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The benefit of pre-transplant consolidation in patients with acute lymphoblastic leukemia (ALL) who achieved first complete remission (CR1) has not yet been clearly demonstrated. Here, we aimed to investigate the relationship between the treatments received before transplantation and transplant outcome in Ph-ALL patients who underwent myeloablative allo-HSCT in CR1.A total of 55, 32 (58.2%) men and 23 (41.8%) women, who underwent allo-HSCT with the diagnosis of Ph-ALL were evaluated retrospectively. All patients underwent to allo-HSCT with myeloablative conditioning regimen in the 1st CR from the available donor.In patients who received2 consolidation, the 2-year and 3-year OS was 69% and 65%, respectively, while the 2-year and 3-year OS was 39% and 26%, respectively, in those who received2 consolidation (P =.03). RFS was similar in both groups (P = .8). One year- NRM was found 28% in patients who received ≥ 2 consolidations, and 37% in patients who received2 consolidation (P =.06). L-asparaginase, high dose methotrexate, and cranial treatments given before transplantation had no effect on transplant outcomes (P.05).Contrary to the belief that pre-transplant consolidation is not beneficial in ALL patients who proceed with allo-HCST in CR1, our results showed that consolidation treatments reduce NRM and improve the survival.

Objectives:Myelodysplastic syndrome (MDS) is a clonal disease that progresses with cytopenias and has leukemia transformation. Allogeneic Stem Cell Transplantation (ASCT) is a curative treatment in MDS patients. However, to which patient group the ASCT transplant will be applied, the treatments to be given before, and the conditioning regimens applied during the transplant are among the controversial topics. In this study, it was aimed to evaluate MDS patients who were diagnosed and underwent ASCT in our unit.Materials and Methods:Forty-four MDS patients that were diagnosed at our center and underwent ASCT at Stem Cell Transplantation Unit between 1992 and 2016 were evaluated retrospectively.Results:Of the 44 patients included in the study, 31 were male (71%) and 13 were female (29%). The median age was 41 years, six patients (14%) were over 60 years old. Twenty-two of 31 patients with cytogenetic analysis were at high risk according to R-IPSS and nine patients were at intermediate risk. While complete response was observed in 32 patients (73%) after ASCT, engraftment was not achieved in 10 patients (22%). Two patients (5%) were not responsive to treatment. Mucositis developed in all patients and diarrhea developed in 39 patients (89%). The relationship of mucositis, diarrhea and engraftment kinetics with age (60 years), R-IPSS, HCT-Cl score and the type of conditioning regimen was not shown. While 1-year overall survival was 73%, 1-year non-relapse mortality was 71%. In univariate regression analysis, high risk disease category, use of myeloablative conditioning regimen, acute graft versus host disease caused statistically significant decrease in overall survival. In the multivariate analysis, none of the factors affected the overall survival.Conclusion:Long term and sustainable response rates were achieved even if transplantation related toxicities were common in our cohort of MDS patients who underwent ASCT.

Context The AETHERA trial reported an increased progression-free survival (PFS) when brentuximab vedotin (BV) was used as maintenance therapy in high-risk Hodgkin lymphoma (HL) after autologous stem cell transplantation (ASCT). Objective To determine the impact and safety of BV as maintenance after ASCT in real-world patients. Design Patients with relapsed/refractory HL started on BV consolidation therapy after ASCT due to high risk of relapse, between January 2016 and July 2019, from 25 institutions, were retrospectively analyzed. Setting All patients were followed by the bone marrow transplantation team of their hospital. Patients or Other Participants Seventy-five patients were included in the study. The median follow-up time was 26 months. The most common high-risk features were primary refractory or relapsed disease Interventions BV consolidation was initiated within 6 months of ASCT and administered at a dose of 1.8 mg/kg intravenous infusion over 30 min every 3 weeks for up to 16 cycles in an outpatient setting. Main Outcome Features The primary endpoint of the study was PFS; secondary endpoints were safety and overall survival (OS). Results At the time of analysis, 42 patients completed consolidation courses, and BV was discontinued in 33 patients. Fifty patients had an ongoing response (CR in 41, PR in six, and SD in three patients), 25 had progressed. Ten died in the follow-up, eight with progressive disease and two due to infection while in CR. The 2-years PFS and OS rates were 67.75% (95% CI:0.55–0.77) and 87.61% (95% CI:0.76–0.94), respectively. Seventeen patients (23%) received BV in the pre-ASCT treatment lines, and there was no survival difference between the BV naive and BV exposed groups. The most common adverse events were neutropenia (27%) and peripheral neuropathy (21%). Sixteen patients (21.3%) experienced grade 3 or 4 toxicity. BV was discontinued due to AE in 12 patients. Conclusions Consolidation with BV after ASCT can achieve a 2-year PFS of 67.75% (95% CI: 0.55–0.75) with an acceptable toxicity profile.

