Evaluation of Hepatitis C in 20 Years: A Turkish Experience

Objective: Hepatitis C virus (HCV) infection still maintains its importance since it is one of the most important causes of liver cirrhosis and hepatocellular carcinoma. Our hospital, located in İstanbul, which is the 10t most crowded city in the world, has a patient cohort where epidemiological change can be observed due to its deep-rooted history and serving people of different nations in terms of settlement. Main aim in this study is to evaluate the change in HCV epidemiology in our country over the years. Methods: Patients who were at the age of 18 and above and whose HCV-RNA was positive between January 2001 and January 2021 were evaluated. Results: 1.166 patients whose HCV genotype was determined were evaluated. The mean age of the population is 52±14.75 years, 83.53% of all patients was infected with genotype 1 (GT1), 8.23% with GT3, 5.83% with GT2, 2.23% with GT4 and 0.17% of them with GT5. While the GT1 rate decreased in patients over the years, an increase was found in other GTs. GT1 and GT2 were more common in females (p<0.001); GT3 and GT4 were more dominant in males (p<0.001). The mean age of females was high in all genotypes. The mean age of GT3 was significantly lower than the other groups (p<0.001). Conclusion: Although GT1 is still dominant in our country, GT3 and GT4 have been increasingly seen over the years, suggesting that the genotype distribution may change in the coming years due to uncontrolled migration and effective direct-acting antivirals

Effects of different pulmonary surfactants in the prevention of postoperative intraabdominal adhesion formation

Background: After abdominal surgery, the formation of postoperative adhesion is a serious problem. The aim of the study is to evaluate the efficacy of 2 different pulmonary surfactants, poractant and beractant, on adhesion prevention in an experimental model. Materials and Methods: An experimental intraabdominal adhesion model was created in 18 adult female rats by cecal abrasion. The rats were randomly assigned to 3 groups. Group I received no further treatment, whereas groups II and III received intraperitoneal poractant and beractant, respectively, before closing the incision. On the 15th postoperative day, all rats underwent relaparotomy, intraabdominal adhesions were scored macroscopically according to Canbaz scoring system, and the cecum in each animal was evaluated microscopically. Results: The median adhesion scores of group II and III rats were significantly lower when compared with group I (P = .02). Group III had a lower median adhesion score than did group II, but this did not reach significance (P N .05). Conclusion: These observations suggest that intraperitoneal instillation of both pulmonary surfactants is associated with lower adhesion scores, higher adhesion-free cases, and improved histologic findings

To rechallenge or not to rechallenge, that is the question? An unsuccessful attempt of hypomethylating agent plus venetoclax in an elderly FLT3-positive relapsed acute myeloid leukemia patient after a yearlong period of remission

Dear Editor, Acute myeloid leukemia is the most common sub-type of acute leukemia in adulthood [1]. It has a detrimental prognosis with conventional combination chemotherapy, mainly with anthracyclines and cytarabine. Allogeneic stem cell transplantation has signifcantly prolonged the overall survival in a particular “eligible” patient population, but as AML is a disorder of the elderly, not all patients are able to proceed with allogeneic stem cell transplantation

Assesment of patient's perspective on treatment free remission in CML: A Turkish multicenter cohort

Treatment free remission (TFR) is one of the main goals of therapy in Chronic Myeloid Leukemia (CML). Patient perspective and expectations have an indicative effect on discontinuation decisions. We analyzed 116 CML patients' perspective on TFR and factors that associated with willingness for tyrosine kinaz inhibitor (TKI) discontinuation from four different center in Turkey based on a national survey. Patients in our cohort had 7.8% awareness of TFR and after brief information willingness to attempt TFR has been reached to 58.9% in all population. Shorter disease duration was associated with enhanced willingness to attempt discontinuation in multivariate analyses (p=0.031). Most common patient related limitation for TKI discontinuation decision was anxiety about disease relaps and TKI resistance. Even disease relaps in TFR means molecular and detectable with close monitoring, patients still had considerable concerns about TKI discontinuation

