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Abstract Background Severe inflammation and one or more extrapulmonary organ dysfunctions have been reported and this clinical picture is defined as "multisystem inflammatory syndrome in adults" (MIS-A) in severe coronavirus disease-2019 (COVID-19). We aimed to determine the effect of LDH/lymphocyte ratio (LLR) on the development of MIS-A. Methods The data of 2333 patients were retrospectively analyzed. Results MIS-A rate was found to be 9.9% and MIS-A related mortality was 35.3%. LRR level above 0.24 was found to predict MIS-A development with 70% sensitivity and 65.2% specificity. The risk of MIS-A development was found to be 3.64 times higher in those with LRR levels above 0.24 compared to those with 0.24 and below. In patients with MIS-A, LRR level above 0.32 predicts mortality with 78% sensitivity and 70% specificity. Conclusions Early detection of MIS-A with high sensitivity and specificity in a practical ratio is very important in terms new studies.

Introduction:Mucormycosis is an aggressive-progressive invasive fungal infection caused by mold fungi in the division of mucorales of the zygomycetes class with high mortality, and is the most common fungal infection in patients with hematologic malignancies.Methods:This study retrospectively evaluated patients with mucormycosis diagnosis between January 2015 and December 2019, including demographic features, hematologic diseases and comorbidities, radiological evaluations, symptoms and signs, treatments, and outcomes.Results:Maxillofacial 9/19 (47.37%) of patients and 10/19 (59.9%) rhinoorbital mucor. Hematologic malignancy was observed in 15 (78.95%) patients, whereas others had additional pre-disposing factors, such as diabetes mellitus and chronic renal failure. The most common find-ings were persistent fever, mucopurulent nasal flux, and periorbital edema. Endoscopic sinus surgery + medication was administered in 12/19 (62.2%) patients and antifungal therapy in 7/19 (37.8%). In addition, 15/19 (79.95%) patients died and 4/19 recovered with sequela.Conclusion:The first large-scale mucormycosis study from our country will guide in determining the treatment algorithm. Effective and early surgery and antifungal application reduce mortality in mucormycosis by early diagnosis and multidisciplinary approach, without bone destruction in the paranasal sinus computed tomography with recurrent fever and earlystage sinusitis finding by performing a biopsy.

Introduction:Chronic myeloid leukaemia (CML) is a myeloproliferative neoplasm characterised by the overproduction of haematopoietic cells in the granulocytic series, involving translocation of chromosomes 9 and 22. The first tyrosine kinase inhibitor, imatinib, used in the treatment of CML, represents one of the most successful targeted therapies marking a new era in the treatment of CML. Many scoring systems such as the Hasford and Sokal systems have been developed to stratify CML patients into risk categories, and to predict patient outcome. We aimed to evaluate the relationship between blood lymphocyte count (BLC) at diagnosis and molecular response to imatinib therapy as a prognostic factor.Methods:A total of 108 chronic phase CML patients diagnosed between January 2010 and January 2020 were evaluated. Patient characteristics, laboratory results, BLC and response to treatment were recorded.Results:The median BLC was 4,665/mm3 and patients were divided into two groups according to the median BLC as ≤4,665/mm³ and >4,665/mm³. The responses at 3, 6, 12 month and the final status of patients, namely achievement of major molecular response or not, did not differ between the two groups of patients.Conclusion:The introduction of new therapeutic options in CML necessitates improvement in existing risk scoring systems. No direct relationship was found between the initial BLC and imatinib response in CML. However this is the first study exploring the role of BLC at diagnosis in CML patients receiving imatinib, and further studies that look into lymphocyte subgroups as well as bone marrow lymphocyte count at diagnosis might allow a more precise evaluation about the contribution of lymphocyte count to risk assessment in CML patients.