A number of modalities including both pharmaceutical and cell-based treatments have long been tested and developed to prevent and treat relapses after allogeneic stem cell transplantation (allo-HSCT). The ability of donor T cells to recognize antigenic structures on leukemic cell surfaces and destroy them is a well-known fact. Based on this fact, the idea of using donor T cells to contribute to the development of adoptive immunotherapy has emerged. Donor lymphocytes are easy to obtain and donor lymphocyte infusions (DLI) have a simple rational while this treatment modality is an effective example of cellular therapy. The group of chronic myeloid leukemia patients who are more likely to benefit from DLI include: a) patients in the chronic phase of hematologic relapse and b) patients with molecular/cytogenetic relapse. DLI appear to be an appropriate treatment option to be used in combination with conventional chemotherapy or hypomethylating agents in the treatment of post-allo-HSCT relapse for acute myeloid leukemia and myelodysplastic syndrome, if:) the burden of tumor is low b) the relapse is at a molecular level rather than an overt hematologic relapse c) the patient has favorable cytogenetic characteristics d) time interval between transplantation and relapse is relatively longer (>5 months) e) response could be obtained after salvage therapies. In the event that minimal residual disease (MRD) or increasing mixed chimerism is detected, prompt administration of DLI for prophylactic purposes without waiting for a manifest relapse, was found to be effective in inducing a full donor chimerism and overcoming MRD and eventually preventing a manifest relapse.

Iron overload is an adverse prognostic factor for patients undergoing hematopoietic stem cell transplantation (HSCT). In the HSCT setting, pretransplant and early posttransplant ferritin and transferrin saturation were found to be highly elevated due to high transfusion requirements. In addition to that, post-HSCT iron overload was shown to be related to infections, hepatic sinusoidal obstruction syndrome, mucositis, liver dysfunction, and acute graft-versus-host disease. Hyperferritinemia causes decreased survival rates in both pre- and posttransplant settings. Serum ferritin levels, magnetic resonance imaging, and liver biopsy are diagnostic tools for iron overload. Organ dysfunction due to iron overload may cause high mortality rates and therefore sufficient iron chelation therapy is recommended in this setting. In this review the management of iron overload in adult HSCT is discussed.Demir yüklenmesi, hematopoietik kök hücre nakli (HKHN) yapılan hastalarda görülen olumsuz prognostik göstergedir. Pretransplant ve erken posttransplant ferritin ve transferrin satürasyonlarının yüksekliği, transfüzyon ihtiyacına bağlıdır. Posttransplant demir yüklenmesi; enfeksiyonlar, hepatik sinüzoidal obstrüksiyon sendromu, mukozit, karaciğer disfonksiyonu ve akut graft versus host hastalığı ile ilişkili olarak bulunmuştur. Hiperferritinemi, pre ve posttransplant sağkalım oranlarında düşüklüğe neden olur. Demir yüklenmesinin tanısında serum ferritin düzeyleri, magnetik rezonans görüntüleme ve karaciğer biyopsisi kullanılır. Demir yüklenmesine bağlı organ disfonksiyonu yüksek mortalite oranlarıyla ilişkilidir ve bu durumda yeterli demir şelasyon tedavisi önerilmektedir. Bu derlemede erişkin HKHN’de demir yüklenmesine yaklaşım tartışılmıştır.

