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Boga C, Eliacik E, Yalcin C, Kocer NE, Durdag E, Gereklioglu C. Diagnostic clues in a stem cell transplant patient manifested with chronic central nervous system GVHD and IRIS. Transpl Immunol 2023; 81:101916. [PMID: 37567484 DOI: 10.1016/j.trim.2023.101916] [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: 06/23/2023] [Accepted: 08/08/2023] [Indexed: 08/13/2023]
Abstract
Transplant physicians should be aware of the immune deviation-related clinical conditions as allogeneic hematopoietic stem cell transplantation is widely used for the treatment of patients with malignant and non-malignant disorders. Neurological manifestations and graft-versus-host disease (GVHD) may commonly develop in transplant recipients. However, overlapping clinical immunological conditions may lead to diagnostic challenges. Herein, we discussed the differential diagnosis of a patient with immune reconstitution inflammatory syndrome (IRIS) developing on the basis of chronic GVHD.
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Affiliation(s)
- Can Boga
- Adana Adult Bone Marrow Transplantation Center, Department of Hematology, Başkent University Faculty of Medicine, Ankara, Turkiye.
| | - Eylem Eliacik
- Adana Adult Bone Marrow Transplantation Center, Department of Hematology, Başkent University Faculty of Medicine, Ankara, Turkiye
| | - Cigdem Yalcin
- Department of Radiology, Başkent University Faculty of Medicine, Ankara, Turkiye
| | - Nazım Emrah Kocer
- Department of Pathology, Başkent University Faculty of Medicine, Ankara, Turkiye
| | - Emre Durdag
- Department of Neurosurgery, Baskent University Faculty of Medicine, Ankara, Turkiye
| | - Cigdem Gereklioglu
- Department of Family Medicine, Başkent University Faculty of Medicine, Ankara, Turkiye
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Abstract
Thalidomide may be used as a treatment option for pyoderma gangrenosum (PG) and myelodysplastic syndrome (MDS). Herein, we aimed to report a patient who was treated well with thalidomide and whose diagnosis was PG with MDS. A 61-year-old man with painless ecchymotic lesions in his right upper extremity was admitted to the hospital in Isparta, Turkey, in January 2015. The lesions were diagnosed as PG. In his anamnesis, it was found that he was diagnosed with MDS 6 years ago and had been treated with cyclosporine at 2×100 mg for 5 years, which was stopped in January 2015. Aspiration from liver lesion revealed the presence of Mycobacterium tuberculosis, so antituberculosis treatment was started. Bone marrow investigation revealed MDS-refractory anemia with excess blasts (7%). For lesions in bilateral upper extremities, thalidomide treatment was started at 50 mg/d. After 1 month from the initiation of thalidomide treatment, the lesions in upper extremities had disappeared. In the literature, there are some reports of patients with PG who were successfully treated with thalidomide. Our patient is a complicated case who simultaneously has MDS, PG, and tuberculosis infection. The reason for thalidomide usage in our patient was the need of immune modulation without immune suppression. Our patient has tolerated the drug well, and excellent response was obtained after 1 month of initiation of thalidomide treatment. To conclude, thalidomide is a very effective drug acting as an immune modulator, which is useful in the clinical management of both MDS and PG.