Background: COVID-19 (Coronavirus Disease-2019) is a pandemic disease, infecting more than 26.5 million people. Since there is no specific and effective treatment; early diagnosis and optimal isolation of the patient are of vital importance. Real-time polymerase chain reaction-based (RT-PCR) analyses do not achieve sufficient sensitivity in the diagnosis of the disease. Methods: The data from 2217 patients diagnosed as COVID-19 between March 2020 and June 2020 and hospitalized or discharged with home isolation were retrospectively analyzed. Demographic data, comorbidities, PCR results, initial computed tomography (CT), laboratory values, Lactate Dehydrogenase (LDH)/Lymphocyte ratio, initial treatments and last status were recorded. The diagnostic sensitivity of LDH/Lymphocyte ratio, which is the main purpose of the study, was analyzed statistically. Results: In order to test the effectiveness of LDH/Lymphocyte ratio for COVID-19 for diagnostic purposes, CT results were considered as gold standard. The area under the curve (AUC) was found to be 0.706 (p < 0.001; cut-off > 0.06) (Sensitivity: 76.4, specificity: 59.60). For the evaluation of LDH/Lymphocyte ratio in terms of survival, AUC was found to be 0.749 (p < 0.001; cut-off > 0.21) (Sensitivity: 70.59, specificity: 73.88). Conclusion: Studies based on radiological findings have demonstrated that CT involvement has higher sensitivity. LDH/Lymphocyte ratio was analyzed in terms of diagnosis and mortality with using specific CT involvement as gold standard method which was found to be a more sensitive due to PCR false negativity; 0.06 and 0.21 were obtained as cut off values for diagnosis and mortality.

Abstract Background Diffuse large B-cell lymphoma is the most common subtype of non-Hodgkin lymphoma and may occur with lymph node and/or extranodal involvement. Recurrence in patients with diffuse large B-cell lymphoma usually occurs within the first few years after treatment and may occur in a different area outside the initial localization. Case presentation A female Turkish patient who was diagnosed with nodular sclerosing Hodgkin lymphoma through lymphadenopathy examination reached remission after chemotherapy and radiotherapy. In the 11th year of follow-up and at the age of 45, newly developed multiple lymphadenopathies were diagnosed with a pathological result of diffuse large B-cell lymphoma in her advanced examination. Due to massive splenomegaly and cystic necrotic splenic residues, splenectomy was performed after eight cycles of a first-line chemotherapy regimen and two cycles of high-dose methotrexate treatment for central nervous system prophylaxis. A pericardial mass (maximum standardized uptake value 34.8), which was not present at the time of diagnosis and interim evaluation of positron emission tomography/computed tomography, was detected through chest pain in the third month after the last screening, although a complete response had been obtained. Pathological examination of the pericardial area revealed the pathological result was a recurrence. Conclusions Patients with diffuse large B-cell lymphoma have an aggressive clinical course, but cardiac involvement is very rare. In our patient’s case, pericardial involvement was observed after treatment and scanning revealed that recurrence took place in an area different from the pericardium. Cooperation of clinicians and pathologists and rapid evaluation are very important in cases of diffuse large B-cell lymphoma relapse. Although a tumoral invasion of the pericardium mostly suggests secondary malignancies, it should be kept in mind that recurrence of lymphoma is also possible.

Background: Chronic lymphocytic leukemia (CLL) is one of the most common hematological malignancies. In patients with CLL, serum immunoglobulin levels decrease over time due to both the disease itself and the chemo-immunotherapeutic agents used. It was aimed to reveal the relationship between hypogammaglobulinemia and disease stage, and chemo-immunotherapies. Materials and Methods: Data were obtained by retrospectively examining 74 patients who were followed-up between 2008-2019. The relationship between all parameters (demographic characteristics, RAI stages or therapy subtypes) and serum IgG levels was analyzed. Results: Thirty-two of 74 patients received a therapy. Twenty-two patients were on combined therapy with rituximab or only rituximab and 10 were treated with chemotherapeutic agents only. The frequency of hypogammaglobulinemia was 5.4% at the diagnosis, this rate was 55% in patients receiving a therapy. Hypogammaglobulinemia was higher in advanced stages. In patients with rituximab, higher levels of IgG decrease were observed. Conclusion: Serum IgG level was significantly lower in patients with advanced-stage, received chemotherapy, especially rituximab. In addition to basal IgG, immunoglobulin levels should be checked during treatment, and follow-up period. Early replacement intravenous immunoglobulins will be important to reduce severe infection attacks due to secondary immunodeficiency.

