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Sönmez Ö, Özgür Yurttaş N, İhtiyaroğlu İ, Çakır HM, Atlı Z, Elverdi T, Salihoğlu A, Seyahi N, Ar MC, Öngören Ş, Başlar Z, Soysal T, Eşkazan AE. Effect of Tyrosine Kinase Inhibitor Therapy on Estimated Glomerular Filtration Rate in Patients with Chronic Myeloid Leukemia. Clin Lymphoma Myeloma Leuk 2024; 24:232-239. [PMID: 38281820 DOI: 10.1016/j.clml.2023.12.004] [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] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 12/03/2023] [Accepted: 12/04/2023] [Indexed: 01/30/2024]
Abstract
INTRODUCTION The advent of tyrosine kinase inhibitors (TKIs) was revolutionary in the management of chronic myeloid leukemia (CML). Although TKIs were generally considered to be safe, they can be associated with renal injury. We evaluated the effect of TKIs on renal functions in a cohort of patients with long-term follow-up. MATERIAL AND METHODS We retrospectively examined patients with chronic phase CML treated with TKIs. We analyzed the estimated glomerular filtration rate (eGFR) of patients from the initiation of TKI to the last follow-up. eGFR values of CML patients were compared to those of patients with stage 1 or 2 chronic kidney disease (CKD). RESULTS A total of 195 patients with CML and 138 patients with CKD were examined. eGFR decline was 1.556 ml/min/1.73m2/year for patients with CML (P = .221). Patients receiving second-generation TKIs (2GTKI) were estimated to have 0.583 ml/min/1.73m2 higher eGFR value than that of the imatinib group, but it was not significant (P = .871). eGFR of patients who had used bosutinib had a downward trend. Duration of TKI therapy, age, and hypertension were found to be significant factors in eGFR decline for CML patients. Lower baseline GFR was associated with an increased risk of CKD development. CONCLUSION Imatinib could result in a decline in eGFR which was clinically similar to early-stage CKD patients. We did not observe significant kidney function deterioration in patients receiving 2GTKIs including dasatinib and nilotinib. We recommend close renal function monitoring in patients receiving imatinib, especially for elderly patients with lower baseline eGFR and hypertension.
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Affiliation(s)
- Özge Sönmez
- Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Nurgül Özgür Yurttaş
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - İlker İhtiyaroğlu
- Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Halil Mete Çakır
- Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Zeynep Atlı
- Department of Statistics, Faculty of Science and Letters, Sinop University, Sinop, Turkey
| | - Tuğrul Elverdi
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Ayşe Salihoğlu
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Nurhan Seyahi
- Division of Nephrology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Muhlis Cem Ar
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Şeniz Öngören
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Zafer Başlar
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Teoman Soysal
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Ahmet Emre Eşkazan
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey.
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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] [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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Yılmaz U, Küçükyurt S, Ar MC, Eşkazan AE. Acute Thrombocytopenia Complicating the Initial Administration of Obinutuzumab: Is It More Frequent Than We Think? Oncol Ther 2024; 12:157-161. [PMID: 38252230 PMCID: PMC10881447 DOI: 10.1007/s40487-023-00259-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 12/15/2023] [Indexed: 01/23/2024] Open
Abstract
Thrombocytopenia has been reported more frequently with obinutuzumab in clinical trials where it was directly compared with rituximab. However, more significant than the frequency, a unique form of severe thrombocytopenia manifesting very early after the first obinutuzumab infusion has been published in case reports. To further explore this subject, we went through the records of our clinic to identify similar cases of obinutuzumab-induced acute thrombocytopenia (OIAT). Among 24 patients who received obinutuzumab outside of clinical trials, we recovered three cases with OIAT. This paper describes these three cases in detail, placing emphasis on the timing, severity, and the clinical course. Notably, all three patients developed severe OIAT within 5 days of their first obinutuzumab exposure, responded well to transfusion, and recovered within a few days without severe bleeding. None of the patients experienced a similar event in the second course of the obinutuzumab-based therapy. Our observations suggest that OIAT may be a frequent, possibly non-relapsing, and unique event that deserves more attention than it currently receives.
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Affiliation(s)
- Umut Yılmaz
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Fatih, Istanbul, Turkey
| | - Selin Küçükyurt
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Fatih, Istanbul, Turkey
| | - Muhlis Cem Ar
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Fatih, Istanbul, Turkey
| | - Ahmet Emre Eşkazan
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Fatih, Istanbul, Turkey.
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Çakmakkaya ÖS, Meydanlı EG, Kafadar AM, Demirci MS, Süzer Ö, Ar MC, Yaman MO, Demirbaş KC, Gönen MS. Factors affecting medical students' satisfaction with online learning: a regression analysis of a survey. BMC Med Educ 2024; 24:11. [PMID: 38172870 PMCID: PMC10765570 DOI: 10.1186/s12909-023-04995-7] [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] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 12/20/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Medical education requires the implementation of different teaching methods and strategies for future doctors to achieve broad learning objectives. This wide range of methods and strategies includes the use of Information Technologies. For a long time, there was a call for a change in medical education for blending new teaching approaches to lessen medical students' class time. The COVID-19 pandemic then sped up the transition to the new way of medical education and classroom lectures were quickly moved to a virtual environment. We expect that these changes will continue, and online learning will be one of the main teaching strategies in medical education. Therefore, educational experiences during the COVID-19 pandemic will improve our understanding of online learning and will help to develop blended medical school curricula in the future. For this reason, we aimed to determine students' overall satisfaction with their online learning experience and to define the main factors affecting students' satisfaction with their online learning program at Cerrahpaşa Medical Faculty. METHODS A cross-sectional survey study was conducted to determine medical students' overall satisfaction with online learning methods and to identify factors associated with positive and negative satisfaction levels. A questionnaire, consisting of 24 questions to collect demographic characteristics, factors associated with online education experience and overall satisfaction levels was developed and distributed to 1600 medical students. Multivariable linear regression analysis was used to determine the factors associated with positive and negative satisfaction levels. RESULTS Regression analysis showed that being familiar with online teaching techniques (β = 0.19, 95% CI [0.07, 0.30], faculty members' higher online teaching skill levels (β = 0.42, 95% CI [0.32, 0.51], interactive online teaching approaches (β = 0.54, 95% CI [0.41, 0.67], having a personal workspace (β = 0.43, 95% CI [0.19, 0.67], and a self-reported longer attention span (β = 0.75, 95% CI [0.57, 0.92] were associated with higher overall satisfaction with online learning. The occurrence of technical problems (β = -0.19, 95% CI [-0.26, -0.12] was associated with lower overall satisfaction. CONCLUSIONS Higher online teaching skills of faculty members, use of interactive approaches, students' familiarity with online teaching techniques, provision of a personal workspace, and self-reported longer attention spans positively contributed to higher levels of student satisfaction with online learning. Considering the increasing significance of online educational methods, our study identified key components that affect students' level of satisfaction. This information might contribute to the development of online educational programs in the future.
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Affiliation(s)
- Özlem Serpil Çakmakkaya
- Cerrahpaşa Medical Faculty, Department of Medical Education, İstanbul University-Cerrahpaşa, İstanbul, Fatih, 34098, Türkiye.
| | - Elif Güzel Meydanlı
- Cerrahpaşa Medical Faculty, Department of Histology and Embryology, İstanbul University-Cerrahpaşa, İstanbul, Türkiye
| | - Ali Metin Kafadar
- Cerrahpaşa Medical Faculty, Department of Neurosurgery, İstanbul University-Cerrahpaşa, İstanbul, Türkiye
| | - Mehmet Selman Demirci
- Cerrahpaşa Medical Faculty, Department of Anatomy, İstanbul University-Cerrahpaşa, İstanbul, Türkiye
| | - Öner Süzer
- Cerrahpaşa Medical Faculty, Department of Medical Pharmacology, İstanbul University-Cerrahpaşa, İstanbul, Türkiye
| | - Muhlis Cem Ar
- Cerrahpaşa Medical Faculty, Department of Internal Medicine, Division of Haematology, İstanbul University-Cerrahpaşa, İstanbul, Türkiye
| | - Muhittin Onur Yaman
- Vocational School of Health Services, Department of Medical Services and Techniques, İstanbul University-Cerrahpaşa, İstanbul, Türkiye
| | - Kaan Can Demirbaş
- Cerrahpaşa Medical Faculty, İstanbul University-Cerrahpaşa, İstanbul, Türkiye
| | - Mustafa Sait Gönen
- Cerrahpaşa Medical Faculty, Department of Internal Medicine, Division of Haematology, İstanbul University-Cerrahpaşa, İstanbul, Türkiye
- Cerrahpaşa Medical Faculty, Department of Internal Medicine, Division of Endocrinology, İstanbul University-Cerrahpaşa, İstanbul, Türkiye
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Seyhan Erdoğan D, Benbir Şenel G, Gündüz A, Uçar BP, Elverdi T, Salihoğlu A, Ar MC, Öngören Ş, Başlar Z, Eşkazan AE. A cross-sectional study on restless legs syndrome (RLS) in polycythemia vera (PV): is iron deficiency the only culprit? Neurol Res 2023; 45:1144-1151. [PMID: 37736879 DOI: 10.1080/01616412.2023.2257443] [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: 02/20/2023] [Accepted: 07/03/2023] [Indexed: 09/23/2023]
Abstract
INTRODUCTION In polycythemia vera (PV) patients undergoing phlebotomy, iron deficiency (ID) may develop. ID has been linked to restless legs syndrome (RLS), and in one study, 29.6% of PV patients had RLS. We aimed to evaluate the frequency of RLS in PV and to evaluate factors that might play a role in RLS development among PV and essential thrombocythemia (ET) patients. METHODS We consecutively included PV cases as the patient group, and ET and ID patients and healthy subjects (HSs) were included as controls. Those with conditions that could lead to RLS were excluded. All subjects were questioned according to the diagnostic criteria of the International Restless Legs Syndrome Study Group. RESULTS Twenty-seven PV, 23 ET, and 22 ID patients and 23 HSs were included. RLS was detected in 25.9%, 34.8%, and 45.5% of PV, ET, and ID patients, respectively. None of the HSs had RLS. In univariate analysis, interferon-α and anagrelide use, magnesium levels, and the Leeds assessment of neuropathic symptoms and signs (LANSS) scores had a significant impact on RLS in PV and ET patients (p = 0.014, p = 0.032, p = 0.036, and p = 0.003, respectively). CONCLUSION RLS was more common among PV and ET patients than HSs, which was irrespective to the iron status. RLS was more frequent in ET patients than that observed in PV cases, indicating that ID may not be the only causative factor for RLS development in PV. Further prospective studies are needed to determine the prevalence and risk factors of RLS developing in PV and ET.
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Affiliation(s)
- Duygu Seyhan Erdoğan
- Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Gülçin Benbir Şenel
- Department of Neurology, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Ayşegül Gündüz
- Department of Neurology, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Beria Peren Uçar
- Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Tuğrul Elverdi
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Ayşe Salihoğlu
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Muhlis Cem Ar
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Şeniz Öngören
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Zafer Başlar
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Ahmet Emre Eşkazan
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
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Yılmaz U, Zulfaliyeva G, Güzelli AN, Özmen D, Elverdi T, Salihoğlu A, Eskazan AE, Öngören Ş, Başlar Z, Ar MC. Does discontinuing bleomycin due to toxicity increase the risk of lymphoma progression? Real-life data from a homogeneous population of advanced stage Hodgkin lymphoma. J Chemother 2023:1-8. [PMID: 37974409 DOI: 10.1080/1120009x.2023.2281089] [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: 09/05/2023] [Accepted: 11/03/2023] [Indexed: 11/19/2023]
Abstract
Hodgkin Lymphoma (HL) is often curable with ABVD therapy and improving outcomes is a main goal of ongoing research. Bleomycin-associated pneumonitis (BAPT) is a potentially life-threatening complication that necessitates bleomycin discontinuation. We conducted this study on a homogenous cohort of advanced stage HL treated only with ABVD for frontline therapy to assess if bleomycin discontinuation increases the risk of lymphoma progression. After the exclusion of patients who received radiotherapy or other drugs, 106 and 28 patients in the six-cycle ABVD and BAPT groups respectively had similar survival curves for progression and death with a 49-month median follow-up. PFS rates were also very similar at two and four years from diagnosis with 2-year PFS rates of 83.9% and 82.1% (RR = 1.1 95%CI = 0.45-2.2). Outcome comparisons were also similar between the two groups when stratified according to early response assessment with PET/CT. Patients who discontinued bleomycin due to toxicity did not experience an increased risk of progression compared to patients who completed six ABVD cycles.
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Affiliation(s)
- Umut Yılmaz
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Güldane Zulfaliyeva
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Adnan Nuri Güzelli
- Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Deniz Özmen
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Tuğrul Elverdi
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Ayşe Salihoğlu
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Ahmet Emre Eskazan
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Şeniz Öngören
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Zafer Başlar
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Muhlis Cem Ar
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
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Kılıçkıran Avcı B, Soysal AU, Cerme E, Kargın OA, Hatemi Aİ, Ar MC, Öngen Z. Pulmonary Hypertension Due to High-Output Heart Failure: Hereditary Hemorrhagic Telangiectasia. Turk Kardiyol Dern Ars 2023; 51:493-497. [PMID: 37861254 DOI: 10.5543/tkda.2023.13614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023] Open
Abstract
Pulmonary hypertension (PH) is a complex disorder that should be managed with a multidisciplinary approach. Although most of the underlying causes of left heart disease can be easily diagnosed with cardiac imaging, some pathologies might necessitate careful investigation to go beyond the obvious. High-output heart failure (HF) due to arteriovenous malformation (AVMs) is an unnoticeable cause for HF and PH. Patients with hepatic AVMs should always be carefully evaluated with regard to hereditary hemorrhagic telangiectasia (HHT) since they can have multiple signs related to the other systems without any symptoms. In this case report, we discussed a patient who was initially diagnosed as PH associated with HF with preserved ejection fraction but eventually was found to have PH associated with high-output HF due to hereditary hemorrhagic telangiectasia (HHT, or Osler Weber Rendu syndrome) after detailed evaluation.