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Affiliation(s)
- Umit Yavuz Malkan
- Department of Hematology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Gursel Gunes
- Department of Hematology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Eylem Eliacik
- Department of Hematology, School of Medicine, Hacettepe University, Ankara, Turkey
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Malkan UY, Gunes G, Eliacik E, Haznedaroglu IC, Etgul S, Aslan T, Yayar O, Aydin S, Demiroglu H, Ozcebe OI, Sayinalp N, Goker H, Aksu S, Buyukasik Y. The factors affecting early death after the initial therapy of acute myeloid leukemia. Int J Clin Exp Med 2015; 8:22564-22569. [PMID: 26885243 PMCID: PMC4730029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Accepted: 12/08/2015] [Indexed: 06/05/2023]
Abstract
There are some improvements in management of acute myeloid leukemia (AML). However, induction-induced deaths still remain as a major problem. The aim of this study is to assess clinical parameters affecting early death in patients with AML. 199 AML patients, who were treated with intensive, non-intensive or supportive treatment between 2002 and 2014 in Hacettepe Hematology Department, were analyzed retrospectively. In our study early death rate for elderly was found to be lower than previous reports whereas it was similar for those who were under age of 60. Better ECOG performance (ECOG performance score 0 and 1) and non-intensive treatment associated with lower early death rates, however APL-type disease associated with higher early death rates. ECOG performance score at diagnosis was found to be the most related independent factor with higher rate of early death in 15 days after treatment (P<0.001). Therefore we decided to understand the factors which were related with ECOG. WBC count at diagnosis was found to be the only related parameter with ECOG performance score. Leucocyte count at diagnosis appears like to have an indirect effect on early death in AML patients. It maybe suggested that in recent years there is an improvement in early death rates of elderly AML patients. The currently reported findings require prospective validation and would encourage the incorporation of other next generation genomics for the prediction of early death and overall risk status of AML.
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Affiliation(s)
- Umit Yavuz Malkan
- Department of Hematology, Hacettepe University, School of MedicineTR-0100 Ankara, Turkey
| | - Gursel Gunes
- Department of Hematology, Hacettepe University, School of MedicineTR-0100 Ankara, Turkey
| | - Eylem Eliacik
- Department of Hematology, Hacettepe University, School of MedicineTR-0100 Ankara, Turkey
| | | | - Sezgin Etgul
- Department of Hematology, Hacettepe University, School of MedicineTR-0100 Ankara, Turkey
| | - Tuncay Aslan
- Department of Hematology, Hacettepe University, School of MedicineTR-0100 Ankara, Turkey
| | - Okan Yayar
- Department of Hematology, Diskapi Research and Training HospitalTR-0100 Ankara, Turkey
| | - Seda Aydin
- Department of Hematology, Hacettepe University, School of MedicineTR-0100 Ankara, Turkey
| | - Haluk Demiroglu
- Department of Hematology, Hacettepe University, School of MedicineTR-0100 Ankara, Turkey
| | - Osman Ilhami Ozcebe
- Department of Hematology, Hacettepe University, School of MedicineTR-0100 Ankara, Turkey
| | - Nilgun Sayinalp
- Department of Hematology, Hacettepe University, School of MedicineTR-0100 Ankara, Turkey
| | - Hakan Goker
- Department of Hematology, Hacettepe University, School of MedicineTR-0100 Ankara, Turkey
| | - Salih Aksu
- Department of Hematology, Hacettepe University, School of MedicineTR-0100 Ankara, Turkey
| | - Yahya Buyukasik
- Department of Hematology, Hacettepe University, School of MedicineTR-0100 Ankara, Turkey
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Gunes G, Malkan UY, Yasar HA, Eliacik E, Haznedaroglu IC, Demiroglu H, Sayinalp N, Aksu S, Etgul S, Aslan T, Goker H, Ozcebe OI, Buyukasik Y. Clinicopathological associations of acquired erythroblastopenia. Int J Clin Exp Med 2015; 8:22515-22519. [PMID: 26885236 PMCID: PMC4730022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 12/08/2015] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Acquired erythroblastopenia (AE) is a rare clinical situation. It is characterized by the reduction of erythroid precursors in the bone marrow together with the low reticulocyte counts in the peripheral blood. BACKGROUND Main secondary causes of AE are drugs, Parvovirus B19 and other infectious reasons, lymphoid and myeloid neoplasia, autoimmune diseases, thymoma and pregnancy. The aim of this study is to assess the frequencies and clinical associations of AE via analyzing 12340 bone marrow samples in a retrospective manner. MATERIAL AND METHOD Bone marrow aspirations which were obtained from patients who applied to Hacettepe University Hematology Clinic between 2002 and 2013, were analyzed retrospectively. RESULTS Thirty four erythroblastopenia cases were found. Patients ranged in age from 16 to 80 years with a median of 38 years. Fifteen patients were men (44%) and nineteen were women (56%). In these patients, detected causes of erythroblastopenia were MDS, idiopathic pure red cell aplasia (PRCA), parvovirus infection, post chemotherapy aplasia, plasma proliferative diseases, copper deficiency due to secondary amyloidosis, fever of unknown origin, hemophagocytic syndrome, enteric fever and legionella pneumonia. We found that between those reasons the most common causes of erythroblastopenia are MDS (17.7%) and idiopathic PRCA (17.7%). DISCUSSION As a result, erythroblastopenia in the bone marrow may be an early sign of MDS. In those AE cases possibility of being MDS must be kept in mind as it can be mistaken for PRCA. CONCLUSION To conclude, in adults MDS without excess blast is one of the most common causes of erythroblastopenia in clinical practice and in case of erythroblastopenia the presence of MDS should be investigated.
