Improved outcomes over time and higher mortality in CMV seropositive allogeneic stem cell transplantation patients with COVID-19; An infectious disease working party study from the European Society for Blood and Marrow Transplantation registry

Introduction: COVID-19 has been associated with high morbidity and mortality in allogeneic hematopoietic stem cell transplant (allo-HCT) recipients. Methods: This study reports on 986 patients reported to the EBMT registry during the first 29 months of the pandemic. Results: The median age was 50.3 years (min – max; 1.0 – 80.7). The median time from most recent HCT to diagnosis of COVID-19 was 20 months (min – max; 0.0 – 383.9). The median time was 19.3 (0.0 - 287.6) months during 2020, 21.2 (0.1 - 324.5) months during 2021, and 19.7 (0.1 – 383.9) months during 2022 (p = NS). 145/986 (14.7%) patients died; 124 (12.6%) due to COVID-19 and 21 of other causes. Only 2/204 (1%) fully vaccinated patients died from COVID-19. There was a successive improvement in overall survival over time. In multivariate analysis, increasing age (p<.0001), worse performance status (p<.0001), contracting COVID-19 within the first 30 days (p<.0001) or 30 – 100 days after HCT (p=.003), ongoing immunosuppression (p=.004), pre-existing lung disease (p=.003), and recipient CMV seropositivity (p=.004) had negative impact on overall survival while patients contracting COVID-19 in 2020 (p<.0001) or 2021 (p=.027) had worse overall survival than patients with COVID-19 diagnosed in 2022. Discussion: Although the outcome of COVID-19 has improved, patients having risk factors were still at risk for severe COVID-19 including death

Secondary Infections in Cancer Patients with Febrile Neutropenia

OBJECTIVE: Patients with neutropenia due to cancer chemotherapy are prone to severe infections. Cancer patients can experience >1 infectious episode during the same period of neutropenia. This study aimed to determine the etiological and clinical characteristics of secondary infectious episodes in cancer patients with febrile neutropenia and to identify the factors associated with the risk of secondary infectious episodes. METHODS: All cancer patients that received antineoplastic chemotherapy at Ankara University, School of Medicine, Department of Hematology between May 2004 and May 2005 and developed neutropenia were included in the study. Data were collected using survey forms that were completed during routine infectious diseases consultation visits. Categorical data were analyzed using the chi-square test, whereas Student’s t-test was used for continuous variables. Multivariate logistic regression analysis was performed to identify independent predictors of secondary infections (SIs). RESULTS: SIs were observed during 138 (53%) of 259 febrile neutropenic episodes. Of the 138 episodes, 89 (64.5%) occurred in male patients with a mean age of 40.9 years (range: 17-76 years). In total, 80% of the SIs were clinically or microbiologically documented. Factors on d 4 of the initial febrile episode were analyzed via a logistic regression model. The presence of a central intravenous catheter (OR: 3.01; P < 0.001), acute myeloid leukemia (AML) as the underlying disease (OR: 2.12; P = 0.008), diarrhea (OR: 4.59; P = 0.005), and invasive aspergillosis (IA) during the initial febrile episode (OR: 3.96; P = 0.009) were statistically significant risk factors for SIs. CONCLUSION: Among the cancer patients with neutropenia in the present study, AML as the underlying disease, the presence of a central venous catheter, diarrhea, and IA during the initial febrile episode were risk factors for the development of SIs

Is the end close for the graft-versus-host disease that is a big problem following allogeneic hematopoetic stem cell transplantation?

60th Annual Meeting of the American-Society-of-Hematology (ASH) -- DEC 01-04, 2018 -- San Diego, CAWOS: 000454842807143…American Society of Hematolog

Ibrutinib as a promising treatment for pulmonary complications due to refractory chronic graft versus host disease

