How to manage renal masses in kidney transplant recipients? A collaborative review by the EAU-YAU kidney transplantation and renal cancer working groups

INTRODUCTION

Kidney transplant (KT) recipients have a four-times higher risk of renal malignancies compared to general population. As these patients frequently harbor bilateral or multifocal tumors, the management of renal masses is still under debate.

OBJECTIVE

To explore the current management of the native kidney masses in KT patients.

ACQUISITION OF EVIDENCE

We performed a literature search on MEDLINE/PubMed database. A number of 34 studies were included in the present review.

SYNTHESIS OF EVIDENCE

In frail patients with renal masses below 3 cm, active surveillance is a feasible alternative. Nephron-sparing surgery is not justified for masses in the native kidney. Radical nephrectomy is the standard treatment for post-transplant renal tumors of the native kidneys in KT recipients, with laparoscopic techniques leading to significantly less perioperative complication rates as compared to the open approach. Concurrent bilateral native nephrectomy at the time of transplantation can be considered in patients with renal mass and polycystic kidney disease, especially if no residual urinary output is present. Patients with localized disease and successful radical nephrectomy do not require immunosuppression adjustment. In metastatic cases, mTOR agents can ensure efficient antitumoral response, while maintaining proper immunosuppression in order to protect the graft.

CONCLUSIONS

Post-transplant renal cancer of the native kidneys is a frequent occurrence. Radical nephrectomy is most frequently performed for localized renal masses. A standardized and widely-approved screening strategy for malignancies of native renal units is yet to be implemented.

Comprehensive mastocytosis data analysis from a single center

Mastocytosis is a very rare disorder and is divided into three prognostically distinct variants by World Health Organization: Cutaneous mastocytosis (CM), systemic mastocytosis (SM), and mast cell sarcoma or localized mast cell (MC) tumors. The wide range of complaints may cause patients to consult various clinics, with resulting mis- or underdiagnosis. Therefore, cooperation between different subspecialties is of paramount importance. In this article, we have compiled 104 adult mastocytosis cases diagnosed and followed in our Hematology and other clinics. 86 (82.7%) of 104 patients had systemic mastocytosis. Osteoporosis, disease-related complications, and secondary malignancies are important topics in this group. We know that indolent form has great survival. But smoldering or aggressive mastocytosis has a poor prognosis. CM and indolent SM have a significantly better prognosis compared to aggressive SM (p < 0.001). We found that the presence of more than 25% of mast cells in the bone marrow, the presence of concomitant marrow dysplasia, and the presence of disease-related complications affect survival (p < 0.001). In addition to the WHO classification, the IPSM scoring system is indicative of the prognosis in this rare disease.

Biosimilar Rituximab (Redditux) Added to CHOP Chemotherapy for De-novo Diffuse Large B-cell Lymphoma Patients: Real-life Single Center Experience

Objective

Redditux®(RED), the biosimilar rituximab, was approved in Turkey for all indications of the original Mabthera®(MAB) in March 2018. The aim of our study was to evaluate the efficacy and safety of RED in de-novo DLBCL.

Materials and Methods

Fifty-one patients received RED combined with CHOP regimen. The median follow-up was 31 months. The historical control group included 219 patients treated with MAB-CHOP regimen and the median follow-up time was 38 months. We compared the response rates and survival outcomes of the RED- and MAB-CHOP treated cohorts.

