Impact of Hemoglobin, Leucocyte and Thrombocyte Levels at Diagnosis on the Survival Outcomes of Chronic Myeloid Leukemia Patients

Background:Since the development of tyrosine kinase inhibitors (TKIs), the prognosis for chronic myeloid leukemia (CML) has significantly improved. Several predicted prognostic scores and indicators at diagnosis have been used to predict the prognosis of chronic phase chronic myeloid leukemia (CML-CP) during the TKI period. When CML patients are first diagnosed, hemogram parameter aberrations are rather prevalent in clinical practice, although it is still unknown how those parameters affect the prognosis. This study aims to evaluate the hemogram parameters at diagnosis on the survival outcomes of CML-CP patients. Materials and Methods:One hundred thirty-seven patients who were diagnosed with CML-CP and received treatment were assessed between the years 2006 and 2020. Results:There were 65 (47.4%) males and 72 (52.6%) females with a median age of 50 (range: 18-78) years at diagnosis. Median hemoglobin level was 12.1 gr/dL (4.3-17.4), leucocyte count was 66.2 ×109 /L (7.5-520.2), and thrombocyte count was 362 ×109 /L (18-3.496) for all patients. The median progression-free survival (PFS) was 16.7 months 16.7 (2.0-106.4) and the median overall survival (OS) was 63.8 months (0.43-166.2) for all patients. Conclusion:This study is valuable in terms of predicting the prognosis of CML patients with hemoglobin, leukocyte, and platelet values at the time of diagnosis. While emphasizing the importance of platelet count at the time of diagnosis, similar to the previously defined risk scores, it showed that leukocyte and hemoglobin values at the time of diagnosis did not have a statistically significant effect on OS and PFS

Retrospective Evaluation of Patients Diagnosed with Diffuse Large B Cell Lymphoma (DLBCL)

Aim: Diffuse Large B Cell Lymphoma (DLBCL) is the most common NHL and %80 of all NHLs. Although it has some subtypes with heterogenous characteristic for prognosis, in area of rituximab monoclonal anti-body, improvement in overall survival (OS) was achieved. We evaluated response of treatment, epidemiologic features, OS and progression-free survival (PFS) of our patients with DLBCL for 5-years retrospectively.Materials and Methods: We investigated 160 patients from three centers in Turkey. Demografic features, stages, risk groups, the type of first-line therapy and its reason, duration of remission, relapse status and adverse events were collected. Package for the Social Sciences (SPSS) 22.0 program were used for statistical analysis. Dates of survival and significancies were obtained by Kaplan-Meier analysis and long-rank test, respectively. Analyses with p values below 0.05 were recognized as statistically significant.Results: Mean age of patients at the time of diagnoses was 60.75 ± 13.95. Number of patients with only nodal involved and extranodal involved were 109 (%68,1) and 51 (%31,9), respectively. Frequency of relaps after the first therapy was significancy superior in males than females. Althought there was no significant differencies between stage and OS, and response to treatment (p=0,140 ve p=0,378), significant difference was obtained between stage and PFS (p=0,038). In additon there wasn’t significant differencies between OS and PFS among patients with nodal and extranodal involved. Otherwise patients with advance age adjuested international prognostic index (aaIPI) scores had significancy inferior rate of response of first treatment (p=0,031).Conclusion: We demosrated the characteristics of patients with DLBCL as a general population and other else results related risk factors were similary with literatures

Hodgkin lenfoma hastalarında EORTC QLQ ile yaşam kalitesi değerlendirmesi: Çok merkezli çalışma

