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Background: In a phase 1b study, intravenous daratumumab plus pomalidomide and dexamethasone induced a very good partial response or better rate of 42% and was well tolerated in patients with heavily pretreated multiple myeloma. We aimed to evaluate whether daratumumab plus pomalidomide and dexamethasone would improve progression-free survival versus pomalidomide and dexamethasone alone in patients with previously treated multiple myeloma. Methods: In this ongoing, open-label, randomised, phase 3 trial (APOLLO) done at 48 academic centres and hospitals across 12 European countries, eligible patients were aged 18 years or older, had relapsed or refractory multiple myeloma with measurable disease, had an Eastern Cooperative Oncology Group performance status of 0–2, had at least one previous line of therapy, including lenalidomide and a proteasome inhibitor, had a partial response or better to one or more previous lines of antimyeloma therapy, and were refractory to lenalidomide if only one previous line of therapy was received. Patients were randomly assigned (1:1) by an interactive web-response system in a random block size of two or four to receive pomalidomide and dexamethasone alone or daratumumab plus pomalidomide and dexamethasone. Randomisation was stratified by number of previous lines of therapy and International Staging System disease stage. All patients received oral pomalidomide (4 mg, once daily on days 1–21) and oral dexamethasone (40 mg once daily on days 1, 8, 15, and 22; 20 mg for those aged 75 years or older) at each 28-day cycle. The daratumumab plus pomalidomide and dexamethasone group received daratumumab (1800 mg subcutaneously or 16 mg/kg intravenously) weekly during cycles 1 and 2, every 2 weeks during cycles 3–6, and every 4 weeks thereafter until disease progression or unacceptable toxicity. The primary endpoint was progression-free survival in the intention-to-treat population. Safety was analysed in all patients who received at least one dose of study medication. This trial is registered with ClinicalTrials.gov, NCT03180736. Findings: Between June 22, 2017, and June 13, 2019, 304 patients (median age 67 years [IQR 60–72]; 161 [53%] men and 143 [47%] women) were randomly assigned to the daratumumab plus pomalidomide and dexamethasone group (n=151) or the pomalidomide and dexamethasone group (n=153). At a median follow-up of 16·9 months (IQR 14·4–20·6), the daratumumab plus pomalidomide and dexamethasone group showed improved progression-free survival compared with the pomalidomide and dexamethasone group (median 12·4 months [95% CI 8·3–19·3] vs 6·9 months [5·5–9·3]; hazard ratio 0·63 [95% CI 0·47–0·85], two-sided p=0·0018). The most common grade 3 or 4 adverse events were neutropenia (101 [68%] of 149 patients in the daratumumab plus pomalidomide and dexamethasone group vs 76 [51%] of 150 patients in the pomalidomide and dexamethasone group), anaemia (25 [17%] vs 32 [21%]), and thrombocytopenia (26 [17%] vs 27 [18%]). Serious adverse events occurred in 75 (50%) of 149 patients in the daratumumab plus pomalidomide and dexamethasone group versus 59 (39%) of 150 patients in the pomalidomide and dexamethasone group; pneumonia (23 [15%] vs 12 [8%] patients) and lower respiratory tract infection (18 [12%] vs 14 [9%]) were most common. Treatment-emergent deaths were reported in 11 (7%) patients in the daratumumab plus pomalidomide and dexamethasone group versus 11 (7%) patients in the pomalidomide and dexamethasone group. Interpretation: Among patients with relapsed or refractory multiple myeloma, daratumumab plus pomalidomide and dexamethasone reduced the risk of disease progression or death versus pomalidomide and dexamethasone alone and could be considered a new treatment option in this setting. Funding: European Myeloma Network and Janssen Research and Development. © 2021 Elsevier Ltd

Background As lenalidomide becomes increasingly established for upfront treatment of multiple myeloma, patients refractory to this drug represent a population with an unmet need. The combination of pomalidomide, bortezomib, and dexamethasone has shown promising results in phase 1/2 trials of patients with relapsed or refractory multiple myeloma. We aimed to assess the efficacy and safety of this triplet regimen in patients with relapsed or refractory multiple myeloma who previously received lenalidomide. Methods We did a randomised, open-label, phase 3 trial at 133 hospitals and research centres in 21 countries. We enrolled patients (aged >= 18 years) with a diagnosis of multiple myeloma and measurable disease, an Eastern Cooperative Oncology Group performance status of 0-2, who received one to three previous regimens, including a lenalidomide-containing regimen for at least two consecutive cycles. We randomly assigned patients (1:1) to bortezomib and dexamethasone with or without pomalidomide using a permutated blocked design in blocks of four, stratified according to age, number of previous regimens, and concentration of beta(2) microglobulin at screening. Bortezomib (1.3 mg/m(2)) was administered intravenously until protocol amendment 1 then either intravenously or subcutaneously on days 1,4, 8, and 11 for the first eight cycles and subsequently on days 1 and 8. Dexamethasone (20 mg [10 mg if age >75 years]) was administered orally on the same days as bortezomib and the day after. Patients allocated pomalidomide received 4 mg orally on days 1-14. Treatment cycles were every 21 days. The primary endpoint was progression-free survival in the intention-to-treat population, as assessed by an independent review committee. Safety was assessed in all patients who received at least one dose of study medication. This trial is registered at ClinicalTrials.gov, number NCT01734928; patients are no longer being enrolled. Findings Between Jan 7, 2013, and May 15,2017,559 patients were enrolled. 281 patients were assigned pomalidomide, bortezomib, and dexamethasone and 278 were allocated bortezomib and dexamethasone. Median follow-up was 15.9 months (IQR 9.9-21.7). Pomalidomide, bortezomib, and dexamethasone significantly improved progression-free survival compared with bortezomib and dexamethasone (median 11.20 months [95% CI 9.66-13-73] vs 7.10 months [5.88-8-48]; hazard ratio 0.61, 95% CI 0.49-0-77; p

