism revealed both recipient and donor cell population. We conclude that tissue chimerism analysis after DLI may not accurately document the cell origin.
Collapse
Affiliation(s)
- Sevgi Kalayoglu-Besisik
- Department of Internal Medicine, Division of Hematology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.
| | | | | | | | | | | |
Collapse
|
15
|
Azezli A, Bayraktaroglu T, Topuz S, Kalayoglu-Besisik S. Hyperthyroidism in molar pregnancy: rapid preoperative preparation by plasmapheresis and complete improvement after evacuation. Transfus Apher Sci 2008; 36:87-9. [PMID: 17346650 DOI: 10.1016/j.transci.2006.05.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [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: 05/26/2006] [Indexed: 11/20/2022]
Abstract
Human chorionic gonadotropin bears structural homology to pituitary thyrotropin. The extremely elevated levels of human chorionic gonadotropin in patients with molar pregnancy or other trophoblastic diseases can lead to hyperthyroidism. We describe a patient with molar pregnancy who had secondary hyperthyroidism prepared rapidly by plasmapheresis for surgery. The clinical picture improved dramatically after the first plasmapheresis. Three subsequent plasmapheresis provided a 75.1% decrease in serum free T3 concentrations and 63.9% free T4 concentrations and recovery after evacuation. This is the first use of plasmapheresis in rapid preparation of a patient who had secondary hyperthyroidism due to molar pregnancy.
Collapse
Affiliation(s)
- Adil Azezli
- Division of Hematology and Division of Endocrinology, Department of Internal Medicine, Istanbul University, Capa, 34 390 Istanbul, Turkey
| | | | | | | |
Collapse
|
16
|
Saka B, Kalayoglu-Besisik S, Ozturk GB, Dogan O, Erten N. Primary Biliary Cirrhosis and IgG-kappa Type Multiple Myeloma Both Respond Well to Vincristine, Adriamycin and Dexamethasone: Is There a Pathogenic Relationship? J Formos Med Assoc 2008; 107:185-90. [DOI: 10.1016/s0929-6646(08)60133-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
17
|
Bahat G, Erten N, Saka B, Uzun S, Onur I, Kalayoglu-Besisik S, Buyukbabani N. Immunoglobulin D lambda multiple myeloma and amyloidosis with predominant soft tissue involvement. Amyloid 2007; 14:305-8. [PMID: 17968692 DOI: 10.1080/13506120701614206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Multiple myeloma (MM) is associated with amyloidosis in approximately 15% of the patients. The most frequent presenting signs of such an association are nephrotic syndrome, cardiomyopathy and peripheral neuropathy. Amyloid arthropathy is not a frequent feature. We report a patient with immunoglobulin D (IgD) lambda type MM with presenting symptoms related to mucocutaneous amyloidosis and also amyloid arthropathy. He had no clinical and laboratory involvement due to nephrotic syndrome or cardiomyopathy. IgD myeloma is a rare form of MM and therefore much of the information about the disease is derived from case reports describing patients with associated symptoms. Our case also shows an unusual organ distribution of amyloid.
Collapse
Affiliation(s)
- Gulistan Bahat
- Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
| | | | | | | | | | | | | |
Collapse
|
18
|
Bahat G, Kalayoglu-Besisik S, Ozturk S, Kilicaslan I, Tunc M, Sargin D. Inflammatory pseudotumor following hematopoietic stem cell transplantation: a new case and review of the literature. Bone Marrow Transplant 2007; 40:915-8. [PMID: 17660842 DOI: 10.1038/sj.bmt.1705784] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [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: 11/08/2022]
Abstract
Inflammatory pseudotumor (IPT) is a rare tumor that occurs in various organs and tissues. The clinical picture varies from the more frequent benign lesions to the rare malignant tumors with distant metastases. IPT associated with hematopoietic stem cell transplantation (HSCT) is rarely reported. In this article, we review the reports of IPT after HSCT and describe the first case of bladder IPT. We also review the possible factors involved in the pathogenesis. IPT might be rare but it is a potentially serious complication of HSCT. It should be considered in patients with otherwise unexplained inflammatory symptoms or signs or with any mass lesion in the post-HSCT period. A knowledge of this entity and insistence on a definitive biopsy of mass lesions in the post-HSCT period can avoid unnecessary treatment such as radical surgery, chemotherapy or radiotherapy.
