Idiopathic Thrombocytopenic Purpura and Cardiovascular Disease: Is Elevated Triglycerides to High-density Lipoprotein Cholesterol Ratio a Marker?

Introduction:Triglycerides to high-density lipoprotein cholesterol (TG/HDL-C) ratio is used as a cardiovascular risk marker. We aimed to investigate the relationship between TG/HDL ratio and eltrombopag use, current platelet values and whether or not splenectomy was performed in patients with chronic idiopathic thrombocytopenic purpura (ITP), and to emphasize its prognostic importance in terms of cardiovascular markers.Methods:One hundred and thirty-nine chronic ITP patients followed in the hematology outpatient clinic were evaluated retrospectively. We investigated the negative effect of splenectomy, eltrombopag use and current platelet values on cardiovascular diseases. Patients were stratified into two groups according to their baseline TG/HDL-C ratio, using a TG/HDL-C ratio cut-off value of 2.5.Results:A total number of 139 chronic ITP patients aged between 18-76 years, followed-up in the hematology outpatient clinic, were included in the study; and 102 of the patients were female (75%). The mean platelet value was 2913.24±103353.64/mm3, and the mean TG/HDL-C ratio was 2.91±2.09. There were 46 (33.8%) patients who had splenectomy. When patients were evaluated in terms of treatment modalities; 127 patients (93.4%), 60 patients (44.1%), and 19 (13.9%) patients were using methyl prednisolone, intravenous immunoglobulin, and eltrombopag, respectively. It was observed that the parameters were similar in patients using and not using eltrombopag (p>0.05). There was a weak and statistically significant correlation between TG/HDL-C values and age (r=0.275; p=0.001). There was a significant correlation between the presence of DM and hyperlipidemia and the TG/HDL-C ratio (p<0.05). In risk assessment, the TG/HDL-C ratio of individuals without coronary artery disease was 2.29 (1.47 3.38) and it was found to be statistically significantly low (p=0.025).Conclusion:TG/HDL-C ratio can be used as an independent risk marker that can be diagnostic in predicting cardiovascular disease risk in ITP patients with advanced age and additional comorbid diseases (DM and hyperlipidemia)

Erythrocyte Sedimentation Rate May Predict Diagnosis of Lymphoma Without Fine-needle Aspiration Biopsy: A Retrospective Study

Objective:To assess the relationship between routine blood values recorded before fine-needle aspiration biopsy (FNAB) and final diagnosis in patients whose diagnoses could not be confirmed with FNAB, necessitating surgical excisional biopsy (SEB) as a second invasive procedure.Method:The data of patients who could not be diagnosed via FNAB and who underwent SEB of the cervical lymph node between March 2014 and March 2019 in the otolaryngology department of a research hospital were evaluated retrospectively. According to the definitive diagnosis determined by SEB, the cases were divided into 3 groups as follows: 1) benign, 2) other malignancies, 3) lymphoma.Results:The frequency of males in the other malignancies group was significantly higher compared to the other two groups (p=0.007). Compared to the other two groups, C-reactive protein levels were statistically significantly lower in the benign group (p=0.001). Erythrocyte sedimentation rate (ESR) in the lymphoma group was significantly higher than in the other groups (p35.5 mm/hr (area under the curve= 0.784, 95% confidence interval: 0.708-0.861, p<0.001).Conclusion:Although ESR is non-specific for the diagnosis of lymphoma in asymptomatic patients, it may be a supportive marker to reduce repetitive invasive procedures in symptomatic patients who may require cervical lymph node biopsy for diagnosis

An Unexpected Innocent Complication Associated with Azacitidine Treatment of Myelodysplastic Syndrome: Erythema Annulare Centrifugum