Introduction: Hemorrhagic cystitis (HC) is a serious and common complication of hematopoietic cell transplantation (HCT) affecting both allogeneic (alloHCT) and haploidentical HCT recipients. Early urinary bleeding after transplant is usually attributed to toxic effects of cyclophosphamide (Cy) or other agents used in the conditioning regimen or for graft-versus-host disease (GVHD) prevention. HC occurring beyond 3 to 4 weeks after HCT is usually attributed to BK polyoma virus or other viruses, e.g. cytomegalovirus or adenovirus. The aims of this study were to determine the incidence, risk factors, severity, morbidity pattern and toxicity of treatment, and outcome of HC in recipients of HSCT at a single tertiary transplant center. Methods: We analyzed all patients undergoing haploidentical (haploHCT) or MRD/MUD alloHCT at our bone marrow transplant unit from September 2012 through June 2019. In alloHCT group, 70% (n=205) of the patients received myeloablative conditioning consisted of Cy and only six patients (2%) received identical GVHD prevention with a post-transplant Cy-based regimen. Conversely; in haploHCT group, use of Cy-containing preparative regimen was not often (22.9 % (n=8)) but 77.1% (n=27) of the patients received post-transplant Cy. Grading of HC was based on the system used by Droller et al. and classified as grade I if the hematuria was microscopic and grade II if macroscopic. The presence of clots in the urine was regarded as grade III and obstructive uropathy with or without renal impairment as grade IV HC, respectively. All patients with a clinical diagnosis of HC had urine and blood analyzed for presence of BK virus by PCR. Results: A total of 328 HSCTs were performed during the study period, of which 169 (51.5%) alloHSCT from MUD, 124 (37.8%) alloHCT from MRD and 35 (10.7%) haploHCT. Baseline characteristics of the patients were similar among two groups with regarding to age, diagnosis, disease status and intensity of conditioning (Table 1). Hemorrhagic cystitis was diagnosed in 78 of 328 patients (23.8%) with a median follow up 7.4 months. Disease status at transplant, recipient age, cytomegalovirus antigenemia and the intensity of conditioning regimen were not associated with the development of HC. In addition, use of bone marrow versus peripheral blood had no influence on development of hemorrhagic cystitis (p=0.16). The incidence of HC was significantly higher in patients who received grafts from haploidentical donors compared to those receiving grafts from MRD/MUDs (54.3% (n=19) vs 20.1% (n=59), p Conclusion: Conditioning regimen is an important factor in the development of HC and its mechanism has been well described. In our study, we could not demonstrate the increased HC risk of conditioning regimens including cyclophosphamide. We also showed that cyclophosphamide in MAC had similar HC risk compared with RIC containing cyclophosphamide. BK virus was frequently found to be a risk factor for HC. In this retrospective analysis, BK virus was detected 45 patients out of 78 patients with HC and BK viruria was not associated with HC severity. Table 1 Disclosures Özcan: Amgen: Honoraria, Other: Travel support; Novartis: Research Funding; Celgene Corporation: Research Funding, Travel support; MSD: Research Funding; AbbVie: Other: Travel support, Research Funding; Jazz: Other: Travel support; Janssen: Other: Travel support, Research Funding; Takeda: Honoraria, Other: Travel support, Research Funding; Archigen: Research Funding; Roche: Other: Travel support, Research Funding; Bayer: Research Funding; Sanofi: Other: Travel support; Abdi Ibrahim: Other: Travel support; BMS: Other: Travel support. Beksac:Celgene: Speakers Bureau; Janssen: Research Funding, Speakers Bureau; Amgen: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Takeda: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau.

