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Case report: Five types of gene variants are seen in hereditary spherocytosis (ANK, SPTB, SPTA1, SLC4A1, EPB42). JAK2 V617F mutation; is most common seen in bcr-abl negative chronic myeloproliferative diseases. As a result of NGS performed before splenectomy, SPTB c.4973+2T> C and JAK-2 c.1849G>T p.(Val617Phe) mutations were detected. Co-occurrence of these two mutations requires special attention in terms of the management of thrombocytosis and side effects that may occur after splenectomy.

Introduction All-trans retinoic acid (ATRA) is a physiological metabolite of vitamin A and it is used for the treatment of acute promyelocytic leukemia (APL). Hypercalcemia is a rare side effect of ATRA and it may be potentiated after interaction of ATRA with azole group antifungals. Herein, we have reported an APL case with hypercalcemia that is caused by the interaction of ATRA and posaconazole. Case Report A 49-year-old female patient was diagnosed as APL after the examinations performed upon the detection of pancytopenia when she had presented with the complaints of widespread bruising and fever. After the initiation of posaconazole and ATRA, her serum calcium levels begin to increase (10.3 to 11.1mg/dl). Her vitamin D level was 21.9 ng/ml and PTH 17.8 pg/ml, both were in the normal ranges. The Drug Interaction Probability Scale score of our case was calculated as 6, indicating that the probable adverse drug reaction. Therefore, the high level of serum calcium was attributed to the interaction between ATRA and posaconazole. Management & Outcome Although hypercalcemia with ATRA and other antifungal agents have been previously reported in the literature, this is the first report of hypercalcemia with the concomitant use of ATRA and posaconazole. Discussion This case highlights the importance of monitoring ATRA’s side effects when it is used in combination with drugs inhibiting the cytochrome P450 enzymes. In conclusion, the concomitant use of posaconazole and ATRA may lead to hypercalcemia and serum calcium levels return to normal ranges with the discontinuation of these drugs.

GirişBu enfeksiyonun seyrini etkileyebilecek öngörücü parametreler, COVID-19 (Koronavirüs hastalığı 2019) pandemisinin başlangıcından bu yana ana araştırma konusu olmuştur. Kan gruplarının keşfinden bu yana bunların bulaşıcı hastalıklar üzerindeki etkisi her zaman ilgi çekici olmuştur.Araç ve yöntemlerCOVID-19 hastalarında ABO kan grubunun mortalite, hastanede kalış süresi ve hematolojik ve sitokin fırtınası parametreleri üzerindeki etkisini analiz etmek.Bu retrospektif çalışma, COVID-19 tanısı konan 140 hasta üzerinde yapıldı. Demografik özellikler, ABO kan grubunu içeren laboratuvar parametreleri, tam kan sayımı (CBC) parametreleri, biyokimyasal testler, sitokin fırtınası parametreleri, hastanede kalış süresi ve son durum (taburculuk veya ölüm) kaydedildi.Bulgular: Analize dahil edilen 140 hastanın 72’si (%51.4) erkek ve 68’i (%48.6) kadından oluşmakta olup, ortalama yaşları 66.3±14.0 yıldır. Yaş ve cinsiyet, hastanede kalış süresi ve ölüm oranları tüm kan grubu gruplarında benzerdi. Sadece D-dimer değerleri A kan grubunda diğer kan gruplarına göre daha yüksek bulundu.Tartışma: Gruplar arasında mortalite açısından fark saptanmamakla birlikte A kan grubuna sahip COVID-19 hastalarında D-dimer düzeyi istatistiksel olarak anlamlı derecede yüksekti. D-dimer düzeylerini enfeksiyonun klinik seyrine ve dolayısıyla günlük uygulamaya yansıtmak için daha büyük çalışmalara ihtiyaç vardır., Introduction Predictive parameters that can affect the course of this infection have been the main topic of research since the beginning of the COVID-19 (Coronavirus disease 2019) pandemic. Since the discovery of blood groups, the effect of these on infectious diseases has always been of interest.Objectives To analyze the effect of ABO blood group on mortality, hospitalization duration and hematological and cytokine storm parameters in patients with COVID-19. Patients and methods: This retrospective study was conducted on 140 patients diagnosed with COVID-19. Demographic characteristics, laboratory parameters including ABO blood group, complete blood count (CBC) parameters, biochemical tests, cytokine storm parameters, duration of hospitalization, and final status (discharge or death) were recorded.Results: The 140 patients included in the analysis comprised 72 (51.4%) males and 68 (48.6%) females with a mean age of 66.3±14.0 years. . Age and gender, hospitalization duration and mortality rates were similar in all blood group types. Only D-dimer levels were found to be higher in blood group A compared with other blood groups.Conclusion: Although no difference in mortality was determined between groups, the D-dimer level was statistically significantly higher in COVID-19 patients with A blood group. Larger studies are needed to reflect D-dimer levels on the clinical course of infection, and thus on daily practice.

Objectives Marginal zone lymphoma accounts 5%-17% of all non-Hodgkin lymphomas and has an indolent clinical course. The parameters that predict prognosis and the need for treatment are still unclear. The aim of the current study was to examine the impact of parameters on the course of disease and the need for treatment in marginal zone lymphoma. Methods A retrospective study was conducted with marginal zone lymphoma patients in the two centres between 2010 and 2018. The demographic and disease characteristics, and also hematological and biochemical parameters at the time of diagnosis were examined. The effect of the parameters on overall survival and need for treatment were analyzed. Results During the follow-up, 25 patients required treatment and 15 patiens were followed up without treatment. Overall survival was significantly higher in patients with nodal marginal zone lymphoma than in extranodal and splenic marginal zone lymphoma patients. overall survival of patients who required treatment was 92.9 months while untreated patients was 58.4 months and there was no significant difference among the groups. The platelet count of untreated patients at the time of diagnosis were significantly higher than patients who received treatment. No significant relationship was found between any parameter and overall survival. Conclusions We demonstrated platelet count at the time of diagnosis as a predictive factor for future treatment need. It is an objective and simple blood test that may be helpful to predict the course of the disease although further studies are warranted.