We aimed to examine the efficiency for prediction of prognosis and response in non-APL AML cases of the “Samatya-predicting score”. A total of 213 patients diagnosed between January 2010-December 2020 were examined. Of the 158 patients included in the study, the median value of risk score was determined as 2,5. The sensitivity for mortality was 88% and the specificity was 42%. In terms of being non-responder to induction therapy, the sensitivity was 90,1%, the specificity was 25,3%. OS was shorter in those with high risk scores. This study makes an important contribution to the literature in terms of creating a different perspective to predict prognosis in AML.

No Abstract required

Objective: We present data of patients with relapsed/ refractory T cell lymphomas treated with brentuximab vedotin (BV) in real-world practice. Material and Method: This study is an observational, multi-center, retrospective study. The data of patients (n=17) treated with BV alone from January 2014 until July 2020 in thirteen centers from Turkey were collected. Results: Bv was given as salvage chemotherapy to 17 patients with median age of 53. Nine (52.9%) patients had diagnosis of peripheral T cell lymphoma, not otherwise specified; 8 (47.1%) patients had anaplastic large T cell lymphoma. The median follow-up of the cohort was 20 months. Nine (52.9%) patients had complete response, 5 (29.5%) had partial response, 3 (17.6%) had progressive disease. The safety results aligned with the established profile of BV, included 2 pneumonia and 1 thrombocytopenia with grade 4. The median progression free survival of the cohort was 10 months. BV cycle and response to BV therapy were found to have an effect on the univariate analysis. Conclusion: In patients with relapsed/ refractory T cell lymphomas, BV seems to have convincing antitumor activity with favorable safety profile.

Introduction: This study aimed to evaluate the results obtained with the preference of eltrombopag according to the line of treatment in patients diagnosed with ITP. Methods: This retrospective study included 51 patients who were treated with eltrombopag for chronic ITP at 3 different centers. Diagnosis of ITP was based on the current literature. Results: Thirty patients (58.8%) received eltrombopag as second-line treatment, 16 patients (31.4%) as third-line, 3 patients (5.9%) as fourth-line treatment, and 2 patients (3.9%) as fifth-line treatment. Twenty-four out of 30 patients (80%) who received eltrombopag as second-line therapy and 12 out of 16 patients who received eltrombopag as third-line therapy demonstrated durable response with no further treatment requirements. Eltrombopag treatment in the second or third line did not affect treatment outcomes (p=0.72). Conclusion: Eltrombopag in the second or third line of treatment did not have a significant effect on treatment response. The earlier line choice of eltrombopag, duration, and possibility of sustained response should be taken into consideration. The lack of a significant relationship between the line of treatment and response to eltrombopag as a TPO-RA should be considered encouraging in terms of long-term follow-up.

Introduction: Renal artery stenosis (RAS) is a clinical picture that is evaluated as a renovascular disorder and includes many diseases in its etiology. The primary purpose of the present study was to reveal the etiology of cases followed up in the nephrology outpatient clinic due to RAS; to describe their demographic, clinical, and radiological features; and investigate their treatment and prognosis. The second aim of the study was to investigate the relationship between isolated RAS cases that cannot be attributed to any etiological cause and Takayasu’s arteritis. Methods: Patients were included in retrospectively examining all patient files that were registered between January 1996 and 2018. Demographic data of the patients, date of diagnosis, initial physical examination findings, comorbid diseases, imaging findings, interventional and medical treatments, need for kidney replacement therapy, and time to hemodialysis/transplantation were recorded. Results: Out of the 17427 (8800 M/8627 F) patients, a total of 134 (70 M/64 F) patients aged over 18 years with RAS were included in the study; 60 (55%) patients had atherosclerotic RAS, whereas 23 (21.1%) patients were diagnosed with vasculitis. In total, 16 patients (13.5%) died with a mean of 6±3.4 years after admission. It was found that advanced age, low GFR at diagnosis, and small kidneys are significant and poor prognostic factors. Conclusion: A more systematic approach model can be developed in terms of applying “maximal medical treatment”, which is our approach that we can currently describe as incomplete in cases of RAS with an early atherosclerotic process.