Skin lesions accompanying hematological malignancies can be formed due to either direct tumor infiltration of the skin or indirect effects. Indirectly developing lesions may be a component of paraneoplastic syndrome. Erythema annulare centrifugum (EAC) is considered to be a hypersensitivity reaction developed against various antigens associated with infections, drugs, and endocrine diseases. EAC, rarely seen in neoplastic diseases, has been reported in lymphoma, leukemia, histiocytosis, and prostate cancer. Here we report EAC in a patient using a hypomethylating agent, azacitidine. A 69-year-old female patient was admitted to our polyclinic with weakness and ecchymosis in her legs existing for 3 months. She was considered as having refractory anemia with excess blasts-2 according to myelodysplastic syndrome (MDS) classification [1]. Because there was only hyperdiploidy in conventional cytogenetic examination, she was classified in group intermediate-2 of the International Prognostic Scoring System. She had a history of radical mastectomy and adjuvant chemoradiotherapy for breast cancer 3 years ago. She said that variously sized round and oval erythematous, itching, painless lesions had formed in the abdominal region on the 4th day of azacitidine usage (75 mg/m2/day, 7 days, s.c.) (Figure 1 and 2). There were no concomitant complaints or physical examination findings except fatigue. After azacitidine was stopped, a skin biopsy was taken. In the biopsy, mild perivascular inflammatory infiltration accompanying vascular ectasia in the papillary dermis was detected. The possibility of paraneoplastic syndrome was excluded due to the disappearance of all lesions by 1 week after cessation of treatment. During the second course of azacitidine, the lesions reoccurred on the second day. Subsequently to the second course, the patient died of sepsis, which developed after pneumonia

Circulating Endothelial Progenitor Cells and Their Relation to Thrombosis in Paroxysmal Nocturnal Hemoglobinuria and Aplastic Anemia

Thrombosis is a leading cause of morbidity and mortality in paroxysmal nocturnal hemoglobinuria (PNH). Multiple factors are responsible for the thrombotic tendency in these patients. Endothelial progenitorcells (EPCs) originate from primitive hematopoietic stem cells. The EPC count is considered indicative of potential damage and restoration capacity in vascular disease; lower EPC counts are deemed as a risk factor in cardiovascular diseases. We aimed to investigate the count of circulating EPCs in PNH and aplastic anemia (AA) patients receiving eculizumab treatment or not receiving treatment and their relationship with thrombosis. Seventeen PNH patients, 18 AA patients, and 10 healthy volunteers were included in the study. The CD309, CD133, and CD34 antibodies were used to determine counts of circulating EPCs using flowcytometry. EPC levels were compared between the PNH, AA, and healthy control groups. Kolmogorov-Smirnov test. ANOVA, Kruskal-Wallis, and Mann-Whitney U testswereperformedto analyze the quantitative data, while chi 2 testing was performed to analyze the qualitative data. Therewasnosignificantdifference in EPC levelsbetweenpatientswithandwithout a history of thrombosis (P > 0.05). Further, therewasnosignificantdifference in thelevels of EPCsbetweenthe AA and PNH groups (P > 0.05). However, there was a significant positive correlation between levels of EPCs and lactate dehydrogenase (LDH) in multivariate analysis (P < 0.05). The study findings suggest that hemolysis promotes vascular endothelial and new blood vessel formation. Increased EPCs in PNH may indirectly indicatevascular endothelial damage in PNH

The Correlation Between Systemic Inflammatory Response And Survival in Patients with Metachronous and Synchronous Liver Metastatic Colorectal Cancer

AbstractObjectives: Recent data suggest that a low lymphocyte count in a colorectal tumor is associated with poor prognosis.The NLR has been shown to be an effective prognostic factor for survival in colorectal and ovarian cancer. It has beensuggested that the preoperative NLR may be a simple method to identify patients with a poor prognosis of colorectalcancer. The aim of this study was to evaluate the effect of the NLR on survival in patients with colorectal cancer whounderwent liver metastasectomy.Methods: The study included 76 patients who were admitted to the Medical Oncology Outpatient Clinic of Kartal Dr.Lutfi Kırdar Training and Research Hospital, who underwent liver metastasectomy and were followed up for colorectalcancer and whose clinical data and pre-metastasectomy laboratory values could be retrieved. The SPSS 17.0 softwarepackage was used in the analysis of the study. The mean, standard deviation, minimum-maximum, median, rate andfrequency values were used for the descriptive statistics of the data. The distribution of the variables was assessed bythe Kolmogorov Smirnov test. The independent samples t-test and Mann-Whitney U test were used for the analysis ofquantitative data. The chi-square test was used for analysis of qualitative data. The Cox regression and Kaplan-Meiersurvival analysis were used for survival analyses. Spearman’s correlation analysis was used for correlation analyses.Results: Age had a significant effect on survival time in the univariate model (p&lt;0.05). Sex, colonic localization, lymphnode involvement, histological grade, metastatic status, surgical margin, diameter of metastases, number of metasta-ses, leukocytes, neutrophils, lymphocytes, NLR, CRP, albumin and CEA parameters had no significant effect on survivalin the univariate model (p&gt;0.05).Conclusion: In our study, when a survival analysis was carried out on all variables, the only variable affecting survivalwas age. The mean age of the metasynchronous group was 56.2±10.6 years, and the mean age of the synchronousgroup was 61.3±11.1 years. Despite the numerical difference, there was no statistical significance (p=0.055). Althoughthe mean age of the synchronous group was numerically higher, the survival was longer. This may be due to the shortfollow-up time and the small sample size.Keywords: Colorectal cancer, liver metastatis, metasynchronous, neutrophil-lymphocyte ratioCite This Article: Posteki EA, Turan Erkek E, Posteki G, Erkek A, Aliustaoglu M. The Correlation Between Systemic InflammatoryResponse And Survival in Patients with Metachronous and Synchronous Liver Metastatic Colorectal Cancer. EJMI 2020;4(1):17–23.&nbsp;</div