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Affiliation(s)
- Burçak Kılıçkıran Avcı
- Department of Cardiology, İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, İstanbul, Türkiye
| | - Ali Uğur Soysal
- Department of Cardiology, İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, İstanbul, Türkiye
| | - Emir Cerme
- Department of Internal Medicine, Division of Gastroenterology, İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, İstanbul, Türkiye
| | - Osman Aykan Kargın
- Department of Radiology, İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, İstanbul, Türkiye
| | - Ali İbrahim Hatemi
- Department of Internal Medicine, Division of Gastroenterology, İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, İstanbul, Türkiye
| | - Muhlis Cem Ar
- Department of Internal Medicine, Division of Hematology, İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, İstanbul, Türkiye
| | - Zeki Öngen
- Department of Cardiology, İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, İstanbul, Türkiye
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Ar MC, El Fakih R, Gabbassova S, Alhuraiji A, Nasr F, Alsaeed A, Sayinalp N, Marashi M. Management of humoral secondary immunodeficiency in hematological malignancies and following hematopoietic stem cell transplantation: Regional perspectives. Leuk Res 2023; 133:107365. [PMID: 37643508 DOI: 10.1016/j.leukres.2023.107365] [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: 03/06/2023] [Revised: 07/17/2023] [Accepted: 07/25/2023] [Indexed: 08/31/2023]
Abstract
Secondary immunodeficiency (SID) can occur as a result of multiple factors, including hematological malignancies, hematopoietic stem cell transplantation (HSCT), immunosuppressive treatment, biologics, and anti-inflammatory drugs. SID includes disorders resulting from impairment of both cellular and humoral immunity. This review focuses on the current risk factors, implications, and challenges in managing SID patients with impaired humoral immunity, which includes quantitative (hypogammaglobulinemia) and/or functional antibody and B-cell deficiencies specifically related to hematological malignancies and post-HSCT. Increased physician awareness is needed surrounding the disease presentation and early risk factors, as SID may be caused by several etiologies. Careful clinical assessment is then required to optimize management, which encompasses close monitoring of clinical parameters, vaccination, antibiotic prophylaxis, and immunoglobulin replacement therapy (IGRT). Novel methods of IGRT administration are associated with enhanced pharmacokinetics, IgG trough level stability, no need for venous access, as well as fewer systemic adverse events and better administration flexibility compared with traditional methods. Published international guidelines supported by observations from clinical data are broadly followed; however, best practices within each country have nuances that underline the need to tailor treatment plans to the individual patient.
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Affiliation(s)
- Muhlis Cem Ar
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa School of Medicine, Istanbul University, Cerrahpaşa, Istanbul, Turkey
| | - Riad El Fakih
- Oncology Center, Section of Stem Cell Transplant and Cellular Therapy, King Faisal Hospital and Research Center, Riyadh, Saudi Arabia
| | - Saule Gabbassova
- Center for Hematology and Bone Marrow Transplantation, Kazakh Scientific Research Institute of Oncology and Radiology, Almaty, Kazakhstan; Al-Farabi Kazakh National University, Almaty, Kazakhstan
| | - Ahmad Alhuraiji
- Department of Hematology, Kuwait Cancer Control Center, Kuwait City, Kuwait
| | - Fady Nasr
- Department of Hemato-Oncology, Hôtel-Dieu de France Hospital, Faculty of Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon
| | - Ahmad Alsaeed
- Princess Noorah Oncology Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia; College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Nilgun Sayinalp
- Department of Hematology, Hacettepe University Medical School, Ankara, Turkey
| | - Mahmoud Marashi
- Department of Hematology, Mediclinic City Hospital, Dubai, United Arab Emirates.
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Demir AM, Ar MC, Şahin F, Altunbaş M. Level of Awareness of Acquired Hemophilia A Among Physicians in Türkiye: A Survey Study. Turk J Haematol 2023; 40:197-201. [PMID: 37649419 PMCID: PMC10476256 DOI: 10.4274/tjh.galenos.2023.2023.0236] [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: 06/14/2023] [Accepted: 07/27/2023] [Indexed: 09/01/2023] Open
Abstract
This survey study aimed to evaluate the level of awareness and knowledge of acquired hemophilia A (AHA) among physicians from various specialties. Data were collected by administering a questionnaire containing questions about two patient profiles to evaluate the approaches of physicians from different specialties. The study included a total of 945 physicians. The most common suspected diagnosis for the clinical patient profile was immune thrombocytopenia, followed by hemophilia. For the laboratory patient profile, the most common suspected diagnosis was hemophilia. While only 9.4% of the physicians stated that they had good knowledge of this disease, only 21.6% wanted to learn more about AHA. Most of the participating physicians do not rank AHA first in the differential diagnosis of a patient with clinical and laboratory findings of AHA. Appropriate educational activities to raise awareness of AHA will help reduce disease-related morbidity and mortality.
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Affiliation(s)
- Ahmet Muzaffer Demir
- Trakya University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Edirne, Türkiye
| | - Muhlis Cem Ar
- İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Türkiye
| | - Fahri Şahin
- Ege University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İzmir, Türkiye
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10
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Cho SY, Ar MC, Machado CM, Wu D, Singh I, Sandhu A, Demuth D, Slavin M. Epidemiology, treatment patterns, and disease burden of cytomegalovirus in hematopoietic cell transplant recipients in selected countries outside of Europe and North America: A systematic review. Transpl Infect Dis 2023; 25:e14083. [PMID: 37287436 DOI: 10.1111/tid.14083] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/12/2023] [Accepted: 05/19/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Cytomegalovirus (CMV) disease impacts morbidity and mortality in hematopoietic cell transplant (HCT) recipients. This systematic review summarized data on the epidemiology, management, and burden of CMV post-HCT outside of Europe and North America. METHODS The MEDLINE, Embase, and Cochrane databases were searched for observational studies and treatment guidelines in HCT recipients across 15 selected countries from Asia-Pacific, Latin America, and Middle East (search period: 1 January 2011-17 September 2021). Outcomes included incidence of CMV infection/disease, recurrence, risk factors, CMV-related mortality, treatments, refractory, resistant CMV, and burden. RESULTS Of 2708 references identified, 68 were eligible (67 studies and one guideline; 45/67 studies specific to adult allogeneic HCT recipients). The rates of CMV infection and disease within 1 year of allogeneic HCT were 24.9%-61.2% (23 studies) and 2.9%-15.7% (10 studies), respectively. Recurrence occurred in 19.8%-37.9% of cases (11 studies). Up to 10% of HCT recipients died of CMV-related causes. In all countries, first-line treatment for CMV infection/disease involved intravenous ganciclovir or valganciclovir. Conventional treatments were associated with serious adverse events such as myelosuppression (10.0%) or neutropenia only (30.0%, 39.8%) and nephrotoxicity (11.0%) (three studies), frequently leading to treatment discontinuation (up to 13.6%). Refractory CMV was reported in 2.9%, 13.0%, and 28.9% of treated patients (three studies) with resistant CMV diagnosed in 0%-10% of recipients (five studies). Patient-reported outcomes and economic data were scarce. CONCLUSION The incidence of CMV infection and disease post-HCT is high outside of North America and Europe. CMV resistance and toxicity highlight a major unmet need with current conventional treatments.
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Affiliation(s)
- Sung-Yeon Cho
- Division of Infectious Diseases, Department of Internal Medicine, Seoul St. Mary's Hospital, Catholic Hematology Hospital, Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Muhlis Cem Ar
- Department of Haematology, Istanbul University-Cerrahpasa, Cerrahpassa Medical Faculty, Istanbul, Turkey
| | - Clarisse M Machado
- Virology Laboratory, Institute of Tropical Medicine, Faculty of Medicine, University of São Paulo (LIM52-FMUSP), São Paulo, Brazil
| | - Depei Wu
- Department of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Inderjeet Singh
- Takeda Biopharmaceuticals India Pvt. Ltd., Gurugram, Haryana, India
| | - Anudeep Sandhu
- Takeda Pharmaceuticals International AG-Singapore Branch, Singapore
| | - Dirk Demuth
- Takeda Pharmaceuticals International AG-Singapore Branch, Singapore
| | - Monica Slavin
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Victoria, Australia
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11
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Gezer S, Emrence Z, Elverdi T, Ar MC, Salman Yaylaz B, Paçal F, Ünüvar A, Sarıman M, Eşkazan AE, Karaman S, Salihoğlu A, Karakaş Z, Abacı N, Sırma-Ekmekci S. Upregulation of SPINK2 in acute myeloid leukemia. Adv Lab Med 2023; 4:92-104. [PMID: 37359898 PMCID: PMC10197194 DOI: 10.1515/almed-2022-0047] [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] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 12/14/2022] [Indexed: 06/28/2023]
Abstract
Objectives Acute myeloid leukemia (AML) is a highly heterogeneous disease. Although patients can be classified into risk groups based on their genetic changes, the prognosis of disease within these categories varies widely. This situation raises the need to search for new molecular markers related to AML. Serine peptidase inhibitor Kazal type 2 (SPINK2) has recently been reported to be upregulated in AML and associated with poor outcomes by meta-analysis and in a limited number of AML patients. Methods We analyzed SPINK2 mRNA expression in 62 patients (45 adult and 17 pediatric) with AML and 11 cell lines using quantitative Real-Time PCR (qRT-PCR). SPINK2 protein level was determined using ELISA in cell lines. Results We found that the expression of SPINK2 mRNA and protein levels in AML cell lines (HL60 and NB4) have increased compared to other cell lines (K562, Jurkat and NALM6, MCF7, HeLa, HUVEC, hFOB, 293T, U87). SPINK2 mRNA expression was upregulated in patients with AML compared to controls (p=0.004) and significantly lower in t(8;21)-positive patients compared to negative patients (p=0.0006). Conclusions Our results suggest that SPINK2 serves an important role in AML development. Further studies are needed to evaluate SPINK2 expression in AML patients with t(8.21) and investigate to clarify its prognostic value in various subgroups of AML.
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Affiliation(s)
- Sümbül Gezer
- Department of Genetics, Istanbul University, Aziz Sancar Institute of Experimental Medicine, Istanbul, Türkiye
- Istanbul University, Institute of Graduate Studies in Health Sciences, Istanbul, Türkiye
| | - Zeliha Emrence
- Department of Genetics, Istanbul University, Aziz Sancar Institute of Experimental Medicine, Istanbul, Türkiye
| | - Tuğrul Elverdi
- Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Division of Hematology, Istanbul University-Cerrahpasa, Istanbul, Türkiye
| | - Muhlis Cem Ar
- Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Division of Hematology, Istanbul University-Cerrahpasa, Istanbul, Türkiye
| | - Burcu Salman Yaylaz
- Department of Genetics, Istanbul University, Aziz Sancar Institute of Experimental Medicine, Istanbul, Türkiye
- Istanbul University, Institute of Graduate Studies in Health Sciences, Istanbul, Türkiye
| | - Ferda Paçal
- Department of Genetics, Istanbul University, Aziz Sancar Institute of Experimental Medicine, Istanbul, Türkiye
| | - Ayşegül Ünüvar
- Division of Pediatric Hematology and Oncology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Türkiye
| | - Melda Sarıman
- Department of Genetics, Istanbul University, Aziz Sancar Institute of Experimental Medicine, Istanbul, Türkiye
- Istanbul University, Institute of Graduate Studies in Health Sciences, Istanbul, Türkiye
| | - Ahmet Emre Eşkazan
- Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Division of Hematology, Istanbul University-Cerrahpasa, Istanbul, Türkiye
| | - Serap Karaman
- Division of Pediatric Hematology and Oncology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Türkiye
| | - Ayşe Salihoğlu
- Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Division of Hematology, Istanbul University-Cerrahpasa, Istanbul, Türkiye
| | - Zeynep Karakaş
- Division of Pediatric Hematology and Oncology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Türkiye
| | - Neslihan Abacı
- Department of Genetics, Istanbul University, Aziz Sancar Institute of Experimental Medicine, Istanbul, Türkiye
| | - Sema Sırma-Ekmekci
- Department of Genetics, Istanbul University, Aziz Sancar Institute of Experimental Medicine, Istanbul, Türkiye
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12
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Yılmaz U, Yaşar A, Öngören Ş, Başlar Z, Ar MC. Short-Term Clinical Outcomes of Packed Red Blood Cell Transfusions with Isolated Enzyme-Phase Crossmatch Incompatibility: A Single-Center Cross-Sectional Study. Turk J Haematol 2023; 40:50-63. [PMID: 36510383 PMCID: PMC9979731 DOI: 10.4274/tjh.galenos.2022.2022.0284] [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: 12/14/2022] Open
Abstract
Acute hemolytic transfusion reactions (AHTRs) are feared complications of packed red blood cell (PRBC) transfusions. This study aimed to investigate the clinical consequences of isolated enzyme-phase crossmatch-incompatible PRBC transfusions by clinically observing all events during the study period at a single institution with the primary goal of detecting AHTRs. Ninety-four transfusions of interest were administered during the study period. Laboratory investigations were adequate in 73 episodes, where no AHTR developed and a mean hemoglobin concentration rise of 1.1 g/dL was documented. Three transfusions were terminated prematurely; however, further investigations ruled out AHTR. The remaining 21 transfusions were also completed uneventfully without noteworthy clinical deterioration. This study’s results provide clinical validation to omit pretransfusion screening with enzyme-phase crossmatch and document the safety and short-term efficacy of isolated enzyme-phase incompatible transfusions. The findings may encourage future clinical research to better understand the long-term efficacy of such transfusions, which may be valuable for transfusion-dependent patients.
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Affiliation(s)
- Umut Yılmaz
- İstanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty, Department of Internal Medicine, Division of Hematology, İstanbul, Türkiye,* Address for Correspondence: İstanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty, Department of Internal Medicine, Division of Hematology, İstanbul, Türkiye E-mail:
| | - Alper Yaşar
- İstanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty, Department of Internal Medicine, İstanbul, Türkiye
| | - Şeniz Öngören
- İstanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty, Department of Internal Medicine, Division of Hematology, İstanbul, Türkiye
| | - Zafer Başlar
- İstanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty, Department of Internal Medicine, Division of Hematology, İstanbul, Türkiye
| | - Muhlis Cem Ar
- İstanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty, Department of Internal Medicine, Division of Hematology, İstanbul, Türkiye
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13
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Arslan Davulcu E, Demirci Z, Yılmaz U, Ar MC, Teke HÜ, Karakuş V, Çiftçiler R, Selim C, Yavaşoğlu İ, Durusoy SS, Okan V, Akdeniz A, Yolcu A, Aydoğdu İ, Güney T, Yılmaz AF, Şahin F. Acquired Hemophilia A In Adults: A Multicenter Study from Turkey. Indian J Hematol Blood Transfus 2023; 39:107-115. [PMID: 36699428 PMCID: PMC9868199 DOI: 10.1007/s12288-022-01556-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 07/04/2022] [Indexed: 01/28/2023] Open
Abstract
Acquired hemophilia A (AHA) is a rare disease caused by autoantibodies inhibiting factor VIII (FVIII) activity. Although the conditionis usually idiopathic, there may be other underlying diseases. Treatment consists of two steps: treatment of acute bleeding and immunosuppression. In this multicenter study, we aimed to demonstrate the clinical characteristics, management details, and survival of AHA patients in Turkey. Data was collected from eleven centers in Turkey. aPTT, FVIII, FVIII inhibitor, and hemoglobin (HB) levels, mixing test results, and demographics at diagnosis, treatment information, adverse events, bleeding episodes during follow-up, relapses, and outcome were analyzed. Twenty-nine patients were analyzed (58.6% female). No underlying disorder could be detected in 14 patients. The most prevalent etiologies were pregnancy, malignancy and infections. The median FVIII activity and FVIII inhibitor titer at diagnosis were 0.7% (0.0-29.4%) and 32.6 BU (0.6-135.6 BU) respectively. Bleeding was severe in 44.8% of patients. The HB value was significantly lower in patients with severe bleeding. Most of the patients (n = 25, 86.2%) had only one bleeding episode without relapse, three patients (10.3%) had two bleeding episodes, and one patient had more than three bleedings. 21 (75%) patients received hemostatic therapy. The use of recombinant FVIIa was slightly higher than activated prothrombin complex concentrate (15 versus 10 patients). Immunosuppressive treatment was initiated in 26 (93%) patients. Regimens containing steroid, cyclophosphamide, and rituximab in different combinations were the most preferred. The median follow-up period was 13 months (2-156 months). Median overall survival was 154.97 months. Four and six-year survival were 90.9 ± 0.8% and 77.9 ± 14.1% respectively. This is a unique study that investigated the demographic characteristics, treatment approaches, and patient survival of AHA in Turkey.