Aim: The aim of our study is to obtain data on the quality of life (QoL) in Hodgkin lymphoma (HL) patients in a representative sample of the general population of Turkey with the help of the EORTC QLQ-C30 and QLQ-HL27 questionnaires. Material and Methods: A total of 68 patients from seven different centers diagnosed with HL between 2018-2020 were included in the study. The questionnaires were answered cross-sectionally by the patient under the control of a physician in the centers participating in the study. Results: Out of 68 patients, 42.6% (n=29) were female and 57.4% (n=39) were male. The ages of the patients ranged from 18 to 74 years, with a mean of 42.10±16.62 and with a median value of 40 years. There was no significant difference between age subgroups in terms of QLQ-C30 global health status/ QoL, functional or symptom scales and HL27 SB, PC, EI and WF scores (p>0.05, for all). It was determined that the constipation scores of females were higher than the scores of males (p=0.041). No statistically significant difference was found in terms of HL27 SB, PC, EI and WF sub-dimension scores according to gender (p>0.05). Conclusions: There was only a statistically significant difference in terms of QLQ-C30 constipation sub-dimension scores according to gender. The constipation scores of females were higher than the scores of men. More detailed and large population studies are needed to reveal the effectiveness of QoL assessment in HL patients.Amaç: Çalışmamızın amacı, EORTC QLQ-C30 ve QLQ-HL27 anketleri yardımıyla Türkiye genelini temsil eden bir örneklemde Hodgkin lenfoma (HL) hastalarında yaşam kalitesi hakkında veri elde etmekti. Gereç ve yöntemler: 2018-2020 yılları arasında, HL tanısı almış yedi farklı merkezden toplam 68 hasta çalışmaya dahil edildi. Anketler, araştırmaya katılan merkezlerde hekim kontrolünde hasta tarafından yanıtlandı. Bulgular: 68 hastanın %42.6'sı (n=29) kadın, %57.4'ü (n=39) erkekti. Hastaların yaşları 18 ile 74 arasında değişmekte olup, ortalama 42.10±16.62 ve ortanca değeri 40 idi. QLQ-C30 global sağlık durumu/ yaşam kalitesi, fonksiyonel veya semptom skalaları ve HL27 SB, PC, EI ve WF skorları açısından yaş alt grupları arasında anlamlı fark yoktu (tümü için, p>0.05). Kadınların kabızlık puanlarının erkeklere göre daha yüksek olduğu belirlendi (p=0.041). Cinsiyete göre HL27 SB, PC, EI ve WF alt puanları açısından istatistiksel olarak anlamlı fark bulunmadı (p>0.05). Sonuç: Cinsiyete göre sadece QLQ-C30 kabızlık alt puanları açısından istatistiksel olarak anlamlı bir fark vardı. Kadınların kabızlık puanları erkeklerin puanlarından daha yüksekti. HL hastalarında QoL değerlendirmesinin etkinliğini ortaya çıkarmak için daha ayrıntılı ve geniş popülasyon çalışmalarına ihtiyaç olduğu görülmektedir

Have COVID-19 pandemic restrictions impacted the functioning of the hematology clinic?

Amaç: Çalışmamızın amacı, kısıtlamaların uygulandığı COVID-19 pandemi sürecinde hematoloji klinik işleyişinin değerlendirilmesidir. Hastalar ve Yöntem: Pandeminin ilk döneminde sokağa çıkma kısıtlamalarının uygulandığı 13.03.2020-15.05.2020 ile bu tarih aralığına karşılık gelen 2019 döneminde Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi ve İstanbul Medipol Üniversitesi Tıp Fakültesi Erişkin Hematoloji kliniklerine yatışı yapılan hastalar retrospektif olarak değerlendirildi. Bulgular: Her iki dönemde de yatan hasta sayısı 266 idi. 65 yaş üstü hasta oranı anlamlı olmamakla birlikte 2020’de daha düşük saptandı (%33.1’e kaşın %40.6, p= 0.72). Pandemi döneminde 2019’a göre tanısal amaçlı yatışı yapılan hasta sayısı anlamlı olarak yüksek (OR: 2,1, %95 GA: 1.35-3.26, p< 0.001); herhangi bir enfeksiyon nedeniyle yatış oranı ise düşük (OR: 0,44, %95 GA: 0.27-0.71, p< 0.001) bulundu. Tanısal amaçlı yatış yapılan hastalarda 2020 yılında hem erkek hasta oranı yüksek (OR: 0.4, %95 GA: 0.18-0.92, p= 0.031) hem de yatış süresi daha uzun (medyan 7’ye 14 gün, p= 0.007) bulundu. Kemoterapi, destek ve mobilizasyon amaçlı yatışlar arasında fark saptanmadı. Replasman ihtiyacı nedeniyle yatışı yapılan hasta oranı yine pandemic döneminde yüksek iken (OR: 4.7, %95 GA: 1.7-12.6, p< 0.001), tüm hastalar değerlendirildiğinde kan ürünü kullanımı sıklığı iki yıl arasında farklı değildi. Sonuç: Çalışmamız, kısıtlamalar sürecinde hematoloji hasta yönetiminin önemini ve işlevselliğinin değişmediğini vurgulamaktadır.Objective: The aim of our study is to assess the clinical functioning of hematology during the COVID-19 pandemic when lockdown restrictions are enforced. Patients and Methods: Patients who were admitted to Necmettin Erbakan University Meram Medical Faculty and Istanbul Medipol University Medical Faculty Adult Hematology clinics between March 13, 2020, and May 15, 2020, when lockdown restrictions were enforced in the first phase of the pandemic were evaluated retrospectively by comparing them with those who were admitted to same clinics between March 13, 2019, and May 15, 2019. Results: The number of inpatients during both periods was 266. It was determined that during the period of the pandemic, the number of patients hospitalized for diagnostic purposes was significantly higher compared to 2019 (OR: 2.1, 95% CI: 1.35-3.26, p< 0.001), whereas the rate of hospitalization due to any infection was significantly lower (OR: 0.44, 95% CI: 0.27-0.71, p<0.001). Of the patients who were hospitalized for diagnostic purposes in 2020, both the rate of male patients was higher (OR: 0.4, 95% CI: 0.18-0.92, p= 0.031) and the duration of hospitalization was longer (7 vs. 14 days; p= 0.007) found. While the rate of patients hospitalized due to the need for replacement was also higher during the period of pandemic (OR: 4.7, 95% CI; 1.7-12.6, p< 0.001), when all patients were assessed, the frequency of blood product use was not different between two years. Conclusion: Our study highlights the cruciality and functionality of hematology patient management during the period of lockdown restrictions