Results

In the RED cohort, the overall response rate (ORR) at the end of the treatment protocol was 86%, with 37 CR (72.5%) and 7 PR (13.5%). In the historical MAB cohort, the overall response rate was 84%, with a CR and PR rate of 82% and 2%, respectively. The 24-month PFS rates were 73.76% (95%CI 0.59-0.84) and 85.2 (95%CI:0.79-0.90) for RED and MAB cohorts, respectively (p=0.0106). The 24-month OS rates were 78.4% (95%CI:0.64-0.87) and 81.4% (95%CI:0.75-0.86) for RED and MAB cohorts, respectively (p=0.7461). For pts with high R-IPI score; the 24-month PFS was 45.5% (95%CI:0.17-0.71) and 63% (95%CI:0.37-0.80) for RED and MAB cohorts, respectively (p=0.0711). In the RED cohort, CNS relapse was significantly increased compared to MAB cohort (10% vs 1.83%, p=0.004). Among our RED cohort, bone involvement at the time of diagnosis was a risk factor for CNS relapse (p=0.028). Thirteen pts died in the follow-up. There was not any serious adverse event causing the cessation of the drug.

Conclusion

RED has similar ORR to MAB. However, PFS rates were worse in the RED cohort. Additionally, CNS relapse ratio was a major concern for our RED cohort. Large prospective controlled studies and real-life data with longer follow-up are needed to document the non-inferiority of RED compared to MAB.

Inhibition of SUMOylation modulates the immunosuppressive microenvironment of pancreatic cancer

Objective

Pancreatic cancer (PC) is a highly aggressive disease that is poorly responsive to available immunotherapy approaches, such as checkpoint inhibitors. Post-translational protein modification (PTM) by small ubiquitin-like modifier (SUMO) is upregulated in cancer, and high expression of SUMOylation-related factors correlates with poor survival in PC. TAK-981 is a novel inhibitor of SUMOylation that has demonstrated induction of anti-tumor immune responses in preclinical models. Our hypothesis is that TAK-981 will decrease SUMOylated proteins and subsequently modulate the tumor microenvironment to increase anti-tumor immunity.

Methods

In order to recapitulate the microenvironment of human PC, a 3-dimensional organoid cell line derived from a genetically-engineered “KPC” mouse was used. Organoids were injected orthotopically into the head of the pancreas via laparotomy. Once tumors reached 5–7 mm in diameter on ultrasound imaging, mice were randomized to one of two treatment groups: Control/Vehicle versus TAK-981 (15 mg/kg) delivered daily via intraperitoneal injection. Tumors were harvested on day 14 for gene expression analysis by quantitative real time PCR (RT-qPCR).

Results

Tumor growth (Fig. 1) in the TAK-981 15 mg/KG daily group (mean + SD volume = 207 + 109 mm3) was significantly inhibited compared to the vehicle group (595 + 141 mm3, p &lt; 0.01). Immunohistochemical staining for CD 31 (Fig. 2) and Caspase 3 indicated a reduction of angiogenesis and increased apoptosis of tumor cells, consistent with the well-established roles of SUMOylation in angiogenesis and tumorigenesis. Gene expression analysis of tumor lysates showed a 26-fold increase in expression of Interferon beta (p&lt;0.05), and an almost 2-fold increase in expression of genes related to dendritic cell activation, including CD80 (p&lt;0.05) and CD86 (p=0.14) in the TAK-981 group, suggesting a modulation of the immune microenvironment.

Conclusion

Our results suggest that the inhibition of SUMOylation with TAK-981 is associated with improved local tumor control and changes in the immunosuppressive tumor microenvironment. We expect that TAK-981 will improve PC responsiveness to immunotherapy, such as with checkpoint inhibitors.

[A Case of Chronic Q Fever Endocarditis Mimicking Lymphoproliferative Disorders]

