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Çınar OE, Göker H, Fidan K, Aydın Ö, Pashayev T, Malkan ÜY, Velet M, Büyükaşık Y, Aksu S, Özcebe Oİ, Haznedaroğlu İC, Sayınalp N, Vural F, Turgut M, Ünal A, Demiroğlu H. Prophylactic Central Nervous System Irradiation Is Not Indispensable In Adult Patients With Acute Lymphoblastic Leukemia: A Multi-Center Retrospective Cohort Study. Turk J Haematol 2022; 39:152-159. [PMID: 35445593 PMCID: PMC9421337 DOI: 10.4274/tjh.galenos.2022.2021.0680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: Studies comparing the efficacy and safety of prophylactic regimens for central nervous system (CNS) involvement in acute lymphoblastic leukemia (ALL) are scarce in adults. This multicenter retrospective study aimed to compare the efficacy of prophylactic regimens with and without CNS irradiation on the development of CNS relapse during follow-up. Materials and Methods: This was a multicenter comparative cohort study. A total of 203 patients were included from four tertiary care centers in Turkey. Patients were divided into two groups according to whether they received CNS irradiation or not. The groups were analyzed retrospectively regarding patient and disease characteristics, with the main focus being CNS relapse. Results: While 105 patients received chemotherapy-based prophylaxis, 98 patients received additional CNS irradiation. These groups were statistically comparable in terms of demographic characteristics and risk factors for CNS involvement. In the irradiation group, patients were younger and had more stem cell transplants. In a median of 23.8 (11.1-62.4) months, there was no difference between the two groups regarding CNS relapse-free survival (log-rank p=0.787). Conclusion: Craniospinal irradiation may not be indispensable for every adult patient with ALL, similarly to pediatric patients. It is crucial to avoid the long-term toxicities of radiation, especially in patients with long life expectancy. Craniospinal irradiation may be reserved for therapeutic use in cases of CNS relapse and prophylaxis for some high-risk patients.
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Affiliation(s)
| | - Hakan Göker
- Hacettepe University, Division of Hematology, Turkey
| | - Kemal Fidan
- Erciyes University, Division of Hematology, Turkey
| | - Öznur Aydın
- Ondokuz Mayıs University, Division of Hematology, Turkey
| | | | | | - Mustafa Velet
- Hacettepe University, Division of Hematology, Turkey
| | | | - Salih Aksu
- Hacettepe University, Division of Hematology, Turkey
| | | | | | | | - Filiz Vural
- Ege University, Division of Hematology, Turkey
| | - Mehmet Turgut
- Ondokuz Mayıs University, Division of Hematology, Turkey
| | - Ali Ünal
- Erciyes University, Division of Hematology, Turkey
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2
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Yılmaz F, Soyer N, Cengiz Seval G, Civriz Bozdağ S, Topcuoğlu P, Ünal A, Kaynar L, Özgür G, Sucak G, Göker H, Velet M, Özdoğu H, Yılmaz M, Kaya E, Salim O, Deveci B, Karadoğan İ, Saydam G, Şahin F, Vural F. Hematopoietic Stem Cell Transplantation for Patients with Paroxysmal Nocturnal Hemoglobinuria with or without Aplastic Anemia: A Multicenter Turkish Experience. Turk J Haematol 2021; 38:195-203. [PMID: 34057336 PMCID: PMC8386301 DOI: 10.4274/tjh.galenos.2021.2021.0105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: Although inhibition of the complement system at different steps is a promising therapy modality in patients with paroxysmal nocturnal hemoglobinuria (PNH), allogeneic hematopoietic stem cell transplantation (HCT) is still the only curative therapy, especially for patients with intractable hemolysis or bone marrow failure. The aim of this study is to evaluate the outcomes of allogeneic HCT in PNH patients with aplastic anemia (PNH-AA) or without. Materials and Methods: Thirty-five PNH/PNH-AA patients who were treated with allogeneic HCT in 10 transplantation centers in Turkey were retrospectively analyzed. Results: Sixteen (45.7%) and 19 (54.3%) patients were diagnosed with classical PNH and PNH-AA, respectively. The median age of the patients was 32 (18-51) years. The 2-year overall survival (OS) rate and rate of graft-versus-host disease-free, failure-free survival (GFFS) was 81.2% and 78.1%, respectively. The 2-year OS in cases of classical PNH and PNH-AA was 81.3% and 79.9%, respectively (p=0.87), and 2-year GFFS in cases of PNH and PNH-AA was 79% and 76% (p=0.977), without statistical significance. The OS and GFFS rates also did not differ between transplantations with matched sibling donors (MSDs) and matched unrelated donors (MUDs). Conclusion: Allogeneic HCT with MSDs or MUDs is a good option for selected patients with classical PNH and PNH-AA. In particular, patients with debilitating and refractory hemolysis and patients with bone marrow failure might form an excellent group of candidates for allogeneic HCT.