Introduction Hemophagocytic lymphohistiocytosis (HLH) is an aggressive and life-threatening syndrome of excessive immune activation. Herein, we aimed to report a diffuse large B-cell lymphoma (DLBCL) case that was presented as HLH. Case report A 32-year-old man presented to a hospital with complaints of vomiting, nausea and diarrhea in October 2019. Fever and hepatosplenomegaly was detected in physical investigation. Bone marrow aspiration investigation revealed the hemaphagocytosis. HLH-2004 protocol was started for hemophagocytosis. Whole body magnetic resonance imaging (MR) revealed no lymphadenopathy. Bone marrow biopsy revealed high-grade B-cell lymphoma, favoring DLBCL. There were no pathologic cells in lumber puncture investigation. Management and outcome He was diagnosed with secondary hemaphagocytic syndrome due to DLBCL, and chemotherapy was switched to rituximab, etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin (R-EPOCH) regimen. After three cycles of R-EPOCH chemotherapy regimen, complete remission was confirmed with positron emission tomography-computerised tomography (PET-CT) scan. Discussion Our patients’ findings are suitable for six out of eight criteria of hemaphagocytic syndrome. The H-score of our patient was more than 250, reflecting the >99% probability of HLH syndrome. Compatible with literature knowledge, our patient had responded very well to etoposide-containing regimens. In our patient, no lymphadenopathy was detected by physical examination or MR scan, and the diagnosis of DLBCL was only made by the result of bone marrow investigation. In conclusion, herein, we have reported a DLBCL case that had presented with HLH, and clinicians should be aware that B-cell lymphomas may be the underlying cause of HLH.

Myeloproliferative neoplasms (MPNs) are diseases of myeloid series usually with an increase in peripheral blood cells. Among this disease group, only chronic myeloid leukemia (CML) has t(9; 22) (Philadelphia chromosome) leading to the production of BCR-ABL1 fusion gene with tyrosine kinase activity. The main distinction between the diagnosis and treatment of this heterogeneous group is the presence of BCR-ABL1 or JAK-2 V617F mutation. The coexistence of these two mutations may be observed, although not frequently, and can lead to delay in the diagnosis. The case here presents the detection and clinical management of JAK-2 V617F mutation after the suspicion of other MPNs due to fluctuations in clinical and hematological responses of this rare entity in a 78-year-old female patient with CML. To the best of our knowledge, this is the first CML case with coexistence of BCR-ABL1 translocation and JAK2 V617F mutation from Turkey.

Introduction Dasatinib is a potent tyrosine-kinase inhibitor which is used for chronic myeloid leukemia treatment. Pleural effusion is a frequent side effect in patients during dasatinib treatment. Pulmonary arterial hypertension is a rare and life-threatening adverse event of dasatinib. The relationship between dasatinib and autoimmune disorders is unclear, but there are reports of possible mechanisms that have triggered autoimmunity by dasatinib. Case report A 53-year-old male was diagnosed with chronic myeloid leukemia and initiated imatinib mesylate as a treatment. Imatinib was changed to dasatinib as the patient was unresponsive in the first year of treatment. In the fourth year of dasatinib when chronic myeloid leukemia was in both hematological and cytogenetical remission, the patient presented with bilateral massive exudative pleural effusion. Echocardiography was consistent with pericardial effusion with right ventricle enlargement and normal left-side cardiac function. Pulmonary arterial hypertension was diagnosed with high systolic pulmonary arterial pressure. When he had fever and arthralgia, further investigation showed positivity of anti-nuclear antibodies (1/160 titer) and anti-RNP/Sm, which have high specificity for the diagnosis of Systemic Lupus Erythematosus (SLE). Management and outcome Dasatinib was discontinued and nilotinib was initiated. As the pleural effusion persisted despite diuretics and methylprednisolone, mycophenolate mofetil was initiated as a steroid-sparing immune-suppressive agent. The lupus-like symptoms disappeared, and antibodies became undetectable after dasatinib discontinuation. Pericardial effusion improved and pleural effusion did not relapse. Discussion Screening for auto-antibodies may be recommended for patients with a history or symptoms of autoimmune disease before starting dasatinib. All patients who develop pleural effusion while on dasatinib treatment should be investigated for antibodies for lupus.

BackgroundPatients with cancer are at increased risk of thromboembolic complications. There is no evidence-based guideline on the use of routine prophylaxis in hematological malignancies except in patients with multiple myeloma. The purpose of this study was to determine the incidence and risk factors of thrombosis and suggest a rationale for primary thromboprophylaxis in acute leukemia and lymphoma patients.Patients and methodsA retrospective study was conducted on newly-diagnosed acute leukemia and lymphoma patients who presented at our institution from November 2009 to March 2018. The study included a total of 157 patients with acute leukemia and 238 patients with lymphoma. The groups were analyzed to determine the incidence and risk factors of thromboembolic complications.ResultsThe incidence of all thrombotic complications was 10.12% (40/395) including 11.4% (18/157) in patients with acute leukemia and 9.2% (22/238) in patients with lymphoma. The majority of events occurred in the first 6 months. Acute leukemia patients with thrombosis had a higher number of comorbidities than those without thrombosis ( p 3).ConclusionsAcute leukemia patients with any comorbidity and lymphoma patients with higher lactate dehydrogenase and beta-2-microglobulin are at high risk of developing thromboembolic complications. The prophylactic use of anticoagulant should be considered for those patients especially in the first 6 months.