Collapse
Affiliation(s)
- G Bahat
- Istanbul Faculty of Medicine, Department of Internal Medicine, Istanbul University, Istanbul, Turkey.
| | | | | | | | | | | |
Collapse
|
19
|
Kalayoglu-Besisik S, Yurci A, Yazici H, Yonal I, Sargin D. Long-Term Outcome of Nephrotic Syndrome in an Allogeneic Hematopoietic Stem Cell Recipient Without Typical Features of Graft Versus Host Disease. Transplantation 2007; 83:1407-8. [PMID: 17519800 DOI: 10.1097/01.tp.0000263333.65558.8b] [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]
|
20
|
Kalayoglu-Besisik S, Ozturk GB, Caliskan Y, Nalcaci M, Gurses N, Cin N, Ozbek U, Sargin D. Autologous stem cells collected after debulking by high dose chemotherapy in late phase chronic myeloid leukemia may improve Imatinib efficacy. Transfus Apher Sci 2007; 36:91-4. [PMID: 17222585 DOI: 10.1016/j.transci.2006.05.018] [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] [Received: 04/06/2006] [Accepted: 05/18/2006] [Indexed: 11/16/2022]
Abstract
The current curative therapeutic option for the treatment of chronic myeloid leukemia (CML) in the chronic phase is still allogeneic stem cell transplantation (SCT). For the patients who are not candidates for allogeneic SCT, Imatinib is the treatment of choice. It was found that high dose chemotherapy with autologous stem cell rescue prolongs the disease-free survival and may also restore sensitivity to interferon. Here we report the results of Imatinib treatment in three late-phase CML patients who were submitted to autologous SCT following resistance to interferon. Complete cytogenetic response and major molecular response were achieved in the three cases. Imatinib has the potential to induce late molecular remissions during the course of treatment and its effect may be optimized by a previous autologous SCT in this type of patients.
Collapse
Affiliation(s)
- Sevgi Kalayoglu-Besisik
- Istanbul University, Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Capa 34 390, Istanbul, Turkey
| | | | | | | | | | | | | | | |
Collapse
|
21
|
Kalayoglu-Besisik S, Yenerel MN, Caliskan Y, Ozturk S, Besisik F, Sargin D. Time-related changes in the incidence, severity, and clinical outcome of hepatic veno-occlusive disease in hematopoietic stem cell transplantation patients during the past 10 years. Transplant Proc 2005; 37:2285-9. [PMID: 15964400 DOI: 10.1016/j.transproceed.2005.03.025] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [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: 01/09/2005] [Indexed: 12/23/2022]
Abstract
Veno-occlusive disease (VOD) of the liver occurs in 10% to 50% of patients after hematopoietic stem cell transplantation (HSCT), ranging from a mild reversible disease to a fulminant course with a mortality rate close to 100%. We retrospectively evaluated the clinical signs, diagnosis, prognosis, therapy, and outcome of 13 hepatic VOD cases which developed after HSCT. A total of 193 consecutive patients (age: 15-62 years; median 33 years) with various hematologic diseases underwent 197 HSCT (allogeneic HSCT, n = 128; autologous HSCT, n = 69). In general, the conditioning regimen consisted of cyclophosphamide combined either with total body irradiation or busulfan. Since 2000, to reduce hepatic complications, all patients received ursodexycolic acid and discontinuation of norethisterone which inhibits ovulation. VOD diagnosed clinically was mainly managed in supportive fashion. Five patients received thrombolytic therapy (t-plasminogen activator [t-PA], n = 3; defibrotide [DF], n = 2). VOD developed in 13 of 197 cases (6.6%). All except one were in the allogeneic group who had received a busulfan-containing conditioning regimen; Ten (77%) were severe. Thirty-three of 197 (17%) cases died before day 100 with VOD as the cause in eight (24%). All of the t-PA administered patients died with significant hemorrhagic complications. DF patients improved completely, even after renal and respiratory failure, despite high total bilirubin levels. Only one patient who received DF became a long-term survivor; the other died with sepsis during the following days. The dramatic improvement with regard to VOD during DF therapy was encouraging.