Lenalidomide-based treatment results in patients with relapsed/refractory lymphoma (excluding mantle cell lymphoma): A multi-centre experience

Amaç: Lenfomalar, çoğunlukla B hücre kökenli heterojen bir hastalık grubunu temsil eder. Lenalidomid, kemo-immünoterapötik ajanlara talidomidin yapısal bir analoğu olarak dahil edilmiştir. Bu çalışmada amaç, mantle hücreli lenfoma dışı lenfomalarda, lenalidomid ile ilgili gerçek yaşam verilerimizi ortaya çıkarmaktır. Hastalar ve Yöntem: Ocak 2018- Ocak 2020 tarihleri arasında lenfoma tanısı alan hastalar geriye dönük olarak incelendi. Lenalidomid kombine rejimleri şu şekilde gruplandırılmıştır: Lenalidomi -deksametazon (Len-D); lenalidomid-bendamustin (Len-B); lenalidomid-rituksimab (Len-R). Bulgular: On beş (%60.9) hasta Len-D, 6 (%30.4) hasta Len-B ve 2 (%8.7) hasta Len-R aldı. En yaygın yanıt 13 (%56.5) hasta ile progresif hastalık idi, sadece 2 (%8.7) hastada tam yanıt vardı. Sonuç: Lenalidomid, diffüz büyük B hücreli lenfomalar (DBBHL), folliküler lenfoma (FL) ve indolen relaps/refrakter lenfomalar ile relaps/refrakter Hodgkin lenfomada (HL) yeni tedavi seçenekleri arasında yer almaktadır.Objective: Lymphomas represent a heterogeneous group of diseases, mostly of B-cell origin. Lenalidomide is included in chemo-immunotherapeutic agents as a structural analog of thalidomide. In this study, the goal is to reveal our real-life data on lenalidomide. Patients and Methods: Patients diagnosed with lymphoma between January 2018-2020, were retrospectively analyzed. Lenalidomide combined regimens were grouped as: Lenalidomidedexamethasone (Len-D); lenalidomide-bendamustine (Len-B); lenalidomide-rituximab (Len-R). Results: Fifteen (60.9%) patients received Len-D, 6 (30.4%) patients received Len-B and 2 (8.7%). patients received Len-R Most common response was progressive disease with 13 (56.5%) patients, only 2 (8.7%) patients had a complete remission. Conclusion: Lenalidomide appears as new treatment options in relapsed/refractory Hodgkin lenfoma (HL), diffuse large B-cell lymphoma (DLBCL), follicular lymphoma (FL) and indolent lymphomas

Gilteritinib (XOSPATA (R)) in Turkey: Early access program results

Background And Objectives: Gilteritinib (XOSPATA (R), Astellas) is a type I oral FLT3 inhibitor, a tyrosine kinase AXL inhibitor, involved in both c-Kit and FMS-like tyrosine kinase 3 (FLT3) resistance. In the phase 3 ADMIRAL trial, gilteritinib was compared with the standard of care in (R/R) acute myeloid leukemia (AML) patients who harbored any FLT3 mutation and showed superior efficacy with regard to response and survival. Objectives: This research aimed to investigate the real-life efficacy and safety of gilteritinib in FLT3-positive R/R AML patients who were treated as a part of an early access program held in Turkey in April 2020 (NCT03409081). Results: The research included 17 R/R AML patients who had received gilteritinib from seven centers. The overall response rate was 100%. The most common adverse events were anemia and hypokalemia (7 patients, 41.2%). Grade 4 thrombocytopenia was observed in one patient only (5.9%), leading to permanent treatment discontinuation. Patients with peripheral edema had a 10.47 (95% CI: 1.64-66.82) times higher risk of death than those without peripheral edema (p<0.05). Conclusion: This research showed that patients with febrile neutropenia and peripheral edema were at a high risk of death when compared to patients without febrile neutropenia and peripheral edema

Hodgkin lenfoma hastalarında EORTC QLQ ile yaşam kalitesi değerlendirmesi: Çok merkezli çalışma