Multipl miyelom tanılı hastalarda EORTC QLQ ile yaşam kalitesi değerlendirmesi: Çok merkezli çalışma

Objective: Both the length of the treatment period and the diversity of the agents used in the treatment significantly affect the quality of life (QoL) of the patients with multiple myeloma (MM). With the aid of the EORTC Quality of Life Questionnaire Consisting of 30 Questions “EORTC QLQ-C30” and the Quality of Life Questionnaire Multiple Myeloma Module “QLQ-MY20”, we aimed to obtain data on quality of life in MM patients in a representative sample of the general population of our country. Methods: One hundred sixty eight patients from 6 different centers followed between 2018-2020 were included in the study. The QLQ-C30, and the QLQ-MY20 questionnaires specific for MM patients were used and the results were reported statistically. Results: Seventy eight (46%) of the patients were female, while 90 (54%) were male. The median age was 64 (22-84). When the findings were analysed, it was found that there was a greater effect on the symptom scale compared to the functional scale. Conclusion: The importance of the treatment-related side effect management, together with the adequate administration of appropriate symptomatic treatment in holistic treatment management were emphasized as effective factors in terms of the QoL of patients with MM.Amaç: Hem tedavi süresinin uzunluğu, hem de tedavide kullanılan ajanların çeşitliliği multipl miyelomlu (MM) hastaların yaşam kalitesini (YK) önemli ölçüde etkiler. Otuz sorudan oluşan EORTC Yaşam Kalitesi Anketi “EORTC QLQ-C30” ve Yaşam Kalitesi Anketi-Multipl Miyelom Modülü “QLQ-MY20” yardımıyla MM hastalarında yaşam kalitesine ilişkin verileri elde etmeyi amaçladık. Yöntem: 2018-2020 yılları arasında takip edilen, 6 farklı merkezden 168 hasta çalışmaya dahil edildi. MM hastalarına özel QLQ-C30 ve QLQ-MY20 anketleri kullanılmış ve sonuçlar istatistiksel olarak rapor edilmiştir. Bulgular: Hastaların 78’i (%46) kadın, 90’ı (%54) erkekti. Ortanca yaş 64 (22-84) idi. Bulgular incelendiğinde semptom ölçeğinde fonksiyonel ölçeğe göre daha fazla etkinin olduğu görüldü. Sonuç: Bütüncül tedavi yönetiminde, uygun tedavinin yeterli uygulanması ile birlikte tedaviye bağlı yan etki yönetiminin önemi, MM’li hastaların yaşam kalitesi açısından etkili faktörler olarak vurgulanmıştır

The evaluation of treated with imatinib on the effect of erectile function in patient with chronic myeloid leukemia

