Eltrombopag for the treatment of immune thrombocytopenia: The aegean region of Turkey experience

Objective: Immune thrombocytopenia (ITP) is an immune-mediated disease characterized by transient or persistent decrease of the platelet count to less than 100x109/L. Although it is included in a benign disease group, bleeding complications may be mortal. With a better understanding of the pathophysiology of the disease, thrombopoietin receptor agonists, which came into use in recent years, seem to be an effective option in the treatment of resistant cases. This study aimed to retrospectively assess the efficacy, long-term safety, and tolerability of eltrombopag in Turkish patients with chronic ITP in the Aegean region of Turkey. Materials and Methods: Retrospective data of 40 patients with refractory ITP who were treated with eltrombopag in the Aegean region were examined and evaluated. Results: The total rate of response was 87%, and the median duration of response defined as the number of the platelets being over 50x109/L was 19.5 (interquartile range: 5-60) days. In one patient, venous sinus thrombosis was observed with no other additional risk factors due to or related to thrombosis. Another patient with complete response and irregular follow-up for 12 months was lost due to sudden death as the result of probable acute myocardial infarction. Conclusion: Although the responses to eltrombopag were satisfactory, patients need to be monitored closely for overshooting platelet counts as well as thromboembolic events. © 2015 Turkish Society of Hematology. All rights reserved

DETECTION OF PHYSIOLOGICAL AND GENOTOXIC DAMAGES REFLECTING TOXICITY IN KALANCHOE CLONES

In order to make assessments in understanding of physiological and genotoxic effects of imposing cadmium (Cd) on photosynthetic pigment contents along with the changes occurring in genetic material of Kalanchoe plants were used in relation to various Cd-treatments. Young plantlets were originated from a single host plant as clones, and developed in vitro. Developed clones were grown in standard pots with daily watering of Hoagland solution (20 ml) containing different concentrations of cadmium chloride for two months. Cd concentrations of the collected samples were measured by employing ICP-OES and RAPD-PCR technique was applied for detecting the genotoxic effects of Cd. After two month of experimental period, the comparisons between unexposed and exposed Kalanchoe clone groups revealed reductions in photosynthetic pigment contents, especially at the highest level of Cd exposure and a genomic instability when application of Cd concentration increases. RAPD-PCR analyses demonstrated the distinguishable banding pattern in number and band intensities between Cd-treated and control groups. In addition, progressive Cd accumulations in leaves, stems and roots of plant samples were observed when the application of exposure level increased.Marmara University, Commission of Scientific Research ProjectMarmara University [FEN-C-YLP-040712-0283]This study was funded by Marmara University, Commission of Scientific Research Project under grant FEN-C-YLP-040712-0283.WOS:0003739272000202-s2.0-8503888275

The role of pet/ct in the evaluation of bone marrow involvement in lymphoma patients at the initial staging [Lenfoma hastalarında tanı anında evreleme amaçlı çekilen PET/CT’nin kemik iliği infiltrasyonunu göstermedeki yeri]

Objective: Bone marrow (BM) involvement is one of the most important prognostic factors in lymphoma patients. Therefore, it is important to determine the presence of BM involvement in lymphoma patients at the time of diagnosis. Bone marrow biopsy (BMB) is still accepted as the gold standard for evaluating the marrow but it is painful and invasive. In this retrospective study, we aimed to evaluate the role of positron emission tomography combined with computed tomography (PET/CT) in evaluating the BM involvement in lymphoma patients at the initial staging. Patients and Methods: The patients who were evaluated by PET/CT and bone marrow biopsy at time of diagnosis were enrolled in the study. Results: The overall sensitivity of PET/CT in demonstrating BM involvement was 65.8%, and the specificity was 89.4%. In the subgroup analysis of 176 Hodgkin lymphoma (HL) patients, the sensitivity and specificity of the PET/CT were 81% and 84% respectively. Negative predictive value was 98%. In 201 diffuse large B cell lymphoma (DLBCL) patients, the sensitivity and specificity of the test were 91.3% and 94.3%, respectively. Negative predictive value was 98.8%. Conclusion: PET/CT is an accurate and complementary modality with high specificity and sensitivity in detecting BM infiltration in HL and DLBCL patients. © 2017, Marmara University. All rights reserved

Eltrombopag for the treatment of immune thrombocytopenia: The aegean region of Turkey experience [İmmün Trombositopeni Tedavisinde Eltrombopag: Türkiye Ege Bölgesi Deneyimi]

PubMed ID: 25914025Objective: Immune thrombocytopenia (ITP) is an immune-mediated disease characterized by transient or persistent decrease of the platelet count to less than 100x109/L. Although it is included in a benign disease group, bleeding complications may be mortal. With a better understanding of the pathophysiology of the disease, thrombopoietin receptor agonists, which came into use in recent years, seem to be an effective option in the treatment of resistant cases. This study aimed to retrospectively assess the efficacy, long-term safety, and tolerability of eltrombopag in Turkish patients with chronic ITP in the Aegean region of Turkey. Materials and Methods: Retrospective data of 40 patients with refractory ITP who were treated with eltrombopag in the Aegean region were examined and evaluated. Results: The total rate of response was 87%, and the median duration of response defined as the number of the platelets being over 50x109/L was 19.5 (interquartile range: 5-60) days. In one patient, venous sinus thrombosis was observed with no other additional risk factors due to or related to thrombosis. Another patient with complete response and irregular follow-up for 12 months was lost due to sudden death as the result of probable acute myocardial infarction. Conclusion: Although the responses to eltrombopag were satisfactory, patients need to be monitored closely for overshooting platelet counts as well as thromboembolic events. © 2015 Turkish Society of Hematology. All rights reserved

