Kronik Lenfositik Lösemili Hastaların Prognostik Özellikleri ve Tedaviye Yanıtlarının Retrospektif Olarak Değerlendirilmesi

Chronic lymphocytic leukemia (CLL) is a disease with a wide range of clinic spectrum and outcome, and it is seen frequently in elderly population. It is important to determine the prognostic factors that affect the survival, and based on these prognostic factors we can detect high-risk patients. In recent years new treatment modalities improve the survival in patients with CLL. But there are few studies about prognosis and treatment of CLL in our country. In our study, we aimed to determine the prognostic factors and their effect on survival; to investigate the response of different treatment modalities and their impact on survival in CLL. Between January 2000 and June 2013, we analyzed the 245 patients diagnosed as CLL according to criteria of International Workshop on CLL (IWCLL). Clinical characteristics of patients, the pattern of bone marrow involvement, serum lactat dehydrogenase-LDH and ß2microglobulin levels, the findings of flow cytometry and flourescence in situ hybridization (FISH) (del17p, del11q), different treatment regimens, the response to treatment regimens acoording to IWCLL 2008 criteria, treatment-related and disease-related complications were analyzed. Based on prognostic factors we performed treatment free survival (TFS) and overall survival (OS) analysis. In addition to these we also analyzed response rates to treatment protocol, time to next treatment (TTNT1 and TTNT2) and OS after the treatment. We evaluated 245 patients whose median age was 62, male/female ratio was 1,6. The percentage of Rai stage III/IV was 21,7%. As a result; the presence of B symptoms, Rai stage II and more, Binet stage B and C disease, diffuse infiltration of bone marrow by lymphocytes, number of lymphadenopathy region 3 and more, eleveted LDH and ß2microglobulin level and CD (cluster of differantiation) 38 level above the 20%; reduce both TFS and OS (p0,05). FCR rejimine cevap alınan hastaların hiçbirinin ikinci bir tedaviye ihtiyaç duymadığı görüldü, FCR ile TTNT1=88,13 ay (OS ile eşit) olarak saptanırken; fludarabin-siklofosfamid (FC) ile TTNT1= 45,7 ay; fludarabin monoterapi ile TTNT1=37,7 ay; Klorambusil ile TTNT1=35ay olarak saptandı. TTNT1 açısından tedaviler arasında istatistiksel olarak anlamlı fark oluşurken p=0,011), OS açısından istatistiksel olarak anlamlı fark gözlenmedi (p=0,096). Hastalarda gelişen 3-4.derece nötropeni en sık FCR alan hastalarda %71,4 oranında görülürken, major enfeksiyonlar (pnömoni, sepsis, hospitalizasyon gerektiren nötropenik ateş) en sık (%42,8) siklofosfamid-vinkristin-(adriamisin)-prednisolon (COP-CHOP) alan hastalarda görüldü. Relaps-refrakter hastalarda verilen ikinci basamak tedavilerde kullanılan rejimlerin fazla olması ancak hasta sayısının az olması nedeniyle tedavi protokollerine göre yanıt oranları, OS ve TTNT2?de istatistiksel olarak anlamlı fark saptanmadı. KLL?de tanı anında ve tedaviyi planlama aşamasında kötü prognostik özelliklerin belirlenerek yüksek riskli hastaların saptanması önemlidir. FCR rejiminin performans durumu iyi olan uygun hastalarda ve antimikrobiyal profilaksi ile ilk basamakta uygulanması yanıt oranları artırmakta ve daha uzun tedavisiz sağkalım elde edilmektedir

Splenic Marginal Zone Lymphoma in Turkey: Association with Hepatitis B Instead of Hepatitis C Virus as an Etiologic and Possible Prognostic Factor - A Multicenter Cohort Study

Objective: Chronic antigenic stimulation is frequently blamed in the pathogenesis of extranodal marginal zone lymphomas including splenic marginal zone lymphoma (SMZL). Chronic hepatitis C is frequently observed in SMZL patients in some geographical regions. However, these reports are largely from North America and Europe, and data from other countries are insufficient. In this multicenter study we aimed to identify the clinical characteristics of SMZL patients in Turkey, including viral hepatitis status and treatment details

A Multi-Center Study on the Efficacy of Eltrombopag in Management of Refractory Chronic Immune Thrombocytopenia