In the randomized phase-3 OPTIMISMM study, the addition of pomalidomide to bortezomib and low-dose dexamethasone (PVd) resulted in significant improvement in progression-free survival (PFS) in lenalidomide-pretreated patients with relapsed or refractory multiple myeloma (RRMM), including lenalidomide refractory patients. Here, we report health-related quality of life (HRQoL) results from this trial. Patients received PVd or Vd in 21-day cycles until disease progression or discontinuation. HRQoL was assessed using the EORTC QLQ-C30, QLQ-MY20, and EQ-5D-3L instruments on day 1 of each treatment cycle. Mean score changes for global QoL, physical functioning, fatigue, side effects of treatment domains, and EQ-5D-3L index were generally stable over time across treatment arms. The proportion of patients who experienced clinically meaningful worsening in global QoL and other domains of interest was similar. These HRQoL results with PVd along with previously demonstrated improvement in PFS vs Vd continue to support its use in patients with RRMM. © 2020 Informa UK Limited, trading as Taylor & Francis Group.

The present study investigated the efficacy and safety profile of daratumumab monotherapy in 42 patients with relapsed refractory multiple myeloma through a Turkish early access program. The current findings have confirmed the efficacy of daratumumab monotherapy in heavily pretreated patients with refractory multiple myeloma because of the deep and durable responses and favorable safety and tolerability profile. Background: In countries where frontline drug approval is limited to first-generation proteasome inhibitors or immunomodulatory drugs, relapses have been both more frequent and less durable. We investigated real world data on the efficacy and safety of daratumumab monotherapy among patients with relapsed refractory multiple myeloma (RRMM) from Turkey using a prospective early access program. Patients and Methods: A total of 42 patients with RRMM after a minimum of 3 previous lines of proteasome inhibitor/immunomodulatory drug-based treatments were included from 25 centers across Turkey. Daratumumab monotherapy was administered intravenously at a dose of 16 mg/kg weekly (cycles 1-2), on alternate weeks (cycles 3-6), and monthly thereafter. Results: The median daratumumab monotherapy duration was 5.5 months (range, 0.2-28.7 months). The overall response rate was 45.2%, including 14 (33.3%) partial responses, 4 (9.5%) very good partial responses, and 1 (2.4%) complete response. The median duration of response was 4.9 months. The median progression-free survival (PFS) was 5.5 (95% confidence interval, 2.6-8.4 months) with 12- and 18-month PFS rates of 35.7% and 31.0%, respectively. The median overall survival was not reached; the 12- and 18-month overall survival rates were 64.3% and 59.5%, respectively. The depth of response had a significant effect on PFS (log-rank test, P = .026). Overall, of the 76 adverse events reported, 33 (43.4%) were grade >= 3; only 4 (9.52%) were grade 3 infusion-related reactions. No infusion-related reactions or adverse events led to treatment discontinuation. Conclusion: The present findings from our daratumumab early access program have confirmed the efficacy and safety profile of daratumumab monotherapy in heavily pretreated Turkish patients with RRMM. C1 [Beksac, Meral; Ilhan, Osman] Ankara Univ, Dept Hematol, Fac Med, Ankara, Turkey. [Aydin, Yildiz] Istanbul Univ, Dept Hematol, Cerrahpasa Fac Med, Istanbul, Turkey. [Goker, Hakan] Hacettepe Univ, Dept Hematol, Fac Med, Ankara, Turkey. [Turgut, Mehmet] Ondokuz Mayis Univ, Dept Hematol, Fac Med, Samsun, Turkey. [Besisik, Sevgi Kalayoglu] Istanbul Univ, Dept Hematol, Istanbul Fac Med, Istanbul, Turkey. [Cagirgan, Seckin] Med Pk Hosp, Dept Hematol, Izmir, Turkey. [Tuglular, Tulin] Marmara Univ, Dept Hematol, Fac Med, Istanbul, Turkey. [Vural, Filiz] Ege Univ, Dept Hematol, Fac Med, Izmir, Turkey. [Yagci, Munci] Gazi Univ, Dept Hematol, Fac Med, Ankara, Turkey. [Alacacioglu, Inci] Dokuz Eylul Univ, Dept Hematol, Fac Med, Izmir, Turkey. [Aytan, Pelin; Ozdogu, Hakan; Solmaz, Soner] Adana Baskent Hosp, Dept Hematol, Adana, Turkey. [Goksoy, Hasan Sami] Sisli Florence Nightingale Hosp, Dept Hematol, Istanbul, Turkey. [Gulbas, Zafer] Kocaeli Private Anadolu Med Ctr, Dept Hematol, Kocaeli, Turkey. [Gunes, Ahmet Kursad] Ankara Numune Training & Res Hosp, Dept Hematol, Ankara, Turkey. [Gurkan, Emel; Paydas, Semra] Cukurova Univ, Dept Hematol, Fac Med, Adana, Turkey. [Hacioglu, Sibel Kabukcu] Pamukkale Univ, Dept Hematol, Fac Med, Denizli, Turkey. [Karti, Suleyman Sami] Atakent Acibadem Hosp, Dept Hematol, Istanbul, Turkey. [Kaynar, Leylagul] Erciyes Univ, Dept Hematol, Fac Med, Kayseri, Turkey. [Sonmez, Mehmet] Karadeniz Tech Univ, Dept Hematol, Fac Med, Trabzon, Turkey. [Tekgunduz, Emre] Ankara Dr Abdurrahman Yurtaslan Oncol Training &, Dept Hematol, Ankara, Turkey. [Yildirim, Rahsan] Ataturk Univ, Dept Hematol, Fac Med, Erzurum, Turkey.