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Affiliation(s)
- Gursel Gunes
- Department of Internal Medicine, Division of Hematology, School of Medicine, Hacettepe University Turkey
| | - Umit Yavuz Malkan
- Department of Internal Medicine, Division of Hematology, School of Medicine, Hacettepe University Turkey
| | - Hatime Arzu Yasar
- Department of Internal Medicine, Division of Hematology, School of Medicine, Hacettepe University Turkey
| | - Eylem Eliacik
- Department of Internal Medicine, Division of Hematology, School of Medicine, Hacettepe University Turkey
| | | | - Haluk Demiroglu
- Department of Internal Medicine, Division of Hematology, School of Medicine, Hacettepe University Turkey
| | - Nilgun Sayinalp
- Department of Internal Medicine, Division of Hematology, School of Medicine, Hacettepe University Turkey
| | - Salih Aksu
- Department of Internal Medicine, Division of Hematology, School of Medicine, Hacettepe University Turkey
| | - Sezgin Etgul
- Department of Internal Medicine, Division of Hematology, School of Medicine, Hacettepe University Turkey
| | - Tuncay Aslan
- Department of Internal Medicine, Division of Hematology, School of Medicine, Hacettepe University Turkey
| | - Hakan Goker
- Department of Internal Medicine, Division of Hematology, School of Medicine, Hacettepe University Turkey
| | - Osman Ilhami Ozcebe
- Department of Internal Medicine, Division of Hematology, School of Medicine, Hacettepe University Turkey
| | - Yahya Buyukasik
- Department of Internal Medicine, Division of Hematology, School of Medicine, Hacettepe University Turkey
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Ipek S, Cekic C, Alper E, Coban E, Eliacik E, Arabul M, Aslan F, Vatansever S, Yalcin H, Unsal B. Can red cell distribution width be a marker of disease activity in ulcerative colitis? Int J Clin Exp Med 2015; 8:13848-13853. [PMID: 26550336 PMCID: PMC4613021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 07/21/2015] [Indexed: 06/05/2023]
Abstract
AIM The current study aimed to investigate the association between disease activity and red cell distribution width (RDW) levels in ulcerative colitis and to determine whether RDW can be used as a marker of disease activity in non-anemic ulcerative colitis. METHODS The RDW levels of 310 ulcerative colitis patients who underwent colonoscopy were analyzed retrospectively. The patients were divided into two groups (active disease and remission) according to the endoscopic activity index. In addition, the accuracy of RDW in determining disease activity in non-anemic patients was assessed. The efficacy of RDW in determining disease activity was compared to that of white blood cell count, platelet count, C-reactive protein, and erythrocyte sedimentation rate. RESULTS Two hundred and six (66.5%) patients had active disease, and 104 (33.5%) were in remission. The mean RDW levels in patients with active ulcerative colitis and in those in remission were 16.8±2.9 and 15.5±1.4, respectively (P<0.001). Ninety-six (46.6%) patients in the active disease group and 89 (85.6%) in the remission group were non-anemic, and their respective RDW levels were 15.4±1.2 and 15.3±1.1 (P=0.267). The sensitivity and specificity of RDW in determining inflammation were 41% and 91%, respectively (AUC 0.65, P<0.001). CONCLUSIONS This study demonstrated that RDW can be used as a marker for disease activity in ulcerative colitis, but it did not have the same efficacy in the non-anemic group.