Q fever is a zoonosis caused by Coxiella burnetii. In this report, a case of chronic Q fever endocarditis with pancytopenia and hypergammaglobulinemia mimicking a lymphoproliferative disease was presented. A 39-years-old male living in Çatalca and whose family is engaged in animal husbandry admitted with the complaints of weakness and fatigue. The patient had aortic valve replacement 29 years ago and had aortic valve re-replacement, and ascending aorta grafting because of endocarditis three years ago. It was revealed that the second operation of the patient was due to possible infective endocarditis, but no definitive agent could be identified. He was evaluated for massive hepatosplenomegaly, pancytopenia, hypergammaglobulinemia, presence of M-spike and elevated β-2 microglobulin levels and was referred to our hematology clinic with a preliminary diagnosis of lymphoproliferative disease. Lymphoplasmacytic lymphoma was excluded with the result of bone marrow biopsy and he was referred to our clinic for the investigation of possible infectious etiologies. We detected hepatosplenomegaly and finger clubbing. His blood analyses were normal except for the following: leukocyte count 3800/μl, platelet count 148000/μl, gamma globulin 5.9 gr/dl, rheumatoid factor (RF) and antinuclear antibody (ANA) positivity. Chronic Q fever endocarditis was suspected and C.burnetii Phase I IgG test was found positive in 1/132071 titers. Although transesophageal echocardiography showed no lesion of endocarditis, positron emission tomography/computed tomography revealed increased fluorodeoxyglucose uptake around the prosthetic heart valve and graft. The patient was diagnosed as having Q fever endocarditis and graft infection. He refused hospitalization and was started on hydroxychloroquine and doxycycline treatment. The patient stopped taking these antibiotics by himself seven days after the diagnosis. He was admitted with a headache to another hospital and operated for an intracranial hemorrhage and died shortly after. Apart from unfamiliarity, wide range of clinical presentations of disease could also lead to delayed diagnosis. Among patients with chronic Q fever, continuous bacteremia and antigenic stimulus causes inflammatory syndrome with hepatosplenomegaly, hypergammaglobulinemia and, presence of autoantibodies which leads to misdiagnoses of rheumatologic, autoimmune or hematologic diseases Chronic Q fever should be investigated in patients with known valvulopathy and chronic hepatomegaly or splenomegaly, pancytopenia, hypergammaglobulinemia, and unexplained autoantibody positivity.

COVID-19 infection in patients with acute leukemia; Istanbul experience

Coronavirus disease 2019 (COVID-19) has led to a global pandemic that has also challenged the management of various other life-threatening conditions, such as malignant disorders. In this study, we present the clinical features and treatment outcomes of twenty-seven COVID-19 positive patients with leukemia across seven different centers in Istanbul. From March 1st to December 31st 2020, 116 patients were diagnosed with acute leukemia. Thirty-two cases with acute lymphocytic leukemia (ALL), 82 cases with acute myeloid leukemia (AML), and 2 cases with mixed phenotype acute leukemia (MPAL) were identified. Of the 27 patients with the COVID-19 infection, seven patients had ALL, 19 patients had AML and one patient had MPAL. The mortality rate was 37% among the patients with AML, whereas there were no deaths in the ALL group. The mortality rate of AML patients with the COVID-19 infection was higher compared to cases without the infection (P<0.05). We could not detect any significant difference in the ALL cohort. This study, which includes one of the largest acute leukemia series in literature proved that acute myeloid leukemia patients with the COVID-19 infection have worse outcomes than patients without the infection. The high mortality among patients with acute leukemias hospitalized with COVID-19 highlight the need for aggressive infection prevention, increased surveillance and protective isolation and even modification of the therapy, in case of minimal residual disease (MRD) negativity.

Evaluation of retinal and optic nerve vasculature by optic coherence tomography angiography in Migraine with Aura

PURPOSE

This study aimed to evaluate the retina by optic coherence tomography angiography (OCTA) in patients with migraine with aura (MA) in comparison with healthy controls.

MATERIALS AND METHODS

A total of 60 patients with MA and 56 control subjects who applied to the Ophthalmology Clinic of Dicle University between January 2020 and February 2020 were included in this study. In all patients, the vascular density (VD) of the radial peripapillary capillaries (RPCs) and optic nerve head (ONH), the VD of deep and superficial macular vascular networks, and foveal avascular zone (FAZ) were measured.

