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Yiğit Kaya S, Mutlu YG, Malkan ÜY, Mehtap Ö, Keklik Karadağ F, Korkmaz G, Elverdi T, Saydam G, Özet G, Ar MC, Melek E, Maral S, Kaynar L, Sevindik ÖG. Single agent vemurafenib or rituximab-vemurafenib combination for the treatment of relapsed/refractory hairy cell leukemia, a multicenter experience. Leuk Res 2024; 140:107495. [PMID: 38599153 DOI: 10.1016/j.leukres.2024.107495] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/07/2024] [Accepted: 03/21/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Hairy cell leukemia (HCL) is a rare mature B-cell malignancy that is primarily treated with purine analogues. However, relapse remains a significant challenge, prompting the search for alternative therapies. The BRAF V600E mutation prevalent in HCL patients provides a target for treatment with vemurafenib. PATIENTS AND METHODS This multicenter retrospective study included nine patients with relapsed/refractory (R/R) HCL from six different centers. Patient data included demographics, prior treatments, clinical outcomes, and adverse events. RESULTS Patients received different treatment regimens between centers, including vemurafenib alone or in combination with rituximab. Despite the differences in protocols, all patients achieved at least a partial response, with seven patients achieving a complete response. Adverse events were generally mild with manageable side effects. The absence of myelotoxic effects and manageable side effects make BRAF inhibitors attractive, especially for patients ineligible for purine analogues or those with severe neutropenia. CONCLUSION Single agent vemurafenib or in combination with rituximab appears to be a promising therapeutic option for R/R HCL. Further research is needed to establish standardized treatment protocols and to investigate long-term outcomes.
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Affiliation(s)
- Süreyya Yiğit Kaya
- Department of Hematology, Faculty of Medicine, Istanbul Medipol University, Turkey.
| | - Yaşa Gül Mutlu
- Department of Hematology, Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Ümit Yavuz Malkan
- Department of Hematology, Faculty of Medicine, Hacettepe University, Turkey
| | - Özgür Mehtap
- Department of Hematology, Faculty of Medicine, Kocaeli University, Turkey
| | | | - Gülten Korkmaz
- Department of Hematology, Ankara Bilkent City Hospital, Turkey
| | - Tuğrul Elverdi
- Department of Hematology, Cerrahpaşa Faculty of Medicine, Istanbul University, Turkey
| | - Güray Saydam
- Department of Hematology, Faculty of Medicine, Ege University, Turkey
| | - Gülsüm Özet
- Department of Hematology, Ankara Bilkent City Hospital, Turkey
| | - Muhlis Cem Ar
- Department of Hematology, Cerrahpaşa Faculty of Medicine, Istanbul University, Turkey
| | - Elif Melek
- Department of Hematology, Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Senem Maral
- Department of Hematology, Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Leylagül Kaynar
- Department of Hematology, Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Ömür Gökmen Sevindik
- Department of Hematology, Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey
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Firat O, Kara E, Malkan ÜY, Demirkan K, Inkaya AÇ. Tigecycline-associated hypofibrinogenemia: A single center, retrospective, controlled study. Thromb Res 2024; 236:155-160. [PMID: 38452447 DOI: 10.1016/j.thromres.2024.03.003] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/27/2024] [Accepted: 03/04/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Tigecycline-associated hypofibrinogenemia has been reported as an important adverse effect in recent years, but controlled studies minimizing confounding factors are needed. The objective of our study was to assess changes in fibrinogen levels in patients for hospitalization, comparing two antibiotic episodes (tigecycline and other) within the same patients. METHODS The retrospective, self-controlled case series study was conducted at our University Hospitals. The study compared the change in fibrinogen levels during the patient's hospitalization for tigecycline (TigePer) and another antibiotic period (OtherPer). In addition, bleeding events, bleeding risk (determined by the IMPROVE bleeding risk score), as well as 15- and 30-day mortality rates between TigePer and OtherPer were compared. RESULTS The study enrolled 50 patients with 100 episodes of antibiotic treatment. The median age (interquartile range) of the patients was 68.5 (21.5) years, and 38 % were female. As compared to OtherPer, TigePer had a statistically significant reduction in fibrinogen levels (p < 0.001), with a hypofibrinogenemia rate of 40 % in TigePer as compared to 2 % in OtherPer (p < 0.001). TigePer demonstrated a significantly higher 15-day mortality rate (p = 0.006). No significant differences were observed between the two periods in terms of bleeding risk, rate of bleeding events, and 30-day mortality rate (p > 0.05). CONCLUSION Hypofibrinogenemia and other coagulopathies, without associated bleeding events, are more frequently observed in patients receiving tigecycline. Therefore, it is crucial for clinicians to monitor fibrinogen levels during tigecycline use.
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Affiliation(s)
- Oğuzhan Firat
- Hacettepe University, Faculty of Pharmacy, Department of Clinical Pharmacy, Ankara, Turkiye.
| | - Emre Kara
- Hacettepe University, Faculty of Pharmacy, Department of Clinical Pharmacy, Ankara, Turkiye
| | - Ümit Yavuz Malkan
- Hacettepe University Faculty of Medicine, Department of Internal Diseases, Hematology Subdivision, Ankara, Turkiye
| | - Kutay Demirkan
- Hacettepe University, Faculty of Pharmacy, Department of Clinical Pharmacy, Ankara, Turkiye.
| | - Ahmet Çağkan Inkaya
- Hacettepe University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkiye
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Göker H, Çınar OE, Demiroğlu H, Malkan ÜY, Aladağ Karakulak E, Büyükaşık Y. Venetoclax and Azacitidine Treatment in Relapsed Acute Myeloid Leukemia after Hematopoietic Stem Cell Transplantation: A Cohort Study in the Real-World Setting of a Tertiary Center. Turk J Haematol 2023; 40:213-215. [PMID: 37314288 PMCID: PMC10476247 DOI: 10.4274/tjh.galenos.2023.2023.0089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/23/2023] [Indexed: 09/01/2023] Open
Affiliation(s)
- Hakan Göker
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Türkiye
| | - Olgu Erkin Çınar
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Türkiye
| | - Haluk Demiroğlu
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Türkiye
| | - Ümit Yavuz Malkan
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Türkiye
| | - Elifcan Aladağ Karakulak
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Türkiye
| | - Yahya Büyükaşık
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Türkiye
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Göker H, Çınar OE, Demiroğlu H, Malkan ÜY, Aladağ Karakulak E, Büyükaşık Y. Venetoclax and Azacitidine Treatment in Relapsed Acute Myeloid Leukemia After Hematopoietic Stem Cell Transplantation: A Cohort Study in a Tertiary Center Real-World Setting. Turk J Haematol 2023. [PMID: 37314288 DOI: 10.4274/tjh.galenos.2023.2023-0089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Affiliation(s)
- Hakan Göker
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Türkiye
| | - Olgu Erkin Çınar
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Türkiye
| | - Haluk Demiroğlu
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Türkiye
| | - Ümit Yavuz Malkan
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Türkiye
| | - Elifcan Aladağ Karakulak
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Türkiye
| | - Yahya Büyükaşık
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Türkiye
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Malkan ÜY, Göker H, Demiroğlu H, Tekin F, Akdemir NB, Karakulak EA, Sayınalp N, Haznedaroğlu İC, Özcebe Oİ, Büyükaşık Y. A single-center experience of haploidentical stem cell transplantation in hematological malignancies. Turk J Med Sci 2023; 53:352-359. [PMID: 36945951 PMCID: PMC10388032 DOI: 10.55730/1300-0144.5591] [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: 08/05/2022] [Accepted: 11/22/2022] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND Since well-designed prospective comparative trials are lacking, haploidentical hematopoietic stem cell transplantations approach should be based on the expertise of a particular center. In this study, we aimed to report the results and outcomes of patients who underwent haploidentical hematopoietic stem cell transplantation. METHODS : Thirty-nine patients who underwent transplantation in our clinic between 2015 and 2022 were retrospectively analyzed. Primary end point of this study is to find out the survival rates of the patients. RESULTS The overall survival of patients was 29.9 ± 4.9 months. The disease-free survival of the patients was 37.8 ± 5.7 months. The 3-year overall survival rate of the patients was %50 and the 3-year disease-free survival rate of the patients was %53. Nineteen patients were nonsurvivors among a total of 39 patients. Busulfan-fludarabine-thiotepa was the most frequently used conditioning regimen for transplantation. Busulfan-fludarabin-antithymocyte globulin regimen is the second preferred conditioning regimen. Cyclosporine- cyclophosphamide-mycophenolate mofetil was the most widely used graft-versus-host disease prophylaxis regimen. Sixteen patients had graft-versus-host disease, 28% of the patients had acute graft-versus-host disease, and 13% had chronic graft-versus-host disease. Gastrointestinal system consists of the most involved organs in graft-versus-host disease since 15% of the patients had gastrointestinal graft-versus-host disease. First-degree relatives (parent/child) were the most frequent donor source for haploidentical hematopoietic stem cell transplantation. Sepsis was the most frequent reason of death among transplant patients. DISCUSSION In our center, we prefer to use high dose posttransplantation cyclophosphamide after haploidentical hematopoietic stem cell transplantation for graft-versus-host disease prophylaxis. With this approach, our center's overall survival and disease-free survival rates are comparable and compatible with the literature findings.
