Pleural Effusion: A Rare Side Effect of Nilotinib—A Case Report

Pleural effusion, as a side effect of tyrosine kinases, may be seen as most commonly associated with dasatinib and very rarely seen with nilotinib. In this report we present a chronic phase of CML case that was treated with nilotinib due to imatinib (Gleevec) allergy and had pleural effusion with nilotinib at 5th year of treatment. If pleural effusion develops in patients taking nilotinib and if this effusion is exudative and lymphocyte predominant, after ruling out pulmonary and cardiac etiologies, it must be associated with nilotinib; according to stage of effusion drug should be discontinued and/or steroid should be started and/or surgery should be performed

HIV-ASSOCIATED NON HODGKIN LYMPHOMA: A CASE SERIES STUDY FROM TURKEY

Background: Human immunodeficiency virus (HIV) is a global health concern with major risks for opportunistic infections and predisposition to malignancies including Kaposi sarcoma associated with Human Herpes Virus-8 (HHV-8) and non-Hodgkin lymphoma (NHL) commonly associated with Epstein Barr Virus (EBV). Although the exact mechanisms of predisposition to certain malignancies are unclear, HIV (+) cancer patients typically have poorer prognosis. Materials and Methods: We included all five HIV positive NHL patients receiving antiretroviral therapy (ART) and chemotherapy in our clinic and aim to determine their follow-up outcomes associated with ART. Results: The use of ART in conjunction with chemotherapy regimens lead to better therapeutic outcome in our cases with no mortality over three years of follow-up despite high rates of poor prognostic factors and studies demonstrating 1-year survival rates of approximately 30% in HIV-associated lymphoma. No significant adverse effect has been recorded. Conclusion: We recommend use of ART along with chemotherapy regimens in HIV positive lymphoma patients for better treatment response

Glofitamab in relapsed/refractory diffuse large B cell lymphoma: Real world data

Abstract INTRODUCT ̇ION Glofitamab is a T-cell-engaging bispecific antibody connecting CD20 on B cells and CD3 on T cells. Although, most of the patients with B-cell non-Hodgkin lymphoma (BNHL) achieve complete response (CR) following firstline treatment with rituximab and chemotherapy, about 40% of patients with diffuse large B-cell lymphoma (DLBCL) is refractory or relapse (R/R). Autologous stem-cell transplantation (ASCT) can cure some of these patients but many patients cannot undergo this procedure. CAR-T therapies are a significant advance but not available in many countries like Turkey. In Phase II expansion study, the overall response rate (ORR) was 51.6% and complete remission (CR) rate was 39.4% in R/R DLBCL patients (Dickinson er al. JCO 2022). In this retrospective study, we aimed to report the outcomes of patients who used glofitamab via compessionate use in Turkey

Polatuzumab vedotin, rituximab, and bendamustine combination in relapsed or refractory diffuse large B-cell lymphoma: A real-world data from Turkey

Polatuzumab vedotin (Pola) with bendamustine and rituximab (BR) is a promising option for patients with relapsed/refractory (R/R) diffuse large B-cell lymphoma (DLBCL). We analyzed the data of 71 R/R DLBCL patients who had been treated with Pola-BR in the named patient program from March 2018 to April 2021 from 32 centers in Turkey. All patients received up to six cycles of Pola 1.8 mg/kg, rituximab 375 mg/m2 on day 1, and bendamustine 90 mg/m2 on days 1–2 of each cycle. Median age at Pola-BR initiation was 55 (19–84). The overall response rate was 47.9%, including 32.4% CR rate when a median of 3 cycles was applied. With a median follow-up of 5 months, the median OS was 5 months. Grade 3–4 neutropenia and thrombocytopenia were the most common hematological toxicities. The real-world data from our cohort showed the Pola-BR is an effective option with a manageable toxicity profile

Platelet Dysfunction in Patients with Chronic Myeloid Leukemia: Does Imatinib Mesylate Improve It?