Kronik miyeloid lösemi (KML), 9. ve 22. kromozomlar arasındaki translokasyon sonucu oluşan, philadelphia kromozomu olarak adlandırılan BCR/ABL füzyon geni ve bu genin tirozin kinaz aktivitesi yüksek onkoproteinleri ile karakterize, tüm hematolojik kök hücre serilerini tutan miyeloproliferatif bir hastalıktır. Genellikle ileri yaşlarda görülür. KML'de ispatlanmış etiyolojik bir ajan söz konusu değildir.KML'de allojeneik kök hücre nakli de dâhil çeşitli tedavi yöntemleri uygulanmıştır. Tirozin kinaz inhibitörlerinden (TKİ) imatinibin keşfi ve tedaviye girmesi, tedavi yanıtları ve sağ kalım açısından bir dönüm noktası kabul edilebilir.TKİ ile hücre içi sinyal iletimi, hücre proliferasyonu ve farklılaşması baskılanır. Hayvan çalışmalarında (ratlar, maymunlar ve köpeklerde) imatinibin spermatogenezi etkilediği ancak diyabetik ratlarda diyabete bağlı gelişen erektil disfonksiyonların TKİ tedavisi ile gerileyebileceği gösterilmiştir. TKİ'lerinin teratojenik etkileri olabileceğinden korkulması nedeni ile TKİ kullanan şahısların gebelikten kesin bir şekilde kaçınması gerektiği önerilmektedir.İmatinib kullanımı sırasında gebeliklerin gerçekleştiği ve bunların normal bir şekilde sonlanabildiği de bir gerçektir. İnsanlar üzerinde yapılmış gonadal fonksiyonları inceleyen bir çalışma hali hazırda yoktur. İmatinib tedavisi altındaki erkeklerde erektil fonksiyonları değerlendiren çalışmamız literatürde bir ilki oluşturmaktadır.Çalışmamızda Uludağ Üniversitesi Tıp Fakültesi İç Hastalıkları Anabilim Dalı Hematoloji Bilim Dalı'nda takip ve tedavi altındaki erkek KML hastalar incelendi. KML dışında bilinen bir sistemik hastalık öyküsü olmayan, TKİ dışında farmakolojik tedavi almayan 31 hasta tespit edildi. Bunlardan 24'ü imatinib, 6'sı nilotinib ve 1'i de dasatinib tedavisi almaktaydı. Bu hastaların erektil fonksiyonları, Uluslararası Erektil Fonksiyon Değerlendirme İndeksi (IIEF-5) ile değerlendirildi. Tüm hastaların 12'sinde (%38,7) erektil disfonksiyon (ED) saptanmadı. İmatinib kullanan hasta grubuna bakıldığında 10 hastada (%41,5) ED saptanmazken, 11 hastada (%45,8) hafif, 3 hastada (%12,5) orta şiddette ED bulundu. Bu olgular yaşlarına göre değerlendirildiğinde ED oranı normal sınırlar içinde saptandı. ED ile imatinib kullanım dozu ve tedavi süresi arasındaki ilişki değerlendirildiğinde istatistikî yönden anlamlı bulunmadı (sırasıyla; p=0,255 ve p=0,243). Sonuç olarak; olgu sayısı sınırlı olmakla birlikte bu çalışmada TKİ kullanımının ED oluşturmadığı belirlendi. Hormonal özellikleri de içeren ve daha geniş olgu sayılı çalışmalara ihtiyaç olduğu kanısına varıldı.Chronic myeloid leukemia (CML) is a myeloproliferative disease that keeps all the haematological stem cell series and characterized by the Philadelphia (Ph) chromosome caused by translocation between 9. and 22. chromosomes so-called BCR/ABL fusion gene and high tyrosine kinase activited oncoproteins of the fusion gene. Usually seen in older age. There is no provenly etiologic agent in CML.Various treatment methods that also included allogeneic stem cell transplantion have been applied in CML. The discovery of tyrosine kinase inhibitör (TKI) imatinib can be considered a turning point in terms of treatment reponses and survival.Intracellular signal transduction, cellular proliferation and differentiation is supressed by TKI. In animal studies (Rats, monkeys and dogs), It has showed that imatinib impairs the spermatogenesis however erectile disfunction caused diabet can degrade by TKI treatment in diabetic rats. Because of the fear of teratogenic effects may be ıts recommended that patient who treated with tyrosin kinases inhibitör is currently avoid to pregnancy.Its also true that pregnancies occurred while receiving imatinib and could result eventful. There is no clinical trials that investigated gonadal functions in human. Our study which was evaluatied of erectile disfunction (ED) in men taking imatinib is a compose such as firstly in literature.In the study, male patients with CML who were treated and applied to outpatient clinic of Uludag University Medical Faculty Internal Medicine Department Hematology Division investigated. Thirty-one patients identified who has no a know history of systemic disease without CML and not used any pharmacological agent out of TKI. Twenty-four of the patients were received imatinib, six of the patients were received nilotinib and one of the patient was receive dasatinib. Erectile functions were evaluated using the International Index of Erectile Function (IIEF-5). Twelve of the all patients (%38,7) were not determined ED. In the imatinib group, 11 of patients (%45,8) had mild severity, 3 of patients (%12,5) had moderate severity while 10 of patients (%41,5) were no determined ED. Rate of ED were determined within normal limites when the cases assesed according to age. Evaluation of the relationship between dosage and during treatment of imatinib with ED were no signicifiantly difference (respectively; p=0,255 and p=0,243). As a result; in this study, it determined that use of TKI do not occur ED although limited number of cases. It was concluded that studies which includes also hormonal features and more number of cases is needed