Sarcoidosis is known to be associated with higher incidence of solid tumors and hematological malignancies. ALK(−) CD30(+) anaplastic large cell lymphoma is a type of non-Hodgkin lymphoma showing poor prognosis, and seldom co-occurs with sarcoidosis. As this rare and highly mortal disease did not respond to classical chemotherapies and showed remission with brentuxumab vedontin treatment, we are presenting our first case reported from Turkey hoping to contribute to the literature.

Case report: Bone involvement is rare in DLBCL. 70-yearold patient, applied to the orthopedics clinic dueto knee pain. Kneeprosthesis was planned. During operation suspicious nontumoral lesion with unclear borders was observed. Bone biopsy was taken from the intraoperatively detected lesion and a knee prosthesis was placed. According to PETCT and bonemarrow biopsy results, patient was diagnosed as stage 1E. Awareness of DLBCL with atypical presentation are of great importance in terms of early diagnosis

Objective T-cell prolymphocytic leukemia (T-PLL) is a rare and highly aggressive T cell neoplasm with rapidly progressing clinical course. T-PLL accounts for 2% of mature lymphocytic leukemia in adults. Median overall survival with modern therapy is reported one to three years. Here we report a T-PLL patient with peritoneum involvement and progressive ascite despite anti-CD52 treatment. Case report A 65-year-old man with diabetes mellitus was admitted to hospital due to fatigue for a few weeks. Laboratory workup revealed that white blood cell count 469 × 103/µl (90% lymphocytes), haemoglobin of 11.4 g/dl, platelets of 104 × 103/µl. Medium sized atypical lymphoid cells with partial chromatin condensation and a visible nucleolus were observed on blood smear. Methodology On physical examination, palpable inguinal lymph nodes, splenomegaly 3 cm below the rib margin and a palpable lesion on the helix of left ear were noticed. Punch biyopsy of skin lesion was reported as a mature and immature T cell infiltration which are CD3 and CD10 positive and Tdt, CD34, CD20, CD99 negative. Flow cytometric study of peripheral blood sample was revealed that T-Chronic Lymphocytic Leukemia (T-CLL). Results FMC protocol (fludarabine, mitoxantrone, and cyclophosphamide ) was initiated and followed by intravenous alemtuzumab at a dose of 3 mg on day 1, 10 mg on day 2 and 30 mg on day 3. However after two months of anti-CD52 treatment, his general situation dete­riorated and pleural effusion and abdominal distension developed due to massive ascites. Small, mature lymphocytic cell infiltration was shown in ascites fluid on cytological examination. He died after six months of diagnosis. Conclusion T-PLL is a very aggressive disease with a median survival of less than 1 year. Not all patients diagnosed with T-PLL require treatment immediately.Currently, IV alemtuzumab (anti-CD52) is the accepted best avaliable treatment with very high response rates when given as first-line treatment. However, treatment is notcurative and a minority of T-PLL patients experience long-term disease-free survival.

Giriş: Coronavirus hastalığı 2019, şiddetli akut solunum sendromu coronavirüs 2'nin (SARS-CoV-2) sebep olduğu viral bir antitedir. Klinik ve laboratuvar belirleyicileri, mortalite riski altındaki hastaları belirleyebilir ve tedaviye rehberlik edebilir. Bu çalışmanın amacı, COVID-19 hastalarında laboratuvar parametrelerini analiz etmek ve hangi parametrelerin mortalite ve hastaneye yatışı etkilediğini belirlemektir.Araçlar ve Yöntem: Demografik özellikler, tam kan sayımı (CBC) parametrelerini içeren laboratuvar parametreleri, biyokimyasal testler, pıhtılaşma parametreleri, hastanede kalış süresi ve son durum (taburculuk veya ölüm) kaydedildi.Bulgular: Bu retrospektif çalışma, COVID-19 teşhisi konan 101 hasta üzerinde yapıldı. Analize dahil edilen 101 hasta 52(%51.5) erkek ve 49(%48.5) kadından oluşmaktaydı ve ortalama yaşları 65.7±14.7 idi. İzlem süresi sonunda hayatta kalanlar ve hayatta kalmayanlar arasında karşılaştırmalar yapıldı. Çok değişkenli analiz, ortalama trombosit hacmi (MPV), trombosit dağılım genişliği (PDW) ve laktat dehidrogenazın (LDH) mortalitenin önemli belirleyicileri olduğunu gösterdi. Hastanede kalış süresinin cut-off değeri 10 gün olarak saptandı ve hastalar iki gruba ayrıldı. Tek değişkenli ve çok değişkenli modellerde, hastanede yatış süresinin öngörülmesi için anlamlı bağımsız parametre gözlenmedi.Sonuç: Mevcut çalışmanın sonuçları, MPV, PDW ve LDH' nin mortaliteyi öngörmede önemli bağımsız değişkenler olduğunu göstermiştir. SARS-CoV -2 ve SARS-CoV'nin aynı reseptörü kullandığı bilindiğinden, mutant varyantlar ve ilk varyant için benzer bir yapı ve reseptör olabilir, dolayısıyla bu öngörücü parametrelerin mutant varyantlarda da etkili olduğu düşünülebilir., Purpose: Coronavirus disease 2019 is a viral disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Clinical and laboratory predictors may provide identification of patients at risk of mortality and guide treatment. This study aims to analyze laboratory parameters in COVID-19 patients and to determine which parameters affect mortality and hospitalization.Materials and Methods: Demographic characteristics, the parameters including complete blood count (CBC) parameters, bio-chemical tests, coagulation parameters, duration of hospitalization, and final status (discharge or death) were recorded in patients diagnosed with COVID-19.Results: This retrospective study was conducted with 101 patients diagnosed with COVID-19. The 101 patients included in the analysis comprised 52(51.5%) males and 49(48.5%) females with a mean age of 65.7±14.7 years. Comparisons were made between survivors and non-survivors at the end of the follow-up period. Multiple analyses showed mean platelet volume (MPV), platelet distribution width (PDW), and lactate dehydrogenase (LDH) to be significant predictors of mortality. The cut-off value of the hospitalization period was found to be 10 days; therefore, the patients were divided into two groups. In the univariate and multiple models, no significant independent parameter was observed for the prediction of hospitalization duration.Conclusion: The results of the current study demonstrated that MPV, PDW and LDH were significant independent variables for the prediction of mortality. As SARS-CoV-2 and SARS-CoV are known to use the same receptor, there may be similar structures and receptors for mutant variants and the first variant, so these predictive parameters can be considered effective in mutant variants.