Background: As lenalidomide becomes increasingly established for upfront treatment of multiple myeloma, patients refractory to this drug represent a population with an unmet need. The combination of pomalidomide, bortezomib, and dexamethasone has shown promising results in phase 1/2 trials of patients with relapsed or refractory multiple myeloma. We aimed to assess the efficacy and safety of this triplet regimen in patients with relapsed or refractory multiple myeloma who previously received lenalidomide. Methods: We did a randomised, open-label, phase 3 trial at 133 hospitals and research centres in 21 countries. We enrolled patients (aged ≥18 years)with a diagnosis of multiple myeloma and measurable disease, an Eastern Cooperative Oncology Group performance status of 0–2, who received one to three previous regimens, including a lenalidomide-containing regimen for at least two consecutive cycles. We randomly assigned patients (1:1)to bortezomib and dexamethasone with or without pomalidomide using a permutated blocked design in blocks of four, stratified according to age, number of previous regimens, and concentration of β2 microglobulin at screening. Bortezomib (1·3 mg/m2)was administered intravenously until protocol amendment 1 then either intravenously or subcutaneously on days 1, 4, 8, and 11 for the first eight cycles and subsequently on days 1 and 8. Dexamethasone (20 mg [10 mg if age >75 years])was administered orally on the same days as bortezomib and the day after. Patients allocated pomalidomide received 4 mg orally on days 1–14. Treatment cycles were every 21 days. The primary endpoint was progression-free survival in the intention-to-treat population, as assessed by an independent review committee. Safety was assessed in all patients who received at least one dose of study medication. This trial is registered at ClinicalTrials.gov, number NCT01734928; patients are no longer being enrolled. Findings: Between Jan 7, 2013, and May 15, 2017, 559 patients were enrolled. 281 patients were assigned pomalidomide, bortezomib, and dexamethasone and 278 were allocated bortezomib and dexamethasone. Median follow-up was 15·9 months (IQR 9·9–21·7). Pomalidomide, bortezomib, and dexamethasone significantly improved progression-free survival compared with bortezomib and dexamethasone (median 11·20 months [95% CI 9·66–13·73]vs 7·10 months [5·88–8·48]; hazard ratio 0·61, 95% CI 0·49–0·77; p

Therapeutic plasma exchange (TPE) is used to treat more than 60 diseases worldwide and has drawn growing interest. Little is known about the current situation of TPE activity in Turkey, so we developed a survey to obtain information about this timely topic. We collected data on TPE from 28 apheresis units throughout Turkey. We performed a total of 24,912 TPE procedures with 3203 patients over the past decade. Twenty years ago, the majority of procedures were performed for neurological and hematological disorders, and today, most TPE procedures are done for the same reasons. The only historical change has been an increase in TPE procedures in renal conditions. Currently, renal conditions were more frequently an indication for TPE than rheumatic conditions. Fresh frozen plasma was the most frequently used replacement fluid, followed by 5% albumin, used in 57.9% and 34.6% of procedures, respectively. The most frequently used anticoagulants in TPE were ACD-A and heparin/ACD-A, used with 1671 (52.2%) and 1164 (36.4%) patients, respectively. The frequency of adverse events (AEs) was 12.6%. The most common AEs were hypocalcemia-related symptoms, hypotension, and urticaria. We encountered no severe AEs that led to severe morbidity and mortality. Overall, more than two thirds of the patients showed improvement in the underlying disease. Here, we report on a nationwide survey on TPE activity in Turkey. We conclude that there has been a great increase in apheresis science, and the number of TPE procedures conducted in Turkey has increased steadily over time. Finally, we would like to point out that our past experiences and published international guidelines were the most important tools in gaining expertise regarding TPE. © 2019 Elsevier Ltd