RESULTS

Patients with MA showed reduced VD measurements of the nasal and inferotemporal ONH, inferonasal RPCs, and deep macular plexus. No statistically significant difference was observed in the superficial macular VD values between the study groups. The majority of patients with MA showed hypertrophy in the deep FAZ.

CONCLUSION

There was a decrease in VD measurements in the deep macular capillary plexus, ONH, and peripapillary capillaries and hypertrophy in the deep FAZ in patients with MA. According to these results, patients with MA may have an increased risk of developing ocular and systemic vascular complications. Therefore, OCTA can be used to evaluate systemic and ocular hypoperfusion in patients with MA.

Inhibition of SUMOylation enhances responses to irreversible electroporation in pancreatic cancer

Objective

The revolutionary results of immunotherapy have not yet translated to pancreatic cancer (PC).

Irreversible electroporation (IRE) is a non-thermal ablative therapy that can generate tumor-specific immune responses, yet not sufficient to eradicate distant metastatic disease. Post-translational protein modification (PTM) by small ubiquitin-like modifier (SUMO) is involved in carcinogenesis and PD-L1 mediated immunosuppression. TAK-981 is a novel inhibitor of SUMOylation that has demonstrated induction anti-tumor immune responses in preclinical models. Our hypothesis is that TAK-981 will augment the effects of IRE in an immunocompetent orthotopic mouse model of PC.

Methods

The PC cell line (KPC4580P) was derived from an autochthonous tumor arising in a genetically engineered mouse model (KPC). The tumors were implanted orthotopically into the pancreas via laparotomy. Once tumors reached 5-7 mm in diameter, mice were randomized to one of four treatment groups: IRE alone, TAK-981 alone, IRE + TAK-981, or no treatment. IRE versus sham laparotomy (150 x 90 microsec pulses at 1500 V/cm) was performed once through second laparotomy. TAK-981 (7.5mg/kg) versus vehicle was delivered via subcutaneous injection twice weekly x four doses, starting on the day of IRE. Tumors were harvested on day 14 for flow cytometric analysis.

Results

Ultrasound was performed on days 8, 14 and 20 after initiation of treatment. Tumor growth in the IRE + TAK-981 group was significantly inhibited compared to sham-treated tumors (Fig. 1, *p=0.0002), and this effect persisted to day 20, even after treatment with TAK-981 was stopped on day 11 (p &lt; 0.01). Flow cytometry revealed a greater than 2-fold increase in CD8+ T-cells (Fig. 2a, *p &lt;0.05) and 4-fold increase in IFN-gamma+ CD8+ T-cells (Fig. 2b, *p=0.01) in tumors treated with the combination relative to sham-treated tumors.

Conclusion

Our results suggest that the combination of IRE with TAK-981 is associated with better local tumor control and a significant increase of CD8+ T-cells and IFN-gamma+ CD8+ T-cells. We expect that this combination might contribute systemic immune responses that would prevent or even eradicate distant metastasis. Given that immunosuppression mediated by PD-L1 is regulated by ubiquitination and is seen in 50% of PC tumors, targeting PTM with TAK-981 might also render PC responsive to immunotherapy with checkpoint inhibitors.

TRPV2 POLYMORPHISMS INCREASE OR REDUCE THE RISK OF TYPE 2 DIABETES - HASHIMOTO THYROIDITIS COMORBIDITY

Context

Thyroid disorders are common in diabetics and related to severe diabetic complications. TRPV2 ion channels have crucial functions in insulin secretion and glucose metabolism which have an important role in the pathophysiology of diabetes. Also, they have a significant effect on various immunological events that are involved in the HT pathophysiology.

Objective

This study aimed to investigate rs14039 and rs4792742 polymorphisms of the TRPV2 ion channels in type 2 diabetes mellitus (T2DM, n=100) Hashimoto thyroiditis (HT, n=70) and comorbid T2DM and HT (T2DM+HT, n=100) patients and control (n=100).

Design

Case-control study.