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Affiliation(s)
- Serkan Ipek
- Department of Gastroenterology, Izmir Katip Celebi University, Atatürk Training and Research HospitalIzmir, Turkey
| | - Cem Cekic
- Department of Gastroenterology, Izmir Katip Celebi University, Atatürk Training and Research HospitalIzmir, Turkey
| | - Emrah Alper
- Department of Gastroenterology, Izmir Katip Celebi University, Atatürk Training and Research HospitalIzmir, Turkey
| | - Eyup Coban
- Department of Gastroenterology, Izmir Katip Celebi University, Atatürk Training and Research HospitalIzmir, Turkey
| | - Eylem Eliacik
- Department of Hematology, Hacettepe UniversityAnkara, Turkey
| | - Mahmut Arabul
- Department of Gastroenterology, Izmir Katip Celebi University, Atatürk Training and Research HospitalIzmir, Turkey
| | - Fatih Aslan
- Department of Gastroenterology, Izmir Katip Celebi University, Atatürk Training and Research HospitalIzmir, Turkey
| | - Sezgin Vatansever
- Department of Gastroenterology, Izmir Katip Celebi University, Atatürk Training and Research HospitalIzmir, Turkey
| | - Hulya Yalcin
- Department of Biochemistry, Tepecik Training and Research HospitalIzmir, Turkey
| | - Belkis Unsal
- Department of Gastroenterology, Izmir Katip Celebi University, Atatürk Training and Research HospitalIzmir, Turkey
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Bektas O, Uner A, Aydin SM, Eliacik E, Uz B, Işık A, Haznedaroğlu IC, Goker H, Sayinalp N, Aksu S, Demiroglu H, Ozcebe OI, Buyukasik Y. High frequency of autonomous T-cell proliferation compatible with T-cell large granular lymphocytic leukemia in patients with cytopenia of unknown etiology. Int J Hematol 2015; 102:211-7. [PMID: 26009282 DOI: 10.1007/s12185-015-1816-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 05/14/2015] [Accepted: 05/15/2015] [Indexed: 02/07/2023]
Abstract
Large granular lymphocytic leukemia/lymphoproliferative disorder (LGL-L/LPD) is a heterogeneous neoplastic disease of large granular lymphocytes and is a well-known cause of cytopenias. We aimed to reveal the incidence of LGL-L/LPD in patients with cytopenia(s) of unknown etiology (CUE). Twenty-eight patients with CUE were investigated for LGL-L/LPD. T-cell LGL leukemia (LGL-L) was diagnosed in 12 (42.9 %) patients. The frequencies of LGL-L in patients who had anemia, neutropenia, and thrombocytopenia were 9/14 (64.2 %), 11/23 (47.8 %), and 3/10 (30 %), respectively. Seventeen of the 28 patients met the criteria of idiopathic cytopenia of undetermined significance (ICUS), and LGL-L was found in six (35.3 %) of them. We conclude that LGL-L is a rather common disease in patients with CUE and ICUS. It should be considered in this patient group and investigated thoroughly.
