Gilteritinib (XOSPATA (R)) in Turkey: Early access program results

Background And Objectives: Gilteritinib (XOSPATA (R), Astellas) is a type I oral FLT3 inhibitor, a tyrosine kinase AXL inhibitor, involved in both c-Kit and FMS-like tyrosine kinase 3 (FLT3) resistance. In the phase 3 ADMIRAL trial, gilteritinib was compared with the standard of care in (R/R) acute myeloid leukemia (AML) patients who harbored any FLT3 mutation and showed superior efficacy with regard to response and survival. Objectives: This research aimed to investigate the real-life efficacy and safety of gilteritinib in FLT3-positive R/R AML patients who were treated as a part of an early access program held in Turkey in April 2020 (NCT03409081). Results: The research included 17 R/R AML patients who had received gilteritinib from seven centers. The overall response rate was 100%. The most common adverse events were anemia and hypokalemia (7 patients, 41.2%). Grade 4 thrombocytopenia was observed in one patient only (5.9%), leading to permanent treatment discontinuation. Patients with peripheral edema had a 10.47 (95% CI: 1.64-66.82) times higher risk of death than those without peripheral edema (p<0.05). Conclusion: This research showed that patients with febrile neutropenia and peripheral edema were at a high risk of death when compared to patients without febrile neutropenia and peripheral edema

“The Lolelaplap (Marshall Islands) in Us: Sailing West to East (Ralik→Ratak) to These Our Atolls (Aelon Kein Ad) Ad Jolet Jen Anij (Our Blessed Inheritance from God)”

This paper discusses the expansion of Oceania through a Marshallese indigenous lens as a focal point. It explains that decolonizing methodologies allows reclaiming of space for mental liberation and reassurement of constitutional rights. It highlights similar occurrences of decolonization practices meeting resistance in the 21st century all while strengthening the human right argument that no human deserves any less than their fellow human brothers and sisters. It argues that an indigenous imagery can only be viewed through an indigenous lens where the researches’ level of purity is retained and unfiltered. It nevertheless argues that Marshallese ethnolinguistics reveal the same cultural practices in America, Judeo-Christianity, and Oceania thus dictating the reality that “we are the same not withstanding one stays here and one there (Bedbedjin Bedbedjen, Bedbedjinma wot Kwe)”. It further explains the importance in these similarities and how Marshallese spirituality predates introduced American Judeo-Christianity despite the latter attempting to marginalize the former. It concludes by stating that Marshallese contributions on the global stage are rooted in that culture of love (IaKwe) which is echoed by the custom(s) revealing the significance of Marshallese validation academically, spiritually, economically, & socially to prevent institutionalized discrimination. This paper ends stating that the agency to know one’s self and how one should fit in the world, is a human right in itself and Marshallese are entitled to this sense of self worth through knowing thy self by thy self where real thinking takes place in one’s own mind as we all live our own lives

Defining the role of sticky platelet syndrome in patients with acute coronary syndrome

