Evaluation of Thromboembolism Risk in Patients with Cancer; Single Center Real-life Data

Introduction:Venous thromboembolism (VTE) is an important cause of mortality and morbidity in cancer patients. Both cancer itself and its treatment have been reported to result in an increased risk of VTE. Several scoring systems have been developed to predict cancer-associated VTE risk. The aim of this study was to prospectively test the validity of the Khorana thrombosis score in predicting the risk of VTE development in cancer outpatients at a single centre.Methods:One hundred and fifty-two consecutive patients diagnosed with cancer and scheduled to receive outpatient chemotherapy at University of Health Sciences Turkey, İstanbul Training and Research Hospital between August 2012 and August 2013 were included in the study. Khorana risk scores were calculated for each patient at study entry. Patients were then followed up for at least 24 months after diagnosis or until VTE developed.Results:Thrombosis was detected in 13 of the 152 patients following cancer diagnosis. The median time from diagnosis to thrombosis was 4 months (1-48 months). Thrombosis was of venous and arterial origin in 7 and 6 patients, respectively. The Khorana score failed to differentiate high-risk patients. Scores in patients with and without venous thrombosis were not statistically different (p=0.38).Conclusion:It is important to identify cancer patients at high risk for VTE to decrease the thrombosis-associated dismal outcome. However, in an outpatient setting, the Khorana score failed to differentiate the target population. This could be partly explained by the heterogeneity and the relatively small number of patients included

Osteoporosis in patients with hemophilia: Single-center results from a middle-income country

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

Novelties in the management of B-cell malignancies: B-cell receptor signaling inhibitors and lenalidomide

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 immunomudulatory 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