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Affiliation(s)
- Eren Arslan Davulcu
- University of Health Sciences Bakırkoy Dr. Sadi Konuk Training and Research Hospital, Hematology Clinic, Istanbul, Turkey
| | - Zühal Demirci
- Hematology Department, Ege Adult Haemophilia and Thrombosis Center, Ege University Medical Faculty, İzmir, Turkey
| | - Umut Yılmaz
- Division of Hematology, Department of Internal Medicine, Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Istanbul, Turkey
| | - Muhlis Cem Ar
- Division of Hematology, Department of Internal Medicine, Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Istanbul, Turkey
| | - Hava Üsküdar Teke
- Internal Medicine, Hematology Department, Eskişehir Osmangazi University Medical Faculty, Istanbul, Turkey
| | - Volkan Karakuş
- Hematology Clinic, University of Health Sciences Antalya Training and Research Hospital, Istanbul, Turkey
| | - Rafiye Çiftçiler
- Hematology Clinic, Aksaray University Training and Research Hospital, Aksaray, Turkey
| | - Cem Selim
- Internal Medicine Hematology Department, Aydın Adnan Menderes University Medical Faculty, Istanbul, Turkey
| | - İrfan Yavaşoğlu
- Internal Medicine Hematology Department, Aydın Adnan Menderes University Medical Faculty, Istanbul, Turkey
| | | | - Vahap Okan
- Department of Hematology, Gaziantep University School of Medicine, Gaziantep, Turkey
| | - Aydan Akdeniz
- Medical Faculty Hematology Department, Mersin University, Mersin, Turkey
| | - Alkım Yolcu
- Department of Internal Medicine, Faculty of Medicine, Manisa Celal Bayar University, Manisa, Turkey
| | - İsmet Aydoğdu
- Hematology Department, Faculty of Medicine, Manisa Celal Bayar University, Mersin, Turkey
| | - Tekin Güney
- Department of Hematology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Asu Fergün Yılmaz
- Hematology Depertmet, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Fahri Şahin
- Hematology Department, Ege Adult Haemophilia and Thrombosis Center, Ege University Medical Faculty, İzmir, Turkey
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14
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Küçükyurt S, Şahin K, Yılmaz U, Erçalışkan A, Özkan Tekin T, Ortaboz D, Elverdi T, Salihoğlu A, Ar MC, Öngören Ş, Başlar Z, Eşkazan AE. Diagnosis and Management of Classical Hodgkin Lymphoma During the COVID-19 Pandemic. Curr Probl Cancer 2022; 46:100913. [PMID: 36399974 PMCID: PMC9554335 DOI: 10.1016/j.currproblcancer.2022.100913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 09/17/2022] [Accepted: 10/04/2022] [Indexed: 01/30/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has brought life to a standstill globally. Intermittent quarantines were applied to control the pandemic and reduce contamination. During the pandemic, patients with hematological malignancies were among the most vulnerable population. Our aim was to compare in terms of demographic data, disease-related factors, symptom-to-diagnosis interval, diagnosis-to-treatment interval , and interim and end-of-treatment response in classical Hodgkin lymphoma patients diagnosed during the pandemic and in the pre-pandemic periods. A total of 90 patients were included, of which 65 and 25 were diagnosed in the 2 years before the pandemic and the 12-month period during the pandemic, respectively. Demographic features were comparable in both groups. Although the percentage of patients with advanced-stage disease was higher during the pandemic (64% vs 53.8%), this difference did not reach statistical significance (P = 0.384). The median symptom-to-diagnosis interval was significantly longer during the pandemic than was observed within the pre-pandemic era (16 weeks vs 8 weeks, P = 0.042). The median diagnosis-to-treatment intervals was similar in both groups (13 days vs 15 days, P = 0.253). In the pre-pandemic and pandemic periods, 85.2% and 72.7% of the patients had complete response at end-of-treatment evaluation, respectively (P = 0.208). We found that symptom-to-diagnosis interval was significantly prolonged during the pandemic. Higher percentage of patients with advanced-stage disease during the pandemic might also be due to this delay, nevertheless, this difference did not reach to a significant difference regarding treatment response in both groups.
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Affiliation(s)
- Selin Küçükyurt
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Kübra Şahin
- Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Umut Yılmaz
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Abdülkadir Erçalışkan
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Tuba Özkan Tekin
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Damla Ortaboz
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Tuğrul Elverdi
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Ayşe Salihoğlu
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Muhlis Cem Ar
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Şeniz Öngören
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Zafer Başlar
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Ahmet Emre Eşkazan
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey,Correspondence to: Ahmet Emre Eşkazan, Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Fatih, Istanbul, Turkey
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15
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Cirakoglu A, Kuru RD, Yilmaz S, Deviren A, Ongoren S, Yalniz FF, Keskin D, Eskazan AE, Salihoglu A, Cem Ar M, Sahin S, Aydin Y, Hacihanefioglu S, Baslar Z, Soysal T, Arguden YT. Cytogenetic profile of adult AML patients in Turkey: a single center study with comprehensive comparison with literature. Afr Health Sci 2022; 22:183-191. [PMID: 36910358 PMCID: PMC9993311 DOI: 10.4314/ahs.v22i3.21] [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] [Indexed: 11/16/2022] Open
Abstract
Background Cytogenetic findings are important prognostic factors in acute myeloid leukemia. Large systematic data about chromosomal characteristics of Turkish AML patients have not been reported to date. Objectives The karyotypic profiles of 157 adult AML patients were evaluated retrospectively and compared with other reports from different populations. Methods Cytogenetics analyses were performed on bone marrow samples using G-banding. Patients were categorized according to their cytogenetic results into four groups with the addition of a normal karyotyped group to the favorable, intermediate and adverse groups of European Leukemia Network. Results Cytogenetic analyses were carried out successfully in 138 patients (88%). Abnormal karyotypes were found in 79 (57.2%) patients of which 13 (9.4%) were in favorable, 37 (26.8%) in intermediate and 29 (21%) in adverse groups. t(8;21) (5%) was the most common favorable abnormality while monosomal karyotypes (15.9%) in adverse group. Conclusion This single center study is the most comprehensive study about the cytogenetic profile of acute myeloid leukemia in Turkey with comparison of other population-based studies. While there were similarities and differences with different publications, our results did not show a marked tendency to the findings of any specific geographic region.
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Affiliation(s)
- Ayse Cirakoglu
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Medical Biology
| | - Rahiye Dilhan Kuru
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Medical Biology
| | - Sukriye Yilmaz
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Medical Biology
| | - Ayhan Deviren
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Medical Biology
| | - Seniz Ongoren
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Internal Medicine, Division of Hematology
| | - Fevzi Firat Yalniz
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Internal Medicine, Division of Hematology
| | - Dilek Keskin
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Internal Medicine, Division of Hematology
| | - Ahmet Emre Eskazan
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Internal Medicine, Division of Hematology
| | - Ayse Salihoglu
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Internal Medicine, Division of Hematology
| | - Muhlis Cem Ar
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Internal Medicine, Division of Hematology
| | - Serdar Sahin
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Internal Medicine, Division of Hematology
| | - Yildiz Aydin
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Internal Medicine, Division of Hematology
| | - Seniha Hacihanefioglu
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Medical Biology
| | - Zafer Baslar
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Internal Medicine, Division of Hematology
| | - Teoman Soysal
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Internal Medicine, Division of Hematology
| | - Yelda Tarkan Arguden
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Medical Biology
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16
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Çokgezer S, Elverdi T, Salihoğlu A, Ar MC, Öngören Ş, Başlar Z, Eşkazan AE. Treatment Responses, Toxicity, and Survival in Patients with Classical Hodgkin Lymphoma Aged ≥50 Years: A Single-Center Experience Over Two Decades. Cancer Manag Res 2022; 14:1911-1921. [PMID: 35698602 PMCID: PMC9188373 DOI: 10.2147/cmar.s363235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 06/01/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction The aim of this study was to evaluate treatment responses, toxicity, and survival among cHL patients aged ≥50 years. Methods We retrospectively identified all newly diagnosed cHL patients and only included cases who were ≥50 years old at the time of diagnosis and with data available between 1999 and 2020. Results There were 101 patients, of which 52 were between 50 and 59 years of age, and 49 patients were ≥60 years old. Sixty-two patients were male, and the most common histopathological subtype was mixed cellularity cHL (58.4%). ECOG PS, CCI, CIRS, and ACE-27 scores were significantly higher in patients aged ≥60 years than those of 50–59 age group. While all patients aged 50–59 years received ABVD as first-line therapy, 79% (n=39) of cases aged ≥60 years had ABVD. In patients receiving ABVD, 95% and 92.7% of the cases aged 50–59 and ≥60 years had CR, respectively (p=0.999). Age groups were comparable in terms of hematological and non-hematological toxicities (p=0.369, p=0.127, respectively). Although not statistically significant, median survival was longer in patients receiving a transplant than in those without transplantation (108 months vs 52 months, p=0.069). In multivariate analysis, the risk of progression was higher in patients with lymphocyte ≤600/mm3 and in those who were unresponsive to first-line therapy (p=0.002 and p<0.001, respectively). Patients with B symptoms, age ≥60 years, and CIRS >3 had higher risk of mortality (p=0.001, p=0.012, p=0.038, respectively). By using these 3 parameters, we defined a new risk score, which divided our patient cohort into two as low- and high-risk groups. Low-risk patients had significantly higher survival rates than the high-risk group (83.9% vs 40.5%, p<0.001). Discussion This new prognostic score should be further tested and validated in other patient populations. Although our study has some limitations including the limited number of patients and its retrospective nature, there are not so many studies in elderly cHL patients and elderly and/or frail patients are generally excluded in most of the clinical trials. Thus, this real-life single-center experience would contribute to the literature.
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Affiliation(s)
- Simay Çokgezer
- Department of Internal Medicine, Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Istanbul, Turkey
| | - Tuğrul Elverdi
- Division of Hematology, Department of Internal Medicine, Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Istanbul, Turkey
| | - Ayşe Salihoğlu
- Division of Hematology, Department of Internal Medicine, Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Istanbul, Turkey
| | - Muhlis Cem Ar
- Division of Hematology, Department of Internal Medicine, Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Istanbul, Turkey
| | - Şeniz Öngören
- Division of Hematology, Department of Internal Medicine, Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Istanbul, Turkey
| | - Zafer Başlar
- Division of Hematology, Department of Internal Medicine, Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Istanbul, Turkey
| | - Ahmet Emre Eşkazan
- Division of Hematology, Department of Internal Medicine, Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Istanbul, Turkey
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17
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Özbalak M, Güzel Mastanzade M, Özlük Ö, Tiryaki TO, Erdem S, Özbalak EP, Elverdi T, Yönal Hindilerden İ, Altay AY, Yeğen G, Eşkazan AE, Ar MC, Yenerel MN, Soysal T, Nalçacı M, Ferhanoğlu B, Kalayoğlu Beşışık S. Biosimilar Rituximab (Redditux) Added to CHOP Chemotherapy for De-novo Diffuse Large B-cell Lymphoma Patients: Real-life Single Center Experience. Turk J Haematol 2022; 39:254-261. [PMID: 35657203 DOI: 10.4274/tjh.galenos.2022.2022.0142] [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] [Indexed: 12/01/2022] Open
Abstract
Objective Redditux®(RED), the biosimilar rituximab, was approved in Turkey for all indications of the original Mabthera®(MAB) in March 2018. The aim of our study was to evaluate the efficacy and safety of RED in de-novo DLBCL. Materials and Methods Fifty-one patients received RED combined with CHOP regimen. The median follow-up was 31 months. The historical control group included 219 patients treated with MAB-CHOP regimen and the median follow-up time was 38 months. We compared the response rates and survival outcomes of the RED- and MAB-CHOP treated cohorts. Results In the RED cohort, the overall response rate (ORR) at the end of the treatment protocol was 86%, with 37 CR (72.5%) and 7 PR (13.5%). In the historical MAB cohort, the overall response rate was 84%, with a CR and PR rate of 82% and 2%, respectively. The 24-month PFS rates were 73.76% (95%CI 0.59-0.84) and 85.2 (95%CI:0.79-0.90) for RED and MAB cohorts, respectively (p=0.0106). The 24-month OS rates were 78.4% (95%CI:0.64-0.87) and 81.4% (95%CI:0.75-0.86) for RED and MAB cohorts, respectively (p=0.7461). For pts with high R-IPI score; the 24-month PFS was 45.5% (95%CI:0.17-0.71) and 63% (95%CI:0.37-0.80) for RED and MAB cohorts, respectively (p=0.0711). In the RED cohort, CNS relapse was significantly increased compared to MAB cohort (10% vs 1.83%, p=0.004). Among our RED cohort, bone involvement at the time of diagnosis was a risk factor for CNS relapse (p=0.028). Thirteen pts died in the follow-up. There was not any serious adverse event causing the cessation of the drug. Conclusion RED has similar ORR to MAB. However, PFS rates were worse in the RED cohort. Additionally, CNS relapse ratio was a major concern for our RED cohort. Large prospective controlled studies and real-life data with longer follow-up are needed to document the non-inferiority of RED compared to MAB.