Objective: The aim of the present study was to evaluate the efficacy and safety of eltrombopag, an oral thrombopoietin receptor agonist, in patients with chronic immune thrombocytopenia (ITP). Materials and Methods: A total of 285 chronic ITP patients (187 women, 65.6%; 98 men, 34.4%) followed in 55 centers were enrolled in this retrospective cohort. Response to treatment was assessed according to platelet count (/mm3) and defined as complete (platelet count of >100,000/mm3), partial (30,000-100,000/mm3 or doubling of platelet count after treatment), or unresponsive (<30,000/mm3). Clinical findings, descriptive features, response to treatment, and side effects were recorded. Correlations between descriptive, clinical, and hematological parameters were analyzed. Results: The median age at diagnosis was 43.9±20.6 (range: 3-95) years and the duration of follow-up was 18.0±6.4 (range: 6-28.2) months. Overall response rate was 86.7% (n=247). Complete and partial responses were observed in 182 (63.8%) and 65 (22.8%) patients, respectively. Thirty-eight patients (13.4%) did not respond to eltrombopag treatment. For patients above 60 years old (n=68), overall response rate was 89.7% (n=61), and for those above 80 years old (n=12), overall response rate was 83% (n=10). Considering thrombocyte count before treatment, eltrombopag significantly increased platelet count at the 1st, 2nd, 3rd, 4th, and 8th weeks of treatment. As the time required for partial or complete response increased, response to treatment was significantly reduced. The time to reach the maximum platelet levels after treatment was quite variable (1-202 weeks). Notably, the higher the maximum platelet count after eltrombopag treatment, the more likely that side effects would occur. The most common side effects were headache (21.6%), weakness (13.7%), hepatotoxicity (11.8%), and thrombosis (5.9%). Conclusion: Results of the current study imply that eltrombopag is an effective therapeutic option even in elderly patients with chronic ITP. However, patients must be closely monitored for response and side effects during treatment. Since both response and side effects may be variable throughout the follow-up period, patients should be evaluated dynamically, especially in terms of thrombotic risk factors.PubMedWoSScopu

A Multi-Center Study on the Efficacy of Eltrombopag in Management of Refractory Chronic Immune Thrombocytopenia: A Real-Life Experience

Objective: The aim of the present study was to evaluate the efficacy and safety of eltrombopag, an oral thrombopoietin receptor agonist, in patients with chronic immune thrombocytopenia (ITP)

A Multi-Center Study on the Efficacy of Eltrombopag in Management of Refractory Chronic Immune Thrombocytopenia: A Real-Life Experience

Objective: The aim of the present study was to evaluate the efficacy and safety of eltrombopag, an oral thrombopoietin receptor agonist, in patients with chronic immune thrombocytopenia (ITP). Materials and Methods: A total of 285 chronic ITP patients (187 women, 65.6 \%; 98 men, 34.4\%) followed in 55 centers were enrolled in this retrospective cohort. Response to treatment was assessed according to platelet count (/mm(3)) and defined as complete (platelet count of >100,000/mm(3)), partial (30,000-100,000/mm(3) or doubling of platelet count after treatment), or unresponsive (<30,000/mm(3)). Clinical findings, descriptive features, response to treatment, and side effects were recorded. Correlations between descriptive, clinical, and hematological parameters were analyzed. Results: The median age at diagnosis was 43.9 +/- 20.6 (range: 3-95) years and the duration of follow-up was 18.0 +/- 6.4 (range: 6-28.2) months. Overall response rate was 86.7\% (n=247). Complete and partial responses were observed in 182 (63.8\%) and 65 (22.8\%) patients, respectively. Thirty-eight patients (13.4\%) did not respond to eltrombopag treatment. For patients above 60 years old (n=68), overall response rate was 89.7\% (n=61), and for those above 80 years old (n=12), overall response rate was 83\% (n=10). Considering thrombocyte count before treatment, eltrombopag significantly increased platelet count at the 1st, 2nd, 3rd, 4th, and 8th weeks of treatment. As the time required for partial or complete response increased, response to treatment was significantly reduced. The time to reach the maximum platelet levels after treatment was quite variable (1-202 weeks). Notably, the higher the maximum platelet count after eltrombopag treatment, the more likely that side effects would occur. The most common side effects were headache (21.6\%), weakness (13.7\%), hepatotoxicity (11.8\%), and thrombosis (5.9\%). Conclusion: Results of the current study imply that eltrombopag is an effective therapeutic option even in elderly patients with chronic ITP. However, patients must be closely monitored for response and side effects during treatment. Since both response and side effects may be variable throughout the follow-up period, patients should be evaluated dynamically, especially in terms of thrombotic risk factors