Introduction Several studies have attempted to describe the characteristics associated with Large granular lymphocytosis (LGL) lymphocytosis following allogeneic hematopoietic stem cell transplantation (allo-HSCT) and its clinical significance. The aim of current study to define the cumulative incidence of LGL lymphocytosis, to identify associations with transplant-related clinical parameters and to assess the impact on transplant related outcomes. Patients and Methods During a 14-year follow up period (2005-2017) in this unicentric cohort study, we identified 19 patients (2.8%) with a significant LGL lymphocytosis, among 667 consecutive adult patients who underwent allo-HSCT. Results A total of 19 (Female/ male: 10 [52.6 %]/ 9 [47.4 %]) patients included into the study met the morphological criteria for LGL lymphocytosis. The median onset of LGL lymphocytosis was 11.5 (2.1- 55.7) months and median lymphocyte count at the time of diagnosis of LGL lymphocytosis was 5400/ mL (5170- 8700/ mL). None of the patient showed palpable splenomegaly, and none of them had typical signs or symptoms of an autoimmune disease. GvHD, viral infections, disease relapse and loss of donor chimerism were excluded during lymphocytosis. Flow cytometry studies confirmed a T cell phenotype of LGLs in the majority of patients (n=12). Two patients presented with LGLs consistent with NK cells and seven showed properties of a mixed NK/T-cell lineage. A monoclonal LGL population of T-cell origin was identified in eight (42.1%) of these patients. None of the 19 patients experiencing LGL lymphocytosis had shown unexplained fever, night sweats, weight loss or lymphadenopathy suggestive of lymphoproliferative neoplasms. In subgroup analysis, we compared the OS of monoclonal and oligoclonal LGL lymphocytosis and 1-year-OS was longer but non-significantly in monoclonal LGL lymphocytosis group; 75 ± 1.6% vs. 44.4 ± 2.2%, respectively. Median PFS was 28.8 months in oligoclonal LGL lymphocytosis group and 8.3 months in monoclonal LGL lymphocytosis group but the number of patients in this group does not provide enough statistical power to confirm whether the differences in PFS were statistically significant. At the time of this report, 2 of 3 patients died of TRM (10.5%). Discussion In conclusion, we observed LGL lymphocytosis in 2.8 % of a large cohort of post allo-HSCT survivors. Regardless of clonality, all patients were clinically asymptomatic with respect to LGL lymphocytosis. Our data indicate that, even if monoclonal, post-transplantation LGL expansion may be considered as an expression of chronic stimulation triggered by GVHD or relapse of the disease rather than the result of a malignant transformation. Whether the presence of LGL expansion is the expression of a balanced chronic immune response with a possible effect after allogeneic HSCT should be evaluated in a larger cohort of patients.

Thrombotic episodes are far less common than bleeding complications after hematopoietic stem cell transplantation (HSCT). However, they lead to significant morbidity and mortality. These complications are classified into four groups, including venous thromboembolic events (VTE), catheter-induced thrombosis (CIT), transplant-associated thrombotic microangiopathy (TA-TMA) and sinusoidal obstruction syndrome (SOS) or veno-occlusive disease (VOD). The frequency of VTE is increased among patients undergoing HSCT due to some acquired conditions including underlying malignancy, infections, administration of myeloablative conditioning regimens and/or total body irradiation, prolonged hospitalizations leading to immobility and presence of central venous catheters. Central venous catheters provide a convenient long-term venous access during HSCT. But they may lead to VTE and related complications such as pulmonary embolism or post-thrombotic syndrome by inducing endothelial trauma and inflammation. TA-TMA is a heterogeneous, fatal disorder seen within 100days post-transplant and presents with thrombocytopenia, hemolysis, acute renal failure, mental status changes and involvement of other organs. SOS or VOD is another life threatening complication occuring within the first 35-40days following a myeloablative regimen and presents with painful hepatomegaly, weight gain and elevated serum bilirubin levels. In this review, we aimed to define the epidemiology, specific risk factors, prevention and management of each group of complications in view of the recent relevant literature.

Post-transplant erythrocytosis is an infrequent complication and has been reported after allogeneic hematopoietic stem cell transplantation (allo-HSCT) in aplastic anemia, acute myeloid leukemia, and chronic myeloid leukemia. The pre-disposing factors and treatment are not clearly defined. We present 11 post-transplant erythrocytosis cases. More studies should be conducted to distinguish the pathogenesis and follow-up for this rare complication.