Objective: Full blood count with the associated components is a widely used marker in the diagnosis of patients with diffuse large B cell lymphoma DLBCL as it is simple and inexpensive and can be easily interpreted. The aim of the current study was to evaluate the prognostic role of complete blood count parameters with the associated components in patients with DLBCL.Material and Methods: In this retrospective study, the neutrophil/lymphocyte ratio NLR , lymphocyte/monocyte ratio LMR , and platelet/lymphocyte ratio PLR were evaluated and an analysis was made of the progression-free survival PFS and overall survival OS in patients who were diagnosed with DLBCL and treated with a total of 6 cycles of R-CHOP chemotherapy in the 2011-2017 period.Results: 66 patients were included in the study. In the Cox-Regression Model, high NLR and the low LMR were associated with short OS and PFS; high PLR was associated with short PSF.Conclusion: Pre-treatment NLR, LMR, and PLR values can be used as prognostic factors in DLBCL patients, Amaç: Diffüz büyük b hücreli lenfoma DBBHL tanısı alan hastalarda tam kan sayımı ve ilişkili bileşenleri, prognozun belirlenmesinde basit, ucuz, kolaylıkla yorumlanabilen ve yaygın olarak kullanılan markerlardan biridir. Çalışmanın amacı, DBBHL hastalarında tam kan sayımı parametreleri ile ilişkili bileşenlerin prognostik rolünü değerlendirmektir. Gereç ve Yöntemler: Retrospektif olarak 2011-2017 yıllarında DBBHL tanısı almış ve toplam 6 kür R-CHOP kemoterapisi ile tedavi edilmiş hastaların tanıdaki nötrofil/lenfosit oranına NLR , lenfosit-monosit oranına LMR ve Platelet-lenfosit oranına PLR bakıldı ve progresyonsuz sağkalım PFS ve genel sağkalım OS analizi yapıldı. Bulgular: Çalışmaya 66 hasta dahil edildi. Cox-Regresyon Modelinde, yüksek NLR ve düşük LMR kısa OS ve PFS ile ilişkiliydi; yüksek PLR, kısa PSF ile ilişkiliydi.Sonuç: Çalışmamızın sonucunda tedavi öncesi NLR, LMR, PLR değerlerinin DBBHL hastalarında bağımsız prognostik faktör olarak kullanılabileceğini gösterir

Introduction Synchronous detection of multiple myeloma and acute myeloid leukemia in a single patient is a rare coincidence. Treatment of these patients is still unclear, mostly based on acute myeloid leukemia strategies combined with bortezomib. Case report A 72-year-old male with no medical history was investigated for pancytopenia. On medical examination, he was complicated with a wide and severe skin infection on arm. On examination of bone marrow aspirate, 25% myeloblasts infiltration and additional 10% plasma cells were seen. Acute myeloid leukemia was diagnosed and plasma cell proliferation was attributed to reactive plasmacytosis due to skin infection. However, flowcytometric studies and immunohistochemical examination revealed two different cell populations with 30–40% atypical plasma cells and >20% myeloblasts. Serum M-protein detected by serum electrophoresis test and immunofixation test revealed a monoclonal IgG lambda band. He was diagnosed with concurrent acute myeloid leukemia and multiple myeloma without history of chemotherapy. Management and outcome: The patient was initially treated with bortezomib and dexamethasone for the myeloma. Subsequently, azacitidine was administered subcutaneously for the acute myeloid leukemia treatment. The tru-cut biopsy of the lesion on his arm revealed suppurative inflammatory findings and no malign cells detected. Antibiotherapy was started according to susceptibility. He expired after three months of survival. Discussion The synchronous occurrence of these two different clonal hematological malignancies is rare in hematology practice. Patient-based prospective studies and case series are needed to guide diagnosis and treatment strategies. Furthermore, this report highlights the importance of ruling out reactive plasmacytosis in patients with hematological malignancy who developed severe infections.

Background To investigate the demographics and treatment details of the myeloma patients who were diagnosed and followed up in Turkey and received up to two lines of therapy. Methods Patients who were recorded on the database of Turkish Myeloma Registry project were included in this study if they had only received one or two lines of therapy. Demographics, patient, and disease related parameters both at the time of diagnosis and at the follow up and treatment outcomes were presented. Results A total of 532 patients were included in the study 44% of the patients were female. Median age at the time of diagnosis was 63 (30-106). 47.7% of the patients were diagnosed with IgG myeloma. According to the ISS risk stratification, 20.4% of patients had ISS 1, 34.7% of patients had ISS 2 and remaining 44.9% had ISS 3 disease. Defining high risk disease as harboring one or more of these following cytogenetic abnormalities; del 17p, t(4;14), t(14;16) or t(14;20); 7.1% of the patients were classified as having a high risk disease. Most commonly used frontline therapy approach was bortezomib cyclophosphamide dexamethasone (VCD) (76.5%) and followed by bortezomib dexamethasone (VD) (8.8%), VRd (7.1%). Overall response rates (a better response than stable disease) were 87.6% in VCD induced patients; 63.3% in VD induced patients and 92% in VRd induced patients. The PFS obtained by these frontline approaches was 17.8 months in patients who were able to proceed with high dose chemotherapy with ASCT support and 8.4 in patients who were not able to (p Conclusion As the main concern of this study was to document the demographic features and clinical parameters of a Turkish Myeloma population and to give an idea about the treatment patterns and outcomes in frontline setting and first relapse an overall survival was not calculated. Progression free survival obtained after frontline therapy was relatively shorter than the ones which were presented by other real-world registries. Outcomes of second line therapy will be presented as follow up after 2nd line therapy exceeds a certain threshold. We hope, the results obtained from this study can have a role in the approval and reimbursement of the current standard of care options.