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Affiliation(s)
- Ümit Yavuz Malkan
- Department of Hematology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Hakan Göker
- Department of Hematology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Haluk Demiroğlu
- Department of Hematology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Fatma Tekin
- Department of Hematology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Nadire Buket Akdemir
- Department of Hematology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | | | - Nilgün Sayınalp
- Department of Hematology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | | | - Osman İlhami Özcebe
- Department of Hematology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Yahya Büyükaşık
- Department of Hematology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Çınar OE, Erdoğdu B, Karadeniz M, Ünal S, Malkan ÜY, Göker H, Haznedaroğlu İC. Comment on Zamfir et al. Hematologic Malignancies Diagnosed in the Context of the mRNA COVID-19 Vaccination Campaign: A Report of Two Cases. Medicina 2022, 58, 874. Medicina (B Aires) 2022; 58:medicina58111575. [PMID: 36363532 PMCID: PMC9696869 DOI: 10.3390/medicina58111575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 08/23/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022] Open
Abstract
The SARS-CoV-2 spike protein mRNA-based vaccines have prevented countless mortality and morbidity, and have an excellent risk/benefit ratio. However, various adverse events may rarely occur after the BNT162b2 vaccine, like any other medical intervention. The COVID-19 itself and the spike protein produced endogenously by mRNA vaccines may have immunological, microenvironmental, prothrombotic, and neoplastic effects. As a contribution to the published report, we would like to share our experience regarding four cases in which myeloid neoplasms emerged following the vaccination. Conclusions: There is no doubt that vaccination could continue along the lines of established universal recommendations. Meanwhile, all hematological adverse events must be closely monitored and reported. Further efforts should be focused on the probable pathobiological mechanisms and causalities of spike protein-related toxicity and clonal myeloid disorders.
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Şendur SN, Özmen F, Oğuz SH, İremli BG, Malkan ÜY, Gürlek A, Erbas T, Ünlütürk U. Association of Human Leukocyte Antigen Genotypes with Severe Acute Respiratory Syndrome Coronavirus 2 Vaccine-Induced Subacute Thyroiditis. Thyroid 2022; 32:640-647. [PMID: 35387473 DOI: 10.1089/thy.2022.0010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Despite mass vaccination, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine-induced subacute thyroiditis (SAT) is rarely seen as a complication. The reason why some individuals are susceptible to developing vaccine-induced SAT is not known. SAT develops in genetically predisposed individuals who carry specific human leukocyte antigen (HLA) haplotypes. It is unknown whether specific HLA alleles are associated with SARS-CoV-2 vaccine-induced SAT. Objective: This study compared the HLA profiles of patients with SARS-CoV-2 vaccine-induced SAT to controls, to assess whether there is an association between specific HLA genotypes and development of SAT. The relationship between HLA genotypes and the clinical course of SARS-CoV-2 vaccine-induced SAT was also evaluated. Methods: A case-control study was conducted in a Turkish tertiary care center. Fourteen patients with SARS-CoV-2 vaccine-induced SAT and 100 healthy controls were included. HLA-A, HLA-B, HLA-C, HLA-DQB1, and HLA-DRB1 frequencies were analyzed by next-generation sequencing. Results: The frequencies of HLA-B*35 and HLA-C*04 alleles were significantly higher in SARS-CoV-2 vaccine-induced SAT cohort when compared with controls (HLA-B*35: 13 [93%] vs. 40 [40%], p < 0.001; HLA-C*04: 13 [93%] vs. 43 [43%], p < 0.001, respectively). More severe thyrotoxicosis was seen in patients having HLA-B*35 and HLA-C*04 homozygous alleles (free thyroxine: 4.47 ng/dL [3.77-5.18] vs. 1.41 ng/dL [1.22-2.63], p = 0.048). Inflammation tended to be more severe in homozygous patients (C-reactive protein: 28.2 mg/dL [13.6-42.9] vs. 4.8 [1.2-10.5], p = 0.07). Conclusions: The frequencies of HLA-B*35 and HLA-C*04 alleles were higher in SARS-CoV-2 vaccine-induced SAT compared with controls. Homozygosity for HLA-B*35 and HLA-C*04 was associated with thyrotoxicosis and a greater inflammatory reaction. Our findings should be confirmed in studies of other populations.
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Affiliation(s)
- Süleyman Nahit Şendur
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Füsun Özmen
- Department of Basic Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Seda Hanife Oğuz
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Burçin Gönül İremli
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Ümit Yavuz Malkan
- Division of Hematology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Alper Gürlek
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Tomris Erbas
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Uğur Ünlütürk
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
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Çınar OE, Göker H, Fidan K, Aydın Ö, Pashayev T, Malkan ÜY, Velet M, Büyükaşık Y, Aksu S, Özcebe Oİ, Haznedaroğlu İC, Sayınalp N, Vural F, Turgut M, Ünal A, Demiroğlu H. Prophylactic Central Nervous System Irradiation Is Not Indispensable In Adult Patients With Acute Lymphoblastic Leukemia: A Multi-Center Retrospective Cohort Study. Turk J Haematol 2022; 39:152-159. [PMID: 35445593 PMCID: PMC9421337 DOI: 10.4274/tjh.galenos.2022.2021.0680] [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] [Indexed: 12/01/2022] Open
Abstract
Objective: Studies comparing the efficacy and safety of prophylactic regimens for central nervous system (CNS) involvement in acute lymphoblastic leukemia (ALL) are scarce in adults. This multicenter retrospective study aimed to compare the efficacy of prophylactic regimens with and without CNS irradiation on the development of CNS relapse during follow-up. Materials and Methods: This was a multicenter comparative cohort study. A total of 203 patients were included from four tertiary care centers in Turkey. Patients were divided into two groups according to whether they received CNS irradiation or not. The groups were analyzed retrospectively regarding patient and disease characteristics, with the main focus being CNS relapse. Results: While 105 patients received chemotherapy-based prophylaxis, 98 patients received additional CNS irradiation. These groups were statistically comparable in terms of demographic characteristics and risk factors for CNS involvement. In the irradiation group, patients were younger and had more stem cell transplants. In a median of 23.8 (11.1-62.4) months, there was no difference between the two groups regarding CNS relapse-free survival (log-rank p=0.787). Conclusion: Craniospinal irradiation may not be indispensable for every adult patient with ALL, similarly to pediatric patients. It is crucial to avoid the long-term toxicities of radiation, especially in patients with long life expectancy. Craniospinal irradiation may be reserved for therapeutic use in cases of CNS relapse and prophylaxis for some high-risk patients.