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Affiliation(s)
- Ozlen Bektas
- Department of Hematology, Faculty of Medicine, Hacettepe University, 06100, Sihhiye, Ankara, Turkey
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Goker H, Gunes G, Demiroglu H, Malkan UY, Haznedaroglu I, Sayinalp N, Etgul S, Eliacik E, Aslan T, Isik A, Aydin S, Yalcin S, Aksu S, Ozcebe OI, Buyukasik Y. Extramedullary relapses after allogeneic stem cell transplantation for leukemia: Clinical characteristics, cumulative incidence and risk factors. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e18005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Gursel Gunes
- Hacettepe University School of Medicine, Hematology Department, Ankara, Turkey
| | - Haluk Demiroglu
- Hacettepe University School of Medicine, Hematology Department, Ankara, Turkey
| | - Umit Yavuz Malkan
- Hacettepe University, Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Ibrahim Haznedaroglu
- Department of Hematology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Nilgun Sayinalp
- Hacettepe University School of Medicine, Hematology Department, Ankara, Turkey
| | - Sezgin Etgul
- Hacettepe University School of Medicine, Hematology Department, Ankara, Turkey
| | - Eylem Eliacik
- Hacettepe University School of Medicine, Hematology Department, Ankara, Turkey
| | - Tuncay Aslan
- Hacettepe University School of Medicine, Hematology Department, Ankara, Turkey
| | - Ayse Isik
- Hacettepe University School of Medicine, Hematology Department, Ankara, Turkey
| | - Seda Aydin
- Hacettepe University School of Medicine, Hematology Department, Ankara, Turkey
| | | | - Salih Aksu
- Hacettepe University School of Medicine, Hematology Department, Ankara, Turkey
| | - Osman I. Ozcebe
- Hacettepe University School of Medicine, Hematology Department, Ankara, Turkey
| | - Yahya Buyukasik
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Turkey
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Malkan UY, Gunes G, Isik A, Eliacik E, Etgul S, Aslan T, Balaban MS, Haznedaroglu IC, Demiroglu H, Goker H, Ozcebe OI, Sayınalp N, Aksu S, Buyukasik Y. Rebound Thrombocytosis following Induction Chemotherapy is an Independent Predictor of a Good Prognosis in Acute Myeloid Leukemia Patients Attaining First Complete Remission. Acta Haematol 2015; 134:32-7. [PMID: 25872012 DOI: 10.1159/000369917] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 11/17/2014] [Indexed: 11/19/2022]
Abstract
There are very few data about the relationship between acute myeloid leukemia (AML) prognosis and bone marrow recovery kinetics following chemotherapy. In this study, we aimed to assess the prognostic importance and clinical associations of neutrophil and platelet recovery rates and rebound thrombocytosis (RT) or neutrophilia (RN) in the postchemotherapy period for newly diagnosed AML patients. De novo AML patients diagnosed between October 2002 and December 2013 were evaluated retrospectively. One hundred patients were suitable for inclusion. Cox regression analysis using need for reinduction chemotherapy as a stratification parameter revealed RT as the only parameter predictive of OS, with borderline statistical significance (p = 0.06, OR = 7; 95% CI 0.92-53), and it was the only parameter predictive of DFS (p = 0.024, OR = 10; 95% CI 1.3-75). In order to understand whether RT or RN was related to a better marrow capacity or late consolidation, we considered neutrophil recovery time and platelet recovery time and nadir-first consolidation durations in all patients in the cohort. Both the marrow recovery duration and the time between marrow aplasia and first consolidation were shorter in RT and RN patients. To our knowledge, this is the first study to report a correlation between RT/RN and prognosis in AML.
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Affiliation(s)
- Umit Yavuz Malkan
- Department of Hematology, School of Medicine, Hacettepe University, Ankara, Turkey
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Bektas O, Uner A, Buyukasik Y, Uz B, Bozkurt S, Eliacik E, Işik A, Haznedaroglu IC, Goker H, Demiroglu H, Aksu S, Ozcebe OI, Sayinalp N. Clinical and pathological correlations of marrow PUMA and P53 expressions in myelodysplastic syndromes. APMIS 2015; 123:445-51. [DOI: 10.1111/apm.12369] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 12/28/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Ozlen Bektas
- Faculty of Medicine; Hacettepe University Division of Adult Hematology; Ankara Turkey
| | - Aysegul Uner
- Department of Pathology; Hacettepe University Faculty of Medicine; Ankara Turkey
| | - Yahya Buyukasik
- Faculty of Medicine; Hacettepe University Division of Adult Hematology; Ankara Turkey
| | - Burak Uz
- Faculty of Medicine; Hacettepe University Division of Adult Hematology; Ankara Turkey
| | - Sureyya Bozkurt
- Department of Basic Oncology; Cancer Institute; Hacettepe University; Ankara Turkey
| | - Eylem Eliacik
- Faculty of Medicine; Hacettepe University Division of Adult Hematology; Ankara Turkey
| | - Ayse Işik
- Faculty of Medicine; Hacettepe University Division of Adult Hematology; Ankara Turkey
| | | | - Hakan Goker
- Faculty of Medicine; Hacettepe University Division of Adult Hematology; Ankara Turkey
| | - Haluk Demiroglu