Aim: The aim of our study is to obtain data on the quality of life (QoL) in Hodgkin lymphoma (HL) patients in a representative sample of the general population of Turkey with the help of the EORTC QLQ-C30 and QLQ-HL27 questionnaires. Material and Methods: A total of 68 patients from seven different centers diagnosed with HL between 2018-2020 were included in the study. The questionnaires were answered cross-sectionally by the patient under the control of a physician in the centers participating in the study. Results: Out of 68 patients, 42.6% (n=29) were female and 57.4% (n=39) were male. The ages of the patients ranged from 18 to 74 years, with a mean of 42.10±16.62 and with a median value of 40 years. There was no significant difference between age subgroups in terms of QLQ-C30 global health status/ QoL, functional or symptom scales and HL27 SB, PC, EI and WF scores (p>0.05, for all). It was determined that the constipation scores of females were higher than the scores of males (p=0.041). No statistically significant difference was found in terms of HL27 SB, PC, EI and WF sub-dimension scores according to gender (p>0.05). Conclusions: There was only a statistically significant difference in terms of QLQ-C30 constipation sub-dimension scores according to gender. The constipation scores of females were higher than the scores of men. More detailed and large population studies are needed to reveal the effectiveness of QoL assessment in HL patients.Amaç: Çalışmamızın amacı, EORTC QLQ-C30 ve QLQ-HL27 anketleri yardımıyla Türkiye genelini temsil eden bir örneklemde Hodgkin lenfoma (HL) hastalarında yaşam kalitesi hakkında veri elde etmekti. Gereç ve yöntemler: 2018-2020 yılları arasında, HL tanısı almış yedi farklı merkezden toplam 68 hasta çalışmaya dahil edildi. Anketler, araştırmaya katılan merkezlerde hekim kontrolünde hasta tarafından yanıtlandı. Bulgular: 68 hastanın %42.6'sı (n=29) kadın, %57.4'ü (n=39) erkekti. Hastaların yaşları 18 ile 74 arasında değişmekte olup, ortalama 42.10±16.62 ve ortanca değeri 40 idi. QLQ-C30 global sağlık durumu/ yaşam kalitesi, fonksiyonel veya semptom skalaları ve HL27 SB, PC, EI ve WF skorları açısından yaş alt grupları arasında anlamlı fark yoktu (tümü için, p>0.05). Kadınların kabızlık puanlarının erkeklere göre daha yüksek olduğu belirlendi (p=0.041). Cinsiyete göre HL27 SB, PC, EI ve WF alt puanları açısından istatistiksel olarak anlamlı fark bulunmadı (p>0.05). Sonuç: Cinsiyete göre sadece QLQ-C30 kabızlık alt puanları açısından istatistiksel olarak anlamlı bir fark vardı. Kadınların kabızlık puanları erkeklerin puanlarından daha yüksekti. HL hastalarında QoL değerlendirmesinin etkinliğini ortaya çıkarmak için daha ayrıntılı ve geniş popülasyon çalışmalarına ihtiyaç olduğu görülmektedir

Charlson comorbidity index (CCI) in diffuse large B-cell lymphoma: A new approach in a multicenter study

Purpose: Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of adult lymphomas. The incidence of DLBCL increases with age and has a fairly rapid fatal course without treatment. Patients often have difficulty tolerating standard chemotherapy regimens due to their comorbidities. Charlson Comorbidity Index (CCI), which is calculated by considering 19 different comorbidities, was developed in 1987 and is widely used for mortality prediction in cancer patients. Literature data on CCI and hematological malignancies are limited. Main aim in this study is to evaluate the effectiveness of CCI and compare to the International Prognostic Index (IPI) scoring system in the DLBCL patient group. Methods: A total of 170 patients diagnosed with DLBCL between 1.1.2002- 1.12.2020 were included in the study. Statistical analyzes were performed among patients whose IPI and CCI scores were recorded by considering baseline data. Results: The median age of patients was 58 (range: 17–84). Thirty-five (20.6%) patients had stage III and 76 (44.7%) had stage IV disease. When the CCI, IPI and ECOG scores were compared with the mortality status of the patients as a reference, AUCs were resulted as 0.628 (95% CI: 0.506–0.749), 0.563 (95% CI: 0.484–0.639) and 0.672 (95% CI: 0.596–0.743), respectively. There was no significant difference between the ROC curves of CCI, IPI and ECOG scores. Patients with a CCI score of ≥ 4 had shorter OS comperad to those with a score of < 4. Conclusion: Rather than claiming that CCI is superior to IPI, ECOG or another scoring system in a single-center patient population, it should be stated that CCI is also an effective scoring system in patients diagnosed with DLBCL