IMPORTANCE Herpes zoster, a frequent complication following autologous hematopoietic stem cell transplantation (HSCT), is associated with significant morbidity. A nonlive adjuvanted recombinant zoster vaccine has been developed to prevent posttransplantation zoster. OBJECTIVE To assess the efficacy and adverse event profile of the recombinant zoster vaccine in immunocompromised autologous HSCT recipients. DESIGN, SETTING, AND PARTICIPANTS Phase 3, randomized, observer-blinded study conducted in 167 centers in 28 countries between July 13, 2012, and February 1, 2017, among 1846 patients aged 18 years or older who had undergone recent autologous HSCT. INTERVENTIONS Participants were randomized to receive 2 doses of either recombinant zoster vaccine (n=922) or placebo (n=924) administered into the deltoid muscle; the first dose was given 50 to 70 days after transplantation and the second dose 1 to 2 months thereafter. MAIN OUTCOMES AND MEASURES The primary end point was occurrence of confirmed herpes zoster cases. RESULTS Among 1846 autologous HSCT recipients (mean age, 55 years; 688 [37%] women) who received 1 vaccine or placebo dose, 1735 (94%) received a second dose and 1366 (74%) completed the study. During the 21-month median follow-up, at least 1 herpes zoster episode was confirmed in 49 vaccine and 135 placebo recipients (incidence, 30 and 94 per 1000 person-years, respectively), an incidence rate ratio (IRR) of 0.32 (95% CI, 0.22-0.44; P

Therapeutic plasma exchange (TPE) is used to treat more than 60 diseases worldwide and has drawn growing interest. Little is known about the current situation of TPE activity in Turkey, so we developed a survey to obtain information about this timely topic. We collected data on TPE from 28 apheresis units throughout Turkey. We performed a total of 24,912 TPE procedures with 3203 patients over the past decade. Twenty years ago, the majority of procedures were performed for neurological and hematological disorders, and today, most TPE procedures are done for the same reasons. The only historical change has been an increase in TPE procedures in renal conditions. Currently, renal conditions were more frequently an indication for TPE than rheumatic conditions. Fresh frozen plasma was the most frequently used replacement fluid, followed by 5% albumin, used in 57.9% and 34.6% of procedures, respectively. The most frequently used anticoagulants in TPE were ACD-A and heparin/ACD-A, used with 1671 (52.2%) and 1164 (36.4%) patients, respectively. The frequency of adverse events (AEs) was 12.6%. The most common AEs were hypocalcemia-related symptoms, hypotension, and urticaria. We encountered no severe AEs that led to severe morbidity and mortality. Overall, more than two thirds of the patients showed improvement in the underlying disease. Here, we report on a nationwide survey on TPE activity in Turkey. We conclude that there has been a great increase in apheresis science, and the number of TPE procedures conducted in Turkey has increased steadily over time. Finally, we would like to point out that our past experiences and published international guidelines were the most important tools in gaining expertise regarding TPE.

Background: Isatuximab is a monoclonal antibody that binds a specific epitope on the human CD38 receptor and has antitumour activity via multiple mechanisms of action. In a previous phase 1b study, around 65% of patients with relapsed and refractory multiple myeloma achieved an overall response with a combination of isatuximab with pomalidomide and low-dose dexamethasone. The aim of this study was to determine the progression-free survival benefit of isatuximab plus pomalidomide and dexamethasone compared with pomalidomide and dexamethasone in patients with relapsed and refractory multiple myeloma. Methods: We did a randomised, multicentre, open-label, phase 3 study at 102 hospitals in 24 countries in Europe, North America, and the Asia-Pacific regions. Eligible participants were adult patients with relapsed and refractory multiple myeloma who had received at least two previous lines of treatment, including lenalidomide and a proteasome inhibitor. Patients were excluded if they were refractory to previous treatment with an anti-CD38 monoclonal antibody. We randomly assigned patients (1:1) to either isatuximab 10 mg/kg plus pomalidomide 4 mg plus dexamethasone 40 mg (20 mg for patients aged ≥75 years), or pomalidomide 4 mg plus dexamethasone 40 mg. Randomisation was done using interactive response technology and stratified according to the number of previous lines of treatment (2–3 vs >3) and age (