Introduction: Despite major improvements in allogeneic hematopoetic stem cell transplantation form matched related/ unrelated donor over last decades, chronic graft-versus-host disease (cGVHD) is still the leading cause of late treatmentrelated deaths among recipients. Ibrutinib is a first class inhibitor of BTK was recently employed in corticosteroid-refractory chronic GVHD with encouraging overall response rates Herein, we share a real-life experience using ibrutinib in the treatment of steroid-refractory cGVHD. Patients and Methods This multicenter retrospective study conducted in 10 different stem cell transplant centers included 44 adult patients diagnosed with steroid-refractory cGVHD. We treated off-label these patients from June 2017 to July 2019 with ibrutinib with a dose of 420 mg. Organ sites affected and cGVHD grading were classified according to the NIH 2014 criteria. Results Patients had undergone both myeloablative and non-myeloablative Allo-SCT for a variety of underlying hematological malignancies. As expected mouth and skin were the most frequently involved organs and 67 % of patients showed evidence of cGVHD in more than two organs. The median Karnofsky Performance Status score was 65%. At a median follow-up of 22.3 months (range 7.1-109 months) after evidence of cGVHD showed, 36 (81.8%) patients were still receiving ibrutinib and 4 (9.1%) had discontinued treatment, because of cGVHD progression. Treatment duration ranged from 2 to 12 months (median 6 months) for all patients. Only three patients had grade 2 muscle spasm, arrhythmia and diarrhea as adverse events and need to reduce the 25% of drug dosage. No several adverse events due to ibrutinib were observed in our cohort. In the all treated population, based on the 2005 NIH cGVHD Consensus Panel response criteria, 45.5% PR and 20.5% CR were achieved. Six patients had progression on manifestations of cGVHD. For the responders, the median time to initial response was 28 days. Nine patients had stable disease under the ibrutinib treatment and still continue receiving. Analysis by organ domain showed similar rates of response in the lung (76.4%) skin (66.7%), and GIS (57.1%). However the response in the liver (54.2%) was lower than the others. Out of 17 patients with bronchiolitis obliterans as a manifestation of cGVHD, we observed an immediate improvement in stability of FEV1 decline that persisted over the study period despite the decreased steroid dosing in 13 patients, 3 patients had stable FEV1 and only 1 patient had reduction in FEV1. Discussion Our study suggests that ibrutinib is a safe and effective agent that reduces steroid requirements and stabilizes lung function in patients with bronchiolitis obliterans as a manifestation of cGVHD. Our study adds to a growing body of evidence for ibrutinib's use in cGVHD. It is important to note that, larger prospective studies are needed to verify and augment our findings.American Society for Transplantation & Cellular TherapyCIBMT

Unmet clinical needs and challenges in the management of acute leukemia in Turkey: a modified Delphi study

Aim: To determine the unmet needs and challenges in management, diagnosis, treatment, follow-up and patient-physician communication in acute leukemia (AL). Materials & methods: The study was based on a modified Delphi approach. A questionnaire including the major potential obstacles was circulated twice among 13 hematologists. Results: The obstacles in AL management were limited access to the novel treatments and genetic tests, limited bed capacity, insufficient level of knowledge among allied health personnel, limited availability of psycho-oncological support and low levels of awareness in the population about the importance of stem cell donation. Conclusion: The challenges in the management of AL are critical to guide the efforts to improve the quality of healthcare delivery and the evidence-based decision making at treatment of AL patients

CD5 as a prognostic marker in patients with diffuse large B-cell lymphoma: a multicenter study

© 2022, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma (NHL) and comprises a heterogeneous group of disease. While classification of B-cell lymphomas has been evolving to include clonality in a specific manner, morphology, and immunohistochemistry remain the backbone. We aimed to evaluate the value of CD5 expression on disease characteristics as well as prognosis in patients with DLBCL. Data of 131 patients with DLBCL with CD5 positivity and as a comparison arm, data of 129 patients with DLBCL without CD5 positivity were evaluated. Mean age was 59 and 55.7% of the patients were male. Overall survival was 29.8 months. Poor prognostic factors including (high-LDH levels, B symptoms, low ECOG score, high R-IPI and NCCN-IPI score) were observed to be significantly related with CD5 positivity. Mean survival in CD5 positive patients were 29.8 months, which is significantly shorter than the general DLBCL survival worldwide. CD5 expression shall be evaluated in all samples of DLBCL patients due to its possible effects on outcomes

Merkel cell carcinoma in Turkey: A multicentric study

Background: Merkel cell carcinoma (MCC) is a rare but highly aggressive neuroendocrine carcinoma of the skin. In this study, we aimed to evaluate the clinicopathologic characteristics, treatment outcomes, and survival of MCC cases in Turkey. Materials and methods: The patients diagnosed with MCC between 1999 and 2018 at twenty different centers in Turkey were included in the study. Patient and tumor characteristics and adjuvant and metastatis treatment outcomes were analyzed retrospectively. Results: The median age of totally 89 patients was 70 (26-93). The most common primary location was lower limbs (n = 29, 32.5%). Immunohistochemically, CK20 positivity was present in 59 patients (66.3%). Only two patients had secondary malignancy. The majority of the patients (n = 76, 85.4%) were diagnosed at the localized stage. Surgery was performed for all patients in the early stage, and adjuvant radiotherapy or/and chemotherapy was applied to 52.6% (n = 40) of nonmetastatic patients. The median follow-up was 29 months. Recurrence developed in 21 (27.6%) of the 76 patients who presented with local or regional disease. Two-year disease-free survival (DFS) was 68.1% and 5-year DFS was 62.0% for localized stage. The 5-year DFS was similar for patients receiving adjuvant treatment (chemotherapy, radiotherapy, or sequential chemoradiotherapy) and without adjuvant therapy (P > 0.05). Two-year overall survival in patients who presented with localized disease was 71.3% and 18.5% in metastatic patients (P < 0.001). In the metastatic stage, platinum/etoposide combination was the most preferred combination regimen. Median progression-free survival (PFS) in first-line chemotherapy was 7 months (95% confidence interval: 3.5-10.5 months; standart error: 1.78). Conclusions: Although MCC is rare in Turkey, the incidence is increasing. Gender, CK20 status, tumor size, lymph node involvement, and adjuvant treatment were not associated with recurrence