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Affiliation(s)
- Fergün Yılmaz
- Marmara University Faculty of Medicine, Department of Hematology, İstanbul, Turkey
| | - Nur Soyer
- Ege University Faculty of Medicine, Department of Hematology, İzmir, Turkey
| | | | - Sinem Civriz Bozdağ
- Ankara University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Pervin Topcuoğlu
- Ankara University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Ali Ünal
- Erciyes University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Leylagül Kaynar
- Erciyes University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Gökhan Özgür
- Medical Park Bahçeşehir Hospital, Clinic of Hematology and Transplantation, İstanbul, Turkey
| | - Gülsan Sucak
- Medical Park Bahçeşehir Hospital, Clinic of Hematology and Transplantation, İstanbul, Turkey
| | - Hakan Göker
- Hacettepe University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Mustafa Velet
- Hacettepe University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Hakan Özdoğu
- Başkent University Faculty of Medicine, Adana Bone Marrow Transplantation Center, Department of Hematology, Adana, Turkey
| | - Mehmet Yılmaz
- SANKO University Faculty of Medicine, Department of Hematology, Gaziantep, Turkey
| | - Emin Kaya
- İnönü University Faculty of Medicine, Department of Hematology, Malatya, Turkey
| | - Ozan Salim
- Akdeniz University Faculty of Medicine, Department of Hematology, Antalya, Turkey
| | - Burak Deveci
- İstanbul Gelişim University, Medstar Antalya Hospital Bone Marrow Transplantation Center, Department of Hematology, Antalya, Turkey
| | - İhsan Karadoğan
- İstanbul Gelişim University, Medstar Antalya Hospital Bone Marrow Transplantation Center, Department of Hematology, Antalya, Turkey
| | - Güray Saydam
- Ege University Faculty of Medicine, Department of Hematology, İzmir, Turkey
| | - Fahri Şahin
- Ege University Faculty of Medicine, Department of Hematology, İzmir, Turkey
| | - Filiz Vural
- Ege University Faculty of Medicine, Department of Hematology, İzmir, Turkey
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3
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Karataş A, Malkan ÜY, Velet M, Demiroğlu H, Büyükaşık Y, Telli Dizman G, Inkaya AÇ, Erdoğdu B, Çınar OE, Aladağ E, Aksu S, Haznedaroğlu İC, Özcebe O, Sayınalp N, Göker H. The clinical course of COVID-19 in hematopoietic stem cell transplantation (HSCT) recipients. Turk J Med Sci 2021; 51:1647-1652. [PMID: 33878857 PMCID: PMC8569779 DOI: 10.3906/sag-2103-72] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 04/18/2021] [Indexed: 11/09/2022] Open
Abstract
Background/aim The disease caused by SARS-CoV-2 was named as COVID-19. There is as yet insufficient information about the effects of HSCT on the clinical course of COVID-19. In the present study, we aimed to investigate the clinical course of COVID-19 in patients who had undergone HSCT. Materials and methods We analyzed baseline characteristics, clinical course and findings of COVID-19, hospitalization and death rates, overall survival, and case fatality rates of HSCT recipients diagnosed with COVID-19 retrospectively. Results 57.6% of the patients underwent AHSCT, and 42.4% underwent allo-HSCT. 60.6%, 27.3%, and 12.1% of the patients had mild, moderate, and severe COVID-19 or critical illness, respectively. Overall, 45.5% were hospitalized, 12.1% required intensive care, and 9.1% necessitated invasive mechanical ventilation. The total CFR was 9.1% in HSCT recipients, 22.2% in patients with active hematologic malignancy, and 4.2% in patients without active hematologic malignancy. Conclusion It can be concluded that mortality of HSCT recipients is lower in patients whose primary disease is in remission compared to ones that are not in remission. Further studies with larger group patients are needed in order to delineate the effects of COVID-19 on HSCT patients.
