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We investigated the change in the epidemiology of nosocomial bloodstream infections (BSIs) caused by multidrug-resistant bacteria during Coronavirus Disease (COVID-19) and antibiotic consumption rates at a pandemic hospital and at the Oncology Hospital which operated as COVID-19-free on the same university campus. Significant increases in the infection density rate (IDRs) of BSIs caused by carbapenem-resistant (CRAB) and ampicillin-resistant (ARE) were detected at the pandemic hospital, whereas carbapenem-resistant BSIs were increased at the non-pandemic Oncology Hospital. Pulsed field gel electrophoresis showed a polyclonal outbreak of CRAB in COVID-19 intensive care units. Antibiotic consumption rates were increased for almost all antibiotics, and was most significant for meropenem at both of the hospitals. Increased IDRs of CRAB and ARE BSIs as well as an increased consumption rate of broad-spectrum antibiotics emphasize the importance of a multimodal infection prevention strategy combined with an active antibiotic stewardship program.

Multiple myeloma (MM) is a clonal proliferation of plasma cells in the bone marrow, with criteria including bone marrow plasma cells ≥10% or biopsy-proven plasmacytoma with myeloma-defining events. Solitary plasmacytoma (SP) represents a singular clonal plasma cell lesion without myeloma-defining events, while extramedullary disease (EMD) is an aggressive form of MM characterized by independent growth outside the bone marrow microenvironment. We present a unique case of a 64-year-old patient with bilateral testicular plasmacytoma anteceding the development of Immunoglobulin G (IgG) kappa-type MM, featuring extramedullary renal involvement. [ABSTRACT FROM AUTHOR]

Lymphomas encompass various lymphoid malignancies, although they are classified and evaluated in a similar manner. Prognostic stratification of lymphomas employs biochemical tests; however, these tests do not offer a viable means of assessing response. We included 108 patients with lymphoma who underwent treatment at the Department of Medical Oncology, Hacettepe University, between January 2015 and December 2017. Patients were grouped into good and poor responders, and changes in biochemical parameters were assessed for their utility in evaluating patient response. We evaluated the proposed scoring system's effect size using Cramer's V test. Fifty-seven patients were male, 51 patients were female, and the median age of the patients was 50 years. Twenty-seven patients had HL, 72 patients had B-cell NHL, and 9 patients had T-cell NHL. Fifty-three patients had stage IV, nine patients had stage III, 23 patients had stage II, and 22 patients had stage I disease. Levels of total protein (from 7.12 to 6.79 gr/ dL, p< 0.01), ß2-microglobulin (from 2287 to 2039 ng/mL, p= 0.07), and lactate dehydrogenase (from 297.8 to 230.1 U/L, p< 0.01) decreased in patients with good response, whereas nothing significant was found in patients with poor response. After transforming the parameters, we proposed a 4-point ordinal system comprising total protein, ß2-microglobulin, and lactate dehydrogenase values. Subsequent analysis demonstrated a nearly high effect size (Cramer's V 0.461) and significance in logistic regression (p< 0.01). Our study presents the first scoring system for response assessment in lymphoma using biochemical tests. Further research is necessary to validate our scoring system. [ABSTRACT FROM AUTHOR]

OBJECTIVE The aim of the study is to compare treatment outcomes of the patients with federation of gynecology and obstetrics stages III and IV ovarian carcinomas, who underwent interval debulking surgery after neoadjuvant chemotherapy (NACT), and patients who underwent adjuvant chemotherapy after primary debulking surgery (PDS). METHODS Patients from four centers (n=183) were retrospectively evaluated. Of the patients, 91 (50%) were in the PDS group and 92 (50%) in the NACT group. RESULTS In the NACT group patients have advanced age, poor performance status, high levels of CA125, and advanced disease stage compared with the PDS group (p<0.050). Of the patients receiving NACT, 14 (15%) had a complete response, and 68 (74%) had a partial response. The R0 rate was higher in the PDS group (p=0.018). In univariate analysis, poor prognostic factors affecting OS were NACT in the treatment protocol (p<0.001), poor performance status (p<0.001), advanced age (<70 vs. =70, p=0.002), advanced clinical stage (p=0.042), and localization of the tumor with the largest diameter outside the omentum and ovary at the time of diagnosis (p=0.029). In the multivariate analysis, the presence of NACT (HR: 2.30, 95% CI: 1.25-4.23, p=0.007) and poor performance (HR: 2.52, 95% CI: 1.18-5.10, p=0.017) were independent poor prognostic factors for OS. CONCLUSION In the study, OS was better in the PDS group than in the NACT group. This result was thought to be associated with the NACT group having more disadvantageous characteristics (advanced age, poor performance, high CA125 level, advanced stage, etc.). [ABSTRACT FROM AUTHOR]