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Affiliation(s)
| | - Hakan Göker
- Hacettepe University, Division of Hematology, Turkey
| | - Kemal Fidan
- Erciyes University, Division of Hematology, Turkey
| | - Öznur Aydın
- Ondokuz Mayıs University, Division of Hematology, Turkey
| | | | | | - Mustafa Velet
- Hacettepe University, Division of Hematology, Turkey
| | | | - Salih Aksu
- Hacettepe University, Division of Hematology, Turkey
| | | | | | | | - Filiz Vural
- Ege University, Division of Hematology, Turkey
| | - Mehmet Turgut
- Ondokuz Mayıs University, Division of Hematology, Turkey
| | - Ali Ünal
- Erciyes University, Division of Hematology, Turkey
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Türk S, Türk C, Malkan ÜY, Temirci ES, Peker MÇ, Haznedaroğlu İC. Current community transmission and future perspectives on the COVID-19 process. Turk J Med Sci 2021; 51:1001-1011. [PMID: 33705636 DOI: 10.3906/sag-2012-310] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 03/02/2021] [Indexed: 11/03/2022] Open
Abstract
Background/aim COVID-19 syndrome due to the SARS-CoV-2 virus is a currently challenging situation ongoing worldwide. Since the current pandemic of the SARS-CoV-2 virus is a great concern for everybody in the World, the frequently asked question is how and when the COVID-19 process will be concluded. The aim of this paper is to propose hypotheses in order to answer this essential question. As recently demonstrated, SARS-CoV-2 RNAs can be reverse-transcribed and integrated into the human genome. Our main hypothesis is that the ultimate aim of the SARS-CoV-2 virus is the incorporation to human genome and being an element of the intestinal virobiota. Materials and methods We propose that the SARS-CoV-2 genomic incorporation to be a part of human virobiota is essentially based on three pathobiological phases which are called as the ‘induction’, ‘consolidation’, and ‘maintenance phases’. The phase of ‘recurrence’ complicates any of these three disease phases based on the viral load, exposure time, and more contagious strains and/or mutants. We have performed the ‘random walk model’ in order to predict the community transmission kinetics of the virus. Results Chimerism-mediated immunotherapy at the individual and community level with the help of vaccination seems to be the only option for ending the COVID-19 process. After the integration of SARS-CoV-2 virus into the human genome via the induction, consolidation, and maintenance phases as an element of intestinal virobiota, the chimerism would be concluded. The ‘viral load’, the ‘genomic strain of the SARS-CoV-2’, and ‘host immune reaction against the SARS-CoV-2’ are the hallmarks of this long journey. Conclusion Elucidation of the functional viral dynamics will be helpful for disease management at the individual- and community- based long-term management strategies.
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Affiliation(s)
- Seyhan Türk
- Department of Biochemistry, Faculty of Pharmacy, Hacettepe University, Ankara, Turkey
| | - Can Türk
- Department of Medical Microbiology, Faculty of Medicine, Lokman Hekim University, Ankara, Turkey
| | - Ümit Yavuz Malkan
- Department of Hematology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Elif Sena Temirci
- Department of Molecular Biology and Genetics, Faculty of Science, Bilkent University, Ankara, Turkey
| | - Mustafa Çağrı Peker
- Department of Economics, Faculty of Economic and Administrative Sciences, Hacettepe University, Ankara, Turkey
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Karataş A, Malkan ÜY, Velet M, Demiroğlu H, Büyükaşık Y, Telli Dizman G, Inkaya AÇ, Erdoğdu B, Çınar OE, Aladağ E, Aksu S, Haznedaroğlu İC, Özcebe O, Sayınalp N, Göker H. The clinical course of COVID-19 in hematopoietic stem cell transplantation (HSCT) recipients. Turk J Med Sci 2021; 51:1647-1652. [PMID: 33878857 PMCID: PMC8569779 DOI: 10.3906/sag-2103-72] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 04/18/2021] [Indexed: 11/09/2022] Open
Abstract
Background/aim The disease caused by SARS-CoV-2 was named as COVID-19. There is as yet insufficient information about the effects of HSCT on the clinical course of COVID-19. In the present study, we aimed to investigate the clinical course of COVID-19 in patients who had undergone HSCT. Materials and methods We analyzed baseline characteristics, clinical course and findings of COVID-19, hospitalization and death rates, overall survival, and case fatality rates of HSCT recipients diagnosed with COVID-19 retrospectively. Results 57.6% of the patients underwent AHSCT, and 42.4% underwent allo-HSCT. 60.6%, 27.3%, and 12.1% of the patients had mild, moderate, and severe COVID-19 or critical illness, respectively. Overall, 45.5% were hospitalized, 12.1% required intensive care, and 9.1% necessitated invasive mechanical ventilation. The total CFR was 9.1% in HSCT recipients, 22.2% in patients with active hematologic malignancy, and 4.2% in patients without active hematologic malignancy. Conclusion It can be concluded that mortality of HSCT recipients is lower in patients whose primary disease is in remission compared to ones that are not in remission. Further studies with larger group patients are needed in order to delineate the effects of COVID-19 on HSCT patients.
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Affiliation(s)
- Ayşe Karataş
- Department of Internal Medicine, Division of Hematology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ümit Yavuz Malkan
- Department of Internal Medicine, Division of Hematology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Mustafa Velet
- Department of Internal Medicine, Division of Hematology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Haluk Demiroğlu
- Department of Internal Medicine, Division of Hematology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Yahya Büyükaşık
- Department of Internal Medicine, Division of Hematology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Gülçin Telli Dizman
- Department of Infectious Diseases, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ahmet Çağkan Inkaya
- Department of Internal Medicine, Division of Hematology, Faculty of Medicine, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Batuhan Erdoğdu
- Department of Internal Medicine, Division of Hematology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Olgu Erkin Çınar
- Department of Internal Medicine, Division of Hematology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Elifcan Aladağ
- Department of Infectious Diseases, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Salih Aksu
- Department of Internal Medicine, Division of Hematology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | | | - Osman Özcebe
- Department of Internal Medicine, Division of Hematology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Nilgün Sayınalp
- Department of Internal Medicine, Division of Hematology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Hakan Göker
- Department of Internal Medicine, Division of Hematology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Çiftçiler R, Göker H, Demiroğlu H, Aksu S, Sayınalp N, Haznedaroğlu İC, Malkan ÜY, Büyükaşık Y, Özcebe O. Evaluation of the Survival Outcomes of Multiple Myeloma Patients According to Their Plasmacytoma Presentation at Diagnosis. Turk J Haematol 2019; 37:256-262. [PMID: 31833716 PMCID: PMC7702647 DOI: 10.4274/tjh.galenos.2019.2019.0061] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: Multiple myeloma (MM) associated with extramedullary (EM) plasmacytoma has a poor therapeutic response and poor outcomes when treated with conventional chemotherapy. EM plasmacytoma is divided into two groups: the first group comprises tumors that are extending directly from osteolytic bone lesions (EM-B, bone-related), while the second results from plasmacytoma infiltration into soft tissues with no relationship to the bone (EM-S, soft tissue-related). This study aimed to compare the general characteristics and survival outcomes of transplant-eligible MM patients who had EM-S or EM-B and MM patients who did not have plasmacytoma at the time of diagnosis. Materials and Methods: This study was performed in a retrospective manner. The MM patients who were treated at our tertiary care center between January 2003 and January 2017 were evaluated retrospectively for the presence of plasmacytoma at diagnosis. Results: There were 141 (78.3%) MM patients who did not have plasmacytoma, 22 (12.2%) MM patients who had EM-B, and 17 (9.4%) MM patients who had EM-S at the time of diagnosis in this study. The 5-year overall survival was 63% in patients who had bone EM-B, 63% in patients who had EM-S, and 80% in patients who did not have plasmacytoma (p=0.02). The 5-year disease-free survival was 47% in patients who had EM-B, 35% in patients who had EM-S, and 54% in MM patients who did not have plasmacytoma (p=0.15). Conclusion: These findings lead us to suggest that MM patients with EM plasmacytoma at the time of diagnosis have poorer prognosis than patients without plasmacytoma, even if autologous stem cell transplantation is performed. The presence of EM involvement negatively affects survival outcomes.