Comparison of efficacy and safety of generic plerixafor vs original plerixafor in the mobilization of myeloma patients

Introduction The commonest indication for an Autologous Stem Cell Transplantation (ASCT) is still Multiple Myeloma. A successful mobilization of hematopoietic stem cells (HSC) is a sine qua non of ASCT. The introduction of Plerixafor, which is a partial agonist of the alfa-chemokine receptor CXCR4 has added an important value and impact on mobilization. Plerixafor is successfully integrated into both growth factor-only and cyclophosphamide and growth factor mobilization strategies with significantly reducing the mobilization failure rate in myeloma patients. In addition, plerixafor + G-CSF has also been shown to successfully mobilize the majority of patients who previously failed to mobilize with either growth factor alone or in combination with chemotherapy. Even a Just-in-Time algorithm which induces plerixafor in patients who lacks a certain threshold of CD34 positive HSCs on the day of mobilization led to a cost-effective and successful mobilization with highly restricted rates of mobilization failure. In this study we tried to demonstrate the efficacy and safety of a novel generic Plerixafor (Pleksor - Gen Ilac) and to compare it with original one (Mozobil - Sanofi) in a retrospective manner. Method Patients who were transplanted in two centers who adopted the same mobilization standard operating procedures (SOP) were included in the study. An age and sex matched cohort of patients who received Mozobil (from 2020-2022 - Group A) were compared with the ones who received Pleksor (2021-2022 Group B) as a Just-in-Time conjunct to GCSF alone or chemo mobilization. Poor mobilization was defined as a final yield of 2 million CD34 positive HSCs per kg. Our aim was to collect enough stem cells for at least two ASCTs, thus our current SOP's indicated a minimum CD34 positive HSC threshold of at least 4 million per kg and an ideal HSC threshold of 6 million per kg. Results A total of 28 patients were included and they were equally distributed among Group A (n=14) and B (n=14). Median age of the patients at the time of mobilization were as follows, 60 (35-72) in Group A and 61 (38-70) in Group B. 14 patients who received Pleksor achieved a median yield of 8.40 million CD34 positive HSCs per kg (4.8-21) and the patients who received Mozobil have ended with a yield of 6.7 million CD34 positive HSCs per kg (4.5-13) (p=0.210). None of the patients in both groups were named to be a poor mobilizer according to the threshold of 2 million CD34 positive HSCs per kg but 3 of the patients in Group A and 2 of the patients in Group B ended with a yield of 6 million CD34 positive cells which was below to the ideal threshold for two transplants. Regarding lenalidomide exposure before mobilization, history of radiotherapy, line of the therapies received before mobilization, number of leukapheresis and the mobilization policy (chemo vs gcsf alone) there were no statistically significant difference between two groups (p=0.120, 0.702, 0.842, 0.769 and 0.420 respectively). The median neutrophil engraftment time in days were as follows for Group A and B, 11(10-14) vs 11 (10-16), p=0.541 and the median platelet engraftment time in days were 17 (10-30) in Group A and 16 (10-28) in Group B with a p value of 0.571. In none of the cases any specific side effects were noted which could be attributable to Pleksor or Mozobil. Conclusion Our study demonstrated a comparable efficacy of a generic form of Plerixafor when compared with the originator. This would lead to a decrease in the cost of total process of mobilization with a similar efficacy and toxicity profile. We are now planning to initiate a prospective trial to validate these results in a larger patient population. Up to our knowledge this is the first study comparing the efficacy of a generic Plerixafor in a sole myeloma patient cohort