Ccr2 Expression Was Increased in Patients with Ankylosing Spondylitis Independent From Disease Activity

[No Abstract Available

Blastoid Variant Mantle Cell Lymphoma with Amplified IGH/CCND1 Fusion: A Unique Case and Current Literature Review

Mantle cell lymphoma (MCL) is a subtype of mature B-cell non-Hodgkin lymphoma (NHL). Most cases exhibit CCDN1/IGH translocation; however, reports indicate that amplification of the fusion gene is extremely rare. A 72-year-old male patient diagnosed with an MCL blastoid variant was referred to us. Amplified CCDN1(11q13)/IGH(14q32.3) fusion genes were observed in 75% of the interphase nuclei of the patient. We present the first case of blastoid variant MCL with multiple IGH/CCND1 fusion signals by interphase fluorescence in situ hybridization. Our patient exhibited an aggressive course and passed away on the second day of treatment

Effectiveness and Safety of Autologous Stem Cell Mobilization with Granulocyte Colony Stimulating Factor in an Inpatient or Outpatient Setting

Aim:Autologous hematopoietic stem cell transplantation is the most frequently used treatment method in the treatment of lymphoma and myeloma patients. To apply this treatment method, first of all, a sufficient number of stem cells must be collected from the patient. With the development of apheresis methods and safe, effective mobilization methods, it is now possible to collect stem cells in an outpatient manner. In our study, we aimed to compare the efficacy and safety of outpatient based mobilization versus inpatient based mobilization of hematopoietic stem cells with granulocyte-colony stimulating factor (G-CSF) alone in patients with myeloma and lymphoma.Materials and Methods:A total of 89 patients, including 54 patients who underwent outpatient and 35 patients who underwent inpatient based mobilization of stem cells with G-CSF alone were included in the study. Outpatient and inpatient based mobilization groups were compared in terms of efficacy and safety. Statistical analyses were performed with Jamovi 1.2.27 software. The Mann-Whitney U and chi-square tests were used to examine the differences. MANCOVA was used for univariate and multivariate statistical analysis of factors influencing mobilization.Results:Three leukaphereses resulted in the collection of a mean 9.73x106/kg (4.5-16.5) CD34+ cells in the outpatient based mobilization group and a mean 11.8x106/kg (3.56-59) CD34+ cells in the inpatient based mobilization group (p=0.14). Life-threatening side effects were not observed in any of the patients. Grade 1, 2 side effects were observed and there was no significant statistical difference between the two groups.Conclusion:In this study, we found no significant difference in terms of efficacy and safety between the outpatient and the inpatient based mobilization group patients with myeloma and lymphoma who were mobilized with G-CSF. The results of our study show that outpatient based mobilization can be effectively and safely performed with g-csf, especially in patients who need autologous transplantation and avoid hospitalization, as in the current Coronavirus disease-2019 pandemic

The Diagnosis of Multiple Myeloma With Macroglossia and Edema Symptoms

In this case, the importance of multiple myeloma in differential diagnosis of non-specific symptoms, such as macroglossia and significant pretibial edema, is highlighted. A 44-year-old male presented to the internal medicine outpatient clinic with complaints of ongoing and increasing enlargement of the tongue, difficulty in swallowing, and swelling of legs, all of which had been occurring for 6 months. In the CT scan, significant symmetrical enlargement of the tongue was detected. Making a pre-diagnosis of amyloidosis, a biopsy of the tongue was performed, but the results did not suggest amyloidosis. A rectal biopsy was therefore subsequently performed, and this time the results showed amyloid accumulation. Findings from the transthoracic echocardiography showed an ejection fraction of 48%, contrast hypertrophy in the left ventricle, Grade 3 diastolic dysfunction, 15–19 ml of pericardial fluid around the heart, and mild mitral failure. Taking into consideration the pathological and cardiologic findings, the patient was diagnosed with amyloidosis. Bearing in mind the possible relation between primary hematologic malignancy and amyloidosis, a bone marrow aspiration and a bone marrow biopsy were performed. From the results of the biopsy and aspiration of bone marrow, the patient was diagnosed with multiple myeloma and treatment plans were made accordingly. However, as the patient was in the process of undergoing treatment he died due to the development of cardiopulmonary failur