Introduction: Leptin (LEP) and LEP receptor (LEPR) play roles in cancer progression. We evaluated LEP-2548G/A and LEPR 668 A/G variants in patients with multiple myeloma (MM). In addition, the methylation status of CpG sites at 31 and 51 nucleotides (nt) according to the transcription start region of the LEPgene was examined. Methods: DNA was extracted from the peripheral blood of study participants who were healthy controls and patients with MM. These variants were analyzed using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. The methylation at -31 and -51 nt in the LEPwas performed using the methylation-specific PCR method. The 2-year progression-free survival (PFS) and 2-year overall survival (OS) were evaluated according to prognostic factors. Results: There was no significant difference in the genotype distributions of LEPR 668A/G and LEP-2548G/A between the control and patient groups (p>0.05). We found that -31 and -51 nt regions of the LEP gene were unmethylated in the patient group compared with the control group (p=0.051 and p=0.001, respectively). The -31 nt methylation was unchanged in 15 patients (78.94%). PFS and OS were higher in these patients than in the others. In multivariate analysis, the methylated/unmethylated ratio at -31 nt methylation was associated with a poor prognosis (p=0.020). Conclusion: To our knowledge, our study is the first to examine these variants and their methylation status in Turkish patients with MM. Our results showed that LEP gene -31 nt unmethylation was associated with PFS and OS. These results need to be confirmed in different ethnic and larger sample groups.

Objective: Hepatitis C virus (HCV) infection still maintains its importance since it is one of the most important causes of liver cirrhosis and hepatocellular carcinoma. Our hospital, located in İstanbul, which is the 10t most crowded city in the world, has a patient cohort where epidemiological change can be observed due to its deep-rooted history and serving people of different nations in terms of settlement. Main aim in this study is to evaluate the change in HCV epidemiology in our country over the years. Methods: Patients who were at the age of 18 and above and whose HCV-RNA was positive between January 2001 and January 2021 were evaluated. Results: 1.166 patients whose HCV genotype was determined were evaluated. The mean age of the population is 52±14.75 years, 83.53% of all patients was infected with genotype 1 (GT1), 8.23% with GT3, 5.83% with GT2, 2.23% with GT4 and 0.17% of them with GT5. While the GT1 rate decreased in patients over the years, an increase was found in other GTs. GT1 and GT2 were more common in females (p

Background and aim: Leptin is mainly produced in adipose tissue and released into systemic circulation. Leptin and its receptor LEPR activate the Janus kinase/signal transducers and activators of transcription signaling cascade and increase cytokine discharge. In our study, we aimed to examine the role of leptin gene (LEP) rs7799039 and LEPR rs1137101 polymorphisms on the susceptibility for febrile neutropenia (FEN) attacks and their relationship with clinical findings during the course of FEN. Methods: This study included pediatric patients with a diagnosis of malignancy who applied to the pediatric emergency department between December 2019 and June 2022 and healthy controls. The genotypes of the LEP rs7799039 and LEPR rs1137101 genes were statistically compared between patients and healthy controls. In addition, the relationship between the genotype distribution of LEP rs7799039 and LEPR rs1137101 polymorphisms and clinical features during the course of FEN was investigated. Results: In the statistical analysis in terms of LEP rs7799039 and LEPR rs1137101 genotype distributions between the patient and healthy groups, there was no significant difference. Patients with the AA genotype of LEPR rs1137101 polymorphism had significantly more commonly a body mass index (BMI) value of

Introduction:Ruxolitinib is a small -molecule inhibitor of the JAK1/2 pathway. This study aimed to reveal the results and side-effect profile of the use of ruxolitinib as a treatment option in polycythemia vera (PV).Methods:A total of 34 patients with PV from 18 different centers were included in the study. The evaluation of the response under treatment with ruxolitinib was determined as a reduction in spleen volume (splenomegaly size: ≥35%) by imaging and control of hematocrit levels (≤45%) compared to baseline.Results:While the number of patients in which a reduction in spleen volume and hematocrit control was achieved was 19 (55.9%) at 3 months of treatment, it was 21 (61.8%) at 6 months. Additionally, while the number of side effects was negatively correlated with the reduction in spleen volume (Spearman’s rho: -0.365, p=0.034), a decrease in the hematocrit level was positively correlated (Spearman’s rho: 0.75, p=0.029). Those without a reduction in spleen volume experienced more constipation (chi-square: 5.988, Fisher’s exact test: p=0.033).Conclusion:This study shed light on the use of ruxolitinib in PV and the importance of splenomegaly on studies planned with larger patient groups.

