CD11b Expression in Acute Myeloid Leukemia is Associated With Hemostatic Complications and Response to Treatment

Aim:In our study, we aimed to investigate the effects of CD11b expression on myeloblasts on clinical course and prognosis in patients with AML.Materials and Methods:Data of 123 patients diagnosed with AML between 2014-2017 in Trakya University Faculty of Medicine, Department of Hematology, a tertiary referral hospital in the Trakya Region, were evaluated in a retrospective manner. The diagnosis of AML was based on WHO 2016 criteria of Myeloid Neoplasms.Results:Of the 123 patients in our study, 60 were female, and 63 were male. The mean age was 57.93 years. CD11b positivity was observed in 40 patients. Platelet counts were significantly lower in patients with CD11b positivity (p = 0.004). Likewise, D-dimer levels at presentation were higher in the CD11b positive patient group (p = 0.000). Regarding outcomes, patients with CD11b positivity were found to have lower rates of remission with first-line remission induction therapy (p = 0.003). There was no significant relationship between CD11b positivity and overall survival with Kaplan Meier survival analysis (8.5 months in CD 11b positive group, 12.1 months in negative group, p: 0.436).Conclusion:Our study demonstrated that patients with CD11b expression had lower remission rates with remission induction chemotherapy

Could ratio of hemoglobin to red cell distribution width and ratio of absolute lymphocyte count to absolute monocyte count be a prognostic tool in newly diagnosed multiple myeloma patients?

IntroductionHemoglobin/red cell distribution width (RDW) ratio (HRR) and lymphocyte-to-monocyte ratio (LMR) are two novel bio-markers associated with overall survival (OS) and prognosis in several types of cancers. The aim of this study is to investigate the value of HRR and LMR in newly diagnosed multiple myeloma (MM) patients. MethodsA total of 180 patients were included in this study. Patients diagnosed with MM between May 2013 and May 2019 at a single center were evaluated. HRR was calculated by dividing hemoglobin to RDW, both measured from the same sample. LMR was calculated by dividing absolute lymphocyte count (ALC) to absolute monocyte count (AMC). ResultsThe cutoff value for HRR was taken as 0.61, and the cutoff value for LMR was taken as 3.28. Patients were divided into low HRR, high HRR, low LMR, and high LMR groups. OS of the patients with low HRR was found lower compared with high HRR (36.7 months for low HRR and 53.2 months for high HRR, < 0.001). Also, OS was found lower in the low LMR group (39.4 months for low LMR and 51.7 months for high LMR, = 0.016). On multivariate analysis, low HRR and low LMR were predictive factors of OS (hazard ratio (HR) 2.08, 95% confidence intervals (CI) 1.31–3.03, and = 0.002 for low HRR; HR 1.47, 95% CI 0.92–2.29, and = 0.010 for low LMR). ConclusionCombining both HRR and LMR could be a prognostic biomarker and it reflects the status of the immune system in newly diagnosed MM patients

Acute renal failure in a patient with severe hemolysis

Paroxysmal nocturnal hemoglobinuria (PNH) is a clonal disorder of bone marrow. It is characterized by blood cells lacking membrane proteins that are normally attached by the glycosylphosphatidylinositol (GPI) anchor. The cellular defect arises in a hematopoetic stem cell and is due to somatic mutation of the Phosphatidylinositolglycan protein-A gene (PIG-A gene), encoding a protein needed for the biosynthesis of the anchor GPI. Paroxysmal nocturnal hemoglobinuria is presented by intravascular hemolysis, cytopenias, frequent infections, bone marrow hypoplasia, and a high incidence of life threatening venous thrombosis. Kidney involvement is usually benign and secondary to chronic tubular deposition of hemosiderin. Acute renal failure may occur in association with a hemolytic crisis. Here we report a case of 40-year-old woman with hematuria, pancytopenia, and acute renal failure due to PNH

Value of Extracellular High Mobility Group Box 1 (HMGB1) in the Clinical Context of Immune Thrombocytopenia

Introduction: High mobility group box 1 protein (HMGB1) is a non-histone chromosomal protein with dual activity. First within the nucleus, binds to DNA and acts as a regulator and second, outside the cell, interacts with receptors for inflammation as a signal molecule. We aimed to investigate and contribute to the value of extracellular HMGB1 in clinical context of ITP and to flourish future clinical directions to this biomarker. Methods: 50 newly diagnosed and treatment naive patients with ITP and 30 healthy controls were enrolled in our study. Results: Age or gender were not related with HMGB1 levels in patients and controls. Platelet levels were significantly related with HMGB1. Especially in patients with platelet counts below 30.000/mm3 highest levels of HMGB1 were observed. Regarding clinical presentation, bleeding was related with low platelet counts and high HMGB1 levels. Response to corticosteroids was observed to be better in patients with high HMGB1 levels. Conclusion: As a sample of autoinflammatory disorders, we observed a relation with extracellular HMGB1 levels and platelet levels in ITP patients. Corticosteroid response and HMGB1 relation supports the assumption of the value of HMGB1 as a potential surrogate of inflammation. This view should be evaluated with larger scale studies