Venetoclax is a selective B-cell lymphoma 2 (BCL2) inhibitor, which is approved to treat elderly patients with newly diagnosed acute myeloid leukemia (AML) and high-risk myelodysplastic syndrome (MDS). A total of 60 patients with a median age of 67 years from different centers were included in the final analysis. Our real-life data support the use of venetoclax in patients with both newly diagnosed and relapsed high-risk MDS and AML. Introduction: Venetoclax is a selective B-cell lymphoma 2 (BCL2) inhibitor, which is approved to treat elderly patients with newly diagnosed acute myeloid leukemia (AML) and high-risk myelodysplastic syndrome (MDS) in combination with either low-dose cytarabine (ARA-C) or hypomethylating agents. We aimed to collect and share data among the efficacy and safety of venetoclax both as a monotherapy or in combination with other drugs used to treat high-risk MDS or AML. Materials and Methods: A total of 60 patients with a median age of 67 (30-83) years from 14 different centers were included in the final analysis. Thirty (50%) of the patients were women; 6 (10%) of the 60 patients were diagnosed with high-risk MDS and the remaining were diagnosed with AML. Results: The best objective response rate (complete remission [CR], complete remission with incomplete hematological recovery (CRi), morphological leukemia-free state [MLFS], partial response [PR]) was 35% in the entire cohort. Best responses achieved during venetoclax per patient number were as follows: 7 CR, 1 CRi, 8 MLFS, 5 PR, and stable disease. Median overall survival achieved with venetoclax was 5 months in patients who relapsed and not achieved in patients who were initially treated with venetoclax. Nearly all patients (86.7%) had experienced a grade 2 or more hematologic toxicity. Some 36.7% of these patients had received granulocyte colony stimulating factor (GCSF) support. Infection, mainly pneumonia (26.7%), was the leading nonhematologic toxicity, and fatigue, diarrhea, and skin reactions were the others reported. Conclusion: Our real-life data support the use of venetoclax in patients with both newly diagnosed and relapsed high-risk MDS and AML.

Background Prophylaxis is strongly recommended in patients with hematological malignancy who are usually at higher risk for infection and neutropenic fever. It is still unclear whether or not there is a definite need for antimicrobial prophylaxis in intermediate-risk hematology patients such as those with lymphoma. Methods A retrospective analysis was made of patients admitted from January 2009 to December 2017 to the Hematology Department of Diskapi Yildirim Beyazit Training and Research Hospital, a tertiary referral hospital in Ankara, Turkey. The study included patients who were diagnosed with any type of lymphoma and given chemotherapy. Routine antimicrobial prophylaxis was administered to 127 lymphoma patients, and not to 65 lymphoma patients. These two groups were compared in respect of the incidence of total infection episodes (IE), febrile neutropenia episodes, and nonneutropenic clinically documented infection episodes. Results For all patients with lymphoma and subtypes of non-Hodgkin lymphoma or Hodgkin lymphoma, no significant difference was determined between the groups in respect of the total incidence of IE, febrile neutropenia and nonneutropenic clinically documented infection both during the first-line chemotherapy and throughout the total follow-up period ( p > 0.05). Patients with prophylaxis had a higher incidence of IE, which was treated with parenteral antibiotics both during the first-line chemotherapy and throughout the total follow-up period ( p Conclusion Antimicrobial prophylaxis was seen to have no effect on the total incidence of infection episode and febrile neutropenia. Therefore, the routine use of antimicrobial prophylaxis should not be recommended for patients with lymphoma.

Multipl myelom kemik iliginde anormal plazma hucre artisi ve immunglobulin veya hafif zincir asiri uretimi nedeniyle organ hasari ile sonuclanabilen malign bir hastaliktir. Hetereojen bir hastalik olan myelomda kolay tolere edilen bir rejim ile mumkun olan en az toksisiteyle, hizli ve etkin sekilde hastaligi kontrol altina almak, hastalik iliskili komplikasyonlari duzeltmek ve onlemek, erken olum riskini azaltmak hedeflenmektedir. Son yillarda multipl myelom tedavisinde cok sayida yeni nesil ajanin hizla tedavi pratigine eklenmesi ile hastalarin sag kalim suresi dramatik sekilde uzamistir. Mevcut tedaviler sag kalim ve hastaliksiz yasam suresine olumlu katki saglamakla birlikte, hastalik nuksunu engelleyememektedir. Halihazirda otolog kok hucre nakli tedavideki yerini korumaktaysa da yeni nesil ajanlar ile gelecek icin umut vaad etmektedir.

The case is here presented of a 70-year old male patient with rare coexistence of Kaposi Sarcoma and resistant Thrombotic Thrombocytopenic Purpura (TTP). The Kaposi lesions were determined before the diagnosis of TTP and were exacerbated after receiving TTP-associated immunosuppressive therapy, in particular associated with rituximab. TTP in this case was resistant to conventional therapies such as steroid and plasma exchange and current immunosuppressive (rituximab, cyclophosphamide, vincristin) treatments. Novel treatment agents consisting of bortezomib and eculizumab given to the patient were also ineffective. To the best of our knowledge, this case presents the first case of coexistence of TTP and Kaposi sarcoma from Turkey and the challenge of refractory TTP management.