Therapeutic plasma exchange (TPE) is used to treat more than 60 diseases worldwide and has drawn growing interest. Little is known about the current situation of TPE activity in Turkey, so we developed a survey to obtain information about this timely topic. We collected data on TPE from 28 apheresis units throughout Turkey. We performed a total of 24,912 TPE procedures with 3203 patients over the past decade. Twenty years ago, the majority of procedures were performed for neurological and hematological disorders, and today, most TPE procedures are done for the same reasons. The only historical change has been an increase in TPE procedures in renal conditions. Currently, renal conditions were more frequently an indication for TPE than rheumatic conditions. Fresh frozen plasma was the most frequently used replacement fluid, followed by 5% albumin, used in 57.9% and 34.6% of procedures, respectively. The most frequently used anticoagulants in TPE were ACD-A and heparin/ACD-A, used with 1671 (52.2%) and 1164 (36.4%) patients, respectively. The frequency of adverse events (AEs) was 12.6%. The most common AEs were hypocalcemia-related symptoms, hypotension, and urticaria. We encountered no severe AEs that led to severe morbidity and mortality. Overall, more than two thirds of the patients showed improvement in the underlying disease. Here, we report on a nationwide survey on TPE activity in Turkey. We conclude that there has been a great increase in apheresis science, and the number of TPE procedures conducted in Turkey has increased steadily over time. Finally, we would like to point out that our past experiences and published international guidelines were the most important tools in gaining expertise regarding TPE. C1 [Korkmaz, Serdal] Univ Hlth Sci, Kayseri Training & Res Hosp, Dept Hematol, Kayseri, Turkey. [Medeni, Serife Solmaz] Univ Hlth Sci, Bozyaka Training & Res Hosp, Dept Hematol, Izmir, Turkey. [Demirkan, Fatih] Dokuz Eylul Univ, Dept Internal Med, Div Hematol, Fac Med,HCT Unit, Izmir, Turkey. [Besisik, Sevgi Kalayoglu; Dadin, Senem Altay] Istanbul Univ, Istanbul Fac Med, Dept Internal Med, Div Hematol, Istanbul, Turkey. [Cagliyan, Gulsum Akgun; Hacioglu, Sibel Kabukcu; Sari, Ismail] Pamukkale Univ, Dept Internal Med, Div Hematol, Denizli, Turkey. [Sahin, Deniz Goren] Istanbul Bilim Univ, Sch Med, Dept Hematol, Istanbul, Turkey. [Sahin, Deniz Goren; Arat, Mutlu] Sisli Florence Nightingale Hosp, Stem Cell Transplantat Unit, Istanbul, Turkey. [Dagdas, Simten; Ozet, Gulsum] Ankara Numune Training & Res Hosp, Dept Hematol, Ankara, Turkey. [Kutlu, Nermin; Akyol, Tulay Karaagac] Hacettepe Univ, Sch Med, Therapeut Apheresis Unit, Ankara, Turkey. [Ozcebe, Osman Ilhami] Hacettepe Univ, Sch Med, Dept Hematol, Ankara, Turkey. [Teke, Hava Uskudar] Eskisehir Osmangazi Univ, Sch Med, Dept Internal Med, Div Hematol, Eskisehir, Turkey. [Unal, Demet Kiper; Guner, Naile; Payzin, Bahriye] Izmir Katip Celebi Univ, Ataturk Training & Res Hosp, Dept Hematol, Izmir, Turkey. [Tombak, Anil] Mersin Univ, Fac Med, Dept Internal Med, Div Heamatol, Mersin, Turkey. [Celik, Halil] Mersin Univ, Fac Med, Dept Internal Med, Mersin, Turkey. [Bay, Ilker; Kiki, Ilhami] Ataturk Univ, Sch Med, Dept Internal Med, Div Hematol, Erzurum, Turkey. [Ozgur, Gokhan] Gulhane Training & Res Hosp, Hematol & HCT Clin, Ankara, Turkey. [Erkurt, Mehmet Ali; Kuku, Irfan] Inonu Univ, Fac Med, Dept Internal Med, Div Hematol, Malatya, Turkey. [Ozatli, Duzgun; Meletli, Ozgur] Ondokuz Mayis Univ, Fac Med, Dept Hematol, Samsun, Turkey. [Demircioglu, Sinan; Demir, Cengiz] Yuzuncu Yil Univ, Fac Med, Dept Internal Med, Div Hematol, Van, Turkey. [Kurtoglu, Erdal] Univ Hlth Sci, Antalya Training & Res Hosp, Dept Hematol, Antalya, Turkey. [Vural, Filiz; Tobu, Mahmut] Ege Univ, Fac Med, Dept Internal Med, Div Hematol, Izmir, Turkey. [Karakus, Abdullah; Ayyildiz, Orhan] Dicle Univ, Fac Med, Dept Internal Med, Div Hematol, Diyarbakir, Turkey. [Dal, Mehmet Sinan; Altuntas, Fevzi] Univ Hlth Sci, Ankara Oncol Training & Res Hosp, Dept Hematol, Ankara, Turkey. [Dal, Mehmet Sinan; Altuntas, Fevzi] Univ Hlth Sci, Ankara Oncol Training & Res Hosp, BMT Unit, Ankara, Turkey. [Ozturk, Berna Afacan; Albayrak, Murat] Univ Hlth Sci, Diskapi Yildirim Beyazit Training & Res Hosp, Hematol & HCT Clin, Ankara, Turkey. [Ocakci, Serkan] Med Pk Izmir Hosp, Dept Hematol, Izmir, Turkey. [Bolaman, Zahit; Cagirgan, Seckin] Adnan Menderes Univ, Fac Med, Dept Internal Med, Div Hematol, Aydin, Turkey. [Sonmez, Mehmet] Karadeniz Tech Univ, Fac Med, Dept Internal Med, Div Hematol, Trabzon, Turkey. [Karakus, Volkan] Mugla Sitki Kocman Univ, Dept Hematol, Training & Res Hosp, Mugla, Turkey. [Sevindik, Omur Gokmen] Firat Univ, Fac Med, Dept Internal Med, Div Hematol, Elazig, Turkey. [Berber, Ilhami] Malatya Training & Res Hosp, Div Hematol, Malatya, Turkey. [Dogu, Mehmet Hilmi] Istanbul Training & Res Hosp, Hematol Clin, Istanbul, Turkey. [Gulturk, Emine] Kartal Dr Lutfi Kirdar Training & Res Hosp, Dept Internal Med, Div Hematol, Istanbul, Turkey. [Ulas, Turgay] Near East Univ, Dept Internal Med, Div Hematol, Nicosia, Cyprus. [Altuntas, Fevzi] Yildirim Beyazit Univ, Fac Med, Dept Internal Med, Div Hematol, Ankara, Turkey.