Abstract Background Invasive pulmonary aspergillosis (IPA) is seen during coronavirus-2019 (COVID-19), has been reported in different incidences, and is defined as COVID-19-associated pulmonary aspergillosis (CAPA). Detection of galactomannan antigen is an important diagnostic step in diagnosing IPA. Enzyme-linked immunoassay (ELISA) is the most frequently used method, and lateral flow assay (LFA) is increasingly used with high sensitivity and specificity for rapid diagnosis. The present study aimed to compare the sensitivity of LFA and ELISA in the diagnosis of CAPA in COVID-19 patients followed in our hospital's ICU for pandemic (ICU-P). Methods This study included patients with a diagnosis of COVID-19 cases confirmed by polymerase chain reaction and were followed up in ICU-P between August 2021 and February 2022 with acute respiratory failure. The diagnosis of CAPA was based on the European Confederation of Medical Mycology (ECMM) and the International Society for Human and Animal Mycology 2020 (ECMM/ ISHAM) guideline. Galactomannan levels were determined using LFA and ELISA in serum samples taken simultaneously from the patients. Results Out of the 174 patients followed in the ICU-P, 56 did not meet any criteria for CAPA and were excluded from the analysis. The rate of patients diagnosed with proven CAPA was 5.7% (10 patients). A statistically significant result was obtained with LFA for the cut-off value of 0.5 ODI in the diagnosis of CAPA (p 0.05) and NPV was 98% (95% CI: 0.95–1.01, p

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.

Background: Gilteritinib (XOSPATA ®, 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: The purpose of this research was 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 that was held in Turkey starting in April 2020 (NCT03409081). Results: The research included 17 R/R AML patients who had received gilteritinib from a total of 7 centers. The most common adverse events were anemia and hypokalemia (7 patients, 41.2%). Grade 4 thrombocytopenia was observed in only one patient (5.9%), which led to permanent discontinuation of treatment. The overall response rate was 100%. 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

Background: We aimed to investigate the association of body mass index (BMI) with treatment response in patients with DLBCL Material and Methods: Seventy-nine DLBCL subjects were included in this study. Data about patient age, sex, serum LDH level, presence of B symptoms, IPI score, ECOG performance score, disease stage, extranodal involvement, and BMI values at diagnosis were retrieved by retrospective patient record review. Patients were staged according to Ann Arbor classification using CT and/or PET/CT findings, and the presence of B symptoms. Body mass index was calculated by dividing weight in kilograms by height in meters squared (kg/m2). Patients were divided into groups according to their BMI as underweight (BMI≤ 18.5 kg/m2), normal weight (BMI 18.5-25 kg/m2), overweight (BMI 25-30 kg/m2), and obese (BMI≥ 30 kg/m2), as defined by the World Health Organization. Results: Patients were divided into four groups according to their BMIs, but because there was only one patient in the underweight group, comparisons were performed between normal-weight, overweight, and obese patients. There was no statistically significant difference between these groups in terms of age, sex, serum LDH level, disease stage, presence of B symptoms, extranodal involvement, ECOG performance score, IPI score, and treatment response (p= 0.070, 0.704, 0.325, 0.464, 0.254, 0.152, 0.658, 0.620, and 0.947, respectively) Conclusion: In our study, we showed that BMI has no significant impact on treatment response in patients with DLBCL.

Background and Objectives: Neutrophil / lymphocyte (NLR) and thrombocyte / lymphocyte ratios (TLR) are also a guiding factors in the prognostic evaluation of infectious diseases. Another parameter to determine inflammation and prognosis is albumin. This study was aimed to determine whether TLR, NLR and neutrophil / albumin ratios (NAR) are effective in predicting the severity and course of Corona Virus Disease-2019 (COVID-19). Materials and Methods: In this retrospective and cross-sectional study, a total of 1597 patients who were admitted to our hospital between 15.03.2020- 1.06.2020, diagnosed with COVID-19 were evaluated. Results: In the estimation of the decision for hospitalization, TLR, NLR and NAR AUROC values were 0.596, 0.634, 0.602 for cutoff values 123.7, 2.3 and 839.5, respectively. In predicting mortality, TLR, NLR and NAR AURO sample size can be specified C values were 0.674, 0.821, 0.787 for cutoff values 168.1, 5.2 and 1303.4, respectively (p