Case report: Inappropriate ADH syndrome is a cause of hyponatremia with increased ADH secretion despite normal plasma osmolality and euvolemic state.There are many related drugs in its etiology.Inappropriate ADH syndrome occured in two B-ALL diagnosed patient during cyclophosphamide and vincristine treatment regimen.The detection of inappropriate ADH syndrome in both patients with euvolemic hyponatremia shows the importance of reviewing the drugs used by the patient in the etiology of hyponatremia.

Objective Chylothorax is the leakage of chylous contents into the pleural space as a result of damage to the thoracic duct. Chylous effusion is seen often unilateral but may be bilateral rarely. Etiology includes non-traumatic and traumatic causes. While sarcoidosis, amyloidosis, superior vena cava thrombosis and congenital anomalies are non-traumatic causes, non-Hodgkin lymphomas are the most common causes.Herein, we present a follicular lymphoma patient who was presented chylothorax at diagnosis. Case report A 31-year-old male patient presented with fatigue, and dyspnea. On physical examination, inguinal and axillary multiple palpable lymphadenopathies (LAP) were observed, and respiratory sounds were significantly decreased on the left side.Computed tomography imaging revealed prevascular, paratracheal, subcarinal LAPs and 5 cm thick pleural effusion in the deepest part and compression atelectasison the left. Excisional LAP biopsy revealed follicular lymphoma Methodology When thoracentesis was performed and milky effusion was classified as an exudative. The high triglyceride level was consistent with a chylous effusion. After 6 cycles of R-CHOP treatment, the patient had a significant regression in the initial LAPs, while the chylous effusion persisted. When cytological examination of thoracentesis did not reveal lymphoma, the patient was followed-up. Conclusion Chylothorax is associated with significant morbidity and mortality if left untreated. Control of the underlying malignancy is still the mainstay of treatment and reported as the most effective. In the literature, successful results were reported with the treatment of the underlying lymphoma. owever, it is known, chylothorax may recur and patients should be follow-up closely.

Diffuse large B cell lymphoma (DLBCL) constitutes the most frequent subtype of all non-Hodgkin's lymphomas. DLBCL is an aggressive disease and extranodal involvement is seen in approximately 30% of patients and most common extranodal sites are gastointestinal tract and skin. Skin involvement may be either primary or secondary. Secondary cutaneous lymphoma has a worse prognosis. The case is here reported of a 56-year old male DLBCL patient with cutaneous lesions and aggressive clinical course. The patient had no skin lesions at diagnosis and during follow up and treatment period, skin, cerebrospinal fluid and bone marrow involvement was occurred. Salvage chemotherapy and autologous stem cell transplantation was planned but the patient died before the second cycle of salvage chemotherapy. In contrast to primary cutaneous lymphoma, which tends to be more indolent, secondary skin involvement is associated with unfavourable prognosis. In conclusion it should be kept in mind that skin can be involved in lymphoma patients and in these cases, skin biopsy should be performed rapidly.

Plasma cell leukemia (PCL) is a rare and an aggressive form of plasma cell dyscrasias. We report a 67-year-old male with PCL which developed while on imatinib mesylate (IM) therapy 38 months after diagnosis of chronic myeloid leukemia (CML). The patient has been treated successfully with bortezomib, melphalan and prednisolone. To our knowledge, only one case of PCL superimposed on Philadelphia positive CML has been reported in the literature and this was before the IM era.

Background Immunophenotyping has a central role in CLL. However, CLL is a very heterogenous disease, both morphologically and immunophenotypically; thus, its diagnosis may prove a challenge. We investigated CD81 ex-pression in the differential diagnosis of CLL and MCL. Methods We retrospectively examined CD81 expression with 8 color Multiparameter Flow cytometry devices in 101 CLL and 19 MCL cases. Results We found negative CD81 expression in CLL cases whereas it was positive in MCL cases. Conclusions Our results suggest that CD81 may be a valuable marker for the differential diagnosis of CLL. We are of the opinion that it should be definitely included in the diagnostic algorithm for CLL.

Aggressive natural killer cell leukemia/lymphoma (ANKL) is a rare and aggressive malignancy of natural killer (NK) cells. It is now regarded as a distinct subtype of leukemia as a provisional entity: “NK cell lymphoblastic leukemia/lymphoma” in the 2016 revision to the World Health Organization classification. It is important to diagnose ANKL early due to its fulminant clinical features that may rapidly progress to multiorgan failure (MOF). However, there is no definite diagnostic marker of the disease so it is difficult to make differential diagnosis from other lymphoproliferative disorders. The case reported here is of a 27-year-old male patient who initially presented with leukopenia, disseminated intravascular coagulation (DIC), and MOF during the early stages of illness, and a diagnosis of ANKL was made after a series of examinations. He had no opportunity to take chemotherapy due to the extremely short and aggressive disease course. To the best of our knowledge, this was the first case with ANKL reported from our hospital and the second case from Turkey.