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Affiliation(s)
- Rafiye Çiftçiler
- Hacettepe University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Hakan Göker
- Hacettepe University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Haluk Demiroğlu
- Hacettepe University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Salih Aksu
- Hacettepe University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Nilgün Sayınalp
- Hacettepe University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | | | - Ümit Yavuz Malkan
- University of Health Sciences Turkey, Dışkapı Training and Research Hospital, Clinic of Hematology, Ankara, Turkey
| | - Yahya Büyükaşık
- Hacettepe University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Osman Özcebe
- Hacettepe University Faculty of Medicine, Department of Hematology, Ankara, Turkey
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12
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Çekdemir D, Güvenç S, Özdemirkıran F, Eser A, Toptaş T, Özkocaman V, Haydaroğlu Şahin H, Ermiş Turak E, Esen R, Cömert M, Sadri S, Aslaner M, Uncu Ulu B, Karakuş A, Bapur DS, Alacacıoğlu İ, Aydın D, Tekinalp A, Namdaroğlu S, Ceran F, Tarkun P, Kiper D, Çetiner M, Yenerel M, Demir AM, Yılmaz G, Terzi H, Atilla E, Malkan ÜY, Acar K, Öztürk E, Tombak A, Sunu C, Salim O, Alayvaz N, Sayan Ö, Ozan Ü, Ayer M, Gökgöz Z, Andıç N, Kızılkılıç E, Noyan F, Özen M, Pepedil Tanrıkulu F, Alanoğlu G, Özkan HA, Aslan V, Çetin G, Akyol Erikçi A, Deveci B, Ersoy Dursun F, Dermenci H, Aytan P, Gündüz M, Karakuş V, Özlü C, Demircioğlu S, Akay Yanar OM, Özatlı D, Ündar L, Tiftik EN, Türköz Sucak AG, Haznedaroğlu İ, Özcan M, Şencan M, Tombuloğlu M, Özet G, Bilgir O, Turgut B, Özcan MA, Payzın KB, Sönmez M, Ayyıldız O, Dal MS, Ertop Ş, Turgut M, Soysal T, Kaya E, Ünal A, Pehlivan M, Atagündüz I, Tuğlular Fıratlı T, Saydam G, Diz Küçükkaya R. A Multi-Center Study on the Efficacy of Eltrombopag in Management of Refractory Chronic Immune Thrombocytopenia: A Real-Life Experience. Turk J Haematol 2019; 36. [PMID: 31327186 PMCID: PMC6863031 DOI: 10.4274/tjh.galenos.2018.0307] [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: 11/28/2022] Open
Abstract
OBJECTIVE The aim of the present study was to evaluate the efficacy and safety of eltrombopag, an oral thrombopoietin receptor agonist, in patients with chronic immune thrombocytopenia (ITP). MATERIALS AND METHODS A total of 285 chronic ITP patients (187 women, 65.6%; 98 men, 34.4%) followed in 55 centers were enrolled in this retrospective cohort. Response to treatment was assessed according to platelet count (/mm3) and defined as complete (platelet count of >100,000/mm3), partial (30,000-100,000/mm3 or doubling of platelet count after treatment), or unresponsive (<30,000/mm3). Clinical findings, descriptive features, response to treatment, and side effects were recorded. Correlations between descriptive, clinical, and hematological parameters were analyzed. RESULTS The median age at diagnosis was 43.9±20.6 (range: 3-95) years and the duration of follow-up was 18.0±6.4 (range: 6-28.2) months. Overall response rate was 86.7% (n=247). Complete and partial responses were observed in 182 (63.8%) and 65 (22.8%) patients, respectively. Thirty-eight patients (13.4%) did not respond to eltrombopag treatment. For patients above 60 years old (n=68), overall response rate was 89.7% (n=61), and for those above 80 years old (n=12), overall response rate was 83% (n=10). Considering thrombocyte count before treatment, eltrombopag significantly increased platelet count at the 1st, 2nd, 3rd, 4th, and 8th weeks of treatment. As the time required for partial or complete response increased, response to treatment was significantly reduced. The time to reach the maximum platelet levels after treatment was quite variable (1-202 weeks). Notably, the higher the maximum platelet count after eltrombopag treatment, the more likely that side effects would occur. The most common side effects were headache (21.6%), weakness (13.7%), hepatotoxicity (11.8%), and thrombosis (5.9%). CONCLUSION Results of the current study imply that eltrombopag is an effective therapeutic option even in elderly patients with chronic ITP. However, patients must be closely monitored for response and side effects during treatment. Since both response and side effects may be variable throughout the follow-up period, patients should be evaluated dynamically, especially in terms of thrombotic risk factors.
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Affiliation(s)
- Demet Çekdemir
- Anadolu Medical Center, Bone Marrow Transplantation Center, Department of Hematology, Kocaeli, Turkey,* Address for Correspondence: Anadolu Medical Center, Bone Marrow Transplantation Center, Department of Hematology, Kocaeli, Turkey Phone: +90 542 484 87 47 E-mail:
| | - Serkan Güvenç
- Yeni Yüzyıl University Gaziosmanpaşa Hospital, Department of Hematology, İstanbul, Turkey
| | - Füsun Özdemirkıran
- İzmir Atatürk Training and Research Hospital, Clinic of Hematology, İzmir, Turkey
| | - Ali Eser
- Marmara University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
| | - Tayfur Toptaş
- Marmara University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
| | - Vildan Özkocaman
- Uludağ University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Bursa, Turkey
| | - Handan Haydaroğlu Şahin
- Gaziantep University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Gaziantep, Turkey
| | - Esra Ermiş Turak
- Erciyes University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Kayseri, Turkey
| | - Ramazan Esen
- Van Yüzüncü Yıl University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Van, Turkey
| | - Melda Cömert
- İnönü University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Malatya, Turkey
| | - Sevil Sadri
- İstanbul University-Cerrahpaşa Cerrahpaşa Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
| | - Müzeyyen Aslaner
- Bülent Ecevit University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Zonguldak, Turkey
| | - Bahar Uncu Ulu
- Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Clinic of Hematology, Ankara, Turkey
| | - Abdullah Karakuş
- Dicle University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Diyarbakır, Turkey
| | - Derya Selim Bapur
- Karadeniz Teknik University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Trabzon, Turkey
| | - İnci Alacacıoğlu
- Dokuz Eylül University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İzmir, Turkey
| | - Demet Aydın
- Okmeydanı Training and Research Hospital, Clinic of Hematology, İstanbul, Turkey
| | - Atakan Tekinalp
- Namık Kemal University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Tekirdağ, Turkey
| | - Sinem Namdaroğlu
- İzmir Bozyaka Training and Research Hospital, Clinic of Hematology, İzmir, Turkey
| | - Funda Ceran
- Ankara Numune Training and Research Hospital, Clinic of Hematology, Ankara, Turkey
| | - Pınar Tarkun
- Kocaeli University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Kocaeli, Turkey
| | - Demet Kiper
- Ege University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İzmir, Turkey
| | - Mustafa Çetiner
- Koç University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
| | - Mustafa Yenerel
- İstanbul University İstanbul Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
| | - Ahmet Muzaffer Demir
- Trakya University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Edirne, Turkey
| | - Güven Yılmaz
- Dr. Lütfi Kırdar Kartal Training and Research Hospital, Clinic of Hematology, İstanbul, Turkey
| | - Hatice Terzi
- Cumhuriyet University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Sivas, Turkey
| | - Erden Atilla
- Ankara University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Turkey
| | - Ümit Yavuz Malkan
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Turkey
| | - Kadir Acar
- Gazi University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Turkey
| | - Erman Öztürk
- Koç University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
| | - Anıl Tombak
- Mersin University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Mersin, Turkey
| | - Cenk Sunu
- Sakarya University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Sakarya, Turkey
| | - Ozan Salim
- Akdeniz University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Antalya, Turkey
| | - Nevin Alayvaz
- Ondokuz Mayıs University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Samsun, Turkey
| | - Özkan Sayan
- Medicana Çamlıca Hospital, Clinic of Hematology, İstanbul, Turkey
| | - Ülkü Ozan
- Medical Park Hospital, Clinic of Hematology, Bursa, Turkey
| | - Mesut Ayer