We aimed to evaluate the seroconversion rates after two doses of inactive COVID‐19 vaccine (CoronaVac) and the benefit of a third dose mRNA vaccine booster in patients with cancer receiving active treatment. Patients with solid tumors receiving active treatment (n = 101) and patients with no‐cancer (n = 48) as the control group were included in the study. All the patients and controls had received two doses of CoronaVac and a third booster dose of the mRNA vaccine (Bnt162b2). Anti‐SARS‐CoV‐2 Spike Receptor Binding Domain IgG antibody levels after the second and third dose were measured with quantitative ELISA. The median age of the patients was 66 (IQR 60‐71). 79% of the patients were receiving chemotherapy, and 21% were receiving immunotherapy at the time of vaccination. Antibody levels measured after two doses of CoronaVac were significantly lower in patients with cancer than in the control group (median 0 μg/ml [IQR 0‐1.17 μg/ml] vs median 0.91 μg/ml [IQR 0‐2.24 μg/ml], respectively, P =.002). Seropositivity rates were 46.5% in patients with cancer and 72.9% in the control group (P =.002). Antibody measurement was performed in 26 patients after the third dose. Seroconversion rate increased from 46.5% to 88.5% (P <.001), and the antibody titers significantly increased with the third‐dose booster (median 0 μg/ml [IQR 0‐1.17 μg/ml] after two doses vs 12.6 μg/ml [IQR 1.8‐69.1 μg/ml] after third booster dose, P <.001). Immunogenicity of CoronaVac is low in patients with cancer receiving active treatment, and administering a third dose of an mRNA vaccine is effective in terms of improving seroconversion rates. [ABSTRACT FROM AUTHOR]

Introduction: It was previously demonstrated that seasonal influenza incidence was significantly decreased during the COVID-19 pandemic, possibly due to respiratory and hygiene precautions. From this point, we hypothesized that the COVID-19 precautions could lead to a decrease in nosocomial infection rates in oncology inpatient wards. Methods: We evaluated the nosocomial infection rates in an inpatient palliative oncology ward in the first 3 months of the COVID-19 pandemic in our country and compared this rate with the same time frame of the previous year in our institution. Results: The percentage of nosocomial infections complicating the hospitalization episodes were significantly reduced in the first 3 months of the pandemic compared to the previous year (43 vs. 55 nosocomial infection episodes; 18.6% vs. 32.2%, p = 0.002). The decrease in the nosocomial infections was consistent in the different types of infections, namely pneumonia (4.8% vs. 7.6%), urinary tract infection (5.2% vs. 7.6%), bacteremia (5.2% vs. 7%) and intraabdominal infections (2.6% vs. 3.5%). The median monthly disinfectant use was significantly increased to 98 liters (interquartile range: 82 – 114) in 2020 compared to 72 L (interquartile range: 36 – 72) in 2019 (p = 0.046). Conclusion: The continuation of the simple and feasible hygiene and distancing measures for healthcare workers and patient relatives and adaptations for earlier discharge could be beneficial for preventing nosocomial infections in oncology wards. These measures could be implemented routinely even after the COVID-19 pandemic for patient safety, especially in settings with higher nosocomial infection rates like inpatients palliative care units. [ABSTRACT FROM AUTHOR]

Aim: We aimed to compare weekly methotrexate (MTX) regimen and methotrexate‐folinic acid (MTX‐FA) 8‐day regimen in the first line treatment of low‐risk gestational trophoblastic neoplasia (GTN). Methods: The study included 73 patients with low‐risk GTN according to FIGO risk score (FIGO risk score < 7). All patients received either weekly MTX (30–50 mg/m2 intramuscular weekly) or MTX‐FA 8‐day (MTX 1 mg/kg IV on day 1, 3, 5, and 7, FA 15 mg orally on day 2, 4, 6, and 8 given 24 h after each MTX dose, every 14 days) regimens in the first‐line treatment of low‐risk GTN. The baseline clinicopathological characteristics and treatment outcomes were analyzed retrospectively. Results: The median age of all patients was 29 (18–51) years, and the median FIGO risk score was 3 (1–6). Of the patients recruited, 53 received MTX‐FA 8‐day, and 20 had MTX weekly regimens. There was a significant difference between the two groups with respect to FIGO risk scores (3 [1–6] vs. 2 [1–5], p = 0.023, MTX‐FA 8‐day vs. MTX weekly, respectively). The complete response rate was significantly higher in MTX‐FA 8‐day group compared to MTX weekly group (83% [44/53] vs. 60% [12/20] p = 0.038). In univariate and multivariate regression analyses, only presence of lung metastasis was found to be an independent risk factor for treatment resistance (OR: 3.959, 95% CI 1.105–14.179, p = 0.035). Conclusion: MTX‐FA 8‐day regimen is more effective than weekly MTX regimen in the first line treatment of low‐risk GTN including patients even with higher FIGO risk scores. Treatment resistance may develop especially in patients with lung metastasis. [ABSTRACT FROM AUTHOR]