Patient characteristics and management practices in chronic myeloid leukemia in Turkey: reflections from an expert meeting

Introduction The therapeutic landscape of chronic myeloid leukemia (CML) has evolved significantly since the introduction of imatinib. The European LeukemiaNet (ELN) recommendations serve as a guide for diagnosis, treatment, and monitorization of CML, but availability and accessibility of diagnostic tools and medications affect their applicability. Areas covered This article provides an overview of the current clinical management of CML in Turkey with reference to the key outputs of the online expert meeting held in November 2020. The applicability of the ELN 2020 recommendations for treating CML in clinical practice was also discussed. Expert opinion Imatinib is the only reimbursed and the most preferred first-line treatment in CML restricting the upfront use of second-generation tyrosine kinase inhibitors (TKIs), thereby limiting the applicability of treatment-free remission approach in Turkey. The ELN recommendations about using the EUTOS Long-Term Survival (ELTS) score for risk assessment and focusing on patient reported outcomes and quality of life can be enhanced with educational activities. The widespread availability of standardized technical infrastructure for diagnosing and monitoring CML will contribute to better disease management. Establishing a sustainable national database for CML is valuable for observing patient characteristics and disease outcomes as well as the impact of treatment patterns over time.Novartis Pharmaceuticals CorporationThe study was funded by Novartis Pharmaceuticals Corporation

Pros and cons for fluorescent in situ hybridization, karyotyping and next generation sequencing for diagnosis and follow-up of multiple myeloma

Multiple myeloma (MM) is one of the plasma cell-related hematological malignancies exceeding 10.0% of all marrow cells, and they make a paraprotein that is a marker of the disease. Myeloma is one of the most common types of hematological malignancies in humans. Genetic bio-markers have been used for prognostic markers in patients diagnosed with MM. The genetic and genomic changes have been identified using karyotyping, fluorescent in situ hybridization (FISH), next generation sequencing (NGS), specifically whole-genome sequencing or exome sequencing. Circulatory plasma cells, circulating free DNA (cfD-NA) and microRNAs (miRNAs) comprised in liquid biopsy are potentially used in diagnosis/prognosis of MM. In this study, we analyzed and compared results of karyo-typing, FISH and NGS in 35 MM cases. Diagnostic strategies are expanding rapidly and newly developed NGS-based testing may help the understanding of the complexities of genetic alterations in karyotypically normal cases

Cox-2 gene polymorphisms in Turkish patients with myelodysplastic syndrome

Cyclooxygenase-2 gene polymorphisms have been studied and known its role one on cancerogenesis even though there has not yet been any studies myelodysplastic syndrome. We aimed to provide the first data on COX-2 gene polymorphisms in myelodysplastic syndrome. A total of 39 patients with MDS and 50 healthy controls were recruited from undertaken hematology departmentand compared in terms of COX-2-765 G -> C and COX-2-1195 A. G genes. Statistically significant difference was observed between patients with MDS and controls in terms of COX-2-765 G -> C genotype and distribution of alleles and COX-2-765 GG genotype was more frequently found in the MDS group (P<0.001). Moreover, COX-2-765 C+(CC+CG) genotype was found to provide 5.6 times more protection against MDS. In conclusion, our results indicate that polymorphisms of the C allele of the COX-2 gene may provide protection against MDS; however, its predictive value and potential as a marker in oncology remain to be investigated in further trials

Relationship Between Left Ventricule Hypertrophy and inflammation and Albuminuria in Patients with Type 2 Diabetes Mellitus

The strong association between diabetes mellitus and the cardiac left ventricular hypertrophy can be partially explanatory for the cardiovascular complications and end organ damage in diabetes, In our study we planned to compare the levels of inflammatory markers and albuminuria, the index for renal failure, between type 2 diabetic patients with and without LVH, with the purpose to find out if the following up of the inflammatory markers in Type 2 diabetic patients can be important for the prevention of the development of cardiac and renal complications

Patient characteristics and management practices in chronic myeloid leukemia in Turkey: reflections from an expert meeting

Introduction The therapeutic landscape of chronic myeloid leukemia (CML) has evolved significantly since the introduction of imatinib. The European LeukemiaNet (ELN) recommendations serve as a guide for diagnosis, treatment, and monitorization of CML, but availability and accessibility of diagnostic tools and medications affect their applicability. Areas covered This article provides an overview of the current clinical management of CML in Turkey with reference to the key outputs of the online expert meeting held in November 2020. The applicability of the ELN 2020 recommendations for treating CML in clinical practice was also discussed. Expert opinion Imatinib is the only reimbursed and the most preferred first-line treatment in CML restricting the upfront use of second-generation tyrosine kinase inhibitors (TKIs), thereby limiting the applicability of treatment-free remission approach in Turkey. The ELN recommendations about using the EUTOS Long-Term Survival (ELTS) score for risk assessment and focusing on patient reported outcomes and quality of life can be enhanced with educational activities. The widespread availability of standardized technical infrastructure for diagnosing and monitoring CML will contribute to better disease management. Establishing a sustainable national database for CML is valuable for observing patient characteristics and disease outcomes as well as the impact of treatment patterns over time