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Affiliation(s)
- Ayşe Karataş
- Department of Internal Medicine, Division of Hematology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ümit Yavuz Malkan
- Department of Internal Medicine, Division of Hematology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Mustafa Velet
- Department of Internal Medicine, Division of Hematology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Haluk Demiroğlu
- Department of Internal Medicine, Division of Hematology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Yahya Büyükaşık
- Department of Internal Medicine, Division of Hematology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Gülçin Telli Dizman
- Department of Infectious Diseases, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ahmet Çağkan Inkaya
- Department of Internal Medicine, Division of Hematology, Faculty of Medicine, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Batuhan Erdoğdu
- Department of Internal Medicine, Division of Hematology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Olgu Erkin Çınar
- Department of Internal Medicine, Division of Hematology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Elifcan Aladağ
- Department of Infectious Diseases, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Salih Aksu
- Department of Internal Medicine, Division of Hematology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | | | - Osman Özcebe
- Department of Internal Medicine, Division of Hematology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Nilgün Sayınalp
- Department of Internal Medicine, Division of Hematology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Hakan Göker
- Department of Internal Medicine, Division of Hematology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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4
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Çınar OE, Sayınalp B, Aladağ Karakulak E, Avşar Karataş A, Velet M, İnkaya AÇ, Ersoy Ortaç NE, Öcal S, Aksu S, Haznedaroğlu İC, Sayınalp N, Özcebe Oİ. Convalescent (immune) plasma treatment in a myelodysplastic COVID-19 patient with disseminated tuberculosis. Transfus Apher Sci 2020; 59:102821. [PMID: 32487513 PMCID: PMC7258803 DOI: 10.1016/j.transci.2020.102821] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [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: 05/04/2020] [Revised: 05/05/2020] [Accepted: 05/05/2020] [Indexed: 12/11/2022]
Abstract
During the ongoing COVID-19 pandemic due to the SARS-CoV-2 virus of which evidence-based medical paradigms cannot be easily applied; difficult clinical decisions shall be required particularly in the 'difficult-to-treat' cases of high risk group with associated comorbidities. Convalescent immune plasma therapy is a promising option as a sort of 'rescue' treatment in COVID-19 immune syndrome, where miraculous antiviral drugs are not available yet. In this report, we aim to convey our experience of multi-task treatment approach with convalescent immune plasma and anti-cytokine drug combination in a COVID-19 patient with extremely challenging comorbidities including active myeloid malignancy, disseminated tuberculosis and kidney failure.
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Affiliation(s)
- Olgu Erkin Çınar
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Hematology Unit, Turkey.
| | - Başak Sayınalp
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Turkey
| | - Elifcan Aladağ Karakulak
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Hematology Unit, Turkey
| | - Ayşe Avşar Karataş
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Hematology Unit, Turkey
| | - Mustafa Velet
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Hematology Unit, Turkey
| | - Ahmet Çağkan İnkaya
- Hacettepe University Faculty of Medicine, Department of Infectious Diseases, Turkey
| | - Nazmiye Ebru Ersoy Ortaç
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Intensive Care Unit, Turkey
| | - Serpil Öcal
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Intensive Care Unit, Turkey
| | - Salih Aksu
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Hematology Unit, Turkey
| | | | - Nilgün Sayınalp
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Hematology Unit, Turkey
| | - Osman İlhami Özcebe
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Hematology Unit, Turkey
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5
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Cebeci E, Şengül Samancı N, Uzun S, Karadağ S, Gürsu M, Şenel Özler TE, Velet M, Öztürk S. Inflammation, Left Ventricular Mass Index and Chronic Renal Failure in Diabetic Patients. Haseki 2020. [DOI: 10.4274/haseki.galenos.2020.5662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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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Gümüş A, Düz ME, Coşkun C, Velet M, Koldaş M. Evaluation of Receptor Activator of Nuclear Factor Kappa-B Ligand and Osteoprotegerin Levels in Patients with Type 2 Diabetes Mellitus Treated with Oral Anti-diabetics (Sulfonylurea and Metformin) or Insulin: Bone Tissue Perspective. Istanbul Med J 2019. [DOI: 10.4274/imj.galenos.2018.04657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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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7
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Gümüş A, Düz ME, Coşkun C, Velet M, Koldaş M. Evaluation of Receptor Activator of Nuclear Factor Kappa-B Ligand and Osteoprotegerin Levels in Patients with Type 2 Diabetes Mellitus Treated with Oral Anti-Diabetic (Sulfonylurea and Metformin) or Insulin from the Perspective of Bone. Istanbul Med J 2019. [DOI: 10.4274/imj.04657] [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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8
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Ermiş Karaali Z, Candan G, Aktuğlu MB, Velet M, Ergen A. Toll-Like Receptor 2 (TLR-2) Gene Polymorphisms in Type 2 Diabetes Mellitus. Cell J 2018; 20:559-563. [PMID: 30124003 PMCID: PMC6099132 DOI: 10.22074/cellj.2019.5540] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 12/13/2017] [Indexed: 12/27/2022]
Abstract
Objective Innate immunity factors are associated with type 2 diabetes (T2DM) and its complications. Therefore, T2DM has
been suggested to be an immune-dependent disease. Elevated fasting glucose level and higher concentrations of innate
immunity soluble molecules are not only related with insulin resistance, but inflammation is also an important factor in beta
cell dysfunction in T2DM. Toll-like receptor 2 (TLR-2), which has an important role in inducing innate immune cells, is thought
to have suppressive roles on immune responses in T2DM. We therefore aimed to investigate the possible role of TLR-2 del
-196-174 and Arg753Gln variants in T2DM pathogenesis.