İş Sağlığı ve Güvenliği Meslek Hastalıkları

Ülkemizde iş sağlığı ve güvenliği ile meslek hastalıkları konularında, kapsamlı Türkçe kitap ihtiyacı bulunmaktadır. Bu saptamadan hareketle “İş Sağlığı ve Güvenliği Meslek Hastalıkları” kitabı iki yılı aşkın bir sürede tamamlanmıştır. Mezuniyet öncesi ve sonrası eğitimlere, sertifika eğitimlerine, çalışanların sağlıklı ve güvenlikli ortamda çalışmaları hakkına, saha uygulamalarına, araştırmalara katkı sağlaması amaçlanmıştır. Kaynak kitap ihtiyacı öncelikle, müfredatlarında konuya ilişkin başlıklar bulunan, Tıp, Mühendislik, Hemşirelik, Sağlık Bilimleri ve Fen fakülteleri, ilgili yüksek lisans ve doktora programları, ilgili yüksek okullar olmak üzere yüksek öğretim öğrencileri için geçerli iken aynı zamanda iş yeri hekimleri, iş güvenliği uzmanları, diğer sağlık personeli sertifika eğitimleri, çalışanların yasal olarak zorunlu olan eğitimleri için de söz konusudur.Kitabın, Hacettepe Üniversitesi Tıp Fakültesi Halk Sağlığı Anabilim Dalı öğretim üyesi Prof. Dr. İsmail TOPUZOĞLU’nun 1980’li yıllarda başlattığı, Prof. Dr. Nazmi BİLİR’in emekli olana kadar 30 yılı aşkın süre ile sürdürdüğü mezuniyet öncesi ve sonrası eğitim, araştırma, uygulama ve yayın çalışmaları ile bu alanlarda öncü rolü olan Hacettepe Üniversitesi’nin yayını olması ayrı bir mutluluk kaynağıdır, kendilerine şükranlarımızı sunarız.Kitap, sayfa dağılımları farklılık gösteren, konu başlıkları itibariyle toplam 79 bölümden oluşmaktadır. Meslek hastalıklarına ilişkin bazı bölümlerde, yazarlar ikinci baskısı yapılmış olan “Yıldız, A.N., Sandal, A. (Ed.). Meslek Hastalıkları İşle İlgili Hastalıklar (Seçilmiş Başlıklarda). Ankara: Hacettepe Üniversitesi Yayını. ISBN: 978-975-491-460-3.” kitabındaki bölümlerini güncelleyerek genişletmişlerdir.Kitabın yazarları başlıca, Hacettepe Üniversitesi öğretim elemanları, Tıp Fakültesi İş ve Meslek Hastalıkları Yan Dal Uzmanlık Eğitimi Programı eğitim kadrosu ile bu kapsamda eğitim almış veya almaya devam eden uzman hekimler, ile T.C. Aile, Çalışma ve Sosyal Hizmetler Bakanlığı yönetici ve uzmanlarıdır. Bütün yazarlara katkıları için teşekkür ederiz.Kitabın elektronik kitap olarak yayınlanması, ulaşılabilirliğinin artması, içerik arama ve güncelleme gibi hususlarda kolaylık sağlayacağı kanaatindeyiz. Ayrıca kaynakları metin içinde gösterilmiş olması da ileri incelemeler için katkı sağlayacaktır.Yoğun çalışma sürecinde gösterdikleri anlayış için ailelerimize, Hacettepe Üniversitesi Hastaneleri Basım Yayın ve Tanıtım Koordinatörlüğü ile Kütüphane ve Dokümantasyon Daire Başkanlığı yetkilileri ve çalışanlarına, kitabı yayına hazırlamada katkı sağlayan Dr. A. Kadir ATLI, Dr. Buhara ÖNAL ve Özge Rojda BENZİL’e teşekkür ederiz.Saygılarımızla,Prof. Dr. Bülent ALTUN (Hacettepe Üniversitesi Tıp Fakültesi Dekanı)Prof. Dr. Ali Naci YILDIZ (Editör)Uzm. Dr. Abdulsamet SANDAL (Editör