Subject and Methods

RT-PCR genotyping was used to determine rs14039 and rs4792742 polymorphisms with DNA samples of subjects and appropriate primer and probes. Besides, required biochemical analyses were performed.

Results

It was determined that the frequencies of the rs14039 GG homozygote polymorphic genotype and the G allele were significantly higher in T2DM+HT patients compared to the control (p=0.03 and p=0.01, respectively) and that especially the GG genotype increases the risk of T2DM+HT 3.046-fold (p=0.01, OR=3.046). It was detected that the GG genotype increased the risk of HT 2.54-fold (p=0.05, OR=2.541). TRPV2 rs4792742 polymorphisms reduce the risk of HT and T2DM+HT comorbidity almost by half and have a protective effect against HT and T2DM+HT.

Conclusion

The rs14039 GG genotype of the TRPV2 gene significantly increases the risks of development of T2DM+HT and HT disorders, may have a significant role in the pathophysiology of these diseases, also leading to predisposition for their development. Conversely, rs4792742 polymorphic genotypes have a strong protective effect against the HT and T2DM+HT comorbidity.

Daily life reflections of acromegaly guidelines

PURPOSE

To determine the differences in acromegaly diagnosis, treatment, and follow-up among Turkish endocrinologists, and to investigate how the published guidelines are applied in clinical practice.

METHODS

The questionnaire was formatted as an electronic survey, conducted between November and December 2015, and sent weekly for 6 weeks via e-mail to 528 endocrinologists in Turkey.

RESULTS

The questionnaire was answered by 37.4 % of endocrinologists. Insulin-like growth factor-1 and nadir growth hormone level after 75 g oral glucose tolerance test (nadir GH-OGTT) were the most commonly preferred methods for the initial diagnosis. A total of 49.5 % of the participants reported using preoperative medical therapy (MT) either routinely or on a case-to-case basis. Somatostatin analogs were the most commonly used drugs, both in pre- and postoperative MT. Disease activity following surgery was assessed in the 3rd postoperative month using IGF-1 levels. Similarly, IGF-1 monitoring was preferred in the follow-up period. Monitoring nadir GH-OGTT levels was the most commonly used method in the assessment of discordant test results. The dose titration was done at month 3 after the start of MT. Resistance to SRLs was considered after using the maximal dose for at least 6 months. Pegvisomant was generally used in second- and third-line therapy. Similarly, cabergoline was not preferred in monotherapy by the majority of participants. Radiotherapy was considered in patients with incomplete response to surgery and medical treatments.

CONCLUSIONS

Although there were subtle differences, clinical practice guidelines were usually followed among Turkish endocrinologists.

Can Positron Emission Tomography and Computed Tomography Be a Substitute for Bone Marrow Biopsy in Detection of Bone Marrow Involvement in Patients with Hodgkin's or Non-Hodgkin's Lymphoma?

Objective:

Positron emission tomography and computed tomography (PET/CT) has become an important part of staging and treatment evaluation algorithms of lymphoma. We aimed to compare the results of PET/CT with bone marrow biopsy (BMB) with respect to bone marrow involvement (BMI) in patients with Hodgkin’s lymphoma (HL) and aggressive non-Hodgkin’s lymphoma (aNHL).

Materials and Methods:

The medical files of a total of 297 patients diagnosed with HL or aNHL and followed at the hematology clinics of 3 major hospitals in İstanbul between 2008 and 2012 were screened retrospectively and 161 patients with classical HL and aNHL were included in the study. The patients were referred for PET/CT and BMB at the initial staging. BMB was performed as the reference standard for the evaluation of BMI.

Results:

There were 61 (38%) HL and 100 (62%) aNHL patients. Concordant results were revealed between PET/CT and BMB in 126 patients (78%) (52 HL, 74 aNHL), 20 with positive PET/CT and BMB results and 106 with negative PET/CT and BMB results. There were discordant results in 35 patients (9 HL, 26 aNHL), 16 of them with positive BMB and negative PET/CT results and 19 of them with negative BMB and positive PET/CT results.