Background: Thiol-disulphide homeostasis has vital role in cell signalling mechanisms, regulation of transcription factors and enzymatic activities, signal transduction and regulation of proliferation rate, apoptosis and detoxification and antioxidant protective mechanism.Objective: This study aims to demonstrate in Polycythemia Vera (PV) patients the thioldisulphide homeostasis which is known to play a role in cell proliferation, apoptosis and various steps of cell cycle.Design: Descriptive prospective cross-sectional study.Settings: Yildirim Beyazıt University Hospital Ankara, Turkey between 2016-2018.Method: Forty-two PV patients and 43 healthy controls were included in the study. Serum total (–SH + –S–S–) and native (–SH) thiol levels were measured in all subjects. The amount of dynamic disulphide bonds and, the ratio of (–S–S–) and (–S–S–) × 100/(–SH), (–S–S–) × 100/(–SH + –S–S–), and –SH ×100/(–SH + –S–S–) were calculated with automatic method. The data obtained from the patient group were compared with the control group.Main outcome measures: The amount of dynamic disulphide bonds and, the ratio of (–S–S–) and (–S–S–) × 100/(–SH), (–S–S–) × 100/(–SH + –S–S–), and –SH ×100/(–SH + –S–S–) were calculated with automatic method in PV patieint and healthy control group. Results: Both groups were similar in terms of age and gender distribution. Compared with the control group, PV group had significantly higher native thiol, total thiol and nativ/total thiol levels.Limitation: The generalizability of the study's findings were limited by the small sample size.Conclusions: In accordance with the nature of the disease, thiol balance in PV patients was in favor of proliferation. Increased total thiol (–SH + –S–S), native thiol (–SH) levels and native thiol/total thiol ratio might be associated with uncontrolled proliferation. The balance of the thiol-disulphide homeostasis shifted to reductive thiol side in the PV. This change can provocate proliferation status of the disease and/or may be secondary to the disease.Conflict of Interest: No conflict of interest was declared by the authors.&nbsp

Hemophagocytic Lymphohistiocytosis (HLH) is a reactive disorder of the mononuclear phagocytic system characterized by increased histiocytic proliferation, activation and hemaphagocytosis. The underlying etiology may be genetic (primary) or acquired (secondary). Secondary causes include drugs, autoimmune diseases, malignancies and infections of which EBV is the most common. A 28-year old male patient who was a shepherd with no known concomitant comorbid disease was admitted to the Emergency Department with the complaints of abdominal pain, fever, severe fatigue. Physical examination revealed high fever, hepatosplenomegaly and laboratory examination revealed pancytopenia, hyperferritinemia and hypertriglyceridemia. Hemophagocytes were observed in the bone marrow biopsy and the patient was diagnosed as HLH. The patient was treated with cyclosporine A, dexamethasone, intravenous immunoglobulin (IvIg) and etoposide according to the HLH 2004 protocol. Coxiella burnetii was detected in the serological evaluation of the etiology and doxycycline was added to the current treatment. Fever was controlled in the second week of the treatment and the patient was discharged after complete recovery of the cytopenia in the fourth week. In the outpatient setting, treatment was completed in 8 weeks and follow-up of the patient is still ongoing without medication. To the best of our knowledge, this is the first case from Turkey of HLH secondary to Q-fever which was treated and managed successfully. Since the mortality of HLH is quite high, the etiology should be determined as soon as possible to be able to provide appropriate treatment.

Transverse myelitis is a quite rare complication of hematopoietic stem cell transplantation. The case is here reported of a 49 year old male with diffuse large B cell lymphoma in complete remission who developed transverse myelitis after autologous stem cell transplantation. The patient presented with numbness and sensory loss of the bilateral lower extremities and difficulty in urinating on the 20th day after cell transplantation. Millimetric hyperintensity was detected in the C5-C6 and T2-T5 segments of the spinal cord on cervical and thoracic vertebral magnetic resonance imaging. Treatment was initiated of pulse steroid and intravenous immunoglubulin followed by plasmapheresis and cyclophosphamide due to inadequate response. The patient then started a rehabilitation program and was discharged in the 9th month after stem cell transplantation when most of the symptoms were relieved. To the best of our knowledge, this is the first case reported in literature of TM development after autologous stem cell transplantation.

Introduction: Bacterial infections and febrile neutropenia (FN) are major causes of morbidity and mortality in patients with hematological malignancy. The aim of this study was to investigate the incidence and risk factors of infections in lymphoma patients. Methodology: This retrospective study was conducted on 200 lymphoma patients diagnosed and treated between January 2009 and December 2017 in Diskapi Yildirim Beyazit Training and Research Hospital, a tertiary referral hospital in Ankara, Turkey. Results: The mean follow-up period was 20.09 ± 19.81 months. The incidence of infection episode (IE) was 32.5% (65/200) and FN was 18.5% (37/200). Analysis of the data revealed that patients with IE had significantly higher rates of diagnosis of primary central nervous system lymphoma (PCNSL), lower baseline hemoglobin, lower baseline hematocrit, higher baseline lactate dehydrogenase levels, higher usage of central cathater, and a higher number of chemotherapy lines compared to patients with no IE. In logistic regression analysis, disease subtype of PCNSL, usage of central catheter and lactate deyhydrogenase (LDH) were found to increase the risk of infection. The odds ratio for PCNSL was 37.866 (p = 0.003), 2.679 for central catheter (p = 0.008) and 1.001 for LDH (p = 0.011). Conclusions: The risk of infection in patients with lymphoma was associated with central catheter usage, higher LDH levels and a diagnosis of PCNSL. Baseline hematological parameters were not determined to have any impact on the occurrence of infection. Patients with these risk factors should be monitored more carefully and the maximum level of infection prevention should be taken.

Various side effects associated with dimethyl sulfoxide (DMSO) which is used for cryopreservation of bone marrow or peripheral blood progenitor cells (PBPCs) have been reported. Among the central nervous system side effects the epileptic seizures, stroke, transient and temporary leucoencephalopathy, and global amnesia are well known. Herein we report a 52-year-old man who experienced tonic–clonic seizure within minutes after the initiation of DMSO cryopreserved autologous PBPC infusion. Unfortunately, he also developed cardiac arrest and required intubation for ventilation after the seizure. Pathophysiology of acute neurological and cardiac toxicity is unclear, but may also be idiosyncratic. Clinicians should be aware of the toxicity of cryoprotectant agents during PBSC infusion. Determining the risk factors associated with increased DMSO toxicity and taking preventive actions is utmost important.