- Haseki Training and Research Hospital, Clinic of Hematology, İstanbul, Turkey
| | - Zafer Gökgöz
- Medicana International Ankara Hospital, Clinic of Hematology, Ankara, Turkey
| | - Neslihan Andıç
- Eskişehir Osmangazi University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Eskişehir, Turkey
| | - Ebru Kızılkılıç
- Acıbadem Kozyatağı Hospital, Clinic of Hematology, İstanbul, Turkey
| | - Figen Noyan
- Başkent University İstanbul Hospital, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
| | - Mehmet Özen
- Tokat Gaziosmanpaşa University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Tokat, Turkey
| | | | - Güçhan Alanoğlu
- Süleyman Demirel University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Isparta, Turkey
| | - Hasan Atilla Özkan
- Yeditepe University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
| | - Vahap Aslan
- Ümit Hospital, Clinic of Hematology, Eskişehir, Turkey
| | - Güven Çetin
- Bezmialem Vakıf University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
| | - Alev Akyol Erikçi
- İstanbul Yeni Yüzyıl University Gaziosmanpaşa Hospital Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
| | - Burak Deveci
- Medstar Antalya Hospital, Clinic of Hematology, Antalya, Turkey
| | - Fadime Ersoy Dursun
- Göztepe Training and Research Hospital, Clinic of Hematology, İstanbul, Turkey
| | - Hasan Dermenci
- Haydarpaşa Numune Training and Research Hospital, Clinic of Hematology, İstanbul, Turkey
| | - Pelin Aytan
- Başkent University Training and Research Hospital, Bone Marrow and Stem Cell Transplantation Center, Department of Hematology, Adana, Turkey
| | - Mehmet Gündüz
- Atatürk Training and Research Hospital, Clinic of Hematology, Ankara, Turkey
| | - Volkan Karakuş
- Muğla Sıtkı Koçman University Training and Research Hospital, Department of Hematology, Muğla, Turkey
| | - Can Özlü
- Ministry of Health Erzurum Regional Training and Research Hospital, Clinic of Hematology, Erzurum, Turkey
| | - Sinan Demircioğlu
- Van Yüzüncü Yıl University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Van, Turkey
| | - Olga Meltem Akay Yanar
- Eskişehir Osmangazi University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Eskişehir, Turkey
| | - Düzgün Özatlı
- Ondokuz Mayıs University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Samsun, Turkey
| | - Levent Ündar
- Akdeniz University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Antalya, Turkey
| | - Eyüp Naci Tiftik
- Mersin University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Mersin, Turkey
| | - Ayhan Gülsan Türköz Sucak
- Gazi University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Turkey
| | - İbrahim Haznedaroğlu
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Turkey
| | - Muhit Özcan
- Ankara University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Turkey
| | - Mehmet Şencan
- Cumhuriyet University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Sivas, Turkey
| | - Murat Tombuloğlu
- Ege University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İzmir, Turkey
| | - Gülsüm Özet
- Ankara Numune Training and Research Hospital, Clinic of Hematology, Ankara, Turkey
| | - Oktay Bilgir
- İzmir Bozyaka Training and Research Hospital, Clinic of Hematology, İzmir, Turkey
| | - Burhan Turgut
- Namık Kemal University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Tekirdağ, Turkey
| | - Mehmet Ali Özcan
- Dokuz Eylül University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İzmir, Turkey
| | - Kadriye Bahriye Payzın
- Yeni Yüzyıl University Gaziosmanpaşa Hospital, Department of Hematology, İstanbul, Turkey
| | - Mehmet Sönmez
- Karadeniz Teknik University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Trabzon, Turkey
| | - Orhan Ayyıldız
- Dicle University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Diyarbakır, Turkey
| | - Mehmet Sinan Dal
- Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Clinic of Hematology, Ankara, Turkey
| | - Şehmus Ertop
- Bülent Ecevit University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Zonguldak, Turkey
| | - Mehmet Turgut
- Ondokuz Mayıs University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Samsun, Turkey
| | - Teoman Soysal
- İstanbul University-Cerrahpaşa Cerrahpaşa Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
| | - Emin Kaya
- İnönü University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Malatya, Turkey
| | - Ali Ünal
- Erciyes University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Kayseri, Turkey
| | - Mustafa Pehlivan
- Gaziantep University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Gaziantep, Turkey
| | - Işık Atagündüz
- Marmara University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
| | - Tülin Tuğlular Fıratlı
- Marmara University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
| | - Güray Saydam
- Ege University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İzmir, Turkey
| | - Reyhan Diz Küçükkaya
- İstanbul University Science Faculty, Department of Molecular Biology and Genetics, İstanbul, Turkey
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13
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Çekdemir D, Güvenç S, Özdemirkıran F, Eser A, Toptaş T, Özkocaman V, Haydaroğlu Şahin H, Ermiş Turak E, Esen R, Cömert M, Sadri S, Aslaner M, Uncu Ulu B, Karakuş A, Selim Bapur D, Alacacıoğlu İ, Aydın D, Tekinalp A, Namdaroğlu S, Ceran F, Tarkun P, Kiper D, Çetiner M, Yenerel M, Demir AM, Yılmaz G, Terzi H, Atilla E, Malkan ÜY, Acar K, Öztürk E, Tombak A, Sunu C, Salim O, Alayvaz N, Sayan Ö, Ozan Ü, Ayer M, Gökgöz Z, Andıç N, Kızılkılıç E, Noyan F, Özen M, Pepedil Tanrıkulu F, Alanoğlu G, Özkan HA, Aslan V, Çetin G, Akyol Erikçi A, Deveci B, Ersoy Dursun F, Dermenci H, Aytan P, Gündüz M, Karakuş V, Özlü C, Demircioğlu S, Akay Yanar OM, Özatlı D, Ündar L, Tiftik EN, Türköz Sucak AG, Haznedaroğlu İ, Özcan M, Şencan M, Tombuloğlu M, Özet G, Bilgir O, Turgut B, Özcan MA, Payzın KB, Sönmez M, Ayyıldız O, Dal MS, Ertop Ş, Turgut M, Soysal T, Kaya E, Ünal A, Pehlivan M, Atagündüz I, Tuğlular Fıratlı T, Saydam G, Diz Küçükkaya R. A Multi-Center Study on the Efficacy of Eltrombopag in Management of Refractory Chronic Immune Thrombocytopenia: A Real-Life Experience. Turk J Haematol 2019; 36:230-237. [PMID: 31327186 DOI: 10.4274/tjh.galenos.2019.2018.0307] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective The aim of the present study was to evaluate the efficacy and safety of eltrombopag, an oral thrombopoietin receptor agonist, in patients with chronic immune thrombocytopenia (ITP). Materials and Methods A total of 285 chronic ITP patients (187 women, 65.6%; 98 men, 34.4%) followed in 55 centers were enrolled in this retrospective cohort. Response to treatment was assessed according to platelet count (/mm3) and defined as complete (platelet count of >100,000/mm3), partial (30,000-100,000/mm3 or doubling of platelet count after treatment), or unresponsive (<30,000/mm3). Clinical findings, descriptive features, response to treatment, and side effects were recorded. Correlations between descriptive, clinical, and hematological parameters were analyzed. Results The median age at diagnosis was 43.9±20.6 (range: 3-95) years and the duration of follow-up was 18.0±6.4 (range: 6-28.2) months. Overall response rate was 86.7% (n=247). Complete and partial responses were observed in 182 (63.8%) and 65 (22.8%) patients, respectively. Thirty-eight patients (13.4%) did not respond to eltrombopag treatment. For patients above 60 years old (n=68), overall response rate was 89.7% (n=61), and for those above 80 years old (n=12), overall response rate was 83% (n=10). Considering thrombocyte count before treatment, eltrombopag significantly increased platelet count at the 1st, 2nd, 3rd, 4th, and 8th weeks of treatment. As the time required for partial or complete response increased, response to treatment was significantly reduced. The time to reach the maximum platelet levels after treatment was quite variable (1-202 weeks). Notably, the higher the maximum platelet count after eltrombopag treatment, the more likely that side effects would occur. The most common side effects were headache (21.6%), weakness (13.7%), hepatotoxicity (11.8%), and thrombosis (5.9%). Conclusion Results of the current study imply that eltrombopag is an effective therapeutic option even in elderly patients with chronic ITP. However, patients must be closely monitored for response and side effects during treatment. Since both response and side effects may be variable throughout the follow-up period, patients should be evaluated dynamically, especially in terms of thrombotic risk factors.