PubMed ID: 31131598, Objective: Significant developments occurred in the clinical management of acute lymphoblastic leukemia (ALL) in adults in recent decades. However, treatment results are still not satisfactory, especially in routine practice. The objective of this study was to evaluate the general clinical features, treatment details, and outcomes of a large group of patients followed in multiple centers in Turkey with a diagnosis of ALL. Materials and Methods: A retrospective analysis of the data of patients with ALL was made, the patients having been diagnosed and treated between January 2003 and June 2017 by different protocols in the hematology clinics of ten different centers. A total of 288 patients, aged between 17 and 76 years old, were included in the study. In this retrospective multicenter analysis of patients with ALL, classification of patients was performed based on treatment period, Philadelphia chromosome positivity, treatment regimen, and administration of allogeneic hematopoietic stem cell transplantation (allo-HSCT). Results: The majority of cases were B-cell in origin, while 224 patients had B-ALL and 64 of the patients had T-ALL. Median follow-up duration for all patients was 18.2 months (range: 0.03-161 months). Philadelphia chromosome positivity was determined in 49 patients (21.9%), and 54 patients (18.8%) were receiving allo-HSCT. After induction chemotherapy, 219 patients (76.0%) achieved complete remission, 32 patients (11.2%) were evaluated as treatment refractory, and 37 patients (12.8%) were deceased. Median overall survival was 47.7 months (95% confidence interval: 36.1-59.2) and median disease-free survival was 23.4 months (95% confidence interval: 6.7-40.0) for all patients. Conclusion: Multicenter studies are extremely important for defining the specific clinical features of a particular disease. The results of this study will make a significant contribution to the literature as they reflect real-life data providing valuable information about the Turkish ALL patient profile. © 2019 by Turkish Society of Hematology.

Autologous hematopoietic cell transplantation (AHCT) is an established treatment option for adult patients presenting with multiple myeloma (MM), Hodgkin lymphoma (HL) and various subtypes of non-Hodgkin lymphoma (NHL) in upfront and/or relapsed/refractory disease settings. Although there are recently published consensus guidelines addressing critical issues regarding autologous hematopoietic progenitor cell mobilization (HPCM), mobilization strategies of transplant centers show high variability in terms of routine practice. In order to understand the current institutional policies regarding HPCM in Turkey and to obtain the required basic data for preparation of a national positional statement on this issue, Turkish Hematology Research and Education Group (ThREG) conducted a web-based HPCM survey. The survey was designed to include multiple-choice questions regarding institutional practice of HPCM in adults presenting MM, HL, and NHL. The representatives of 27 adult HCT centers participated to the study. Here we report the results of this survey shedding light on the real-world experience in Turkey in terms of autologous HPCM mobilization strategies in patients presenting with MM and lymphoma. © 2017 Elsevier Ltd

9th International Eurasian Hematology Oncology Congress (EHOC) -- OCT 17-20, 2018 -- Istanbul, TURKEY, Sahin, Fahri/0000-0001-9315-8891; Saydam, Guray/0000-0001-8646-1673, WOS:000447176600099, [No Abstract Available]