Introduction In this study, our aim is to analyse the effect of conditioned with TBI on the outcome of DLI after allo-HSCT. Patients and Methods This retrospective study cohort included 152 patients treated with a total of 250 DLI for relapsed hematological malignancies after allo-HSCT from March 1991 through July 2018. Patients received myeloablative- (MA) (n=97 (63.8%)) or reduced-intensity (RI) (n=55 (36.2%)) conditioning regimens. TBI was administered at a total dose of 4 Gy/day for 3 days in MA regimens or 2 Gy/day for 1 day in RIC regimens. Results Thirty nine (25.7%) of 152 patients received TBI in conditioning regimen (Table 1). Median number of DLI was 1 (range, 1-5) in both groups. Seventy eight (20 (55.6%) and 58 (53.2%) in TBI and non-TBI group; p>0.1) patients developed acute grade II to IV GVHD. Chronic GVHD was occurred in 22 (51.2%; extensive in 4) and 52 (46%; extensive in 6) patients in TBI and non-TBI group (p=0.07). We could not demonstrate the lower doses of TBI associated with an increased risk of GVHD in TBI groups. Among all patients, 49 (32.2%) and 16 (10.5%) had relapse and/or progressive disease after DLI in non-TBI and TBI groups, respectively (p>0.1). The primary cause of death was relapse in both groups, whereas 5 (23.8%) and 11 (12.8%) patients died of TRM in TBI and non-TBI groups (p>0.1). The OS at 1 and 3 years were slightly higher in non-TBI group (Figure 1a). When analyzed according to the TBI doses, median OS is similar between two groups (Figure 1b). Discussion Irradiation is known to inhibit lymphocyte activity and consequently to reduce the incidence of GVHD in experimental models for allo-HSCT. In our study, acute and chronic GVHD incidence was similar in both groups but lower survival rate was seen in TBI group (p>0.1). Larger and prospective studies are warranted.

We describe a case of blastoid mantle cell lymphoma with a complex karyotype. The blastoid variant is a rare type of non-Hodgkin lymphoma exhibiting an aggressive clinical course. Mantle cell lymphoma is a distinct entity of mature B-cell neoplasms genetically characterized by the presence of t(11;14). In the present case, conventional analysis revealed structural abnormalities of chromosomes 2, 4, 6, 10, 13, and 19, along with 3 additional marker chromosomes. The derivative 1 chromosome determined in the case was a result of t(1p;11q). Our interesting finding was the presence of a different translocation between 11q and chromosome 1 in addition to t(11;14). Thus, the resulting 11q duplication was believed to additionally increase the enhanced expression of cyclin D1 gene, which is responsible in the pathogenesis of the disease. Fluorescence in situ hybridization method by the t(11;14) probe revealed clonal numerical abnormalities of chromosomes 11 and 14 in some cells. The detection of multiple abnormalities explains the bad prognosis in the present case. On the basis of our findings, we can easily conclude that results of cytogenetic analyses of similar mantle cell lymphoma patients would provide clues about new responsible gene regions and disease prognosis. In conclusion, it has been suggested that the presence of multiple chromosomal aberrations in addition to the specific t(11;14) may have a negative impact on clinical course and survival rate.Kompleks karyotipe sahip bir blastoid mantle hücreli lenfoma olgusunu sunuyoruz. Blastoid alt tip, saldırgan bir klinik seyre sahip olup, ender görülen bir Hodgkin dışı lenfoma alt tipidir. Mantle hücreli lenfoma ise, özellikle t(11;14) varlığı ile diğer B hücreli neoplazmlardan ayırt edilmektedir. Sunulan olguda geleneksel kromozom analizi sonrası 1, 2, 4, 6, 10, 13 ve 19. kromozomların yapısal anormalliklerine ek olarak 3 adet marker kromozom saptanmıştır. Hastamızda ayrıca, t(1p;11q) sonucunda oluşmuş türev 1. kromozom gözlenmiştir. Buradan hareketle, 11q bölgesinin, ilginç olarak t(11;14) haricinde 1. kromozom ile farklı bir translokasyona da katıldığını söyleyebiliriz. Bu nedenle ortaya çıkan 11q duplikasyonunun hastalığın oluşma sürecinden sorumlu tutulan siklin D1 geninin ifadelenmesini arttırdığı düşünülmektedir. Çalışma sırasında, floresan in situ melezleme yöntemi ile t(11;14) probu kullanılarak bazı hücrelerde klonal sayısal 11. ve 14. kromozom anormallikleri görüntülenmiştir. Çok sayıda kromozom bozukluğunun saptanmış olması olgumuzun kötü klinik gidişini açıklamaktadır. Hastamıza ilişkin bulgularımız ışığında, aynı tanıya sahip hasta grubunda yapılacak sitogenetik inceleme sonuçlarının yeni sorumlu gen bölgeleri hakkında ipuçları vereceği rahatlıkla söylenebilir. Sonuç olarak, hastamızda t(11;14) varlığına ek olarak çoklu kromozom bozukluklarının bulunmasının, klinik gidiş ve tedavi yanıtı üzerine olumsuz bir etki gösterdiği açıktır.