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Affiliation(s)
- Demet Çekdemir
- Anadolu Medical Center, Bone Marrow Transplantation Center, Department of Hematology, Kocaeli, Turkey
| | - Serkan Güvenç
- Yeni Yüzyıl University Gaziosmanpaşa Hospital, Department of Hematology, İstanbul, Turkey
| | - Füsun Özdemirkıran
- İzmir Atatürk Training and Research Hospital, Clinic of Hematology, İzmir, Turkey
| | - Ali Eser
- Marmara University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
| | - Tayfur Toptaş
- Marmara University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
| | - Vildan Özkocaman
- Uludağ University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Bursa, Turkey
| | - Handan Haydaroğlu Şahin
- Gaziantep University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Gaziantep, Turkey
| | - Esra Ermiş Turak
- Erciyes University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Kayseri, Turkey
| | - Ramazan Esen
- Van Yüzüncü Yıl University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Van, Turkey
| | - Melda Cömert
- İnönü University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Malatya, Turkey
| | - Sevil Sadri
- İstanbul University-Cerrahpaşa Cerrahpaşa Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
| | - Müzeyyen Aslaner
- Bülent Ecevit University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Zonguldak, Turkey
| | - Bahar Uncu Ulu
- Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Clinic of Hematology, Ankara, Turkey
| | - Abdullah Karakuş
- Dicle University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Diyarbakır, Turkey
| | - Derya Selim Bapur
- Karadeniz Teknik University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Trabzon, Turkey
| | - İnci Alacacıoğlu
- Dokuz Eylül University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İzmir, Turkey
| | - Demet Aydın
- Okmeydanı Training and Research Hospital, Clinic of Hematology, İstanbul, Turkey
| | - Atakan Tekinalp
- Namık Kemal University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Tekirdağ, Turkey
| | - Sinem Namdaroğlu
- İzmir Bozyaka Training and Research Hospital, Clinic of Hematology, İzmir, Turkey
| | - Funda Ceran
- Ankara Numune Training and Research Hospital, Clinic of Hematology, Ankara, Turkey
| | - Pınar Tarkun
- Kocaeli University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Kocaeli, Turkey
| | - Demet Kiper
- Ege University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İzmir, Turkey
| | - Mustafa Çetiner
- Koç University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
| | - Mustafa Yenerel
- İstanbul University İstanbul Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
| | - Ahmet Muzaffer Demir
- Trakya University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Edirne, Turkey
| | - Güven Yılmaz
- Dr. Lütfi Kırdar Kartal Training and Research Hospital, Clinic of Hematology, İstanbul, Turkey
| | - Hatice Terzi
- Cumhuriyet University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Sivas, Turkey
| | - Erden Atilla
- Ankara University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Turkey
| | - Ümit Yavuz Malkan
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Turkey
| | - Kadir Acar
- Gazi University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Turkey
| | - Erman Öztürk
- Koç University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
| | - Anıl Tombak
- Mersin University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Mersin, Turkey
| | - Cenk Sunu
- Sakarya University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Sakarya, Turkey
| | - Ozan Salim
- Akdeniz University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Antalya, Turkey
| | - Nevin Alayvaz
- Ondokuz Mayıs University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Samsun, Turkey
| | - Özkan Sayan
- Medicana Çamlıca Hospital, Clinic of Hematology, İstanbul, Turkey
| | - Ülkü Ozan
- Medical Park Hospital, Clinic of Hematology, Bursa, Turkey
| | - Mesut Ayer
- Haseki Training and Research Hospital, Clinic of Hematology, İstanbul, Turkey
| | - Zafer Gökgöz
- Medicana International Ankara Hospital, Clinic of Hematology, Ankara, Turkey
| | - Neslihan Andıç
- Eskişehir Osmangazi University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Eskişehir, Turkey
| | - Ebru Kızılkılıç
- Acıbadem Kozyatağı Hospital, Clinic of Hematology, İstanbul, Turkey
| | - Figen Noyan
- Başkent University İstanbul Hospital, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
| | - Mehmet Özen
- Tokat Gaziosmanpaşa University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Tokat, Turkey
| | | | - Güçhan Alanoğlu
- Süleyman Demirel University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Isparta, Turkey
| | - Hasan Atilla Özkan
- Yeditepe University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
| | - Vahap Aslan
- Ümit Hospital, Clinic of Hematology, Eskişehir, Turkey
| | - Güven Çetin
- Bezmialem Vakıf University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
| | - Alev Akyol Erikçi
- İstanbul Yeni Yüzyıl University Gaziosmanpaşa Hospital Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
| | - Burak Deveci
- Medstar Antalya Hospital, Clinic of Hematology, Antalya, Turkey
| | - Fadime Ersoy Dursun
- Göztepe Training and Research Hospital, Clinic of Hematology, İstanbul, Turkey
| | - Hasan Dermenci
- Haydarpaşa Numune Training and Research Hospital, Clinic of Hematology, İstanbul, Turkey
| | - Pelin Aytan
- Başkent University Training and Research Hospital, Bone Marrow and Stem Cell Transplantation Center, Department of Hematology, Adana, Turkey
| | - Mehmet Gündüz
- Atatürk Training and Research Hospital, Clinic of Hematology, Ankara, Turkey
| | - Volkan Karakuş
- Muğla Sıtkı Koçman University Training and Research Hospital, Department of Hematology, Muğla, Turkey
| | - Can Özlü
- Ministry of Health Erzurum Regional Training and Research Hospital, Clinic of Hematology, Erzurum, Turkey
| | - Sinan Demircioğlu
- Van Yüzüncü Yıl University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Van, Turkey
| | - Olga Meltem Akay Yanar
- Eskişehir Osmangazi University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Eskişehir, Turkey
| | - Düzgün Özatlı
- Ondokuz Mayıs University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Samsun, Turkey
| | - Levent Ündar
- Akdeniz University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Antalya, Turkey
| | - Eyüp Naci Tiftik
- Mersin University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Mersin, Turkey
| | - Ayhan Gülsan Türköz Sucak
- Gazi University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Turkey
| | - İbrahim Haznedaroğlu
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Turkey
| | - Muhit Özcan
- Ankara University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Turkey
| | - Mehmet Şencan
- Cumhuriyet University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Sivas, Turkey
| | - Murat Tombuloğlu
- Ege University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İzmir, Turkey
| | - Gülsüm Özet
- Ankara Numune Training and Research Hospital, Clinic of Hematology, Ankara, Turkey
| | - Oktay Bilgir
- İzmir Bozyaka Training and Research Hospital, Clinic of Hematology, İzmir, Turkey
| | - Burhan Turgut
- Namık Kemal University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Tekirdağ, Turkey
| | - Mehmet Ali Özcan
- Dokuz Eylül University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İzmir, Turkey
| | - Kadriye Bahriye Payzın
- Yeni Yüzyıl University Gaziosmanpaşa Hospital, Department of Hematology, İstanbul, Turkey
| | - Mehmet Sönmez
- Karadeniz Teknik University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Trabzon, Turkey
| | - Orhan Ayyıldız
- Dicle University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Diyarbakır, Turkey
| | - Mehmet Sinan Dal
- Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Clinic of Hematology, Ankara, Turkey
| | - Şehmus Ertop
- Bülent Ecevit University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Zonguldak, Turkey
| | - Mehmet Turgut
- Ondokuz Mayıs University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Samsun, Turkey
| | - Teoman Soysal
- İstanbul University-Cerrahpaşa Cerrahpaşa Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
| | - Emin Kaya