Materials and Methods This study was designed as a case-control study. Polymerase chain reaction-restriction fragment
length polymorphism (PCR-RFLP) technique was used to genotype the two variants in 100 T2DM patients and 98 age-
matched controls.
Results We found significantly higher frequencies of TLR-2 del -196-174 DD genotype (P=0.003), ID genotype
(P=0.009) and D allele (P=0.001) in patients compared with controls. In addition, the II genotype (P=0.001) and the I
allele (P=0.003) frequencies were elevated in healthy controls. We did not find any significant differences in frequency
distribution for the Arg753Gln variant in study groups.
Conclusion We suggest that carrying the D allele of the TLR-2 del -196-174 variant may be related as a risk factor for T2DM.
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Affiliation(s)
- Zeynep Ermiş Karaali
- Department of Internal Medicine, Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Gonca Candan
- Department of Molecular Medicine, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Mehmet Burak Aktuğlu
- Department of Internal Medicine, Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Mustafa Velet
- Department of Internal Medicine, Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Arzu Ergen
- Department of Molecular Medicine, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey. Electronic Address:
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9
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Aktuglu MB, Ayer M, Bireller ES, Rencuzogullari C, Acik H, Karaali Z, Alioglu T, Yigit N, Velet M, Atalay E, Ure OS, Cakmakoglu B. Investigation of DNA repair gene variants on myelodysplastic syndromes in a Turkish population. Med Oncol 2014; 31:174. [DOI: 10.1007/s12032-014-0174-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Accepted: 08/09/2014] [Indexed: 11/30/2022]
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Canbakan B, Senturk H, Tahan V, Hatemi I, Balci H, Toptas T, Sonsuz A, Velet M, Aydin S, Dirican A, Ozgulle S, Ozbay G. Clinical, biochemical and histological correlations in a group of non-drinker subjects with non-alcoholic fatty liver disease. Acta Gastroenterol Belg 2007; 70:277-284. [PMID: 18074737] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The correlation between biochemistry, imaging-studies and histology is a matter of controversy in non-alcoholic fatty liver disease (NAFLD) and the major pathophysiology of non-alcoholic steatohepatitis (NASH) is still unknown. We aimed to perform a comparative analysis between clinical, biochemical and histological variables of NAFLD. One-hundred and five NAFLD patients (F/M: 51/54), were studied, all with no-alcohol intake. The groups were followed-up for six months. Necroinflammation and fibrosis were more severe in patients with diabetes (p = 0.002, and p = 0.0001, respectively). In comparing NAFL to NASH, plasma nitric-oxide and malondialdehyde levels were significantly higher (p = 0.05, for-both), and vitamin-E and-C levels were significantly lower in NASH (p = 0.002, and 0.001, respectively). The serum ferritin levels were higher in NASH patients (p = 0.016). While the ultrasonographic grade was significantly higher, the liver-spleen density gradient was significantly lower in NASH group (p = 0.017, and 0.005, respectively). Within a six month period, serum ALT levels dropped into the normal range in 23/76 (30.3%) patients and serum ALT in the 6th month correlated significantly with the severity of steatosis, inflammation and fibrosis in initial biopsy (p = 0.023, 0.035, 0.011, respectively). In conclusion, the probability of severe liver disease is higher in patients with elevated-ALT in NAFLD. Serum ferritin levels have some prognostic significance in liver damage and fibrosis. Overt diabetes is predictive of advanced fibrosis and inflammation. However impaired glucose-tolerance is not. The advice on diet and exercise for six months after diagnosis may be a good strategy in NAFLD. The patients with normal-ALT without hepatomegaly, morbid-obesity and diabetes seem to have a good prognosis, however some of these patients may still require liver biopsy.
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Affiliation(s)
- B Canbakan
- Department of Gastroenterology, Cerrahpasa Medical Faculty of Istanbul University.
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