Multiple myeloma (MM) remains an incurable disease, with little information available on its management in real-world clinical practice. The results of the present prospective, noninterventional observational study revealed great diversity in the treatment regimens used to treat MM. Our results also provide data to inform health economic, pharmacoepidemiologic, and outcomes research, providing a framework for the design of protocols to improve the outcomes of patients with MM. Background: The present prospective, multinational, noninterventional study aimed to document and describe real-world treatment regimens and disease progression in multiple myeloma (MM) patients. Patients and Methods: Adult patients initiating any new MM therapy from October 2010 to October 2012 were eligible. A multistage patient/site recruitment model was applied to minimize the selection bias; enrollment was stratified by country, region, and practice type. The patient medical and disease features, treatment history, and remission status were recorded at baseline, and prospective data on treatment, efficacy, and safety were collected electronically every 3 months. Results: A total of 2358 patients were enrolled. Of these patients, 775 and 1583 did and did not undergo stem cell transplantation (SCT) at any time during treatment, respectively. Of the patients in the SCT and non-SCT groups, 49%, 21%, 14%, and 15% and 57%, 20%, 12% and 10% were enrolled at treatment line 1, 2, 3, and ≥ 4, respectively. In the SCT and non-SCT groups, 45% and 54% of the patients had received bortezomib-based therapy without thalidomide/lenalidomide, 12% and 18% had received thalidomide/lenalidomide-based therapy without bortezomib, and 30% and 4% had received bortezomib plus thalidomide/lenalidomide-based therapy as frontline treatment, respectively. The corresponding proportions of SCT and non-SCT patients in lines 2, 3, and ≥ 4 were 45% and 37%, 30% and 37%, and 12% and 3%, 33% and 27%, 35% and 32%, and 8% and 2%, and 27% and 27%, 27% and 23%, and 6% and 4%, respectively. In the SCT and non-SCT patients, the overall response rate was 86% to 97% and 64% to 85% in line 1, 74% to 78% and 59% to 68% in line 2, 55% to 83% and 48% to 60% in line 3, and 49% to 65% and 36% and 45% in line 4, respectively, for regimens that included bortezomib and/or thalidomide/lenalidomide. Conclusion: The results of our prospective study have revealed great diversity in the treatment regimens used to manage MM in real-life practice. This diversity was linked to factors such as novel agent accessibility and evolving treatment recommendations. Our results provide insight into associated clinical benefits. © 2018 The Authors

Date of Conference: 24 Nov.-26 Dec. 2017 This study deals with reconstruction of compressed multicontrast magnetic resonance image (MRI) reconstruction using joint dictionary learning. Usually pre-determined dictionaries are used for compressed sensing reconstructions. Here, we propose an alternating-minimization based algorithm for recovering image and sparsifying transformation from only data itself. The proposed method can also be viewed as a joint multicontrast reconstruction extension of a previous blind compressive sensing algorithm [1]. For evaluation, the algorithm is compared in terms of convergence speed and image quality to both individual dictionary learning based method [1], and a joint reconstruction algorithm using pre-determined dictionaries for MRI [2].

PubMed ID: 27094252, Objective: Chronic myeloproliferative neoplasms (CMPNs) that include polycythemia vera (PV), essential thrombocythemia (ET), and primary myelofibrosis (PMF) are Philadelphia-negative malignancies characterized by a clonal proliferation of one or several lineages. The aim of this report was to determine the demographic features, disease characteristics, treatment strategies, and survival rates of patients with CMPNs in Turkey. Materials and Methods: Across all of Turkey, 9 centers were enrolled in the study. We retrospectively evaluated 708 CMPN patients’ results including 390 with ET, 213 with PV, and 105 with PMF. Results: The JAK2V617F mutation was found positive in 86% of patients with PV, in 51.5% of patients with ET, and in 50.4% of patients with PMF. Thrombosis and bleeding at diagnosis occurred in 20.6% and 7.5% of PV patients, 15.1% and 9% of ET patients, and 9.5% and 10.4% of PMF patients, respectively. Six hundred and eight patients (85.9%) received cytoreductive therapy. The most commonly used drug was hydroxyurea (89.6%). Leukemic and fibrotic transformations occurred at rates of 0.6% and 13.2%. The estimated overall survival in PV, ET, and PMF patients was 89.7%, 85%, and 82.5% at 10 years, respectively. There were no significant differences between survival in ET, PV, and PMF patients at 10 years. Conclusion: Our patients’ results are generally compatible with the literature findings, except for the relatively high survival rate in PMF patients. Hydroxyurea was the most commonly used cytoreductive therapy. Our study reflects the demographic features, patient characteristics, treatments, and survival rates of Turkish CMPN patients. © 2017 by Turkish Society of Hematology.

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.

22nd Congress of the European-Hematology-Association -- JUN 22-25, 2017 -- Madrid, SPAIN, WOS: 000404127005030, European Hematol Assoc

The aim of this study was to determine the anthropometric profiles of young male and female swimmers and to investigate the contribution of anthropometric characteristics to two determinants of swimming performance: critical velocity and estimated propulsive force. The study sample consisted of 25 female (age: 12.0 ± 0.9 years, height: 152.2 ± 8.3 cm, body mass: 42.0 ± 7.8 kg) and 25 male (age: 12.4 ± 1.2 years, height: 154.7 ± 11.3 cm, body mass: 49.1 ± 12.0 kg) swimmers. The swimmers were grouped in gender categories. For this study, the anthropometry was divided into 3 categories: length (cm), breadth (cm), and girth (cm) measurements. The critical velocity was estimated from 200-m and 400-m freestyle swimming performance. The estimated propulsive force was calculated using arm muscle area. Statistically significant correlation coefficients (ranging from 0.34 to 0.66) were found between the anthropometric characteristics (19 characteristics) and critical velocity for the female swimmers. Regarding swimming performance determinants, the highest correlations were between the hip girth and critical velocity (r = 0.66; p < 0.05) and between the flexed arm and estimated propulsive force (r = 0.87; p < 0.05). For the male swimmers, the highest correlations were between the transverse chest and critical velocity (r = 0.81; p < 0.05) and between the thoracic girth and estimated propulsive force (r = 0.90; p < 0.05). The somatotype analysis showed that the female swimmers were of the ectomesomorph type, and the male swimmers were of the endo-mesomorph type. The skinfold, length, girth and breadth could be used as predictors of critical velocity and estimated propulsive force in young swimmers. This study could help swimming coaches attain objective knowledge about the swimming performance of their athletes after basic anthropometric measurements and help them to benefit from this knowledge while monitoring the athletes’ developmental process. © JPES.