Objective: Venous, arterial, and microcirculatory events are frequently encountered in the clinical course of essential thrombocytosis and polycythemia vera. We aimed to investigate the levels of soluble endothelial protein C receptor (sEPCR) in myeloproliferative diseases to see whether there was a difference between the patients with and without history of thromboembolism. Materials and Methods: The study included patients with polycythemia vera (n=12), patients with essential thrombocytosis (n=13), and controls (n=29). In all groups, we measured proteins C and S, antithrombin and sEPCR levels, and plasma concentrations of thrombin-antithrombin complex, prothrombin fragments 1+2, and D-dimer. Results: Comparing the patients with and without history of thromboembolic attack, statistically significant differences were not observed in terms of sEPCR, D-dimer, thrombin-antithrombin complex, prothrombin fragments 1+2, and hematocrit levels (p=0.318, 0.722, 0.743, 0.324, and 0.065, respectively). Conclusion: Significant increase in the parameters that reflect activation of coagulation, such as sEPCR, thrombin-antithrombin complex, prothrombin fragments 1+2, and D-dimer, reflects the presence of a basal condition that leads to a tendency toward thrombosis development in ET and PV when compared to healthy controls.

Introduction Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is widely used to treat malignant and non-malignant hematological diseases.The impact of ABO mismatch on outcome following transplantation remains controversial.In this study, our aim is to define effects of ABO mismatch on engraftment, graft vs host disease, relapse free survival (RFS) and overall survival (OS) in patients who underwent allo-HSCT. Patients and Methods Between 1988 and 2016, we retrospectively identified 1016 patients who underwent allo-HSCT at Ankara University School of Medicine, Department of Hematology.Chi-square and FisherOs exact tests were used where appropriate in comparison.Cox regression model and Kaplan Meier curves were applied for survival analysis.P Results The median follow-up period was 34.7 months (range, 0.2-229).In our cohort, there were 420 (41.3%) ABO-mismatched transplants occurred including 167 (16.4%) major, 197 (19.4%) minor and 55 (5.4%) bidirectional mismatches.The pre-transplant characteristics of patients are summarized in Table.Allo-HSCTs from unrelated donors and peripheral blood grafts were detected higher in ABO mismatched patients vs ABO matched patients (28% vs 11%, P 1/128). Pure red cell aplasia was diagnosed in 5 (3%) major ABO mismatched patients.Major ABO mismatch (HR:1.46, 95% Cl:1.06-2.03;P=0.022) was found to be related with lower RFS and OS (HR:1.31, 95% Cl:1.06-1.62;P=0.013).3-year OS and 1-year RFS were lower with major ABO mismatch (38% vs 47%, P=0.02; 15% vs 24%; P=0.02) (Figure). Conclusion Engraftment failure was detected higher with ABO mismatch as well as major ABO mismatch was related with lower RFS and OS although the cohort is heterogeneous.Close monitoring and early treatment strategies for expectable complications would reduce the number fatal events by ABO mismatched allo-HSCT.