Tıpta Uzmanlık TeziTromboembolizm gelişmiş ülkelerde önde gelen morbidite ve mortalite nedenidir. Tanımlanmış hiperkoagülabilitesi olan hastaların yarıdan fazlasında doğumsal veya edinsel koagülasyon veya trombosit bozukluğu bulunur. Yapışkan trombosit sendromu adenozin difosfat ve/veya epinefrine karşı in vivo trombosit hiperreaktivitesi ile karakterize doğumsal bir trombosit bozukluğudur. Yapışkan trombosit sendromu birçok arteryel ve venöz trombozdan sorumlu olan, sık rastlanan, tanı ve tedavisi kolay bir trombosit bozukluğudur. Çalışmamızın ilk basamağında yapışkan trombosit sendromu'nun tanımlanmasında kullanılan farklı konsantrasyonlarda adenozin difosfat ve epinefrin uyarısı sonrası kendi laboratuvarımızın normal agregasyon ve sekresyon değerlerini saptadık. Daha sonra akut koroner sendrom öyküsü olan ve anjiografik olarak koroner arterleri hastalarda yapışkan trombosit sendromu'nun rolünü bulmaya çalıştık. Trombositlerin agregasyon ve sekresyon reaksiyonları lümiagregometri yöntemi kullanılarak eş zamanlı kaydedildi. Çalışmamıza 49 sağlıklı kontrol ve akut koroner sendrom tanılı 23 hasta dahil edildi. 7 (%30) hastada yapışkan trombosit sendromu saptandı. Biri hariç tüm agonist konsantrasyonlarında agregasyon ve sekresyon yanıtları arasında anlamlı korelasyon izledik. Bulgularımız agregasyon ve sekresyon bağlamında trombosit hiperreaktivitesinin global bir fenomen olduğunu ve seçilmiş hasta grubumuzda yapışkan trombosit sendromu'nun sık rastlanan bir bozukluk olduğunu gösterdi.AbstractThromboembolism is the leading cause of morbidity and mortality in developed countries. More than half of patients with defined hypercoagulability have a hereditary or aquired coagulation or platelet disorder that caused thrombosis. The sticky platelet syndrome is a hereditary platelet defect characterized with increased in vivo platelet hyperreactivity to adenosine diphosphate and/or epinephrine . Sticky platelet syndrome is a common, easy to diagnose and easy to treat platelet defect that is responsible for many arteriel and venous thrombotic events. At first step of our study we found normal aggregation and secretion ranges of our own laboratory after stimulation with different concentrations of adenosine diphosphate and epinephrine which was used to define sticky platelet syndrome . Thereafter we tried to find out the role of sticky platelet syndrome among patients with a history of acute coronary syndrome and angiographically normal coronary arteries. Aggregation and secretion reactions of platelets were recorded at the same time using lumiaggregometric method. Our study included 49 healty controls and 23 patients with acute coronary syndrome. 7 (30%) patients were found to have sticky platelet syndrome. We observed significant correlation between aggregation and secretion responses on all but one agonist concentrations. Our findings indicate that platelet hyperreactivity could be a global phenomenon in terms of aggregation and secretion, and sticky platelet syndrome is a common defect in our selected patient population

Acute Lymphoblastic Leukemia in Routine Practice

Objective: Significant developments occurred in the clinical management of acute lymphoblastic leukemia (ALL) in adults in recent decades. However, treatment results are still not satisfactory, especially in routine practice. The objective of this study was to evaluate the general clinical features, treatment details, and outcomes of a large group of patients followed in multiple centers in Turkey with a diagnosis of ALL. Materials and Methods: A retrospective analysis of the data of patients with ALL was made, the patients having been diagnosed and treated between January 2003 and June 2017 by different protocols in the hematology clinics of ten different centers. A total of 288 patients, aged between 17 and 76 years old, were included in the study. In this retrospective multicenter analysis of patients with ALL, classification of patients was performed based on treatment period, Philadelphia chromosome positivity, treatment regimen, and administration of allogeneic hematopoietic stem cell transplantation (allo-HSCT). Results: The majority of cases were B-cell in origin, while 224 patients had B-ALL and 64 of the patients had T-ALL. Median follow-up duration for all patients was 18.2 months (range: 0.03-161 months). Philadelphia chromosome positivity was determined in 49 patients (21.9%), and 54 patients (18.8%) were receiving allo-HSCT. After induction chemotherapy, 219 patients (76.0%) achieved complete remission, 32 patients (11.2%) were evaluated as treatment refractory, and 37 patients (12.8%) were deceased. Median overall survival was 47.7 months (95% confidence interval: 36.1-59.2) and median disease-free survival was 23.4 months (95% confidence interval: 6.7-40.0) for all patients. Conclusion: Multicenter studies are extremely important for defining the specific clinical features of a particular disease. The results of this study will make a significant contribution to the literature as they reflect real-life data providing valuable information about the Turkish ALL patient profile.PubMedWoSScopu