PubMed ID: 25914025, 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.

19th Congress of the European-Hematology-Association -- JUN 12-15, 2014 -- Milan, ITALY, WOS: 000342830903436, European Hematol Assoc

Chronic Lymphocytic Leukemia (CLL) is the most common leukemia in adults. Recently CD38, ZAP70 and hTERT activity have been studied for the evaluation of the prognosis of CLL besides clinical staging and lymphocyte doubling time. There are inconsistent results regarding these markers for the evaluation of the prognosis in CLL patients. In this study CD38, ZAP70 and hTERT values in CLL patients were measured to make comparisons between each other and known prognostic factors. Thirty CLL patients who were included in the study were followed up for 5 years after the initial diagnosis. The mean hTERT value in CLL and control cases were 1.00±1.31 and 3.89±3.58, respectively (p< 0.05). The mean CD38 and ZAP70 were 6.20±7.60 and 5.51±5.67, respectively. No significant association was detected between CD38, ZAP70 and hTERT activity. There was no correlation between those parameters and known prognostic parameters such as Rai staging, peripheral lymphocyte levels, age, and sex of the patients, beta-2 microglobulin and reply to treatment in CLL. The overall five-year survival rate in CLL patients is 96.7%. The overall five-year survival rate in CLL patients is 96.7%. In conclusion, further studies including larger series of patients with longer follow-up periods are recommended. © 2014, UHOD - Uluslararasi Hematoloji Onkoloji Dergisi. All rights reserved.

WOS: 000445782800649

WOS: 000445772400864

WOS: 000319866300008, PubMed ID: 24149805, Tennis performance requires a good aerobic endurance and recovering capacity. Nitric oxide (NO) is a gas which is not only a vasodilator and antioxidant but it also regulates the use of oxygen and glucose. The aim of this study was to examine the relationships between simulated tennis performance test (PT) and NOx (sum of nitrate+nitrite) levels and lactate elimination speed (LES). Twenty well trained male tennis players with game levels of ITN 4 (International Tennis Number) and lower (mean +/- SD; age 22.9 +/- 2.6 yrs; height 1.82 +/- 0.06 m and mass 75.7 +/- 8.0 kg) participated in the study. Participants performed three 4-min bouts and a 2-min continuous groundstroke against balls projected from a tennis ball machine at speeds of 50, 55, 62 and 70 km.h(-1). After this exercise, subjects were given a 20 min passive rest. After each period and at during the recovery phase; plasma NOx, glucose (GLU) and lactate (LA) levels were determined. LES was calculated during passive recovery. GLU, LA and heart rate (HR) showed a linear increase in comparison to the values in the previous step while PT decreased significantly. Following each period NOx and glucose levels increased independently, but their decreasing rates in recovery phase were related (r = 0.470, p < 0.05). The successive increase in NOx and GLU parameters between the third and the forth periods was significant (p < 0.05). Only in the third period was there a significant relation between PT and NOx (r = 0.494; p < 0.05). In the present study, no significant relationship was found between PT and GLU, LA levels and LES. No significant correlation was found between simulated tennis performance and blood NOx levels. However the addition of loads like those in the third period in tennis trainings can be beneficial for performance in trained tennis players. It is recommended that the relationships between tennis performance with NOx and GLU are studied during a real tennis match., Ege University Research FoundationEge University [2007/BIL/033], The authors would like to thank the coaches and players who participated in this study. This study was supported by Ege University Research Foundation (Project Number: 2007/BIL/033).

Both leukocytoclastic vasculitis and metastatic pulmonary calcification are conditions that rarely occur during the course of multiple myeloma. We present a multiple myeloma patient that had severe dyspnea due to metastatic pulmonary calcinosis, and ulceronecrotic skin lesions caused by leukocytoclastic vasculitis. After 3 courses of standarddose chemotherapy all skin and pulmonary lesions disappeared. Autologous peripheral stem cell transplantation was performed and during 1 year of follow-up the patient was in complete remission; after 1 year, laboratory test results indicated disease relapse. Although the patient was treated with bortezomib and dexamethasone, the disease progressed. Non-myeloablative allogeneic stem cell transplantation was performed, but despite of all treatment the patient died due to disease progression.