Hemophilia is a hereditary disease with impaired blood coagulation due to a genetic deficiency of blood coagulation factors. The development of inhibitors further complicates the course of the disease and management. The case is here reported of a haemophilia patient who presented with coexisting development of high titer inhibitor with Gastrointestinal Stromal Tumor (GIST) diagnosis and was admitted with upper gastrointestinal system bleeding. The patient had no prior history of inhibitor presence. During all procedures including surgery, excellent hemostasis was achieved with rFVIIa treatment and no hemorrhagic complication was observed. To the best of our knowledge, this constitutes the first reported case of GIST associated with inhibitor development in a hemophilia A patient.

Acquired hemophilia A (AHA) which presents with spontaneous severe intramuscular, mucosal and/or subcutaneous bleeding is a rare bleeding disorder. Even 50% of AHA patients are defined as idiopathic; 10% of cases are related with malignancy. Here, we present a case of AHA in a 43-year-old lady who was diagnosed with malignancy and venous thromboembolism on vena cava 2 years ago. To the best of our knowledge, this is the first report in literature presented with both acquired hemophilia and thrombosis associated with malignancy. A routine workup for malignancy like solid tumors, lymphoproliferative, or myeloproliferative diseases should be performed and followed up for a long time despite clinical improvement for individuals presented with AHA. Moreover, because of warfarin treatment, the diagnosis may be difficult and delayed. Clinicans should rule out AHA in patients who are on warfarin treatment and have abnormal coagulation tests.

Ankaferd is a folkloric medicinal plant extract which has historically been used as an hemostatic agent in traditional Turkish medi- cine. Ankaferd Hemostat (ABS, Ankaferd BloodStopper®) includes the plants of Thymus vulgaris, Glycyrrhiza glabra, Vitis vinifera, Alpinia officinarum and Urtica dioica. The hemostatic effects of ABS have been established in the in vitro and in vivo studies in the Literature. The basic mechanism of action for ABS is the formation of an encapsulated protein network representing the focal points for the vital erythroid aggregation. The topical usage of ABS as a hemostatic agent in clinical hemorrhages and during dental inter- ventions provided the first clues about the safety and efficacy of ABS in humans. The aim of this study is to search topical safety of ABS in a phase I randomized, double-blinded, cross-over, placebo controlled clinical study in healthy volunteers. Twenty-four healthy volunteers (11 males and 13 females, aged 18-44 years) compatible with the study protocol were enrolled into the study. In this study, topical ABS application for 120 minutes is not different from the placebo, in terms of both the local skin findings and systemic laboratory tests. Based on those data, it is concluded that topical application of ABS is safe and tolerable in humans.

INTRODUCTION: Urinary incontinence impacts the lives of older individuals and it is considered one of the most important and recurrent geriatric syndromes. The aim of this study is to determine the prevalence of urinary incontinence in cancer patients and to evaluate its association with age and quality of life. METHODS: One hundred and thirty three patients with cancer were assessed at hematology/oncology outpatient clinic. The validated form of the Turkish version of the International Consultation on Incontinence Questionnaire-Short Form was used to evaluate urinary incontinence and quality of life (QOL). Descriptive statistics were used. The association between urinary incontinence and age, gender, cancer type and quality of life were evaluated with chi square. RESULTS: A total of 133 patients including 84 male and 49 female were evaluated. The mean age of patients was 62.5±12.3. While 45.9% of patients are older than 65, 54.1% of them are less than 64. The rate of urinary incontinence was found 40.6% (n=54). The association between urinary incontinence and age, quality of life has been shown statistically significant with chi square (P DISCUSSION AND CONCLUSION: Our results suggest that urinary incontinence is a significant problem which is underdiagnosed and undertreated in cancer patients. It inversely affects the quality of life. While focusing on cancer and chemotherapy, this important problem should not be underestimated. This leaves incontinent patients with unresolved physical, functional, and psychological morbidity, and diminished quality of life. The study suggests that awareness and education regarding incontinence should be increased among cancer patients and screening of Urinary Incontinence is an important part of their assessment.

Chronic myeloproliferative disorders such as polycythemia vera (PV), essential thrombocytosis (ET), and idiopathic myelofibrosis arise from clonal proliferation of neoplastic stem cells in the bone marrow. Matrix metalloproteinases (MMPs) are a family of zinc-dependent endopeptidases that have potential to degrade all types of extracellular matrix (ECM) and also play a role in remodeling of the ECM. It is known that MMPs play a role in bone marrow remodeling. The primary goal of our study is to explore the relationship between chronic myeloproliferative diseases and some of MMP gene polymorphisms. The demonstration of a relationship will help to understand whether these polymorphisms may be a potential early diagnosis marker of the diseases. Patients were selected from outpatient clinics of Turgut Ozal University Hospital, Ankara, Turkey, between December 2010 and May 2011. Twenty-eight patients that previously diagnosed and followed-up with PV, 17 with secondary polycythemia (SP), and 12 with ET were enrolled in the study, along with a control group of 22 healthy people. DNA was isolated from peripheral blood. Using polymerase chain reaction–restriction fragment length polymorphism method, MMP2 and MMP9 gene polymorphisms were analyzed with agarose gel electrophoresis. There was a statistically significant difference between the study groups and the control group in terms of Gln279Arg polymorphisms rates of MMP9. The highest MMP9 Gln279Arg polymorphism rate was observed in the ET group. But nobody from the control group had polymorphic MMP9. There was no statistically significant difference between the groups in terms of MMP2-735 C > T polymorphism rates. In conclusion, MMP9 gene Gln279Arg polymorphism was associated with ET, SP, and PV diseases. Hence, we believe that these gene polymorphisms may play a role in the mechanism of bone marrow fibrosis and may be a factor that increases the risk of thrombosis. Illumination of the molecular basis of the relationship between MMP-thrombosis and MMP-fibrosis provides a better understanding of the pathophysiology of PV and ET diseases and will allow new approaches to diagnosis and treatment.