Aim: This study aims to determine the frequency of germline BRCA 1/2 mutations in Turkish women with epithelial ovarian cancer (EOC) and evaluate its relationship with clinicopathological characteristics. Methods: In this cross‐sectional study, all women with recently diagnosed EOC presenting to Zekai Tahir Burak Women's Health Training and Research Hospital Medical Oncology Clinic between 2016 and 2019 were referred for BRCA testing. Peripheral blood samples were obtained from 76 patients applying to Medical Genetics and BRCA1/2 genes were sequenced using next‐generation sequencing. The American College of Medical Genetics and Genomics 2015 criteria were followed for classification of genetic variants. Results: Twenty‐four women (31.6%) had pathogenic germline BRCA1/2 mutations. Of these, 17 patients (22.4%) harbored germline BRCA1 mutations and 7 (9.2%) had BRCA2 mutations. When we compared the patients with and without BRCA mutations, there was significant difference in terms of family history (41.7% vs 9.6%, respectively, P =.001). Among all patients, 15 (19.7%) had history of breast or ovarian cancer in first‐ or second‐degree relatives. Germline BRCA1/2 mutations were detected in 66.7% of patients with family history, while these mutations were found in 22.9% of patients without family history (P =.001). Conclusion: In this sample 31.6% of Turkish women with EOC harbored germline BRCA1/2 mutations, which seems higher compared to other ethnic groups except for the Ashkenazi Jews population. All women with EOC should be referred for BRCA testing regardless of family history, age at diagnosis, and histological subtype. [ABSTRACT FROM AUTHOR]

This study aims to compare efficacy of dose dense and conventionally dosed paclitaxel-carboplatin regimens in the first-line treatment of epithelial ovarian cancer (EOC). We evaluated the medical records of women with EOC followed in Zekai Tahir Burak Women's Health Training and Research Hospital between 2007-2019 retrospectively. The patients with Eastern Cooperative Oncology Group Performance Status of 0-1-2, and stages of IC-IV, without previous treatments, who had undergone primary cytoreductive surgery were included. All patients had received either dose dense paclitaxel-carboplatin (paclitaxel 80 mg/m2 given on days 1, 8, and 15 plus carboplatin Area Under the Curve: 5 on day 1 of the 21 day cycle) or conventionally dosed paclitaxel-carboplatin (paclitaxel 175 mg/m2 plus carboplatin Area Under the Curve: 5 on day 1 of the 21 day cycle) regimens in the first line treatment. Baseline clinicopathological features, progression-free survival, and overall survival were evaluated. This study included data of 133 patients. Forty patients had received dose dense regimen while 93 had conventionally dosed regimen. Median progression-free survival of the dose dense group [34.4 months (31.7 - 37.03)] was significantly longer than the conventional group [25.5 months (19.9-30.9)] [HR= 0. 55 (95% CI, 0.31 - 0.95), p= 0.03]. Median overall survival was 88.2 months (28.3 - 148.3) in the dose dense group and 76.5 months (63.3 - 89.7) in conventional group (p= 0.102). We have found improved progression-free survival in the first-line treatment of EOC with dose dense regimen compared to conventionally dosed regimen. Overall survival was longer in the dose dense group despite being not significant. [ABSTRACT FROM AUTHOR]

Objective: To investigate the impact of cumulative cisplatin dose on clinical outcomes in locally advanced cervical cancer patients undergoing definitive chemoradiotherapy., Methods: A retrospective analysis was conducted on 654 patients with stage IB3-IVA disease treated with definitive chemoradiotherapy. Radiotherapy was applied as external beam pelvic with or without para-aortic radiotherapy and brachytherapy. Concomitant chemotherapy was in the form of weekly or 3 weekly cisplatin. Data on demographics, treatment protocols, cumulative cisplatin dose, adverse effects, and survival outcomes were collected. Statistical analyses, including univariate and multivariate Cox regression models, were used to assess factors influencing progression free survival and overall survival., Results: The median cumulative cisplatin dose was 210 mg (range 40-320), and ≥200 mg in 503 (76.9%) patients. Median follow-up was 35 months (range 1-150). The 5 year progression free survival and overall survival rates were 66.9% and 77.1%, respectively. Multivariate analysis identified poor performance status, non-squamous cell histology, presence of lymph node metastases, and hemoglobin <10 g/dL before chemoradiotherapy as poor prognostic factors for both progression free survival and overall survival in the whole group. When stage III cases were evaluated separately, the cumulative cisplatin dose <200 mg was found to be a significant poor prognostic factor in overall survival (hazard ratio 1.79, 95% confidence interval 1.1 to 3.0, p=0.031)., Conclusion: Our study showed that a cumulative cisplatin dose >200 mg, particularly in patients with lymph node metastases, significantly improved overall survival. Factors such as anemia, toxicity related challenges, and comorbidities were identified as critical considerations in treatment planning. These findings emphasize the balance between maximizing therapeutic efficacy and managing toxicity, guiding personalized treatment approaches for locally advanced cervical cancer., Competing Interests: Competing interests: None declared., (© IGCS and ESGO 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