- İnönü University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Malatya, Turkey
| | - Ali Ünal
- Erciyes University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Kayseri, Turkey
| | - Mustafa Pehlivan
- Gaziantep University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Gaziantep, Turkey
| | - Işık Atagündüz
- Marmara University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
| | - Tülin Tuğlular Fıratlı
- Marmara University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
| | - Güray Saydam
- Ege University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İzmir, Turkey
| | - Reyhan Diz Küçükkaya
- İstanbul University Science Faculty, Department of Molecular Biology and Genetics, İstanbul, Turkey
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14
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Okay M, Aslan T, Özdemir E, Üner A, Sağlam A, Güngör E, Uysal A, Alayvaz Aslan N, Yıldızhan E, Ağıt A, Dal MS, Korkmaz S, Namdaroğlu S, Sivgin S, Akgün Çağlıyan G, Demircioğlu S, Barışta İ, Özhamam E, Vural F, Eser B, Özet G, Yıldırım R, Doğu MH, Berber İ, Erkurt MA, Malkan ÜY, Altuntaş F, Büyükaşık Y. Splenic Marginal Zone Lymphoma in Turkey: Association with Hepatitis B Instead of Hepatitis C Virus as an Etiologic and Possible Prognostic Factor - A Multicenter Cohort Study. Turk J Haematol 2019; 37:84-90. [PMID: 31630512 PMCID: PMC7236417 DOI: 10.4274/tjh.galenos.2019.2019.0177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 02/06/2023] Open
Abstract
Objective: Chronic antigenic stimulation is frequently blamed in the pathogenesis of extranodal marginal zone lymphomas including splenic marginal zone lymphoma (SMZL). Chronic hepatitis C is frequently observed in SMZL patients in some geographical regions. However, these reports are largely from North America and Europe, and data from other countries are insufficient. In this multicenter study we aimed to identify the clinical characteristics of SMZL patients in Turkey, including viral hepatitis status and treatment details. Materials and Methods: Data were gathered from participating centers from different regions of Turkey using IBM SPSS Statistics 23 for Windows. Hepatitis B virus surface antigen (HBsAg), anti-HBs antibody, anti-HB core antigen antibody (anti-HBcAg), HB viral load, anti-hepatitis C virus (HCV) antibody, HCV viral load results were analyzed. Results: One hundred and four patients were reported. Hepatitis C virus positivity was observed in only one patient. However, hepatitis B virus surface antigen (HBsAg) positivity was observed in 11.2% and HBsAg and/or anti-HB core antigen antibody (anti-HBcAg) positivities were seen in 34.2% of the patients. The median age was 60 years (range=35-87). Median follow-up duration was 21.2 months (range=00.2-212; 23.2 months for surviving patients). Median overall survival was not reached. Estimated 3-year and 10-year survival rates were 84.8% and 68.9%, respectively. Older age, no splenectomy during follow-up, platelet count of <90x103/μL, lower albumin, higher lactate dehydrogenase, higher β2-microglobulin, and HBsAg positivity were associated with increased risk of death. Only albumin remained significant in multivariable analysis. Conclusion: These results indicate that hepatitis B virus may be a possible risk factor for SMZL in our population. It may also be an indirect prognostic factor.
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Affiliation(s)
- Müfide Okay
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Turkey
| | - Tuncay Aslan
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Turkey
| | - Evren Özdemir
- Medicana International Ankara Hospital, Clinic of Medical Oncology, Ankara, Turkey
| | - Ayşegül Üner
- Hacettepe University Faculty of Medicine, Department of Pathology, Ankara, Turkey
| | - Arzu Sağlam
- Hacettepe University Faculty of Medicine, Department of Pathology, Ankara, Turkey
| | - Elif Güngör
- Trakya University Faculty of Medicine, Department of Internal Medicine, Edirne, Turkey
| | - Ayşe Uysal
- University of Health Sciences, Trabzon Kanuni Training and Research Hospital, Division of Hematology, Trabzon, Turkey
| | - Nevin Alayvaz Aslan
- Ondokuz Mayıs University Faculty of Medicine, Department of Hematology, Samsun, Turkey
| | - Esra Yıldızhan
- Erciyes University Faculty of Medicine, Department of Hematology, Kayseri, Turkey
| | - Abdullah Ağıt
- Ankara Numune Training and Research Hospital, Division of Hematology, Ankara, Turkey
| | - Mehmet Sinan Dal
- University of Health Sciences, Ankara Oncology Training and Research Hospital, Clinic of Hematology and BMT Unit, Ankara, Turkey
| | - Serdal Korkmaz
- Kayseri Training and Research Hospital, Division of Hematology, Kayseri, Turkey
| | | | | | | | - Sinan Demircioğlu
- Yüzüncü Yıl University Faculty of Medicine, Department of Hematology, Van, Turkey
| | - İbrahim Barışta
- Hacettepe University Faculty of Medicine, Department of Medical Oncology, Ankara, Turkey
| | - Esra Özhamam
- Ankara Numune Training and Research Hospital, Division of Pathology, Ankara, Turkey
| | - Filiz Vural
- Ege University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İzmir, Turkey
| | - Bülent Eser
- Erciyes University Faculty of Medicine, Department of Hematology, Kayseri, Turkey
| | - Gülsüm Özet
- Ankara Numune Training and Research Hospital, Division of Hematology, Ankara, Turkey
| | - Rahşan Yıldırım
- Atatürk University Faculty of Medicine, Department of Hematology, Erzurum, Turkey
| | - Mehmet Hilmi Doğu
- İstanbul Training and Research Hospital, Clinic Hematology, İstanbul, Turkey
| | - İlhami Berber
- Malatya Training and Research Hospital, Division of Hematology, Malatya, Turkey
| | - Mehmet Ali Erkurt
- İnönü University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Malatya, Turkey
| | - Ümit Yavuz Malkan
- University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Clinic of Hematology, Ankara, Turkey
| | - Fevzi Altuntaş
- University of Health Sciences, Ankara Oncology Training and Research Hospital, Clinic of Hematology and BMT Unit, Ankara, Turkey,Yıldırım Beyazıt University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Turkey
| | - Yahya Büyükaşık
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Turkey
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15
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Çiftçiler R, Haznedaroğlu İC, Sayınalp N, Özcebe O, Aksu S, Demiroğlu H, Göker H, Malkan ÜY, Büyükaşık Y. The Impact of Early Versus Late Platelet and Neutrophil Recovery after Induction Chemotherapy on Survival Outcomes of Patients with Acute Myeloid Leukemia. Turk J Haematol 2019; 37:116-120. [PMID: 31475513 PMCID: PMC7236414 DOI: 10.4274/tjh.galenos.2019.2019.0154] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: The prognosis of patients with acute myeloid leukemia (AML) is affected by factors that are both patient- and disease-specific. The aim of this study is to evaluate the impact of early versus late platelet and neutrophil recovery after induction chemotherapy on survival outcomes of AML patients. Materials and Methods: A total of 181 patients with AML who were treated in our tertiary center between 2001 and 2018 were evaluated. Neutrophil and platelet recovery times were accepted as the periods from the beginning of induction chemotherapy to a neutrophil count of ≥0.5x109/L and a platelet count of ≥20x109/L 3 days in a row, respectively. The median time to platelet recovery was 25 days (range=12-52) for all patients. Therefore, platelet recovery in the first 25 days was defined as early platelet recovery (EPR) and at ≥26 days it was defined as late platelet recovery (LPR). The median time to neutrophil recovery was 28 days (range=13-51) for all patients. Therefore, neutrophil recovery in the first 28 days was defined as early neutrophil recovery, and at ≥29 days it was defined as late neutrophil recovery. Results: The 5-year overall survival (OS) rates for patients who had EPR and LPR after induction chemotherapy were 62% and 23%, respectively (p<0.001). The 5-year disease-free survival (DFS) rates for patients who had EPR and LPR after induction chemotherapy were 57% and 15%, respectively (p<0.001). Conclusion: Short bone marrow recovery time may indicate better healthy hematopoiesis and marrow capacity associated with longer OS and DFS.