Conclusion:

We observed that PET/CT is effective to detect BMI, despite it alone not being sufficient to evaluate BMI in HL and aNHL. Bone marrow trephine biopsy and PET/CT should be considered as mutually complementary methods for detection of BMI in patients with lymphoma. In suspected focal involvement, combining biopsy and PET/CT might improve staging results.

Possible relationship between the resistin gene C-420G polymorphism and colorectal cancer in a Turkish population

BACKGROUND/AIMS

In recent years, with improvements in genotyping, a possible relationship between obesity-related gene polymorphisms and colorectal cancer (CRC) has been studied. The promoter region C-420G of the resistin gene is believed to have an important role in the development of malignancy. We prospectively evaluated the possible effect of the resistin C-420G polymorphism on the risk and prognosis of CRC.

MATERIALS AND METHODS

One hundred twenty-three patients with CRC and 79 healthy individuals were included in the study. Blood samples were genotyped, and the relationship between the resistin C-420G polymorphism and demographic characteristics and tumor features was evaluated.

RESULTS

No statistically significant difference was found in genotype distribution between the patient and control groups and among patients in the means of gender, biochemical findings, and tumor characteristics (p>0.05).

CONCLUSION

The relationship between the C-420G polymorphism and various diseases has been evaluated in many studies to date. With the increased importance of obesity in etiopathogenesis, studies have focused on CRC. According to our results, the GG genotype may be associated with a decreased CRC risk. Our study is important because to our knowledge, it is the first one to be conducted in a Turkish population to date, but we believe that more patients and controls are needed to obtain statistically significant results.

A rare entity in multiple myeloma: six nerve paralysis

Ophthalmic involvement appears rarely in multiple myeloma (MM). Ophthalmic findings are mostly noted as complications caused by disease or treatment. MM-associated with 6th nerve paralysis is a rare entity. Bortezomib, one of the novel agents used to treat MM, has neurotoxic effect and may cause permanent nerve damage. Herein, we report a 50-year-old male patient with MM who developed the 6th nerve paralysis while receiving bortezomib and discuss its relevant causes.

Prenatal Diagnosis and Postnatal Follow-up of congenitally corrected transposition of the great arteries and recurrent supraventricular tachycardia

The prenatal sonographic diagnosis of congenitally corrected transposition of the great arteries (ccTGA), a rare form of congenital heart disease is very difficult. A24-year-old woman was referred to our center at 28 weeks' gestationbecause of suspected fetal cardiac anomalies. We report a case of ccTGA with supraventricular tachycardia, ventricular septal defect, pulmonary valve stenosis, tricuspid valvar displacement and moderate tricuspid regurgitation during her pregnancy. The combined presence of SVT and ccTGA are occasionally present in the literature.

Microscopic venous invasion is associated with disease free and cancer free survival in renal cell carcinoma

AIM

The aim of this study was to investigate the significance of microscopic venous invasion (MVI) as a prognostic factor for patients with renal cell carcinoma (RCC).

METHODS

The present study included 220 patients with non-metastatic RCC who underwent radical nephrectomy (RN). MVI was defined by the presence of a cancer cell in blood vessels based on microscopic examination of hematoxylin-eosin stained specimens. The impact of MVI on disease progression and survival after 37 (6-190) months of median follow-up and its correlation with known clinicopathological features were studied. Survival analyses using Kaplan-Meier and log-rank models for univariate comparisons and Cox proportional hazards model for multivariate analyses were performed.