- Faculty of Medicine; Hacettepe University Division of Adult Hematology; Ankara Turkey
| | - Salih Aksu
- Faculty of Medicine; Hacettepe University Division of Adult Hematology; Ankara Turkey
| | - Osman Ilhami Ozcebe
- Faculty of Medicine; Hacettepe University Division of Adult Hematology; Ankara Turkey
| | - Nilgun Sayinalp
- Faculty of Medicine; Hacettepe University Division of Adult Hematology; Ankara Turkey
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Eliacik E, Yildirim T, Sahin U, Kizilarslanoglu C, Tapan U, Aybal-Kutlugun A, Hascelik G, Arici M. Potassium abnormalities in current clinical practice: frequency, causes, severity and management. Med Princ Pract 2015; 24:271-5. [PMID: 25766276 PMCID: PMC5588203 DOI: 10.1159/000376580] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 01/29/2015] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE We aimed to investigate the prevalence and etiology of potassium abnormalities (hypokalemia and hyperkalemia) and management approaches for hospitalized patients. SUBJECTS AND METHODS Over a 4-month period, all hospitalized patients at Hacettepe University Medical Faculty Hospitals who underwent at least one measurement of serum potassium during hospitalization were included. Data on serum levels of electrolytes, demographic characteristics, cause(s) of hospitalization, medications, etiology of potassium abnormality and treatment approaches were obtained from the hospital records. RESULTS Of the 9,045 hospitalized patients, 1,265 (14.0%) had a serum potassium abnormality; 604 (6.7%) patients had hypokalemia and 661 (7.30%) had hyperkalemia. In the hypokalemic patients, the most important reasons were gastrointestinal losses in 555 (91.8%) patients and renal losses in 252 (41.7%) patients. The most frequent treatment strategies were correcting the underlying cause and replacing the potassium deficit. Of the 604 hypokalemic patients, 319 (52.8%) were normokalemic at hospital discharge. The most common reason for hyperkalemia was treatment with renin-angiotensin-aldosterone system blockers in 228 (34.4%) patients, followed by renal failure in 191 (28.8%). Two hundred and ninety-eight (45.0%) patients were followed without any specific treatment. Of the 661 hyperkalemic patients, 324 (49.0%) were normokalemic at hospital discharge. CONCLUSION This study showed a high prevalence of potassium imbalance among hospitalized patients. Although most of the potassium abnormalities were mild/moderate, approximately half of the patients treated for hypokalemia or hyperkalemia were discharged from the hospital with ongoing dyskalemia.
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Affiliation(s)
- Eylem Eliacik
- Department of Internal Medicine, Hacettepe University, Ankara, Turkey
- *Eylem Eliacik, MD, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, TR-06100 Sihhiye, Ankara (Turkey), E-Mail
| | - Tolga Yildirim
- Department of Nephrology, Hacettepe University, Ankara, Turkey
| | - Ugur Sahin
- Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| | | | - Umit Tapan
- Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| | | | - Gulsen Hascelik
- Department of Biochemistry, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Mustafa Arici
- Department of Nephrology, Hacettepe University, Ankara, Turkey
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Eliacik E, Isik A, Aydin C, Uner A, Aksu S, Sayinalp N, Demiroglu H, Goker H, Buyukasik Y, Ozcebe O, Haznedaroglu IC. Bone marrow fibrosis may be an effective independent predictor of the 'TKI drug response level' in chronic myeloid leukemia. ACTA ACUST UNITED AC 2014; 20:392-6. [PMID: 25517484 DOI: 10.1179/1607845414y.0000000221] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES The aim of this study was to assess bone marrow (BM) fibrosis and dysplasia in chronic myeloid leukemia (CML) patients receiving the first-generation tyrosine kinase inhibitor (TKI), imatinib, or second-generation TKIs, dasatinib, and nilotinib. We further investigated whether CML under TKI is associated with dysplastic BM changes during the clinicopathological course of the disease. METHODS In total, pre-treatment BM paraffin blocks of biopsy specimens were available for 41 adult patients diagnosed with chronic phase CML. Post-treatment BM aspirate clot and core biopsy samples were reviewed for fibrosis and dyshematopoiesis. RESULTS Overall, 13 (31.7%) patients achieved a complete cytogenetic response with imatinib treatment, with no events. In 25 patients, imatinib was discontinued owing to primary or secondary resistance. In patients with initial dysmyelopoiesis, the rate of BM fibrosis was 82.4 versus 47.6% for other patient groups (P = 0.02). Overall, 24 patients with newly diagnosed CML showed marrow fibrosis, among which 19 (79.1%) had imatinib resistance. However, only 5 out of 15 patients (33.5%) without marrow fibrosis had imatinib resistance (P = 0.08). Discussion Our findings indicate that BM fibrosis is an independent predictor of the 'TKI drug response level' in CML and support its inclusion as a critical pathobiological parameter for decision-making with regard to TKI drug selection de novo, calculation of prognosis at the onset of disease, and monitoring response to TKI in the long-term disease course of CML.