Objective: The aim of this study was to investigate the effects of imatinib mesylate on platelet aggregation and adenosine triphosphate (ATP) release in chronic myeloid leukemia patients. Materials and Methods: Platelet aggregation and ATP release induced by 5.0 mM adenosine diphosphate, 0.5 mM arachidonic acid, 1.0 mg/ mL ristocetin, and 2 µg/mL collagen were studied by whole blood platelet lumi-aggregometer in 20 newly diagnosed chronic myeloid leukemia patients before and after imatinib mesylate treatment. Results: At the time of diagnosis, 17/20 patients had abnormal platelet aggregation results; 8 (40%) had hypoactivity, 6 (30%) had hyperactivity, and 3 (15%) had mixed hypo- and hyperactivity. Repeat platelet aggregation studies were performed after a mean of 19 months (min: 5 months-max: 35 months) in all patients who received imatinib mesylate during this period. After therapy, 18/20 (90%) patients had abnormal laboratory results; 12 (60%) had hypoactive platelets, 4 (20%) had mixed hypo- and hyperactive platelets, and 2 (10%) had hyperactive platelets. Three of the 8 patients with initial hypoactivity remained hypoactive, while 2 developed a mixed picture, 2 became hyperactive, and 1 normalized. Of the 6 patients with initial hyperactivity, 4 became hypoactive and 2 developed a mixed pattern. All of the 3 patients with initial hypo- and hyperactivity became hypoactive. Finally, 2 of the 3 patients with initial normal platelets became hypoactive while 1 remained normal. There was a significant decrease in ristocetin-induced platelet aggregation after therapy (p<0.001), while platelet aggregation and secretion induced by other agonists showed no difference after treatment (p>0.05). Conclusion: These findings indicate that a significant proportion of chronic myeloid leukemia patients have different patterns of platelet function abnormalities and imatinib mesylate has no effect on these abnormalities, with a significant impairment in ristocetin-induced platelet aggregation

Evaluation of Febrile Neutropenia in Hematologic Malignancy Patients

Introduction: Febrile neutropenia, developing in hematological cancer patients, is a common complication requiring hospitalization and resulting in death. It is assumed that it is caused by infection until its reason is clarified. Hence, it requires a multidisciplinary approach and treatment as a medical emergency. For these patient groups, most of whom are at high risk, death caused by infection is attempted to be minimized by continuously updating treatment approaches. This study aimed to determine clinical characteristics, risk factors, distribution and frequency variance of isolated pathogens and impact in mortality of hematological cancer patients with febrile neutropenia prospectively. Materials and Methods: In this study, 161 febrile neutropenia episodes of 99 patients with hematological cancer monitored between January 2012 and January 2013 in the Department of Hematology in the Hospital of our Medical Faculty were evaluated. Age, gender, underlying disease, chemotherapy regimens, hematologic and radiologic findings, antibacterial and fungal therapeutic regimens were recorded. Routine microbiological blood and urine cultures were performed. When necessitated, cultures from other sterile body sites were taken. Results: Mean age of the patients in the study group was 50.7 ± 15.9. Mean duration of hospitalization was 29.7 ± 14.9 days. Meanduration of neutropenia was 14.6 ± 5.7 days. In 21% of the evaluated episodes, microbiologically defined infection was found, where clinically defined infection was determined in 40% and fever of unknown origin was determined in 39%. A total of 47 isolates were isolated in total. When distribution of all isolated microorganisms, in all cultures was evaluated, 40% were grampositives, 47% were gram-negatives and 13% were fungi. The most frequently observed microorganisms were coagulase negative staphylococci with 31% and Escherichia coli with 22%. In blood cultures, 58% were gram-positives, 32% were gramnegatives and 10% were fungi. The most frequent febrile neutropenia treatment used in our center was carbapenem monotherapy. Mortality rate was 25.4%. Neutropenia duration and stage were the most important factors increasing mortality risk. Conclusion: Febrile neutropenia is a complication which may result in mortality in patients with hematological cancer. In order to define treatment models, each center is supposed to determine its center’s microorganism spectrum and antibiotic resistance profiles periodically

Clinical Significance of Reticulocyte Hemoglobin Content in the Diagnosis of Iron Deficiency Anemia

OBJECTIVE: The aim of this study was to evaluate the clinical significance of reticulocyte hemoglobin content (CHr) in the diagnosis of iron deficiency anemia (IDA) and to compare it with other conventional iron parameters. METHODS: A total of 32 female patients with IDA (serum hemoglobin 120 g/L and serum ferritin <20 ng/mL) were enrolled. RESULTS: CHr was 24.95±3.92 pg in female patients with IDA and 29.93±2.96 pg in female patients with iron deficiency. CHr showed a significant positive correlation with hemoglobin, mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, serum iron, and transferrin saturation and a significant negative correlation with transferrin and total iron-binding capacity. The cut-off value of CHr for detecting IDA was 29 pg. CONCLUSION: Our data demonstrate that CHr is a useful parameter that can be confidently used in the diagnosis of IDA, and a CHr cut-off value of 29 pg predicts IDA