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Affiliation(s)
- Murat Özbalak
- Istanbul University, Istanbul Medical Faculty, Department of Internal Medicine, Division of Hematology, Istanbul, Turkey
| | - Metban Güzel Mastanzade
- Istanbul University, Istanbul Medical Faculty, Department of Internal Medicine, Division of Hematology, Istanbul, Turkey
| | - Özden Özlük
- Istanbul University, Istanbul Medical Faculty, Department of Internal Medicine, Division of Hematology, Istanbul, Turkey
| | - Tarık Onur Tiryaki
- Istanbul University, Istanbul Medical Faculty, Department of Internal Medicine, Division of Hematology, Istanbul, Turkey
| | - Simge Erdem
- Istanbul University, Istanbul Medical Faculty, Department of Internal Medicine, Division of Hematology, Istanbul, Turkey
| | - Ezgi Pınar Özbalak
- Istanbul University, Istanbul Medical Faculty, Department of Internal Medicine, Division of Hematology, Istanbul, Turkey
| | - Tuğrul Elverdi
- Istanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty, Department of Internal Medicine, Division of Hematology, Istanbul, Turkey
| | - İpek Yönal Hindilerden
- Istanbul University, Istanbul Medical Faculty, Department of Internal Medicine, Division of Hematology, Istanbul, Turkey
| | - Ali Yılmaz Altay
- Istanbul University, Istanbul Medical Faculty, Department of Pathology, Division of Hematopathology, Istanbul, Turkey
| | - Gülçin Yeğen
- Istanbul University, Istanbul Medical Faculty, Department of Pathology, Division of Hematopathology, Istanbul, Turkey
| | - Ahmet Emre Eşkazan
- Istanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty, Department of Internal Medicine, Division of Hematology, Istanbul, Turkey
| | - Muhlis Cem Ar
- Istanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty, Department of Internal Medicine, Division of Hematology, Istanbul, Turkey
| | - Mustafa Nuri Yenerel
- Istanbul University, Istanbul Medical Faculty, Department of Internal Medicine, Division of Hematology, Istanbul, Turkey
| | - Teoman Soysal
- Istanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty, Department of Internal Medicine, Division of Hematology, Istanbul, Turkey
| | - Meliha Nalçacı
- Istanbul University, Istanbul Medical Faculty, Department of Internal Medicine, Division of Hematology, Istanbul, Turkey
| | - Burhan Ferhanoğlu
- V.K.V. American Hospital, Department of Internal Medicine, Division of Hematology, Istanbul, Turkey
| | - Sevgi Kalayoğlu Beşışık
- Istanbul University, Istanbul Medical Faculty, Department of Internal Medicine, Division of Hematology, Istanbul, Turkey
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18
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Şentürk G, Ng YY, Eltan SB, Başer D, Ogulur I, Altındirek D, Fırtına S, Yılmaz H, Kocamış B, Kıykım A, Camcıoğlu Y, Ar MC, Sudutan T, Beken S, Temel ŞG, Alanay Y, Karakoc-Aydiner E, Barış S, Özen A, Özbek U, Sayitoğlu M, Hatırnaz Ng Ö. Determining T and B Cell development by TREC/KREC analysis in primary immunodeficiency patients and healthy controls. Scand J Immunol 2021; 95:e13130. [PMID: 34951041 DOI: 10.1111/sji.13130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 12/07/2021] [Accepted: 12/15/2021] [Indexed: 01/26/2023]
Abstract
T cell receptor excision circles (TRECs) and kappa-deleting excision circles (KRECs) are DNA fragments potentially indicative of T and B cell development, respectively. Recent thymic emigrants (RTEs) are a subset of peripheral cells that may also represent thymic function. Here, we investigated TREC/KREC copy numbers by quantitative real-time PCR in the peripheral blood of patients with primary immunodeficiencies (PIDs, n = 145) and that of healthy controls (HCs, n = 86) and assessed the correlation between RTEs and TREC copy numbers. We found that TREC copy numbers were significantly lower in children and adults with PIDs (P < .0001 and P < .002, respectively) as compared with their respective age-matched HCs. A moderate correlation was observed between TREC copies and RTE numbers among children with PID (r = .5114, P < .01), whereas no significant correlation was detected between RTE values and TREC content in the HCs (r = .0205, P = .9208). Additionally, we determined TREC and KREC copy numbers in DNA isolated from the Guthrie cards of 200 newborns and showed that this method is applicable to DNA isolated from both peripheral blood samples and dried blood spots, with the two sample types showing comparable TREC and KREC values. We further showed that RTE values are not always reliable markers of T cell output. Although additional confirmatory studies with larger cohorts are needed, our results provide thresholds for TREC/KREC copy numbers for different age groups.
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Affiliation(s)
- Gizem Şentürk
- Department of Genetics, Health Sciences Institute, Istanbul University, Istanbul, Turkey.,Department of Medical Biology, School of Medicine, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey.,Department of Genetics, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Yuk Yin Ng
- Department of Genetics and Bioengineering, Istanbul Bilgi University, Istanbul, Turkey
| | - Sevgi Bilgiç Eltan
- The Isıl Berat Barlan Center for Translational Medicine, Istanbul, Turkey.,Division of Pediatric Allergy and Immunology, Pendik Research and Training Hospital, Marmara University, Istanbul, Turkey
| | - Dilek Başer
- The Isıl Berat Barlan Center for Translational Medicine, Istanbul, Turkey.,Division of Pediatric Allergy and Immunology, Pendik Research and Training Hospital, Marmara University, Istanbul, Turkey
| | - Ismail Ogulur
- The Isıl Berat Barlan Center for Translational Medicine, Istanbul, Turkey.,Division of Pediatric Allergy and Immunology, Marmara University School of Medicine, Istanbul, Turkey
| | - Didem Altındirek
- Department of Genetics, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Sinem Fırtına
- Department of Bioinformatics and Genetics, Faculty of Engineering and Natural Science, Istanbul Istinye University, Istanbul, Turkey
| | - Hülya Yılmaz
- Division of Hematology, Ankara Medical Faculty, Ankara University, Ankara, Turkey
| | - Burcu Kocamış
- The Isıl Berat Barlan Center for Translational Medicine, Istanbul, Turkey.,Division of Pediatric Allergy and Immunology, Marmara University School of Medicine, Istanbul, Turkey
| | - Ayça Kıykım
- Division of Allergy, and Immunology, Department of Children's Health and Disease, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Yıldız Camcıoğlu
- Division of Allergy, and Immunology, Department of Children's Health and Disease, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Muhlis Cem Ar
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Tuğçe Sudutan
- Department of Genetics, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Serdar Beken
- Department of Pediatrics, School of Medicine, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Şehime G Temel
- Department of Medical Genetics, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey.,Department of Histology and Embryology, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey.,Department of Translational Medicine, Institute of Health Sciences, Bursa Uludag University, Bursa, Turkey
| | - Yasemin Alanay
- Department of Pediatrics, School of Medicine, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey.,Rare Diseases and Orphan Drugs Application and Research Center, Acıbadem University, Istanbul, Turkey
| | - Elif Karakoc-Aydiner
- The Isıl Berat Barlan Center for Translational Medicine, Istanbul, Turkey.,Division of Pediatric Allergy and Immunology, Marmara University School of Medicine, Istanbul, Turkey
| | - Safa Barış
- The Isıl Berat Barlan Center for Translational Medicine, Istanbul, Turkey.,Division of Pediatric Allergy and Immunology, Marmara University School of Medicine, Istanbul, Turkey
| | - Ahmet Özen
- The Isıl Berat Barlan Center for Translational Medicine, Istanbul, Turkey.,Division of Pediatric Allergy and Immunology, Marmara University School of Medicine, Istanbul, Turkey
| | - Uğur Özbek
- Rare Diseases and Orphan Drugs Application and Research Center, Acıbadem University, Istanbul, Turkey.,Department of Medical Genetics, School of Medicine, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Müge Sayitoğlu
- Department of Genetics, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Özden Hatırnaz Ng
- Department of Medical Biology, School of Medicine, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey.,Department of Genetics, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey.,Rare Diseases and Orphan Drugs Application and Research Center, Acıbadem University, Istanbul, Turkey
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19
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Akdeniz A, Ünüvar A, Ar MC, Pekpak E, Akyay A, Mehtap Ö, Karadağ FK, Acıpayam C, Doğan A, Ekinci Ö, Köker SA, Albayrak C, Demirci U, Güney T, Kurt M, Karaman S, Kimyon ÖŞ, Albayrak S, Öncül Y, Ünal S, Şahin F, Tuna R, Zulfikar B, Apak BB, Ümit EG, Demir AM. Results of multicenter registry for patients with inherited factor VII deficiency in Turkey. Scand J Clin Lab Invest 2021; 82:28-36. [PMID: 34915774 DOI: 10.1080/00365513.2021.2013524] [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] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Inherited factor VII (FVII) deficiency (FVIID) is the most common of inherited rare bleeding disorders. Other determinants of clinical severity apart from FVII level (FVIIL) include genetic and environmental factors. We aimed to identify the cut-off FVIILs for general and severe bleedings in patients with FVIID by using an online national registry system including clinical, laboratory, and demographic characteristics of patients. METHODS Demographic, clinical, and laboratory data of patients with FVIID extracted from the national database, constituted by the Turkish Society of Hematology, were examined. Bleeding phenotypes, general characteristics, and laboratory features were assessed in terms of FVIILs. Bleeding rates and prophylaxis during special procedures/interventions were also recorded. RESULTS Data from 197 patients showed that 46.2% of patients had FVIIL< 10%. Most bleeds were of mucosal origin (67.7%), and severe bleeds tended to occur in younger patients (median age: 15 (IQR:6-29)). Cut-off FVIILs for all and severe bleeds were 16.5% and 7.5%, respectively. The major reason for long-term prophylaxis was observed as central nervous system bleeding (80%). CONCLUSION Our data are consistent with most of the published literature in terms of cut-off FVIIL for bleeding, as well as reasons for prophylaxis, showing both an increased severity of bleeding and younger age at diagnosis with decreasing FVIIL. However, in order to offer a classification similar to that in Hemophilia A or B, data of a larger cohort with information about environmental and genetic factors are required.
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Affiliation(s)
- Aydan Akdeniz
- Division of Hematology, Department of Internal Medicine, Medical Faculty, Mersin University, Mersin, Turkey
| | - Ayşegül Ünüvar
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Medical Faculty, Istanbul University Hospital, Istanbul, Turkey
| | - Muhlis Cem Ar
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Esra Pekpak
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Gaziantep Children's Hospital, Gaziantep, Turkey
| | - Arzu Akyay
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Medical Faculty, Inonu University, Malatya, Turkey
| | - Özgür Mehtap
- Division of Hematology, Department of Internal Medicine, Medical Faculty, Kocaeli University, Kocaeli, Turkey
| | - Fatma Keklik Karadağ
- Division of Hematology, Department of Internal Medicine, Medical Faculty, Ege University, İzmir, Turkey
| | - Can Acıpayam
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Medical Faculty, Sutcu Imam University, Kahramanmaras, Turkey
| | - Ali Doğan
- Division of Hematology, Department of Internal Medicine, Medical Faculty, Yuzuncu Yıl University, Van, Turkey
| | - Ömer Ekinci
- Division of Hematology, Department of Internal Medicine, Medical Faculty, Firat University, Elazığ, Turkey
| | - Sultan Aydın Köker
- Department of Pediatric Hematology and Oncology, Antakya State Hospital, Antakya, Turkey
| | - Canan Albayrak
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Medical Faculty, Ondokuz Mayıs University, Samsun, Turkey
| | - Ufuk Demirci
- Division of Hematology, Department of Internal Medicine, Medical Faculty, Trakya University, Edirne, Turkey
| | - Tekin Güney
- Department of Hematology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Meltem Kurt
- Division of Hematology, Department of Internal Medicine, Medical Faculty, Ankara University, Ankara, Turkey
| | - Serap Karaman
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Medical Faculty, Istanbul University Hospital, Istanbul, Turkey
| | - Özge Şahin Kimyon
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Sinan Albayrak
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Gaziantep Children's Hospital, Gaziantep, Turkey
| | - Yurday Öncül
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Medical Faculty, Inonu University, Malatya, Turkey
| | - Serkan Ünal
- Division of Hematology, Department of Internal Medicine, Medical Faculty, Kocaeli University, Kocaeli, Turkey
| | - Fahri Şahin
- Division of Hematology, Department of Internal Medicine, Medical Faculty, Ege University, İzmir, Turkey
| | - Rumeysa Tuna
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Medical Faculty, Istanbul University Hospital, Istanbul, Turkey
| | - Bulent Zulfikar
- Division of Pediatric Hematology-Oncology, Istanbul University, Cerrahpasa Medical Faculty & Istanbul University Oncology Institute, Istanbul, Turkey
| | - Burcu Belen Apak
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Baskent University, Ankara, Turkey
| | - Elif Gülsüm Ümit
- Division of Hematology, Department of Internal Medicine, Medical Faculty, Trakya University, Edirne, Turkey
| | - Ahmet Muzaffer Demir
- Division of Hematology, Department of Internal Medicine, Medical Faculty, Trakya University, Edirne, Turkey
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20
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Civriz Bozdağ S, Cengiz Seval G, Yönal Hindilerden İ, Hindilerden F, Andıç N, Baydar M, Aydın Kaynar L, Koçak Toprak S, Göksoy HS, Balık Aydın B, Demirci U, Can F, Özkocaman V, Gündüz E, Güven ZT, Özkurt ZN, Demircioğlu S, Beksaç M, İnce İ, Yılmaz U, Eroğlu Küçükdiler H, Abishov E, Yavuz B, Ataş Ü, Mutlu YG, Baş V, Özkalemkaş F, Üsküdar Teke H, Gürsoy V, Çelik S, Çiftçiler R, Yağcı M, Topçuoğlu P, Çeneli Ö, Abbasov H, Selim C, Ar MC, Yücel OK, Sadri S, Albayrak C, Demir AM, Güler N, Keklik M, Terzi H, Doğan A, Yegin ZA, Kurt Yüksel M, Sadri S, Yavaşoğlu İ, Beköz HS, Aksu T, Maral S, Erol V, Kaynar L, İlhan O, Bolaman AZ, Sevindik ÖG, Akyay A, Özcan M, Gürman G, Ünal Ş, Yavuz Y, Diz Küçükkaya R, Özsan GH. Clinical Characteristics and Outcome of COVID-19 in Turkish Hematological Malignancy Patients. Turk J Haematol 2021; 39:43-54. [PMID: 34521187 PMCID: PMC8886271 DOI: 10.4274/tjh.galenos.2021.2021.0287] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: Patients with solid malignancies are more vulnerable to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection than the healthy population. The outcome of SARS-CoV-2 infection in highly immunosuppressed populations, such as in patients with hematological malignancies, is a point of interest. We aimed to analyze the symptoms, complications, intensive care unit admissions, and mortality rates of patients with hematological malignancies infected with SARS-CoV-2 in Turkey. Materials and Methods: In this multicenter study, we included 340 adult and pediatric patients diagnosed with SARS-CoV-2 from March to November 2020. Diagnosis and status of primary disease, treatment schedules for hematological malignancies, time from last treatment, life expectancy related to the hematological disease, and comorbidities were recorded, together with data regarding symptoms, treatment, and outcome of SARS-CoV-2 infection. Results: Forty four patients were asymptomatic at diagnosis of SARS-CoV- 2 infection. Among symptomatic patients, fever, cough, and dyspnea were observed in 62.6%, 48.8%, and 41.8%, respectively. Sixty-nine (20%) patients had mild SARS-CoV-2 disease, whereas moderate, severe, and critical disease was reported in 101 (29%), 71 (20%), and 55 (16%) patients, respectively. Of the entire cohort, 251 (73.8%) patients were hospitalized for SARS-CoV-2. Mortality related to SARS-CoV-2 infection was 26.5% in the entire cohort; this comprised 4.4% of those patients with mild disease, 12.4% of those with moderate disease, and 83% of those with severe or critical disease. Active hematological disease, lower life expectancy related to primary hematological disease, neutropenia at diagnosis of SARS-CoV-2, ICU admission, and first-line therapy used for coronavirus disease-2019 treatment were found to be related to higher mortality rates. Treatments with hydroxychloroquine alone or in combination with azithromycin were associated with a higher rate of mortality in comparison to favipiravir use. Conclusion: Patients with hematological malignancy infected with SARS-CoV-2 have an increased risk of severe disease and mortality.