This study addresses the gap in understanding the prognostic relevance of hypoxia-inducible factor-1 alpha (HIF-1 alpha) expression in metastatic cervical squamous cell carcinoma (SCC) patients undergoing anti-vascular endothelial growth factor (VEGF)-based therapy. A retrospective multicenter study (n = 34) explored HIF-1 alpha expression via immunohistochemistry in patients treated with platinum chemotherapy and bevacizumab. Median progression-free survival (PFS) was significantly lower in the HIF-1 alpha low score group compared to the high score group (4.9 vs 12.9 months, P = 0.014). Similarly, the median overall survival (OS) was significantly reduced in the HIF-1 alpha low score group (8.3 vs 20.4 months, P = 0.006). This study, the first of its kind, highlights the prognostic significance of HIF-1 alpha expression in metastatic cervical SCC patients treated with bevacizumab-based therapy.

Aim: We aimed to compare weekly methotrexate (MTX) regimen and methotrexate-folinic acid (MTX-FA) 8-day regimen in the first line treatment of low-risk gestational trophoblastic neoplasia (GTN)., Methods: The study included 73 patients with low-risk GTN according to FIGO risk score (FIGO risk score < 7). All patients received either weekly MTX (30-50 mg/m 2 intramuscular weekly) or MTX-FA 8-day (MTX 1 mg/kg IV on day 1, 3, 5, and 7, FA 15 mg orally on day 2, 4, 6, and 8 given 24 h after each MTX dose, every 14 days) regimens in the first-line treatment of low-risk GTN. The baseline clinicopathological characteristics and treatment outcomes were analyzed retrospectively., Results: The median age of all patients was 29 (18-51) years, and the median FIGO risk score was 3 (1-6). Of the patients recruited, 53 received MTX-FA 8-day, and 20 had MTX weekly regimens. There was a significant difference between the two groups with respect to FIGO risk scores (3 [1-6] vs. 2 [1-5], p = 0.023, MTX-FA 8-day vs. MTX weekly, respectively). The complete response rate was significantly higher in MTX-FA 8-day group compared to MTX weekly group (83% [44/53] vs. 60% [12/20] p = 0.038). In univariate and multivariate regression analyses, only presence of lung metastasis was found to be an independent risk factor for treatment resistance (OR: 3.959, 95% CI 1.105-14.179, p = 0.035)., Conclusion: MTX-FA 8-day regimen is more effective than weekly MTX regimen in the first line treatment of low-risk GTN including patients even with higher FIGO risk scores. Treatment resistance may develop especially in patients with lung metastasis., (© 2021 John Wiley & Sons Australia, Ltd.)

Aim: This study aims to determine the frequency of germline BRCA 1/2 mutations in Turkish women with epithelial ovarian cancer (EOC) and evaluate its relationship with clinicopathological characteristics., Methods: In this cross-sectional study, all women with recently diagnosed EOC presenting to Zekai Tahir Burak Women's Health Training and Research Hospital Medical Oncology Clinic between 2016 and 2019 were referred for BRCA testing. Peripheral blood samples were obtained from 76 patients applying to Medical Genetics and BRCA1/2 genes were sequenced using next-generation sequencing. The American College of Medical Genetics and Genomics 2015 criteria were followed for classification of genetic variants., Results: Twenty-four women (31.6%) had pathogenic germline BRCA1/2 mutations. Of these, 17 patients (22.4%) harbored germline BRCA1 mutations and 7 (9.2%) had BRCA2 mutations. When we compared the patients with and without BRCA mutations, there was significant difference in terms of family history (41.7% vs 9.6%, respectively, P = .001). Among all patients, 15 (19.7%) had history of breast or ovarian cancer in first- or second-degree relatives. Germline BRCA1/2 mutations were detected in 66.7% of patients with family history, while these mutations were found in 22.9% of patients without family history (P = .001)., Conclusion: In this sample 31.6% of Turkish women with EOC harbored germline BRCA1/2 mutations, which seems higher compared to other ethnic groups except for the Ashkenazi Jews population. All women with EOC should be referred for BRCA testing regardless of family history, age at diagnosis, and histological subtype., (© 2021 John Wiley & Sons Australia, Ltd.)