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MESH Headings
- Adult
- Aged
- Drug Resistance, Neoplasm
- Female
- Humans
- Imatinib Mesylate/administration & dosage
- Imatinib Mesylate/adverse effects
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/metabolism
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Male
- Middle Aged
- Myelopoiesis/drug effects
- Primary Myelofibrosis/drug therapy
- Primary Myelofibrosis/metabolism
- Primary Myelofibrosis/pathology
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Goker H, Eliacik E, Buyukasik Y, Haznedaroglu IC, Turgut M, Aksu S, Sayinalp N, Gunes G, Demiroglu H, Ozcebe OI. High-dose chemotherapy and autologous peripheral blood stem cell (PBSC) transplantation with non-cryopreserved PBSCs in multiple myeloma. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e19577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Hakan Goker
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Turkey
| | - Eylem Eliacik
- Hacettepe University School of Medicine, Hematology Department, Ankara, Turkey
| | - Yahya Buyukasik
- Hacettepe University School of Medicine, Hematology Department, Ankara, Turkey
| | | | - Mehmet Turgut
- 19 Mayis University Medical Faculty of Hematology Department, Samsun, Turkey
| | - Salih Aksu
- Hacettepe University School of Medicine, Hematology Department, Ankara, Turkey
| | - Nilgun Sayinalp
- Hacettepe University School of Medicine, Hematology Department, Ankara, Turkey
| | - Gursel Gunes
- Hacettepe University School of Medicine, Hematology Department, Ankara, Turkey
| | - Haluk Demiroglu
- Hacettepe University School of Medicine, Hematology Department, Ankara, Turkey
| | - Osman I. Ozcebe
- Hacettepe University School of Medicine, Hematology Department, Ankara, Turkey
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Goker H, Ozdemir E, Uz B, Buyukasik Y, Turgut M, Serefhanoglu S, Aksu S, Sayinalp N, Haznedaroglu IC, Tekin F, Karacan Y, Unal S, Eliacik E, Isik A, Ozcebe OI. Comparative outcome of reduced intensity and myeloablative conditioning regimen in HLA identical sibling allogeneic hematopoietic stem cell transplantation for acute leukemia patients: a single center experience. Transfus Apher Sci 2013; 49:590-9. [PMID: 23981652 DOI: 10.1016/j.transci.2013.07.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 07/29/2013] [Indexed: 12/01/2022]
Abstract
Due to the high transplant related morbidity and mortality (TRM), relatively younger acute leukemia patients that have a good performance status and no comorbidity are eligible for myeloablative conditioning (MAC) followed by allogeneic hematopoietic stem cell transplantation (allo-HSCT). The outcomes of 84 consecutive adult patients with ALL (n=38) or AML (n=46) who underwent allo-HSCT from their HLA-identical siblings were evaluated retrospectively. The median age at transplantation was 34 (17-58 years) for the whole patient population. Of these, 24 patients received a MAC and 60 patients received a fludarabine-based reduced intensity conditioning regimen (RIC). After a median follow-up of 32 months (range, 1-119), for the entire group, the 3-year estimated overall survival (OS) was 57.5% and the disease-free survival (DFS) was 51.5%. The OS for ALL and AML patients were 53.9% vs 62.1%: and DFS were 50.5% and 53.4%, respectively. The 3-year estimated OS for RIC and MAC patients were 63.2% and 41.7%; and DFS were 57.1% and 34.7%, respectively. In ALL patients, conditioning regimens (RIC vs MAC) led to similar OS and DFS; however, in AML patients both OS (70.1% vs 21.4%) and DFS (59.3% vs 42.9%) were found to be higher in RIC patients compared to MAC recipients. Overall, the TRM at day 100 was 1.7% and has increased up to 5.1% at 1st year. In multivariate analysis, the diagnosis (p=0.03) and RIC regimen (p=0.027) were the prognostic variables for prolonged OS in all patients; and RIC regimen (p=0.031) was the only prognostic factor for prolonged OS in AML patients. The first complete remission (CR1) was correlated with a prolonged DFS as an independent variable for all patients (p=0.09). Eleven of the RIC patients (18.3%) and 6 of the MAC patients (25%) developed acute graft-versus-host disease (GvHD). Seventeen of the RIC patients (33.3%) and 4 of the MAC patients (16.7%) developed chronic GvHD. In conclusion, RIC conditioning regimens may provide a longer OS and DFS, especially in patients with AML who are in first CR, not eligible for MAC conditioning.