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Affiliation(s)
- Sinem Civriz Bozdağ
- Ankara University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | | | - İpek Yönal Hindilerden
- İstanbul University, İstanbul Faculty of Medicine, Department of Internal Medicine, İstanbul, Turkey
| | - Fehmi Hindilerden
- İstanbul Bakırköy Sadi Konuk Training and Research Hospital, Clinic of Hematology, İstanbul, Turkey
| | - Neslihan Andıç
- Eskişehir Osmangazi University Faculty of Medicine, Department of Hematology, Eskisehir, Turkey
| | - Mustafa Baydar
- Erciyes University Faculty of Medicine, Department of Internal Medicine, Kayseri, Turkey
| | - Lale Aydın Kaynar
- Gazi University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Selami Koçak Toprak
- Ankara University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Hasan Sami Göksoy
- Yeni yüzyıl University, Özel Gaziosmanpaşa Hospital, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
| | - Berrin Balık Aydın
- Medipol University Faculty of Medicine, Department of Internal Medicine, İstanbul, Turkey
| | - Ufuk Demirci
- Trakya University Faculty of Medicine, Department of Hematology, Edirne, Turkey
| | - Ferda Can
- Ankara City Hospital, Clinic of Internal Medicine, Ankara, Turkey
| | - Vildan Özkocaman
- Bursa Uludağ University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Bursa, Turkey
| | - Eren Gündüz
- Eskişehir Osmangazi University Faculty of Medicine, Department of Hematology, Eskisehir, Turkey
| | - Zeynep Tuğba Güven
- Erciyes University Faculty of Medicine, Department of Internal Medicine, Kayseri, Turkey
| | - Zübeyde Nur Özkurt
- Gazi University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Sinan Demircioğlu
- Necmettin Erbakan University, Meram Faculty of Medicine, Department of Hematology, Konya, Turkey
| | - Meral Beksaç
- Ankara University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - İdris İnce
- Dr. Ersin Arslan Training and Research Hospital, Clinic of Hematology, Gaziantep, Turkey
| | - Umut Yılmaz
- İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
| | | | - Elgün Abishov
- Yeni yüzyıl University, Özel Gaziosmanpaşa Hospital, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
| | - Boran Yavuz
- Dokuz Eylül University Faculty of Medicine, Department of Hematology, İzmir, Turkey
| | - Ünal Ataş
- Akdeniz University Faculty of Medicine, Department of Hematology, Antalya, Turkey
| | - Yaşa Gül Mutlu
- Medipol University Faculty of Medicine, Department of Internal Medicine, İstanbul, Turkey
| | - Volkan Baş
- Trakya University Faculty of Medicine, Department of Hematology, Edirne, Turkey
| | - Fahir Özkalemkaş
- Bursa Uludağ University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Bursa, Turkey
| | - Hava Üsküdar Teke
- Eskişehir Osmangazi University Faculty of Medicine, Department of Hematology, Eskisehir, Turkey
| | - Vildan Gürsoy
- Bursa City Hospital, Clinic of Hematology, Bursa, Turkey
| | - Serhat Çelik
- Erciyes University Faculty of Medicine, Department of Internal Medicine, Kayseri, Turkey
| | - Rafiye Çiftçiler
- Aksaray Training and Research Hospital, Clinic of Hematology, Aksaray, Turkey
| | - Münci Yağcı
- Gazi University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Pervin Topçuoğlu
- Ankara University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Özcan Çeneli
- Necmettin Erbakan University, Meram Faculty of Medicine, Department of Hematology, Konya, Turkey
| | - Hamza Abbasov
- Yeni yüzyıl University, Özel Gaziosmanpaşa Hospital, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
| | - Cem Selim
- Adnan Menderes University Faculty of Medicine, Department of Hematology, Aydın, Turkey
| | - Muhlis Cem Ar
- İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
| | - Orhan Kemal Yücel
- Akdeniz University Faculty of Medicine, Department of Hematology, Antalya, Turkey
| | - Sevil Sadri
- Medipol University Faculty of Medicine, Department of Internal Medicine, İstanbul, Turkey
| | - Canan Albayrak
- Ondokuz Mayıs University Faculty of Medicine, Department of Pediatric Hematology, Samsun, Turkey
| | | | - Nil Güler
- Pamukkale University Faculty of Medicine, Department of Internal Medicine, Denizli, Turkey
| | - Muzaffer Keklik
- Erciyes University Faculty of Medicine, Department of Internal Medicine, Kayseri, Turkey
| | - Hatice Terzi
- Cumhuriyet University Faculty of Medicine, Department of Hematology, Sivas, Turkey
| | - Ali Doğan
- Van Yüzüncü Yıl University Faculty of Medicine, Department of Hematology, Van, Turkey
| | - Zeynep Arzu Yegin
- Gazi University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Meltem Kurt Yüksel
- Ankara University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Soğol Sadri
- Yeni yüzyıl University, Özel Gaziosmanpaşa Hospital, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
| | - İrfan Yavaşoğlu
- Adnan Menderes University Faculty of Medicine, Department of Hematology, Aydın, Turkey
| | - Hüseyin Saffet Beköz
- Medipol University Faculty of Medicine, Department of Internal Medicine, İstanbul, Turkey
| | - Tekin Aksu
- University of Health Sciences Turkey, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, Department of Pediatric Hematology and Oncology, Ankara, Turkey
| | - Senem Maral
- University of Health Sciences Turkey, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Department of Hematology, Ankara, Turkey
| | - Veysel Erol
- Pamukkale University Faculty of Medicine, Department of Internal Medicine, Denizli, Turkey
| | - Leylagül Kaynar
- Erciyes University Faculty of Medicine, Department of Internal Medicine, Kayseri, Turkey
| | - Osman İlhan
- Ankara University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Ali Zahit Bolaman
- Adnan Menderes University Faculty of Medicine, Department of Hematology, Aydın, Turkey
| | - Ömür Gökmen Sevindik
- Medipol University Faculty of Medicine, Department of Internal Medicine, İstanbul, Turkey
| | - Arzu Akyay
- İnönü University Faculty of Medicine, Department of Pediatric Hematology and Oncology, Malatya, Turkey
| | - Muhit Özcan
- Ankara University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Günhan Gürman
- Ankara University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Şule Ünal
- Hacettepe University Faculty of Medicine, Department of Pediatric Hematology, Ankara, Turkey
| | - Yasemin Yavuz
- Ankara University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Reyhan Diz Küçükkaya
- İstanbul University Faculty of Science, Department of Molecular Biology and Genetic, İstanbul, Turkey
| | - Güner Hayri Özsan
- Dokuz Eylül University Faculty of Medicine, Department of Hematology, İzmir, Turkey
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21
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Eşkazan AE, Özmen D, Öztaş M, Bektaş F, Bayraktar EA, Sadri S, Keskin D, Özgür Yurttaş N, Elverdi T, Salihoğlu A, Ar MC, Öngören Ş, Başlar Z, Aydın Y, Soysal T. Efficacy and Safety of Imatinib Treatment in Elderly Patients With Chronic Myeloid Leukemia: Real-Life Data and a Single-Center Experience. Clinical Lymphoma Myeloma and Leukemia 2021; 21:549-557. [DOI: 10.1016/j.clml.2021.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/03/2021] [Accepted: 04/06/2021] [Indexed: 01/07/2023]
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22
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Küçükyurt S, Kelezoğlu A, Elverdi T, Özmen D, Ar MC, Eşkazan AE. Ponatinib both as an effective bridge to allogeneic hematopoietic stem cell transplantation and as posttransplant maintenance therapy in a chronic myeloid leukemia patient with myeloid blast crisis. Hematol Transfus Cell Ther 2021:S2531-1379(21)00082-1. [PMID: 34210618 DOI: 10.1016/j.htct.2021.04.007] [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] [Received: 12/26/2020] [Revised: 02/20/2021] [Accepted: 04/08/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- Selin Küçükyurt
- Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Alihan Kelezoğlu
- Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Tuğrul Elverdi
- Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Deniz Özmen
- Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Muhlis Cem Ar
- Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Ahmet Emre Eşkazan
- Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey.
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23
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Esatoğlu SN, Keskin D, Eşkazan AE, Elverdi T, Salihoğlu A, Ar MC, Öngören Ş, Başlar Z, Aydin Y, Uzun H, Soysal T. The prognostic value of serum levels of a proliferation-inducing ligand (APRIL) in treatment-naïve patients with chronic lymphocytic leukemia. Turk J Med Sci 2021; 51:348-354. [PMID: 32950049 PMCID: PMC7991891 DOI: 10.3906/sag-2004-282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 09/17/2020] [Indexed: 11/03/2022] Open
Abstract
Background/aim A proliferation-inducing ligand (APRIL) has been investigated as a prognostic marker in chronic lymphocytic leukemia (CLL) patients. However, there is no cut-off level for serum APRIL (sAPRIL) levels that predict time to treatment in CLL patients. Materials and methods Between May and December 2012, 94 consecutive CLL patients and 25 healthy controls were assessed. sAPRIL levels were measured by ELISA. Demographic data and prognostic markers were obtained from the patients’ files. Treatment-naïve patients were followed up for 6.5 years for any treatment need. Results Patients were divided into 3 groups: Treatment-naïve (n = 47), chemotherapy receiving (n = 25), and those who had received chemotherapy previously (n = 22). There was no difference in median sAPRIL levels of patients who were receiving chemotherapy at the sampling time and the healthy controls, which indicates that sAPRIL levels might be influenced by treatment. For treatment-naïve patients, the best cut-off in predicting time to treatment was found at the sAPRIL level of 2.04 ng/mL, with 78% sensitivity and 63% specificity. Time to treatment was significantly earlier in the APRIL high group (n = 27) than in the APRIL low group (n = 20) (P = 0.010, log-rank test). Conclusion sAPRIL, a simple, promising blood test which can be measured by ELISA, will likely obtain a place in the wide range of prognostic markers in CLL. Prospective large-scale studies are required to validate and confirm the feasibility of the proposed cut-off level of 2.04 ng/mL as a predictor of time to treatment in treatment-naïve CLL patients.
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Affiliation(s)
- Sinem Nihal Esatoğlu
- Department of Internal Medicine, Section of Rheumatology, Cerrahpaşa Medical Faculty, İstanbul University-Cerrahpaşa, İstanbul, Turkey
| | - Dilek Keskin
- Department of Internal Medicine, Section of Hematology, Cerrahpaşa Medical Faculty, İstanbul University-Cerrahpaşa, İstanbul, Turkey
| | - Ahmet Emre Eşkazan
- Department of Internal Medicine, Section of Hematology, Cerrahpaşa Medical Faculty, İstanbul University-Cerrahpaşa, İstanbul, Turkey
| | - Tuğrul Elverdi
- Department of Internal Medicine, Section of Hematology, Cerrahpaşa Medical Faculty, İstanbul University-Cerrahpaşa, İstanbul, Turkey
| | - Ayşe Salihoğlu
- Department of Internal Medicine, Section of Hematology, Cerrahpaşa Medical Faculty, İstanbul University-Cerrahpaşa, İstanbul, Turkey
| | - Muhlis Cem Ar
- Department of Internal Medicine, Section of Hematology, Cerrahpaşa Medical Faculty, İstanbul University-Cerrahpaşa, İstanbul, Turkey
| | - Şeniz Öngören
- Department of Internal Medicine, Section of Hematology, Cerrahpaşa Medical Faculty, İstanbul University-Cerrahpaşa, İstanbul, Turkey
| | - Zafer Başlar
- Department of Internal Medicine, Section of Hematology, Cerrahpaşa Medical Faculty, İstanbul University-Cerrahpaşa, İstanbul, Turkey
| | - Yildiz Aydin
- Department of Internal Medicine, Section of Hematology, Cerrahpaşa Medical Faculty, İstanbul University-Cerrahpaşa, İstanbul, Turkey
| | - Hafize Uzun
- Department of Biochemistry, Cerrahpaşa Medical Faculty, İstanbul University-Cerrahpaşa, İstanbul, Turkey
| | - Teoman Soysal
- Department of Internal Medicine, Section of Hematology, Cerrahpaşa Medical Faculty, İstanbul University-Cerrahpaşa, İstanbul, Turkey
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24
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Malhan S, Öksüz E, Antmen B, Ar MC, Balkan C, Kavaklı K. Cost of hemophilia A in Turkey: an economic disease burden analysis. J Med Econ 2021; 24:1052-1059. [PMID: 34355649 DOI: 10.1080/13696998.2021.1965388] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Hemophilia A is the second most common bleeding disorder causing patients to have lifelong follow-up and treatment. Despite being a rare disease, hemophilia A has a high economic burden on individuals and the public. The purpose of this study was to estimate the total disease cost of hemophilia A in Turkey. MATERIALS AND METHODS Data used in this analysis were collected through literature review, including studies conducted in Turkey in December 2018. A disease burden analysis was performed by modeling hemophilia A-related costs among patients, their relatives, and the social security system. Two expert panels were held to evaluate real-world data sources and to provide further information. All direct medical and non-medical costs were calculated annually from the Social Security Institution of the Republic of Turkey perspective, while indirect costs were estimated from the patient and community perspective. RESULTS For the calendar year of 2018, the number of hemophilia A patients in Turkey were estimated to be 5,055, with an average weight of 64.7 kg. The average annual direct medical, direct non-medical, and indirect costs of hemophilia A were calculated as €93,268 ($109,286; ₺502,717), €2,533 ($2,968; ₺13,655), and €7,957 ($9,323; ₺42,888) per patient, respectively, with a total annual cost of €103,759 ($121,578; ₺559,259). For the management of patients with inhibitors (4.9%), the average annual total cost was calculated to be €325,439 ($381,330; ₺1,754,117) per patient. The total annual disease burden of hemophilia A in 2018 was estimated to be about €524 million ($614 million; ₺2.82 billion), which corresponded to 1.6% of the total health expenditure in Turkey. CONCLUSION The most important reason hemophilia A has a significant economic burden in Turkey is that replacement therapy is expensive. The major cost contributor was identified as factor replacement therapy. With inhibitor development, the average annual cost increased more than 3-fold.
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Affiliation(s)
- Simten Malhan
- Faculty of Health Sciences, Department of Health Care Management, Başkent University, Ankara, Turkey
| | - Ergün Öksüz
- Department of Family Medicine, Başkent University School of Medicine, Ankara, Turkey
| | - Bülent Antmen
- Acibadem Hospital, Department of Pediatric Hematology and Oncology, Hemophilia Center, Adana, Turkey
| | - Muhlis Cem Ar
- Department of Internal Medicine, Division of Hematology, Faculty of Medicine, Istanbul University Cerrahpasa, Istanbul, Turkey
| | - Can Balkan
- Faculty of Medicine, Department of Pediatrics, Division of Pediatric Hematology, Ege University, Izmir, Turkey
| | - Kaan Kavaklı
- Faculty of Medicine, Department of Pediatrics, Division of Pediatric Hematology, Ege University, Izmir, Turkey
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25
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Büyükaşık Y, Ali R, Turgut M, Saydam G, Yavuz AS, Ünal A, Ar MC, Ayyıldız O, Altuntaş F, Okay M, Çiftçiler R, Meletli Ö, Soyer N, Mastanzade M, Güven Z, Soysal T, Karakuş A, Yiğenoğlu TN, Uçar B, Gökçen E, Tuğlular T. Patterns of Hydroxyurea Prescription and Use in Routine Clinical Management of Polycythemia Vera: A Multicenter Chart Review Study. Turk J Haematol 2020; 37:177-185. [PMID: 32075363 PMCID: PMC7463219 DOI: 10.4274/tjh.galenos.2020.2019.0431] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: This study aimed to evaluate real-life data on patterns of hydroxyurea prescription/use in polycythemia vera (PV). Materials and Methods: This retrospective chart review study included PV patients who had received hydroxyurea therapy for at least 2 months after PV diagnosis. Data were collected from 10 representative academic medical centers. Results: Of 657 patients, 50.9% were in the high-risk group (age ≥60 years and/or history of thromboembolic event). The median duration of hydroxyurea therapy was 43.40 months for all patients; 70.2% of the patients had ongoing hydroxyurea therapy at last follow-up. Hydroxyurea was discontinued in 22.4% of the patients; the most common reason was death (38.5%). The predicted time until hydroxyurea discontinuation was 187.8 months (standard error: ±21.7) for all patients. This duration was shorter in females (140.3±37.7 vs. 187.8±29.7) (p=0.08). This trend was also observed in surviving patients aged ≥50 years at hydroxyurea initiation (122.2±12.4 vs. 187.8±30.7, p=0.03). Among the patients who were still on hydroxyurea therapy, 40.3% had a hematocrit concentration of ≥45% at their last follow-up visit, and the rate of patients with at least one elevated blood cell count was 67.8%. Conclusion: Hydroxyurea prescription patterns and treatment aims are frequently not in accordance with the guideline recommendations. Its discontinuation rate is higher in females.