Objective: The accompanying thrombocytosis is referred to as the major factor associated with thromboembolism in iron deficiency anemia (IDA). Increased viscosity may increase the risk of thrombosis. We hypothesized that increased platelet count -with reactive thrombocytosis- might also affect plasma viscosity. We planned to evaluate the influence of normal and high platelet count on plasma viscosity in IDA patients. Material and Methods: The patient population consisted of fifty-three newly diagnosed and untreated women aged between 18 and 62 years with IDA. Group 1 consisted of 33 patients, platelet levels below 400 x 109/L. Group 2 consisted of 20 patients, platelet levels above 400 x 109/L. Measurements of plasma viscosity were performed using Brookfield viscometer. Results: Mean plasma viscosity was found as 1.05 ± 0.08 mPa.s. in Group 1, and 1.03 ± 0.06 mPa.s. in Group 2. Mean plasma viscosity was not statistically different. White blood cell count was significantly higher in Group 2. Vitamin B12 levels were significantly higher in Group 2, while folic acid levels were higher in Group 1 (p=0.011 and p=0.033). Plasma viscosity was correlated with erythrocyte sedimentation rate (r=0.512 p=0.002) in Group 1 and inversely correlated with vitamin B12 (r=−0.480 p=0.032) in Group 2. Conclusion: Despite the significant difference between groups in terms of platelet count, no significant difference was detected in plasma viscosity and this finding could be explained as the following; 1-These platelets were not thrombocythemic platelets; 2-Similar to the theory about leukocytes, higher platelet counts – even non-thrombocythemic – may increase plasma viscosity; 3-Evaluating platelet count alone is not sufficient and the associating red-cell deformability should also be taken into account; and 4-Although other diseases that could affect viscosity are excluded, some definitely proven literature criteria such as fibrinogen, hyperlipidemia, and the inflammatory process should also be evaluated by laboratory and clinical measures.

BACKGROUND: RBC transfusions should be based on Hb content of the products instead of units. As high as a 50-percent difference in Hb content can be encountered between two units. In this study, 500 mL of whole blood (WB)-generated RBCs according to their total Hb content was used to decrease the number of units ordered by using a new software called Hemosoft. STUDY DESIGN AND METHODS: Fifty-one con- secutive patients were enrolled for the study. The median age and male-to-female ratio were 38 (range, 16-69) and 28:23, respectively. Patients’ diagnoses were 38 acute leukemia, 11 lymphoma, and 2 multiple myeloma. When placing orders for RBCs, clinicians were asked to send the information about patient's actual body weight (ABW) and their actual and target Hb. The total blood volume of the recipient was calculated, and the aim was to find the best RBCs from the inventory to decrease two-unit orders to one unit, or four units to two or one unit, all done using Hemosoft. Posttransfusion Hb was checked 2 hours after transfusion. ABW and the median pretransfusion Hb level were 64 kg (range, 40-100) and 7.3 g per dL (5.6-9.8), respectively. RESULTS: A total of 104 RBC units were ordered for 51 patients. In 49 (96.1%), the order was for two units and in 2 (3.9%) was for three units. Hemosoft successfully found a suitable match in 62.7 percent (32/51) of the orders. Actual number of RBCs transfused was two units (41.25) and one unit (58.8%), respectively. In total, 72 units were transfused with a reduction of 30 percent (72/104) from the original order. The median target Hb level was 9.3 g per dL (range, 7.0-11.3) and overall success rate to achieve it was 96.6 percent (range, 73.8-124.2). There was no impact of inventory size, but the ABW of the recipient was found significant to have a successful match unit (58.8 ± 11.0 kg vs. 75.0 ± 8.4 kg, respectively; p = 0.0001). CONCLUSION: We clearly demonstrated that the number of RBC transfusions could be minimized by the rational use of the Hb content of the units. Although the total numbers of patients who shall benefit from this approach seems to be limited, it allows us to use high-Hb-content units rationally by using an in-house blood-banking software.