RESULTS

MVI was found in 68 patients (30.8%), and of these, 26 (38.2%) developed a tumor recurrence and 16 (23.5%) died of cancer progression, whereas only 18 (11.8%) of the remaining 152 patients without MVI presented with disease-recurrence and 8 (5.3%) died of cancer. In the multivariate analysis, MVI (P=0.014) Fuhrman's grade (P=0.028), and sarcomatoid differentiation (SD) (P=0.01) were the factors predicted a decreased disease-free survival (DFS). Meanwhile, MVI (P=0.04) and SD (P=0.029) were also found to be predictor of cancer specific survival (CSS) with necrosis (P=0.037) in multivariate analysis.

CONCLUSION

The present study showed that MVI is associated with the vast majority of the adverse pathological features related with RCC. Furthermore, it was found to be an independent clinical prognostic factor for DFS and CSS.

Healthcare marketing on the web: moving forward toward more interactive practices

It is hard to deny the notion that the Internet has been very efficient in distributing health information to millions of individuals and has become one of the best marketing tools in healthcare. We have been witnessing so many very creative and interactive practices in this field that we can safely assume that it is now the time for e-commerce in healthcare industry. While this is true for many participants, there are also some who are concerned about using some of these new online options in the field of healthcare. Most of these concerns are derived from the questionable accuracy of the "health" information on the net. Considering the fact that the subject matter of the field is "health" we can realize that these concerns are serious and deserve an in-depth look. This paper reviews some of the most current practices in the field and provides some examples of these online options. It is hoped that the review of these examples will result in similar inquiries in the future and as those questionable options are exposed more and more, they will eventually be eliminated and replaced with the better ones.

The effects of chronic aerobic and anaerobic exercises n lymphocyte subgroups

Exercise is the strongest stress to which the body is ever exposed. The body responds to this stress through a set of physiological changes in its metabolic, hormonal and immunological systems. In this study, responses of the immune system to the long-term aerobic and anaerobic exercises have been investigated. Twenty-four sedentary male university students and officers participated in this study. Subjects were divided into two groups, each consisting of twelve people. Group-1 (age: 25.67 +/- 3.79 years, height: 174.83 +/- 5.15 cm, body mass: 72.17 +/- 8.05 kg) and Group-2 (age: 24.83 +/- 2.89 years, height: 175.3 +/- 6.68 cm, body mass: 70.67 +/- 6.15 kg). After physical examinations of the two groups, resting ECG, respiratory function tests and metabolic tests with the use of the breath by breath method were completed, and anerobic heart rates at the threshold level were determined. The first group was subjected to exercise using Monark ergometry cycles at a heart rate 10% below the threshold level for 8 weeks, 3 days a week, 30 min a day. The second group exercised at a heart rate 10% above the threshold level for 8 weeks, 3 days a week, 20 min a day. Heart rates were checked with the Polar Test during exercises. Pre-exercise (Ep) venous blood samples were taken from each group before their 1st and 24th exercises. Hb (gr), Hct (%), erythrocyte (x10(6)/microl), leukocyte (x10(6)/microl), leukocyte subpopulations (neutrophil, lymphocyte, monocyte, eosinophil, basophil %) and thrombocyte (x10(6)/microl) values were determined. CD3, CD4, CD8, CD19 and CD56 values were determined by Flow Cytometry method using monoclonal antibodies. The chronic effects of exercise were examined through a comparison of Ep blood samples at the 1st exercise with Ep blood samples at the 24th exercise. While the increase in the total leukocyte number was significant (p<0.05) in the first group, increase in the second group was found to be non-significant. When percentiles of leukocyte subpopulations were taken into consideration, changes in the first and second group were found to be non-significant. When lymphocyte subgroups were examined; in the first group a decrease in CD3 and CD4 percentiles to 7% and 12%, respectively (p<0.05) and a 65% increase (p<0.01) in the CD56 value were observed. In the second group a decrease in CD3 and CD4 percentiles to 13% and 17%, respectively (p<0.05) and a 73% increase (p<0.01) in the CD56 value were observed. The Sample-t Test and The Wilcoxon Test were used for statistical analysis.