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Affiliation(s)
- Yahya Büyükaşık
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Turkey
| | - Rıdvan Ali
- Uludağ University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Bursa, Turkey
| | - Mehmet Turgut
- Ondokuz Mayıs University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Samsun, Turkey
| | - Güray Saydam
- Ege University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İzmir, Turkey
| | - Akif Selim Yavuz
- İstanbul University, İstanbul Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
| | - Ali Ünal
- Erciyes University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Kayseri, Turkey
| | - Muhlis Cem Ar
- İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
| | - Orhan Ayyıldız
- Dicle University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Diyarbakır, Turkey
| | - Fevzi Altuntaş
- Yıldırım Beyazıt University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Turkey,Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Division of Hematology, Ankara, Turkey
| | - Müfide Okay
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Turkey
| | - Rafiye Çiftçiler
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Turkey
| | - Özgür Meletli
- Ondokuz Mayıs University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Samsun, Turkey
| | - Nur Soyer
- Ege University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İzmir, Turkey
| | - Metban Mastanzade
- İstanbul University, İstanbul Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
| | - Zeynep Güven
- Erciyes University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Kayseri, Turkey
| | - Teoman Soysal
- İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
| | - Abdullah Karakuş
- Dicle University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Diyarbakır, Turkey
| | - Tuğçe Nur Yiğenoğlu
- Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Division of Hematology, Ankara, Turkey
| | | | | | - Tülin Tuğlular
- Marmara University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
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26
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Murt A, Elverdi T, Eskazan AE, Salihoglu A, Ar MC, Ongoren S, Baslar Z, Soysal T. Hepatitis B reactivation in hematopoietic stem cell transplanted patients: 20 years of experience of a single center from a middle endemic country. Ann Hematol 2020; 99:2671-2677. [PMID: 32737632 DOI: 10.1007/s00277-020-04206-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 07/27/2020] [Indexed: 01/05/2023]
Abstract
Hematopoietic stem cell transplantation (HSCT) is a risk factor for viral hepatitis reactivations because it affects lymphocyte number and functions. Latent hepatitis B virus (HBV) may stay in dormant form in hepatocytes and may be reactivated in prolonged immunosuppression. This study analyzes the incidence of reactivation of HBV infections in HSCT patients in a middle endemic country like Turkey. Five hundred and sixty-one HSCT patients from 1994 to 2015 were retrospectively evaluated. Sixty-six patients had a serologic feature of HBV infection. Fifteen patients were hepatitis B surface antigen (HBsAg)-positive patients (3 allogeneic and 12 autologous) while 51 of them were anti-hepatitis B core IgG (anti-HBc IgG)-positive patients (22 allogeneic and 29 autologous). Although under lamivudine prophylaxis, reactivation was seen in three of 12 (25%) chronic HBV (HBsAg positive) patients who received autologous HSCT and in two of the three HBsAg-positive patients who received allogeneic HSCT. Rate of reactivation in the whole HBsAg-positive group was 33%. Reactivation occurred on median 270th day (range: 60-730). Reverse seroconversion incidence was 10% on 133th day for HBsAg negative, but anti-HBc IgG-positive patients, which increased to 17% on 360th and to 23% on 1500th day. Cumulative incidence increased to 41% on 2280th day for isolated anti-HBc IgG-positive patients. Hepatitis B surface antibodies (anti-HBs) were found to be protective as reactivation did not exceed 11% on 5050th day when anti-HBs was positive. When anti-HBc IgG-positive cases were analyzed according to their transplantation types, allogeneic HSCT was found to have higher cumulative incidence (45% on 3258th day) for HBV reactivation than autologous HSCT (7% on 5050th day). Besides, HBV reactivation in anti-HBc IgG-positive patients who received allogeneic transplantation was related to mortality. Findings of this study suggest that HBV prophylaxis extending over 1 year should be prescribed for HBsAg-positive patients independent of the transplantation type. Prophylaxis should also be given to anti-HBc IgG-positive patients if an allogeneic HSCT is to be performed.
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Affiliation(s)
- Ahmet Murt
- Cerrahpasa Medical Faculty, Internal Medicine Department, Nephrology Section, Istanbul University - Cerrahpasa, Istanbul, Turkey.
| | - Tugrul Elverdi
- Cerrahpasa Medical Faculty, Internal Medicine Department, Hematology Section, Istanbul University - Cerrahpasa, Istanbul, Turkey
| | - Ahmet Emre Eskazan
- Cerrahpasa Medical Faculty, Internal Medicine Department, Hematology Section, Istanbul University - Cerrahpasa, Istanbul, Turkey
| | - Ayse Salihoglu
- Cerrahpasa Medical Faculty, Internal Medicine Department, Hematology Section, Istanbul University - Cerrahpasa, Istanbul, Turkey
| | - Muhlis Cem Ar
- Cerrahpasa Medical Faculty, Internal Medicine Department, Hematology Section, Istanbul University - Cerrahpasa, Istanbul, Turkey
| | - Seniz Ongoren
- Cerrahpasa Medical Faculty, Internal Medicine Department, Hematology Section, Istanbul University - Cerrahpasa, Istanbul, Turkey
| | - Zafer Baslar
- Cerrahpasa Medical Faculty, Internal Medicine Department, Hematology Section, Istanbul University - Cerrahpasa, Istanbul, Turkey
| | - Teoman Soysal
- Cerrahpasa Medical Faculty, Internal Medicine Department, Hematology Section, Istanbul University - Cerrahpasa, Istanbul, Turkey
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Murt A, Eskazan AE, Yılmaz U, Ozkan T, Ar MC. COVID-19 presenting with immune thrombocytopenia: A case report and review of the literature. J Med Virol 2020; 93:43-45. [PMID: 32497344 PMCID: PMC7300669 DOI: 10.1002/jmv.26138] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 05/28/2020] [Indexed: 01/11/2023]
Affiliation(s)
- Ahmet Murt
- Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ahmet Emre Eskazan
- Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Umut Yılmaz
- Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Tuba Ozkan
- Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Muhlis Cem Ar
- Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
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28
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Sarici A, Ar MC, Yokus O, Ongoren S, Ayer M, Altindal S, Koker HT, Kuzu OF. The impact of transfusion burden and comorbidities on the prognosis of patients with myelodysplastic syndromes. Transfus Apher Sci 2020; 59:102845. [PMID: 32591291 DOI: 10.1016/j.transci.2020.102845] [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: 02/28/2020] [Revised: 04/29/2020] [Accepted: 05/25/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE Early comorbidity detection has been reported to be associated with treatment-related outcomes in several diseases. Two main goals of the present study were to investigate both the impact of comorbidities and transfusion frequencies on the survival and quality of life of patients with myelodysplastic syndromes (MDS). METHODS One hundred and four MDS patients with a median International Prognostic Scoring System (IPSS) score of 0.5 (range: 0-3) were included in the study. Almost half of the patients had more than one comorbidity. RESULTS Median short form health surveys (SF)-36 mental and physical scores were 42.1 (range: 20.6-66.1) and 38.7 (range: 18-59.7), respectively. Mean scores of the Eastern Cooperative Oncology Group (ECOG) performance scales at diagnosis and during recruitment were 1.0 (1.4 ± 1.0) and 2.0 (1.8 ± 1.1), respectively. The mean Charlson Comorbidity Index (CCI) score was 1.0 (1.4 ± 1.5). In the model that was constructed using variables with a p value < 0.100 in the univariate analysis, factors that predicted death were refractory anemia with excess blasts (RAEB) and ECOG scores at recruitment. When ECOG was removed from the model, RAEB and CCI at diagnosis moved to the forefront as mortality predictors. CONCLUSION This study demonstrated that both CCI and ECOG performance status had an impact on survival in MDS patients who had low IPSS scores. ECOG stood out as a better and more practical predictor of survival than CCI, especially after considering its (ECOG) ease of use.
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Affiliation(s)
- Ahmet Sarici
- Division of Haematology, Department of Internal Medicine, Istanbul Training and Research Hospital, University of Health Sciences, Istanbul, Turkey; Division of Haematology, Department of Internal Medicine, Inonu University Faculty of Medicine, Malatya, Turkey.
| | - Muhlis Cem Ar
- Division of Haematology, Department of Internal Medicine, Istanbul University-Cerrahpasa, Faculty of Medicine, Istanbul, Turkey.
| | - Osman Yokus
- Division of Haematology, Department of Internal Medicine, Istanbul Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.
| | - Seniz Ongoren
- Division of Haematology, Department of Internal Medicine, Istanbul University-Cerrahpasa, Faculty of Medicine, Istanbul, Turkey.
| | - Mesut Ayer
- Division of Haematology, Department of Internal Medicine, Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.
| | - Sermin Altindal
- Division of Haematology, Department of Internal Medicine, Istanbul Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.
| | - Hilal Tan Koker
- Division of Haematology, Department of Internal Medicine, Istanbul Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.
| | - Omer Faruk Kuzu
- Division of Haematology, Department of Internal Medicine, Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.
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29
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Drelichman G, Castañeda‐Hernández G, Cem Ar M, Dragosky M, Garcia R, Lee H, Moiseev S, Naderi M, Rosenbaum H, Žnidar I, Zuluaga AF, Freisens S, Mistry PK. The road to biosimilars in rare diseases - ongoing lessons from Gaucher disease. Am J Hematol 2020; 95:233-237. [PMID: 31816110 PMCID: PMC7027782 DOI: 10.1002/ajh.25701] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 12/03/2019] [Accepted: 12/04/2019] [Indexed: 11/24/2022]
Affiliation(s)
| | - Gilberto Castañeda‐Hernández
- Departamento de FarmacologíaCentro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional Mexico City Mexico
| | - Muhlis Cem Ar
- Division of Hematology, Department of Internal MedicineIstanbul University‐Cerrahpasa, Cerrahpasa Faculty of Medicine Istanbul Turkey
| | - Marta Dragosky
- Departamento de OncohematologíaHenry Moore Institute Buenos Aires Argentina
| | - Ricardo Garcia
- Centro Latino Americano de Pesquisa em Biológicos São Paulo Brazil
| | - Howard Lee
- Department of Clinical Pharmacology and TherapeuticsSeoul National University College of Medicine and Hospital, Graduate School of Convergence Science and Technology, Seoul National University South Korea
| | - Sergey Moiseev
- Tareev Clinic of Internal DiseasesSechenov First Moscow State Medical University Moscow Russia
| | - Majid Naderi
- Genetic Research Center in Non‐Communicable DiseaseZahedan University of Medical Sciences Zahedan Iran
| | | | | | - Andrés Felipe Zuluaga
- Departamento de Farmacologia y Toxicologia, Facultad de MedicinaUniversidad de Antioquia Medellín Colombia
| | - Selena Freisens
- Global Medical AffairsSanofi Genzyme Cambridge Massachusetts
| | - Pramod K. Mistry
- Department of MedicineYale University School of Medicine New Haven Connecticut
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Abstract
Increased number of patients with hemophilia have been identified to have osteoporosis at early ages. Low bone mineral density in the setting of hemophilia has been associated with decreased mobility, sedentary life style, on demand treatment or delayed prophylaxis, low body weight and viral infections. The aim of this study was to investigate the impact of hemophilia on bone health of adult patients living in a middle income country. A total of 61 adult patients with hemophilia who were followed at the Hematology Department of Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa were consecutively included in this study. Bone health of the patients was assessed using the bone mineral density (BMD) and vitamin D levels. Z and t scores are used for evaluation of BMD in patients with hemophilia aged < 50 and ≥ 50 years, respectively. Information on treatment and co-morbidities including viral diseases were obtained from the medical files of the recruited patients. Bone mineral density was found normal in 30, and low in 29 patients. Vitamin D levels were below 20 ng/ml in 46 patients. No significant relationship was found between the severity of hemophilia and bone density. Vitamin D levels were significantly lower in patients who had a history of joint intervention. Neither annual bleeding rate nor the treatment modality (on demand versus prophylaxis) were associated with the bone mineral density and vitamin D levels. Annual factor consumption was higher in patients whose bone mineral densities was low both in femoral and lumbar regions. The results of this study depicting the situation of adult hemophilia population from a middle income country show that bone mineral density and vitamin D levels were decreased in a considerable amount of patients at early ages.
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Affiliation(s)
- Serdar Sahin
- 1 Division of Endocrinology, Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Sevil Sadri
- 2 Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Zafer Baslar
- 3 Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Muhlis Cem Ar
- 3 Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Soysal T, Eskazan AE, Serin I, Sadri S, Keskin D, Ozgur Yurttas N, Berk S, Erdogan Ozunal I, Salihoglu A, Ar MC, Ongoren S, Baslar Z, Ozbek U, Aydin Y. The Outcomes of Chronic Myeloid Leukemia Patients With Molecular Warning Responses During Imatinib Treatment According to the European LeukemiaNet 2013 Recommendations. Clinical Lymphoma Myeloma and Leukemia 2019; 19:e377-e384. [DOI: 10.1016/j.clml.2019.03.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 03/13/2019] [Accepted: 03/25/2019] [Indexed: 11/27/2022]
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Abstract
Despite effective factor replacement and various treatment schedules, there remain several challenges and unmet needs in the prophylactic treatment of hemophilia limiting its adoption and thereby posing an increased risk of spontaneous bleeding. In this regard, extended half-life (EHL) recombinant factor VIII (rFVIII) and factor IX (rFIX) products promise optimal prophylaxis by decreasing the dose frequency, increasing the compliance, and improving the quality of life without compromising safety and efficacy. EHL products might lead to higher trough levels without increasing infusion frequency, or could facilitate the ability to maintain trough levels while reducing infusion frequency. This paper aims to provide a comprehensive review of the rationale for developing EHL coagulation factors and their utility in the management of hemophilia, with special emphasis on optimal techniques for half-life extension and criteria for defining EHL coagulation factors, as well as indications, efficacy, and safety issues of the currently available EHL-rFVIII and EHL-rFIX products. Potential impacts of these factors on quality of life, health economics, and immune tolerance treatment will also be discussed alongside the challenges in pharmacokinetic-driven prophylaxis and difficulties in monitoring the EHL products with laboratory assays.