Collapse
Affiliation(s)
- S Kalayoglu-Besisik
- Bone Marrow Transplantation Unit, Division of Hematology, Department of Internal Medicine, Istanbul University School of Medicine, Capa 34 390, Istanbul, Turkey
| | | | | | | | | | | |
Collapse
|
22
|
Ozbey N, Kalayoglu-Besisik S, Gul N, Bozbora A, Sencer E, Molvalilar S. Therapeutic plasmapheresis in patients with severe hyperthyroidism in whom antithyroid drugs are contraindicated. Int J Clin Pract 2004; 58:554-8. [PMID: 15311553 DOI: 10.1111/j.1368-5031.2004.00140.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Four patients with Graves' disease in whom antithyroid drugs could not be used were treated by plasmapheresis preoperatively. On admission all patients had severe hyperthyroidism. All patients were treated by beta blockers, cholestyramine and inorganic iodine before plasmapheresis. Plasmapheresis course consisted of three sessions. Removed plasma was replaced by a synthetic colloid solution and human albumin other than fresh-frozen plasma. Plasmapheresis led to decreases in serum T3 concentrations >78-40% and free T4 concentrations >69%. Near-total thyroidectomy could be performed in all patients. Although screening coagulation tests were within normal limits, patients 1 and 4 experienced more blood loss than usual during the operative procedure. Plasmapheresis could be used as an alternative therapeutic option in the preoperative management of severe hyperthyroid patients with contraindications to antithyroid drugs. However, this is an invasive procedure and patients should be followed carefully for prolonged clinic/subclinic coagulopathy due to plasma exchange.
Collapse
Affiliation(s)
- N Ozbey
- Division of Endocrinology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
| | | | | | | | | | | |
Collapse
|
23
|
Kalayoglu-Besisik S, Caliskan Y, Sargin D, Gurses N, Ozbek U. Methylenetetrahydrofolate reductase C677T polymorphism and toxicity in allogeneic hematopoietic cell transplantation. Transplantation 2004; 76:1775-7. [PMID: 14688536 DOI: 10.1097/01.tp.0000093831.63661.df] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
24
|
Beksac M, Celebi H, Sargín D, Yalcin A, Topcuoglu P, Kalayoglu-Besisik S, Beyan C, Arslan O, Ozcan M, Gurman G, Ilhan O, Akan H. Role of pretransplant interferon-alpha(IFN) treatment in the outcome of stem cell transplantation (SCT) from related donors in chronic myelogenous leukemia (CML): results from three Turkish transplant centers. Bone Marrow Transplant 2003; 31:897-904. [PMID: 12748666 DOI: 10.1038/sj.bmt.1703930] [Citation(s) in RCA: 2] [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: 11/09/2022]
Abstract
Since transplantation cannot be performed immediately after the diagnosis of chronic myelogenous leukemia (CML), interferon treatment is usually required. This study aims to analyze the effects of interferon-alpha (IFN) treatment on allogeneic stem cell transplantation (SCT) outcome. A total of 106 patients aged 16-47 years and transplanted from HLA-identical sibling donors for CML in chronic phase (CP) were evaluated. In all, 48 had received IFN-alpha for a median duration of 5 months (1-18 months) until a median of 1 month prior to transplantation. Of the patients, 50 have received bone marrow transplant (BMT) whereas 56 have received peripheral blood stem cells (PBSCT) between 1991 and 1999 in three major transplant centers in Turkey. Patient characteristics in both groups were similar. More hematological responders were present in the IFN(+) patients (P=0.0001). No difference was found in engraftment kinetics. The incidences of acute or chronic graft-versus-host disease (GVHD), relapse and graft failure were similar in all patients regardless of stem cell source. Overall survival (OS) and disease-free survival (DFS) at 2 years were similar for both IFN(+) or (-) patients following SCT. With multivariate analysis, pretransplant IFN-alpha use, stem cell source, transplant year and CD34+ cell content were not found to be risk factors for OS. In conclusion, prior IFN exposure did not impair BMT or PBSCT outcome.