AML hastalarında t(15;17) PML-RARA translokasyonunun real time RT-PCR ile 5 yıllık sonuçlarının değerlendirilmesi

Aim: Acute promyelocytic leukemia (APL) is a well-defined subtype of acute myeloid leukemia (AML) specifically characterized by the t(15;17)(q22;q12) translocation. t(15;17) results in the fusion of the genes, promyelocytic leukemia (PML) on chromosome 15 and retinoic acid receptor alpha (RARA) located on 17th chromosome. Translocation is detected by conventional cytogenetic, fluorescence in situ hybridization analyses (FISH) and often a real time quantitative reverse transcriptase polymerase chain reaction (qRT-PCR) method. In this study, quantification of t(15; 17) translocation via real time qRT-PCR was aimed in blood or bone marrow materials belonging to APL pre-diagnosed cases that appealed our department. Materials and Methods: Seventy nine children (7.28 ;plusmn; 5.20 years; 45 M, 34 F) and 359 adults (47.71 ;plusmn; 15.57 years; 193 M, 166 F) were included in the study between the years 2009-2013. Following total RNA isolation from blood or bone marrow materials of the cases, cDNA synthesis was carried out. Then, t(15; 17) translocation was studied by qRT-PCR and quantitated. Results: Two cases from children (3%), and in total 6 tests (5%) were detected positive for t(15;17). The average t(15;17) quantification value was 0.0002 ;plusmn; 0.0003. Twenty six cases of the adults (7%), in total 30 tests (8%) were determined as t(15;17) positive. Average t(15;17) quantification value of these cases was 0.067 ;plusmn; 0.144. Conclusion: The superiority of qRT-PCR compared to conventional cytogenetic studies can be found in the fact that all working steps can be monitored simultaneously during the test and the resulting amplicons can be quantitated. The clinical significance of t(15;17) qualitative determination is, confirmation of the diagnosis, all trans-retinoic acid and trioxide arsenic treatment response prediction and treatment efficacy knowledge in addition to minimal residual disease (MRD) monitoring and ability to identify relapse at early ages.Amaç: Akut promyelösitik lösemi (APL), akut myeloid löseminin (AML) iyi tanımlanmış alt tipidir ve spesifik olarak t(15;17)(q22;q12) translokasyonu ile karakterizedir. t(15;17), 15. kromozom üzerinde bulunan promyelösitik lösemi (PML) ve 17. kromozomda lokalize retinoik asit reseptör alfa (RARA) genlerinin füzyonu sonucu oluşur. Translokasyon varlığı, konvansiyonel sitogenetik, floresan in situ hibridizasyon analizi (FISH) ve sıklıkla gerçek zamanlı kantitatif revers transkriptaz polimeraz zincir reaksiyonu (qRT-PCR) yöntemiyle saptanır. Bu çalışmada, anabilim dalımıza başvuran APL ön tanılı olgulara ait kan ya da kemik iliği materyallerinden t(15;17) translokasyonunun gerçek zamanlı qRT-PCR ile kantitasyonu amaçlanmıştır. Gereç ve Yöntem: Çalışmaya 2009-2013 yılları arasında başvuran 79 çocuk (7.28±5.20 yaş; 45 E, 34 K) ve 359 yetişkin (47.71±15.57 yaş; 193 E, 166 K) olgu dahil edilmiştir. Olguların kan ya da kemik iliği materyallerinden total RNA izolasyonunu takiben cDNA sentezi gerçekleştirilmiştir. Sonrasında, qRT-PCR ile t(15;17) translokasyonu çalışılıp, kantite edilmiştir. Bulgular: Çocuk olgulardan 2'si (%3), toplamda 6 test (%5) t(15;17) için pozitif olarak belirlenmiştir. Bu olgulara ait t(15;17) kantitasyon değeri ortalaması, 0.0002±0.0003’tür. Yetişkin olguların 26'sı (%7), toplamda 30 test (%8) t(15;17) için pozitif olarak belirlenmiştir. Bu olgulara ait t(15;17) kantitasyon değeri ortalaması, 0.067±0,144’tür. Sonuç: qRT-PCR’ın konvensiyonel sitogenetik çalışmalara göre üstünlüğü, tüm çalışma basamaklarının test esnasında eş zamanlı olarak izlenebilmesi ve oluşan amplikonların kantitasyonunun yapılabilmesidir. t(15;17) kalitatif tayininin klinikteki önemi, tanının kesinleştirilmesinde, tüm trans-retinoik asit ve trioksid arsenik tedavisine yanıtın öngörülmesi ve tedavinin yararlılığının bilinmesinde, minimal rezidüel hastalığın (MRH) takibi ve relapsın erken evrede belirlenebilmesidir