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Affiliation(s)
- Muhlis Cem Ar
- İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
| | - Can Balkan
- Ege University Faculty of Medicine, Department of Pediatrics, Division of Hemato-Oncology, İzmir, Turkey
| | - Kaan Kavaklı
- Ege University Faculty of Medicine, Department of Pediatrics, Division of Hemato-Oncology, İzmir, Turkey
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Eskazan T, Erturkuner SP, Isildar B, Eskazan AE, Ar MC, Atay K, Baslar Z, Tasyurekli M. Coexistence of Hermansky-Pudlak syndrome and JAK2 V617F-positive essential thrombocythemia. Ultrastruct Pathol 2019; 43:94-98. [PMID: 30932722 DOI: 10.1080/01913123.2019.1593269] [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] [Indexed: 10/27/2022]
Abstract
Hermansky-Pudlak syndrome (HPS) is an autosomal recessive disorder consisting of oculocutaneous albinism, platelet storage pool deficiency, and lysosomal accumulation of ceroid lipofuscin. The storage pool deficiency of HPS is associated with the lack of dense bodies in the platelets, resulting in impaired response in the secondary phase of aggregation. Patients with HPS have normal coagulation tests; however, their bleeding time is usually prolonged despite normal or increased platelet counts. Essential thrombocythemia (ET) is an uncommon condition, with an incidence of approximately 1.1 per 100,000/year, and it is the most common cause of primary thrombocytosis. JAK2V617F positivity can be observed in approximately half of the patients with ET. Bleeding events in ET have usually been associated with acquired von Willebrand syndrome paradoxically occurring when the platelet counts are extremely high. We, herein, present a case with bleeding diathesis diagnosed as having both HPS and JAK2V617F-positive ET.
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Affiliation(s)
- Tugce Eskazan
- a Division of Gastroenterology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine , Istanbul University-Cerrahpasa , Istanbul , Turkey
| | - Salime Pelin Erturkuner
- b Department of Histology, Cerrahpasa Faculty of Medicine , Istanbul University-Cerrahpasa , Istanbul , Turkey
| | - Basak Isildar
- b Department of Histology, Cerrahpasa Faculty of Medicine , Istanbul University-Cerrahpasa , Istanbul , Turkey
| | - Ahmet Emre Eskazan
- c Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine , Istanbul University-Cerrahpasa , Istanbul , Turkey
| | - Muhlis Cem Ar
- c Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine , Istanbul University-Cerrahpasa , Istanbul , Turkey
| | - Kadri Atay
- a Division of Gastroenterology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine , Istanbul University-Cerrahpasa , Istanbul , Turkey
| | - Zafer Baslar
- c Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine , Istanbul University-Cerrahpasa , Istanbul , Turkey
| | - Mustafa Tasyurekli
- b Department of Histology, Cerrahpasa Faculty of Medicine , Istanbul University-Cerrahpasa , Istanbul , Turkey
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Salihoglu A, Yildirim S, Ar MC, Hancer VS, Bozcan S, Yilmaz U, Serin N, Tuzuner N, Celik AF. Case report of a young patient with transthyretin amyloidosis associated with Gly67Ala mutation. Amyloid 2019; 26:75-76. [PMID: 31343303 DOI: 10.1080/13506129.2019.1583194] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Ayse Salihoglu
- a Division of Haematology, Cerrahpasa Medical School, Istanbul University , Istanbul , Turkey
| | - Suleyman Yildirim
- b Division of Gastroenterology, Cerrahpasa Medical School, Istanbul University , Istanbul , Turkey
| | - Muhlis Cem Ar
- a Division of Haematology, Cerrahpasa Medical School, Istanbul University , Istanbul , Turkey
| | | | - Selma Bozcan
- b Division of Gastroenterology, Cerrahpasa Medical School, Istanbul University , Istanbul , Turkey
| | - Umut Yilmaz
- d Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University , Istanbul , Turkey
| | - Nergis Serin
- d Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University , Istanbul , Turkey
| | - Nukhet Tuzuner
- e Department of Pathology, Cerrahpasa Medical School, Istanbul, Istanbul University , Istanbul , Turkey
| | - Aykut Ferhat Celik
- b Division of Gastroenterology, Cerrahpasa Medical School, Istanbul University , Istanbul , Turkey
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Öngören S, Salihoğlu A, Apaydın T, Sadri S, Eşkazan AE, Ar MC, Elverdi T, Başlar Z, Aydın Y, Soysal T. Vincristine as an Adjunct to Therapeutic Plasma Exchange for Thrombotic Thrombocytopenic Purpura: A Single-Institution Experience. Balkan Med J 2018; 35:417-421. [PMID: 29966997 PMCID: PMC6251381 DOI: 10.4274/balkanmedj.2017.1215] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background: Thrombotic thrombocytopenic purpura is a potentially life-threatening condition. Although the introduction of therapeutic plasma exchange has reduced mortality rates from over 90% to 10%-20%, approximately 40% of patients relapse, and outcomes may be fatal in refractory patients. There is clearly a need for additional therapeutic approaches. Aims: To describe the outcomes of relapsed/refractory thrombotic thrombocytopenic purpura patients treated with vincristine as an adjunct to therapeutic plasma exchange. Study Design: Cross-sectional study. Methods: The medical records of all relapsed/refractory patients with thrombotic thrombocytopenic purpura treated with vincristine adjunct to therapeutic plasma exchange between October 2000 and December 2016 were retrospectively reviewed. Diagnosis of thrombotic thrombocytopenic purpura was based on clinical history, physical examination, and laboratory examinations. Patient demographics, laboratory findings, initial date and duration of therapeutic plasma exchange, dosage and time of administration of vincristine, and outcomes were recorded. Results: The study included 15 patients [median age: 37 years (range: 26-65); 7 women and 8 men] with either relapsed or refractory thrombotic thrombocytopenic purpura who were treated with vincristine as an adjunct to therapeutic plasma exchange for a total of 22 episodes. Eighty-seven percent of patients achieved remissions in 20 of 22 episodes, with a median duration of remission of 29.5 months (range: 3-105). After a median follow-up of 55 months, 11 patients were alive. Vincristine was well tolerated with no safety concerns. Conclusion: Vincristine offers a reasonable option for the treatment of patients with relapsed/refractory thrombotic thrombocytopenic purpura. Further studies evaluating vincristine in the front-line setting and in the relapsed/refractory setting are needed to validate the role of vincristine in thrombotic thrombocytopenic purpura patients.
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Affiliation(s)
- Seniz Öngören
- Department of Internal Medicine, Division of Hematology, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Ayşe Salihoğlu
- Department of Internal Medicine, Division of Hematology, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Tuğçe Apaydın
- Department of Internal Medicine, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Sevil Sadri
- Department of Internal Medicine, Division of Hematology, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Ahmet Emre Eşkazan
- Department of Internal Medicine, Division of Hematology, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Muhlis Cem Ar
- Department of Internal Medicine, Division of Hematology, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Tuğrul Elverdi
- Department of Internal Medicine, Division of Hematology, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Zafer Başlar
- Department of Internal Medicine, Division of Hematology, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Yıldız Aydın
- Department of Internal Medicine, Division of Hematology, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Teoman Soysal
- Department of Internal Medicine, Division of Hematology, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey
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Erbilgin Y, Eskazan AE, Hatirnaz Ng O, Salihoglu A, Elverdi T, Firtina S, Tasar O, Mercan S, Sisko S, Khodzhaev K, Ongoren S, Ar MC, Baslar Z, Soysal T, Sayitoglu M, Ozbek U. Deep sequencing of BCR-ABL1 kinase domain mutations in chronic myeloid leukemia patients with resistance to tyrosine kinase inhibitors. Leuk Lymphoma 2018; 60:200-207. [PMID: 29965782 DOI: 10.1080/10428194.2018.1473573] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Tyrosine kinase inhibitor (TKI) therapy is the current treatment of choice for patients with chronic phase chronic myeloid leukemia (CML) leading to rapid and durable hematological as well as molecular responses. However, emergence of resistance to TKIs has been the major obstacle to treatment success on long term. In this regard kinase domain mutations are the most common mechanism of therapy failure. In this study, we analyzed peripheral blood samples from 17 CML patients who had developed resistance to various TKIs by using next-generation sequencing parallel to Sanger sequencing. BCR-ABL1 kinase domain mutations have been found in 59% of the cohort. Our results demonstrate that next-generation sequencing results in a higher mutational detection rate than reported with conventional sequencing methodology. Furthermore, it showed the clonal diversity more accurately.
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Affiliation(s)
- Yucel Erbilgin
- a Aziz Sancar Institute of Experimental Medicine Department of Genetics , Istanbul University , Istanbul , Turkey
| | - Ahmet Emre Eskazan
- b Division of Haematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine , Istanbul University , Istanbul , Turkey
| | - Ozden Hatirnaz Ng
- a Aziz Sancar Institute of Experimental Medicine Department of Genetics , Istanbul University , Istanbul , Turkey
| | - Ayse Salihoglu
- b Division of Haematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine , Istanbul University , Istanbul , Turkey
| | - Tugrul Elverdi
- b Division of Haematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine , Istanbul University , Istanbul , Turkey
| | - Sinem Firtina
- a Aziz Sancar Institute of Experimental Medicine Department of Genetics , Istanbul University , Istanbul , Turkey
| | - Orcun Tasar
- a Aziz Sancar Institute of Experimental Medicine Department of Genetics , Istanbul University , Istanbul , Turkey
| | - Sevcan Mercan
- a Aziz Sancar Institute of Experimental Medicine Department of Genetics , Istanbul University , Istanbul , Turkey
| | - Sinem Sisko
- a Aziz Sancar Institute of Experimental Medicine Department of Genetics , Istanbul University , Istanbul , Turkey
| | - Khusan Khodzhaev
- a Aziz Sancar Institute of Experimental Medicine Department of Genetics , Istanbul University , Istanbul , Turkey
| | - Seniz Ongoren
- b Division of Haematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine , Istanbul University , Istanbul , Turkey
| | - Muhlis Cem Ar
- b Division of Haematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine , Istanbul University , Istanbul , Turkey
| | - Zafer Baslar
- b Division of Haematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine , Istanbul University , Istanbul , Turkey
| | - Teoman Soysal
- b Division of Haematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine , Istanbul University , Istanbul , Turkey
| | - Muge Sayitoglu
- a Aziz Sancar Institute of Experimental Medicine Department of Genetics , Istanbul University , Istanbul , Turkey
| | - Ugur Ozbek
- a Aziz Sancar Institute of Experimental Medicine Department of Genetics , Istanbul University , Istanbul , Turkey.,c Department of Medical Genetics, School of Medicine , Acıbadem Mehmet Ali Aydınlar University , Istanbul , Turkey
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Eskazan AE, Ar MC, Soysal T. Comment and response to: the significance of early warning in chronic myeloid leukemia. Expert Rev Hematol 2018; 11:267-268. [DOI: 10.1080/17474086.2017.1340719] [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: 10/19/2022]
Affiliation(s)
- Ahmet Emre Eskazan
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Muhlis Cem Ar
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Teoman Soysal
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Lehmeier A, Ar MC, Sadri S, Yürüyen M, Başlar Z. Participation in Physical and Sportive Activities among Adult Turkish People with Hemophilia: A Single-Center Experience. Turk J Haematol 2018; 35:81-82. [PMID: 28920578 PMCID: PMC5843783 DOI: 10.4274/tjh.2017.0292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Arni Lehmeier
- İstanbul University Cerrahpaşa Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
| | - Muhlis Cem Ar
- İstanbul University Cerrahpaşa Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
| | - Sevil Sadri
- İstanbul University Cerrahpaşa Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
| | - Mehmet Yürüyen
- İstanbul University Cerrahpaşa Faculty of Medicine, Department of Internal Medicine, Division of Geriatrics, İstanbul, Turkey
| | - Zafer Başlar
- İstanbul University Cerrahpaşa Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
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Öngören Ş, Eşkazan AE, Berk S, Elverdi T, Salihoğlu A, Ar MC, Başlar Z, Aydın Y, Tüzüner N, Soysal T. Retrospective Evaluation of Hairy Cell Leukemia Patients Treated with Three Different First-Line Treatment Modalities in the Last Two Decades: A Single-Center Experience. Turk J Haematol 2017; 34:291-299. [PMID: 29199176 PMCID: PMC5774373 DOI: 10.4274/tjh.2016.0443] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 01/17/2023] Open
Abstract
Objective: In this study, we retrospectively analyzed the clinical outcome, treatment responses, infectious complications, and survival rates of 71 hairy cell leukemia (HCL) cases. Materials and Methods: Sixty-seven patients received a first-line treatment and 2-chlorodeoxyadenosine (cladribine-2-CdA) was administered in 31 cases, 19 patients received interferon-alpha (INF-α), splenectomy was performed in 16 cases, and rituximab was used in one. Results: Although the highest overall response rate (ORR) was observed in patients receiving 2-CdA upfront, ORRs were comparable in the 2-CdA, INF-α, and splenectomy subgroups. Relapse rates were significantly lower in patients who received first-line 2-CdA. The progression-free survival (PFS) rate with 2-CdA was significantly higher than in patients with INF-α and splenectomy, but we found similar overall survival rates with all three upfront treatment modalities. Infections including tuberculosis were a major problem. Conclusion: Although purine analogues have improved the ORRs and PFS, there is still much progress to make with regard to overall survival and relapsed/refractory disease in patients with HCL.