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Affiliation(s)
- Hakan Goker
- Division of Hematology, Department of Internal Medicine, Hacettepe University Medical School, Ankara, Turkey
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Uz B, Buyukasik Y, Atay H, Kelkitli E, Turgut M, Bektas O, Eliacik E, Isik A, Aksu S, Goker H, Sayinalp N, Ozcebe OI, Haznedaroglu IC. EUTOS CML prognostic scoring system predicts ELN-based 'event-free survival' better than Euro/Hasford and Sokal systems in CML patients receiving front-line imatinib mesylate. ACTA ACUST UNITED AC 2013; 18:247-52. [PMID: 23540886 DOI: 10.1179/1607845412y.0000000071] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES The validity of the three currently used chronic myeloid leukemia (CML) scoring systems (Sokal CML prognostic scoring system, Euro/Hasford CML scoring system, and the EUTOS CML prognostic scoring system) were compared in the CML patients receiving frontline imatinib mesylate. PATIENTS AND METHODS One hundred and fourty-three chronic phase CML patients (71 males, 72 females) taking imatinib as frontline treatment were included in the study. The median age was 44 (16-82) years. Median total and on-imatinib follow-up durations were 29 (3.8-130) months and 25 (3-125) months, respectively. RESULTS The complete hematological response (CHR) rate at 3 months was 95%. The best cumulative complete cytogenetic response (CCyR) rate at 24 months was 79.6%. Euro/Hasford scoring system was well-correlated with both Sokal and EUTOS scores (r = 0.6, P < 0.001 and r = 0.455, P < 0.001). However, there was only a weak correlation between Sokal and EUTOS scores (r = 0.2, P = 0.03). The 5-year median estimated event-free survival for low and high EUTOS risk patients were 62.6 (25.7-99.5) and 15.3 (7.4-23.2) months, respectively (P < 0.001). This performance was better than Sokal (P = 0.3) and Euro/Hasford (P = 0.04) scoring systems. Overall survival and CCyR rates were also better predicted by the EUTOS score. DISCUSSION EUTOS CML prognostic scoring system, which is the only prognostic system developed during the imatinib era, predicts European LeukemiaNet (ELN)-based event-free survival better than Euro/Hasford and Sokal systems in CML patients receiving frontline imatinib mesylate. This observation might have important clinical implications.
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Affiliation(s)
- Burak Uz
- Hacettepe University, Ankara, Turkey
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Uz B, Guven GS, Isik A, Kuyumcu ME, Bektas O, Eliacik E, Aksu S, Goker H, Buyukasik Y, Sayinalp N, Haznedaroglu IC. Long-term sustained hemorrhage due to bone marrow biopsy successfully treated with topical ankaferd hemostat in a bleeding-prone patient with secondary amyloidosis. Clin Appl Thromb Hemost 2012; 19:338-40. [PMID: 22914810 DOI: 10.1177/1076029612457709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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