Cytomegalovirus (CMV) and Hepatitis B (HBV) reactivation during autologous stem cell transplantation: A single-center experience

Amaç: Sitomegalovirüs (CMV) reaktivasyonu allojenik hematopoetik kök hücre transplantasyo- nu sırasında sık görülür. Hepatit B reaktivasyonu (HBV), akut hepatit ve fulminan karaciğer yet- mezliği veya sadece HBV DNA düzeyinde artma şeklinde ortaya çıkabilir. Allojenik hematopoetik kök hücre nakli bağımsız bir risk faktörüyken, otolog hematopoetik kök hücre (HKH) alıcıları için risk ve nakil sürecine etkileri net bilinmemektedir. Çalışmamızda, geriye dönük olarak analiz etti- ğimiz otolog HKH alıcılarında CMV enfeksiyonu-engraftman ve hepatit B reaktivasyonu ilişkisini ortaya koymayı amaçladık. Hastalar ve Yöntem: Temmuz 2014-Aralık 2019 tarihleri arasında takip edilmiş olan toplamda 174 otolog KHN alıcı olan hasta değerlendirildi. CMV enfeksiyonuna bağlı organ tutulumları doku tanısı, görüntüleme ve klinik bulgularla doğrulandı. CMV enfeksiyonun tipi hastanın klinik izlemi, radyolojik raporları, hastanın tedavi alıp almamasına göre kopya sayısı seyri, virüsün herhangi bir dokunun patolojik incelemesinde tespit edilip edilmemesine göre değerlendirildi. Bulgular: Çalışmaya toplam 174 otolog KHN alıcı dahil edildi. CMV reaktivasyon oranı 18 has- tayla %10.3’tü. CMV reaktivasyonu olan olguların total Anti-HBc pozitif olma oranı, CMV negatif grubuna göre istatistiksel olarak anlamlı seviyede yüksek saptandı. CMV reaktivasyonu grubun- daki olguların HBV reaktivasyon oranı, CMV reaktivasyonu olmayan hasta grubundan istatistiksel olarak anlamlı seviyede yüksek saptandı. Sonuç: Otolog kök hücre nakli de viral reaktivasyonlar açısından dikkatli olunması gereken önemli bir tedavi tipini oluşturmaktadır.Objective: Cytomegalovirus (CMV) reactivation is a frequently encountered clinical condition during allogeneic hematopoietic stem cell transplantation. Hepatitis B reactivation (HBV) can occur asymptomatically only with re-emergence or increase in blood HBV-DNA levels, as well as in different clinical manifestations, including acute hepatitis and fulminant liver failure. While allogeneic hematopoietic stem cell transplantation is an independent risk factor, the risk for autologous hematopoietic stem cell (HSC) recipients and its effects on the transplantation process are not clear. In our study, we aimed to reveal the relationship between CMV reactivation and engraftment process and HBV reactivation in autologous HSC recipients. Patients and Methods: A total of 174 autologous HSC recipients who were followed-up between July 2014 and December 2019 were included in our study. Organ involvement due to CMV infection was confirmed by tissue pathology, imaging methods and clinical find- ings. The type of CMV infection was evaluated according to the patient’s clinical follow-up, radiological reports, the course of the copy number according to whether the patient received treatment, and whether the virus was detected in the pathological examination of any tissue. Results: The CMV reactivation rate was 10.3% with 18 patients. The rate of total Anti-HBc positivity in cases with CMV reactivation was found to be statistically significantly higher than in the CMV negative subgroup. The HBV reactivation rate of the patients in the CMV reactivation subgroup was found to be statistically significantly higher than the patient group without CMV reactivation. Conclusion: Autologous stem cell transplantation also constitutes an important type of treatment to be careful in terms of viral reacti- vation