Abstract Objective Studies on the genetic background of patients with multiple myeloma (MM) have been increasing; two important factors considered in such works are uncoupling protein-2 (UCP-2) and nuclear receptor subfamily 3 group C member 1 (NR3C1). We aim to reveal the association of MM with NR3C1 and UCP-2 gene polymorphisms. In this prospective study, 200 patients diagnosed between January 2009 and 2018 and 200 healthy individuals were included. For patients who had undergone autologous stem cell transplantation and control subjects, we statistically compared the CC, GC, and GG genotypes and the C and G alleles of the NR3C1 gene, as well as the AA, AG, and GG genotypes and the A and G alleles of the UCP-2 gene. Results While the AA genotype was significantly more common in the MM group (p = 0.001), the GG genotype was significantly more common in the control group (p = 0.016). Overall survival was found to be significantly shorter in patients with the UCP-2 GG genotype (p = 0.034). It was also found that having the GG genotype of the UCP-2 gene was a 2.48-fold risk factor for mortality. The fact that overall survival is significantly shorter in MM patients with the UCP-2 GG genotype and its definition as a risk factor for mortality have been put forward for the first time in the literature.

Abstract Background Multiple myeloma (MM) constitutes approximately 10% of hematological malignancies. Bisphosphonates have established themselves in solid organ metastasis and multiple myeloma lytic bone lesions by inhibiting osteoclast activation. Medication-related osteonecrosis of the jaw (MRONJ) emerges as an important complication. Investigating host-based factors, and developing personal risk factors gain importance in the development mechanism of MRONJ. We aimed to reveal the different genotype polymorphisms, and clinical effects of eNOS in patients with a diagnosis of MRONJ in MM patients. Methods Medical records and blood samples were collected from 60 MRONJ patients with MM and 60 healthy controls. Inclusion criteria was having an exposed maxillofacial bone for more than eight weeks, a history of bisphosphonates, and no history of radiation therapy for the jaws. eNOS G894T and intron 4 VNTR were calculated by polymerase chain reaction and/or restriction fragment length polymorphism. Results eNOS G894T and VNTR genotypes and alleles were compared statistically with the healthy control group. There was no significant difference between the two groups. In comparison between G894T and clinical parameters, aphthous stomatitis was more common in TT genotype, while DMFT > 3 was more common in TG-GG genotype (p = 0.035, 0.023). Conclusions eNOS induces osteogenesis in bone metabolism, with its regulatory effects on bone remodeling and also NO induced angiogenesis takes place indirectly with its protective effect on endothelial functions. We see that these polymorphisms affecting the entire process of bone remodeling and angiogenesis, especially mucosal damage, which is the triggering factor of MRONJ pathology, have been revealed in the MM patient group. Considering the MRONJ initiating factors, it is necessary to emphasize the importance of our study results. It should be seen as an important step for new studies towards MRONJ and its treatment.

Introduction:Multiple myeloma (MM) constitutes approximately 10% of hematological malignan-cies with abnormal proliferation of plasma cells, which causes an abnormal increase of monoclonal immunoglobulin light chains. We aim to examine our young myeloma cases’ data and compare light chain disease with other subtypes, which are known to have a worse prognosis in all age groups.Methods:Fifty-five MM patients diagnosed and treated between January 2010 and 2020 under 60 years old, were analyzed retrospectively. Their demographic data, laboratory, treatment subtypes, MM subtypes, CRAB findings (hypercalcemia, renal failure, anemia, and presence of lytic bone lesions), treatment, and responses to the first-line treatment were analyzed. The patients were divided into two groups, the light chain and other myeloma subgroups, and compared statistically.Results:Seventeen patients were female (30.9%), and 38 were male (69.1%). The median age was 54 (range: 34-59) years. The median duration of follow-up was 30 (range: 3-108) months. The MM sub-types examined were: immunoglobulin G (IgG)/Kappa 13 (23.6%), kappa light chain 10 (18.2%), lambda light chain 10 (18.2%), IgG/Lambda 9 (16.4%), IgA/Lambda 8 (14.5%), and IgA/Kappa 5 (9.1%). There was no significant difference between the two groups except for albumin and calcium values. In the other myeloma subtype group, albumin and calcium values were significantly lower (p