Collapse
Affiliation(s)
- M Beksac
- BMT Unit, Ankara University School of Medicine, Ankara, Turkey
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Abstract
BACKGROUND Nephrotoxicity is a well-known effect of cyclosporine (CsA) that causes a reduction in glomerular filtration rate through vasoconstriction of the afferent glomerular arterioles and may result in acute renal failure. Isolated CsA-induced hyperkalemia occurring through different mechanisms is also common. However, there are only a few "case reports" addressing this phenomenon in allogeneic bone marrow transplantation patients. In this report, we propose mechanisms and methods of managing CsA-associated hyperkalemia in allogeneic transplantation. METHODS We report on four allogeneic blood stem- cell transplant cases and a review of the literature. RESULTS Four adult leukemia patients underwent allogeneic peripheral blood stem cell transplantation and received CsA as a part of their graft-versus-host disease prophylaxis. The patients developed hyperkalemia, despite adequate kidney function. CsA seemed to be the only pharmaceutical agent to which this electrolyte abnormality could be attributed. Renal tubule dysfunction and secondary hypoaldosteronism seemed to be the reasons for CsA-associated hyperkalemia. CONCLUSION This report of four cases demonstrates that CsA should be considered among the possible causes of hyperkalemia in bone marrow transplantation. There may be a need for urgent intervention depending on the severity of hyperkalemia. Monitoring of blood CsA level and dose adjustment are important for the prevention of this complication.
Collapse
Affiliation(s)
- Yasar Caliskan
- Bone Marrow Transplantation Unit, Department of Internal Medicine, Division of Hematology, Istanbul School of Medicine, CAPA 34 390, Istanbul, Turkey
| | | | | | | |
Collapse
|
26
|
Budak-Alpdogan T, Tangün Y, Kalayoglu-Besisik S, Ratip S, Akan H, Baslar Z, Soysal T, Bayik LA, Koç H. The frequency of tuberculosis in adult allogeneic stem cell transplant recipients in Turkey. Biol Blood Marrow Transplant 2001; 6:370-4. [PMID: 10917572 DOI: 10.1016/s1083-8791(00)70013-9] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In general, tuberculosis (Tb) is rarely seen in allogeneic stem cell transplant (alloSCT) recipients, but this observation has been challenged in developing countries such as Turkey, where Tb infection is more prevalent than in Europe and the US. In this retrospective study, we report on the incidence of Tb infections in 351 alloSCT recipients at 4 bone marrow transplantation units in Turkey over the last 10 years. The frequency of Tb in alloSCT recipients after allografting (5 of 351) was far greater than that in the general population (35.4 per 100,000). Of the 351 patients who underwent alloSCT, 77 who received isoniazid (INH) chemoprophylaxis for 6 months did not develop posttransplantation Tb. However, 5 of the remaining 274 patients who received no chemoprophylaxis developed Tb a median of 12 months (range, 10-47 months) after allografting. Antituberculosis therapy resulted in complete recovery in all cases. In 2 additional patients who were found to have active pulmonary Tb at the time of transplantation, alloSCT was delayed until the infections were treated. Infections of mycobacteria other than Mycobacterium tuberculosis were not observed. The number of patients who received and tolerated INH may not be sufficient for firm conclusions, but the data suggest that, in countries where Tb is prevalent, pre- and posttransplantation follow-up for Tb and the use of INH prophylaxis should be considered.
Collapse
MESH Headings
- Adolescent
- Adult
- Antitubercular Agents/administration & dosage
- Antitubercular Agents/toxicity
- Female
- Graft vs Host Disease
- Hematopoietic Stem Cell Transplantation/adverse effects
- Humans
- Isoniazid/administration & dosage
- Isoniazid/toxicity
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/complications
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy
- Leukemia, Myeloid, Acute/complications
- Leukemia, Myeloid, Acute/therapy
- Liver Diseases/etiology
- Male
- Middle Aged
- Prevalence
- Retrospective Studies
- Survival Rate
- Transplantation, Homologous/adverse effects
- Tuberculosis, Pulmonary/drug therapy
- Tuberculosis, Pulmonary/epidemiology
- Tuberculosis, Pulmonary/etiology
- Turkey/epidemiology
Collapse
Affiliation(s)
- T Budak-Alpdogan
- Bone Marrow Transplantation Unit of Istanbul School of Medicine, Istanbul University, Turkey.
| | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Yenerel MN, Budak-Alpdogan T, Kalayoglu-Besisik S, Yanasik M, Sargin D. The influence of flow cytometric gating strategy and cell preparation procedures on CD34+ cell quantification. J Hematother Stem Cell Res 2000; 9:11-2. [PMID: 10738966 DOI: 10.1089/152581600319568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|