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Affiliation(s)
- Rafiye Çiftçiler
- Hacettepe University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | | | - Nilgün Sayınalp
- Hacettepe University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Osman Özcebe
- Hacettepe University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Salih Aksu
- Hacettepe University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Haluk Demiroğlu
- Hacettepe University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Hakan Göker
- Hacettepe University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Ümit Yavuz Malkan
- Dıskapı Education and Research Hospital, Department of Hematology, Ankara, Turkey
| | - Yahya Büyükaşık
- Hacettepe University Faculty of Medicine, Department of Hematology, Ankara, Turkey
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16
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Okay M, Büyükaşık Y, Demiroğlu H, Malkan ÜY, Çiftçiler R, Aladağ E, Aksu S, Haznedaroğlu İC, Sayınalp N, Özcebe Oİ, Göker H. Mitoxantrone-melphalan conditioning regimen for autologous stem cell transplantation
in relapsed/refractory lymphoma. Turk J Med Sci 2019; 49:985-992. [PMID: 31293116 PMCID: PMC7018231 DOI: 10.3906/sag-1809-36] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background/aim High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) has become the standard approach for patients with relapsed/refractory Hodgkin’s lymphoma (HL) or non-Hodgkin’s lymphoma (NHL). In this study, we report the outcome of the mitoxantrone-melphalan conditioning regimen for lymphoma. Materials and methods The study group included 53 patients who were relapsed/refractory HL (n = 14) and NHL (n = 39) and received mitoxantrone and melphalan followed by ASCT. The transplant regimen consisted of mitoxantrone (60 mg/m2) and melphalan (180 mg/m2) followed by peripheral blood stem cell infusion (PBSC). Results Prior to high-dose chemotherapy, 37.7% of the patients were in complete remission (CR) and 45.3% were in partial remission (PR), and 17% had stable or progressive disease. After high-dose chemotherapy and PBSC, 44 out of 51 patients achieved CR (86.2%). CR was achieved in 24 out of 33 patients (72.7%) who were transplanted in a marginally active phase of the disease. At a median followup of 25.4 months (1.8–131.3 months) after ASCT, 13 patients relapsed/progressed and 8 patients died. The estimated 2-year overall survival (OS) was 81.9%, and event-free survival (EFS) was 59.3%. Conclusion High-dose chemotherapy followed by ASCT is an effective conditioning regimen in relapsed/refractory lymphoma patients who are undergoing ASCT.
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Affiliation(s)
- Müfide Okay
- Department of Hematology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Yahya Büyükaşık
- Department of Hematology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Haluk Demiroğlu
- Department of Hematology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ümit Yavuz Malkan
- Department of Hematology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Rafiye Çiftçiler
- Department of Hematology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Elifcan Aladağ
- Department of Hematology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Salih Aksu
- Department of Hematology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | | | - Nilgün Sayınalp
- Department of Hematology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Osman İlhami Özcebe
- Department of Hematology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Hakan Göker
- Department of Hematology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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17
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Aydın MS, Bozkurt S, Güneş G, Malkan ÜY, Aslan T, Etgül S, Büyükaşık Y, Haznedaroğlu İC, Sayınalp N, Göker H, Demiroğlu H, Özcebe Oİ, Aksu S. Sole Infrequent Karyotypic Aberration Trisomy 6 in a Patient with Acute Myeloid Leukemia and Breast Cancer in Remission. Turk J Haematol 2017; 34:103-104. [PMID: 27873741 PMCID: PMC5451672 DOI: 10.4274/tjh.2016.0030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Mürüvvet Seda Aydın
- Hacettepe University Faculty of Medicine, Department of Adult Hematology, Ankara, Turkey E-mail:
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18
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Malkan ÜY, Güneş G, Göker H, Haznedaroğlu İC, Acar K, Eliaçık E, Etgül S, Aslan T, Balaban S, Demiroğlu H, Özcebe OI, Sayınalp N, Aksu S, Büyükaşık Y. The Prognosis of Adult Burkitt's Cell Leukemia in Real-Life Clinical Practice. Turk J Haematol 2016; 33:281-285. [PMID: 27094615 PMCID: PMC5204181 DOI: 10.4274/tjh.2015.0088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 12/14/2015] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Many studies reported an improved prognosis in patients with Burkitt's lymphoma obviating the need of stem cell transplantation. However, prognosis of the advanced disease [i.e. Burkitt's cell leukemia (BCL)] has not been reported with current treatment modalities except for a few prospective trials. The aim of this study is to compare the prognoses of BCL patients with similarly treated and nontransplanted patients with other types of acute lymphoblastic leukemia (ALL) and with ALL patients that underwent allogeneic stem cell transplantation (ASCT) in their first remissions. MATERIALS AND METHODS In this retrospective analysis, BCL patients aged between 16 and 63 who were admitted between 2000 and 2014 to the hospitals of Hacettepe or Gazi University and were treated with intensive therapies aimed at cure were included. All ALL patients who were treated with a similar protocol not including transplantation during the same period (NT-ALL group) and all ALL patients who underwent ASCT in the first complete remission during the same period (T-ALL group) served as control groups. RESULTS The central nervous system or extramedullary involvement rates, lactate dehydrogenase levels, and white blood cell counts at diagnosis were higher in the BCL group than the NT-ALL group and these differences were significant. BCL patients had disease-free survival (DFS) durations comparable with the T-ALL cohort but NT-ALL patients had significantly shorter DFS durations. Both cumulative relapse incidence and cumulative nonrelapse mortality were higher in NT-ALL patients compared to the T-ALL group and BCL patients. CONCLUSION DFS in BCL patients treated with a widely accepted modern regimen, R-HyperCVAD, is comparable to results in other ALL patients receiving allogeneic transplantation. Our results are in agreement with a few prospective noncomparative studies suggesting no further need for stem cell transplantation in BCL.
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Affiliation(s)
- Ümit Yavuz Malkan
- Hacettepe University Faculty of Medicine, Department of Hematology, Ankara, Turkey, Phone: +90 532 778 00 87, E-mail :
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