Waldenström’s macroglobulinaemia is a disease in the B lymphoproliferative diseases group with immunoglobin M monoclonality and may present with different clinical manifestations. A 52-year-old male patient presented with complaints of weight loss and shortness of breath. Computed tomography (CT) results revealed a mass with a malignant soft tissue density in the abdomen. In the thoracic images, free fluid of up to 130 mm was found between the pleural leaves on both sides. His biopsies from the abdominal mass and bone marrow were reported to be compatible with a lymphoplasmocytic lymphoma in the presence of plasmoid differentiation B cell neoplasia and a Waldenström clinic. Cyclophosphamide -adriamycin -vincristine -prednisolone regimen was used in the first cycle chemotherapy. Positron emission tomography/ CT imaging, which was performed on the 15th day after the second cycle of chemotherapy, showed that the patient’s tumour was stable in size, but metabolic partial regression was observed. Bortezomib-dexamethasone-rituximab regimen was planned because of the resistant chylothorax. The patient had a dramatic clinical response and the chylothorax regressed completely after the first cure treatment. Chylothorax is a rare clinical presentation with chyle in the pleural area. It has traumatic and non-traumatic causes. Non-traumatic causes are most frequently seen due to malignancies. Waldenström’s macroglobulinaemia has a very rare incidence, and the clinical association between Waldenström’s macroglobulinaemia and chylothorax is very interesting. Standard treatment regimens vary, but the response to treatment also varies. Our case was resistant to the first line treatment, but had a dramatic response to the bortezomib and rituximab-based treatment.

Introduction. Postoperative meningitis (POM) is an infection with high mortality and morbidity following central nervous system surgery due to trauma or tumor. Intrathecal/intraventricular (IT/IVT) antibiotic administrations have been considered as the last treatment options for multidrug-resistance (MDR) Gram-negative bacteria that do not respond to intravenous (IV) regimens. IT/IVT can bypass the blood-brain barrier, obtain a more effective antibiotic concentration in CSF, and reduce systemic side effects. We aimed to determine the characteristics of postoperative patients who were diagnosed with MDR POM during follow-up in our intensive care unit (ICU). Material and Methods. In this study, POM patients who were followed up in ICU after the central nervous system intervention between January 2016 and December 2019 and whose MDR Gram-negative bacteria were isolated from CSF were evaluated. As soon as the patients were diagnosed with POM, a catheter was inserted and treatment was started. Results. Microbiological eradication was achieved in 3 ± 0.8 days with 30 mg/day amikacin treatment in POM due to K. pneumoniae and 3.7 ± 1.95 days with colistin sodium 10 mg/day treatment in POM due to A. baumannii via IT/IVT catheter. IT/IVT treatment was utilized for a median of 10 days and continued until the defined cure criteria were achieved. While cure was achieved in 6 of 14 POM cases, 8 of them were exitus. Discussion and Conclusion. To avoid the severe consequences of postoperative meningitis, acting fast and adding IT/IVT methods to parenteral administration routes by considering the distribution of MDR microorganisms within the hospital while planning effective treatment will increase the clinical success.

Solitary plasmacytoma accounts for 3–5% of all plasma cell diseases. Our case is about 55 years old male patient, who presented with isolated nasopharyngeal mass. He was consulted to Ear, Nose and Throat Diseases clinic by the Internal Medicine clinic with the complaints of dyspnea and difficulty in swallowing. With an initial diagnosis of the nasopharyngeal tumor; endoscopic examination, magnetic resonance imaging (MR) and tomography show a mass starting from the nasopharynx and reaching the right nasal cavity. As a result of biopsy, CD20 (−), CD19 (−), CD138 (+), CD38 (+), kappa (+), lambda (−), cyclin D1 (−) stained kappa light chain clonal plasma cells were detected and he was referred to our hematology clinic. Systemic disease was excluded by positron emission tomography–computed tomography (PET/CT), biochemical examinations and bone marrow biopsy. Remission was achieved only with localized radiotherapy. Solitary plasmacytomas appear with different clinical findings depending on their location. The diagnosis can be made in case of pathological reveal of clonal plasma cell containing tumor, absence of any other lesions or multiple myeloma-related tissue organ damage, presence of no more than 10% monoclonal plasma cells in the bone marrow. Radiotherapy plays a major role for the treatment.