Posterior reversible encephalopathy syndrome (PRES) is an acute neuroradiological diagnosis presenting with headache, vomiting, seizure, abnormalities of the mental status, and visual disturbances associated with a breakdown in cerebral vasculature regulation. It has a unique neuroradiological pattern of symmetrical parietooccipital vasogenic edema [1]. The most common causes of this syndrome are sudden arterial hypertension, preeclampsia, eclampsia, uremia, immunosuppressive drugs, and cancer chemotherapies such as cyclosporine, tacrolimus, L-asparaginase, vincristine, gemcitabine, cytarabine, and cisplatin, typically used in cases of hematopoietic malignancies [2,3,4,5,6,7]. Intrathecal methotrexate-induced PRES in an adult is exceedingly rare [8]. A 43-year-old woman was admitted to gynecology with metrorrhagia. Cervical cancer was diagnosed and radical hysterectomy with lymph node dissection was performed. Final pathology and immunohistochemical analyses revealed B-cell phenotype malign lymphoma, which is consistent with Burkitt lymphoma. A chemotherapy treatment protocol with R-Hyper CVAD, consisting of rituximab, cyclophosphamide, vincristine, adriamycin, and dexamethasone plus 12 mg of intrathecal methotrexate without preservative, was then started. Twelve days after chemotherapy she had severe analgesic-irresponsive headache, nausea, motor agitation, and cooperation failure. Her vital signs and laboratory findings were normal. Cranial computed tomography revealed hypodense areas due to edema in the bilateral cerebral hemispheres, predominantly in the posterior regions. Magnetic resonance imaging (MRI) of the brain showed multiple confluent hyperintense lesions in T2-weighted and fluid-attenuated inverse recovery (FLAIR) sequences (Figure 1a), with no contrast enhancement in T1-weighted sequences. PRES was diagnosed and she was admitted to the intensive care unit (ICU) because of decreased alertness and agitation. Intrathecal methotrexate treatment was discontinued. On the second day in the ICU her blood pressure rose and was then normalized by diltiazem infusion. On the third day in the ICU, myoclonic jerks were seen in all extremities. Levetiracetam was started. Myoclonic symptoms were no longer observed. After treatment she had no neurological symptoms. Three weeks later, cranial MRI showed significantly improved brain lesions (Figure 1b). The 6-month follow-up was uneventful. Informed consent was obtained. Figure 1a MRI FLAIR images show bilateral multiple subcortical and cortical hyperintense lesions. Figure 1b MRI images 3 weeks after developing PRES revealed significant improvement. During chemotherapy for hematopoietic malignancies, possible causes of neurological symptoms (cerebrovascular disease, metabolic disturbances, neoplasia, and infections) must be excluded by clinical, biological, and imaging findings. During chemotherapy, various types of anticancer drugs are administered, and it is difficult to identify which drug induces PRES. In our case, intrathecal methotrexate treatment was stopped, and the patient’s symptoms were relieved and did not reoccur while her treatment was continued with other anticancer drugs. In treatment, the causal factor must be discontinued. The treatment of overdose of intrathecal methotrexate is dilution and removal from the cerebrospinal fluid with specific antidotal therapy. Leucovorin and anti-inflammatory agents are useful [9]. Although PRES is usually reversible with patient recovery and resolution of the imaging findings, it might be recurrent or result in permanent damage [10,11].

A 50-year-old man presented to our dermatologydepartment with a 1-day history of bluish-purple tenderplaques on his thighs. The patient was on the secondcycle of consolidation chemotherapy for acute myeloidleukaemia (AML) secondary to myelodysplastic syn-drome (MDS), and had neutropenia as a result of thistreatment. He was on intravenous vancomycin andimipenem for the treatment of methicillin-resistantcoagulase-negative staphylococcal bacteraemia. Onphysical examination, purple plaques were found overthe patient’s left lateral thigh and on the medial rightthigh without fluctuation (Fig. 1). The plaques wereextremely tender to light touch, but there were no signsof sepsis. Axillary temperature was 37.4 C, heartrate was 88 beats ⁄min, and blood pressure was110 ⁄75 mmHg. Incisional biopsy specimens wereobtained from the plaques on the right and left thighs.