Comparison of Splenectomy and Eltrombopag Treatment in the Second-Line Treatment of Immune Thrombocytopenic Purpura

Objective: Primary immune thrombocytopenia (ITP) is an acquired autoimmune disease characterized by isolated thrombocytopenia. While first-line treatments focus on inhibiting autoantibodies and platelet destruction, second- and third-line treatments include splenectomy and thrombopoietin receptor agonists. In this study, we aimed to compare the efficiency and toxicities of splenectomy and eltrombopag as second-line treatments in ITP. Materials and Methods: We retrospectively analyzed patients who were diagnosed with ITP and followed between 2015 and 2020. Patients who underwent splenectomy or received eltrombopag treatment as second-line or further therapy were included. For subgroup analyses, patients were further stratified according to whether they received eltrombopag in the second or third line of treatment. Results: There were 38 patients in the splenectomy group and 47 patients in the eltrombopag group. The mean age of patients in the splenectomy and eltrombopag groups was 43.2 and 50.5 years, respectively. Time to response was significantly shorter in the splenectomy arm (p=0.001). However, response rates at the 3 rd, 6 th, 12 th, and 24 th months did not exhibit a statistically significant difference between groups; nor did total duration of response and adverse events. Response rates at the 1st, 3rd, 6th, 12th, and 24th months and the total duration of response did not exhibit a statistically significant difference between eltrombopag subgroups. Eltrombopag treatment was ceased for 20 patients after a median of 54.1 months (range: 1-151). Among them, 12 patients (60%) did not experience a loss of response. Conclusion: Comparing the splenectomy and eltrombopag arms, even though time to achieve response was in favor of the splenectomy group, this advantage disappeared when overall response rates and response rate at the 2 nd year were considered. Using eltrombopag in the second or third line of therapy does not yield any difference in terms of time to achieving response

Eltrombopag in the Treatment of Immune Thrombocytopenia: Two-Center Experience from Istanbul

Immune Thrombocytopenia (ITP) is a disease caused by autoantibodies forming against platelets and T cell dysregulation and is characterized by platelet count falling below 100 x 10(9)/L. Corticosteroids remain as the first-line of treatment, but in the light of recent developments, thrombopoietin receptor agonists are gradually replacing splenectomy in steroid-dependent or refractory patients. In this study, it was aimed to retrospectively evaluate the efficacy, safety and side-effect profile of eltrombopag treatment for chronic ITP. A total of 23 chronic ITP patients treated with eltrombopag from two health institutions in Istanbul were evaluated retrospectively. Overall response rate (partial or complete) was 87%, complete response rate was 78.3%, and the median time from treatment until reaching platelet counts above 50 x 10(9)/L was 14 days (min-max: 4-126). Treatment was discontinued in four patients due to persistent response, two of these were still fully responsive. During treatment, one patient developed basal cell carcinoma, and another developed chronic myelomonocytic leukemia. Although its long-term side effects are not yet known, eltrombopag is a very effective treatment option in ITP and may provide favorable outcomes in patients