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Affiliation(s)
- Şeniz Öngören
- İstanbul University Cerrahpaşa Faculty of Medicine, Department of Hematology, İstanbul, Turkey
| | - Ahmet Emre Eşkazan
- İstanbul University Cerrahpaşa Faculty of Medicine, Department of Hematology, İstanbul, Turkey
| | - Selin Berk
- İstanbul University Cerrahpaşa Faculty of Medicine, Department of Hematology, İstanbul, Turkey
| | - Tuğrul Elverdi
- İstanbul University Cerrahpaşa Faculty of Medicine, Department of Hematology, İstanbul, Turkey
| | - Ayşe Salihoğlu
- İstanbul University Cerrahpaşa Faculty of Medicine, Department of Hematology, İstanbul, Turkey
| | - Muhlis Cem Ar
- İstanbul University Cerrahpaşa Faculty of Medicine, Department of Hematology, İstanbul, Turkey
| | - Zafer Başlar
- İstanbul University Cerrahpaşa Faculty of Medicine, Department of Hematology, İstanbul, Turkey
| | - Yıldız Aydın
- İstanbul University Cerrahpaşa Faculty of Medicine, Department of Hematology, İstanbul, Turkey
| | - Nükhet Tüzüner
- İstanbul University Cerrahpaşa Faculty of Medicine, Department of Pathology, İstanbul, Turkey
| | - Teoman Soysal
- İstanbul University Cerrahpaşa Faculty of Medicine, Department of Hematology, İstanbul, Turkey
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Ongoren S, Eskazan AE, Suzan V, Savci S, Erdogan Ozunal I, Berk S, Yalniz FF, Elverdi T, Salihoglu A, Erbilgin Y, Iseri SA, Ar MC, Baslar Z, Aydin Y, Tuzuner N, Ozbek U, Soysal T. Third-line treatment with second-generation tyrosine kinase inhibitors (dasatinib or nilotinib) in patients with chronic myeloid leukemia after two prior TKIs: real-life data on a single center experience along with the review of the literature. Hematology 2017; 23:212-220. [DOI: 10.1080/10245332.2017.1385193] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Seniz Ongoren
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ahmet Emre Eskazan
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Veysel Suzan
- Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sercan Savci
- Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Isil Erdogan Ozunal
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Selin Berk
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Fevzi Fırat Yalniz
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Tugrul Elverdi
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ayse Salihoglu
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Yucel Erbilgin
- Department of Genetics, Institute of Experimental Medicine (DETAE), Istanbul University, Istanbul, Turkey
| | - Sibel Aylin Iseri
- Department of Genetics, Institute of Experimental Medicine (DETAE), Istanbul University, Istanbul, Turkey
| | - Muhlis Cem Ar
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Zafer Baslar
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Yildiz Aydin
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Nukhet Tuzuner
- Department of Pathology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ugur Ozbek
- Department of Genetics, Institute of Experimental Medicine (DETAE), Istanbul University, Istanbul, Turkey
| | - Teoman Soysal
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Öngören Ş, Eşkazan AE, Berk S, Elverdi T, Salihoğlu A, Ar MC, Başlar Z, Aydın Y, Tüzüner N, Soysal T. Retrospective evaluation of hairy cell leukemia patients treated with 3 different first-line treatment modalities in the last two decades: a single center experience. Turk J Haematol 2017. [DOI: 10.4274/tjh.2017.0443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Eskazan AE, Sadri S, Keskin D, Ayer M, Kantarcioglu B, Demirel N, Aydin D, Aydinli F, Yokus O, Ozunal IE, Berk S, Yalniz FF, Elverdi T, Salihoglu A, Ar MC, Ongoren S, Baslar Z, Aydin Y, Tuzuner N, Ozbek U, Soysal T. Outcomes of Chronic Myeloid Leukemia Patients With Early Molecular Response at 3 and 6 Months: A Comparative Analysis of Generic Imatinib and Glivec. Clin Lymphoma Myeloma Leuk 2017; 17:804-811. [PMID: 28847475 DOI: 10.1016/j.clml.2017.07.255] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Accepted: 07/31/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND The molecular response at 3 months of the original imatinib (OI) in patients with chronic myeloid leukemia has prognostic significance; however, this has never been tested for generic imatinib (GI). PATIENTS AND METHODS We evaluated the BCR-ABL1 [international reporting scale (IS)] transcript levels at 3 and 6 months to determine whether an early molecular response (EMR) had a prognostic effect on the outcome among chronic myeloid leukemia patients receiving GI. Ninety patients were divided into 2 groups, according to the imatinib they received, as OI (group A) and GI (group B). RESULTS Two groups were equally balanced for age, gender, Sokal risk score, and optimal response. The 2 groups did not differ in achieving an EMR at 3 months, and patients with EMR at 3 months had significantly superior complete cytogenetic response and major molecular response rates compared with patients who did not achieve an EMR in both groups. The percentage of an optimal response [BCR-ABL1 (IS), < 1%] and a warning response [BCR-ABL1 (IS), 1%-10%] at 6 months was 93% and 95% for groups A and B, respectively (P = .553). Patients with an optimal response (OR) at both 3 and 6 months had significantly superior event-free survival rates compared with patients without an OR in groups A and B. CONCLUSION The results of the present study have demonstrated most probably for the first time that an OR at 3 and 6 months in patients receiving either first-line GI and OI is clearly associated with greater response and event-free survival rates. Prospective randomized trials with larger numbers of patients and longer follow-up periods are needed to address the effect of EMR in patients receiving GI.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Disease-Free Survival
- Drugs, Generic/therapeutic use
- Female
- Fusion Proteins, bcr-abl/genetics
- Gene Expression Regulation, Leukemic/drug effects
- Humans
- Imatinib Mesylate/therapeutic use
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Male
- Middle Aged
- Protein Kinase Inhibitors/therapeutic use
- Retrospective Studies
- Time Factors
- Treatment Outcome
- Young Adult
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Affiliation(s)
- Ahmet Emre Eskazan
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sevil Sadri
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Dilek Keskin
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mesut Ayer
- Department of Hematology, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Bulent Kantarcioglu
- Department of Hematology, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - Naciye Demirel
- Department of Hematology, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - Demet Aydin
- Department of Hematology, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - Fuat Aydinli
- Department of Hematology, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Osman Yokus
- Department of Hematology, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Isil Erdogan Ozunal
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Selin Berk
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Fevzi Firat Yalniz
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Tugrul Elverdi
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ayse Salihoglu
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Muhlis Cem Ar
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Seniz Ongoren
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey.
| | - Zafer Baslar
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Yildiz Aydin
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Nukhet Tuzuner
- Department of Pathology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ugur Ozbek
- Department of Genetics, Institute of Experimental Medicine (DETAE), Istanbul University, Istanbul, Turkey
| | - Teoman Soysal
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey.
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Eskazan AE, Ar MC, Soysal T. Critical appraisal of European LeukemiaNet (ELN) 2013 recommendations for the management of chronic myeloid leukemia: is it early for a warning? Expert Rev Hematol 2016; 9:919-21. [DOI: 10.1080/17474086.2016.1231572] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Bavunoğlu I, Eşkazan AE, Ar MC, Cengiz M, Yavuzer S, Salihoğlu A, Öngören Ş, Tunçkale A, Soysal T. Treatment of patients with immune thrombocytopenia admitted to the emergency room. Int J Hematol 2016; 104:216-22. [PMID: 27129318 DOI: 10.1007/s12185-016-2003-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 01/21/2016] [Revised: 04/05/2016] [Accepted: 04/05/2016] [Indexed: 12/16/2022]
Abstract
Immune thrombocytopenia (ITP) is the most frequent cause of acquired thrombocytopenia. In adult ITP patients, corticosteroids and intravenous immunoglobulin (IVIg) are used as first-line treatment. The aim of the present study was to investigate retrospectively the demographic and etiologic characteristics of patients with ITP admitted to the emergency room at our hospital. Seventy-five adult patients with ITP were included, and demographic data, bleeding characteristics, etiologic features and responses to treatments were evaluated retrospectively. Fifty-six patients (75 %) were female, and the median age was 43 years. Eighteen patients had a history of ITP, whereas in 57, thrombocytopenia was identified for the first time. During admission, the median platelet count was 5 × 10(9)/L. Cutaneous and/or mucosal bleeding was the most common clinical feature. High-dose dexamethasone was administered in 60 episodes, whereas IVIg and conventional-dose methylprednisolone were used in nine and six episodes, respectively. The overall response rate of the entire cohort following first-line treatments was 67 %, and complete remission was achieved in 31 patients, 19 patients achieved partial remission, and 25 patients were non-responders. In cases with life-threatening bleeding, concomitant infection, post-traumatic bleeding and need for emergency surgery, IVIg can be used as the first line of treatment option in addition to platelet transfusions.
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Affiliation(s)
- Işıl Bavunoğlu
- Division of General Internal Medicine, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University, Fatih, Istanbul, Turkey
| | - Ahmet Emre Eşkazan
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University, Fatih, Istanbul, Turkey
| | - Muhlis Cem Ar
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University, Fatih, Istanbul, Turkey.
| | - Mahir Cengiz
- Division of General Internal Medicine, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University, Fatih, Istanbul, Turkey
| | - Serap Yavuzer
- Division of General Internal Medicine, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University, Fatih, Istanbul, Turkey
| | - Ayşe Salihoğlu
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University, Fatih, Istanbul, Turkey
| | - Şeniz Öngören
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University, Fatih, Istanbul, Turkey
| | - Aydın Tunçkale
- Division of General Internal Medicine, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University, Fatih, Istanbul, Turkey
| | - Teoman Soysal
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University, Fatih, Istanbul, Turkey
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Tanrikulu Simsek E, Eskazan AE, Cengiz M, Ar MC, Ekizoglu S, Salihoglu A, Gulturk E, Elverdi T, Ongoren Aydin S, Senem Demiroz A, Buyru AN, Baslar Z, Ozbek U, Ferhanoglu B, Aydin Y, Tuzuner N, Soysal T. Imatinib reduces bone marrow fibrosis and overwhelms the adverse prognostic impact of reticulin formation in patients with chronic myeloid leukaemia. J Clin Pathol 2016; 69:810-6. [PMID: 26811428 DOI: 10.1136/jclinpath-2015-203320] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 12/23/2015] [Indexed: 11/03/2022]
Abstract
AIMS Before the era of tyrosine kinase inhibitors (TKIs), the presence of bone marrow fibrosis (MF) in patients with chronic myeloid leukaemia (CML) has been established as a poor prognostic factor. The aim of the present study was to evaluate the effects of imatinib treatment on MF and the prognostic significance of MF at this new era of CML therapy. METHODS The study cohort consisted of 135 patients with CML who were exposed to imatinib. The grades of MF pre and post imatinib together with cytogenetic and molecular responses were evaluated. RESULTS Severe MF (grade II-III) was observed in 44 (33%) patients prior to imatinib therapy, and in 8 (8%) after 12 months of imatinib treatment (p=0.001). The complete cytogenetic response (CCyR) rates at 12 months did not differ according to the pre-imatinib MF grades, and CCyR rates in patients with grades 0, I, II and III MF were 36/47 (76.5%), 26/33 (78.7%), 12/23 (52.1%) and 7/10 (70%), respectively (p=0.127). There was no significant difference between patients with or without CCyR at 12 months of imatinib regarding grades of MF (p=0.785). The distribution of the major molecular response rates at 18 months according to pre-treatment grades of MF were determined as grade 0 in 38/45 (84.4%), grade I in 21/28 (75%), grade II in 14/21 (66.6%) and grade III in 7/10 (70%) (p=0.112). There was no significant difference in overall survival rates between initial MF mild (grade 0-I) and severe (grade II-III) groups (p=0.278). CONCLUSIONS According to our findings, MF regresses with imatinib therapy over time, and the MF grades at diagnosis do not have a negative impact on the responses to imatinib treatment. Therefore, the adverse prognostic impact of the MF among patients with CML seems to disappear in the era of the TKIs.
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Affiliation(s)
- Eda Tanrikulu Simsek
- Division of Medical Oncology, Department of Internal Medicine, Pendik Training and Research Hospital, Marmara University, Istanbul, Turkey
| | - Ahmet Emre Eskazan
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mahir Cengiz
- Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Muhlis Cem Ar
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Seda Ekizoglu
- Department of Medical Biology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ayse Salihoglu
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Emine Gulturk
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Tugrul Elverdi
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Seniz Ongoren Aydin
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ahu Senem Demiroz
- Department of Pathology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ayse Nur Buyru
- Department of Medical Biology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Zafer Baslar
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ugur Ozbek
- Department of Genetics, Institute of Experimental Medicine (DETAE), Istanbul University, Istanbul, Turkey
| | - Burhan Ferhanoglu
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Koc University, Istanbul, Turkey
| | - Yildiz Aydin
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Nukhet Tuzuner
- Department of Pathology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Teoman Soysal
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Altunoglu EG, Ar MC, Tuzuner N, Saribeyoglu K. A Splenic Marginal Zone Lymphoma Case Presenting with Cyanosis, Spider Angiomas, and Polycythemia. Istanbul Med J 2016. [DOI: 10.5152/imj.2015.38233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Öztürk E, Özbalak M, Berk S, Erdoğan I, Avşar E, Dolgun A, Çetiner M, Mandel NM, Yalnız FF, Elverdi T, Salihoğlu A, Eşkazan AE, Ar MC, Öngören Ş, Başlar Z, Aydın Y, Soysal T, Ferhanoğlu B. Comparison of International Prognostic Index and NCCN-IPI in 324 patients with de novo diffuse large B-cell lymphoma: a multi-center retrospective analysis. Leuk Lymphoma 2015; 57:1211-4. [PMID: 26294270 DOI: 10.3109/10428194.2015.1079319] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Erman Öztürk
- a Division of Hematology, Department of Internal Medicine , Koç University, School of Medicine , Istanbul
| | - Murat Özbalak
- b Division of Hematology, Department of Internal Medicine , Istanbul University, Cerrahpasa Medical Faculty , Istanbul
| | - Selin Berk
- b Division of Hematology, Department of Internal Medicine , Istanbul University, Cerrahpasa Medical Faculty , Istanbul
| | - Işıl Erdoğan
- b Division of Hematology, Department of Internal Medicine , Istanbul University, Cerrahpasa Medical Faculty , Istanbul
| | - Emin Avşar
- c Division of Oncology , V.K.V. American Hospital , Istanbul
| | - Anıl Dolgun
- d Department of Biostatstics , Hacettepe University , Ankara , and
| | - Mustafa Çetiner
- a Division of Hematology, Department of Internal Medicine , Koç University, School of Medicine , Istanbul
| | - Nil Molinas Mandel
- e Division of Oncology, Department of Internal Medicine , Koç University, School of Medicine , Istanbul , Turkey
| | - Fevzi Fırat Yalnız
- b Division of Hematology, Department of Internal Medicine , Istanbul University, Cerrahpasa Medical Faculty , Istanbul
| | - Tuğrul Elverdi
- b Division of Hematology, Department of Internal Medicine , Istanbul University, Cerrahpasa Medical Faculty , Istanbul
| | - Ayşe Salihoğlu
- b Division of Hematology, Department of Internal Medicine , Istanbul University, Cerrahpasa Medical Faculty , Istanbul
| | - Ahmet Emre Eşkazan
- b Division of Hematology, Department of Internal Medicine , Istanbul University, Cerrahpasa Medical Faculty , Istanbul
| | - Muhlis Cem Ar
- b Division of Hematology, Department of Internal Medicine , Istanbul University, Cerrahpasa Medical Faculty , Istanbul
| | - Şeniz Öngören
- b Division of Hematology, Department of Internal Medicine , Istanbul University, Cerrahpasa Medical Faculty , Istanbul
| | - Zafer Başlar
- b Division of Hematology, Department of Internal Medicine , Istanbul University, Cerrahpasa Medical Faculty , Istanbul
| | - Yıldız Aydın
- b Division of Hematology, Department of Internal Medicine , Istanbul University, Cerrahpasa Medical Faculty , Istanbul
| | - Teoman Soysal
- b Division of Hematology, Department of Internal Medicine , Istanbul University, Cerrahpasa Medical Faculty , Istanbul
| | - Burhan Ferhanoğlu
- a Division of Hematology, Department of Internal Medicine , Koç University, School of Medicine , Istanbul
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Abstract
B-cell lymphoproliferative disorders comprise 85% of Non-Hodgkin's lymphomas. Despite successful chemoimmunotherapy regimens, responses are not durable and the outcome is fatal in a considerable portion of patients. There is an inevitable need for less toxic and more potent therapeutic agents. Over the recent years, a plethora of agents including monoclonal antibodies, Bcl-2 antagonists, tyrosine kinase inhibitors, cyclin-dependent kinase inhibitors, mTOR inhibitors and immunomodulatory drugs have been developed in B-cell malignancies. The aim of this paper is to focus on B-cell receptor signaling inhibitors and lenalidomide as an immunomodulatory drug and to provide insight on how and when to incorporate these agents into the treatment algorithms.
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Affiliation(s)
- Ayse Salihoglu
- a Department of Internal Medicine, Division of Haematology, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Muhlis Cem Ar
- a Department of Internal Medicine, Division of Haematology, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey
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Eskazan AE, Hatemi I, Ongoren Aydin S, Ar MC, Soysal T. Acute colitis presenting with hematochezia in a patient with chronic myeloid leukemia during dasatinib therapy. Turk J Gastroenterol 2015; 25 Suppl 1:233. [DOI: 10.5152/tjg.2014.5281] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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