Search

© 2022 Verduci Editore s.r.l. All rights reserved.Objective: In this study, we aimed to investigate the clinicopathological features and survival of CD, which is quite rare and has many unknowns. Patients and Methods: This study was conducted by retrospectively evaluating patients diagnosed with CD in six different centers in Turkey. Results: The median age of 33 patients included in the study was 49 and 51.5% (n = 17) of these patients were women. 18 (54.5%) patients were in the hyaline vascular subtype and most of the patients were UCD (n = 20, 60.6%). The most common involvement region was head and neck (n = 19, 57.5%). The UCD group was younger than the MCD group (p=0.027). Visceral lymph node involvement was higher in MCD than in UCD (p=0.001). Similarly, it was observed that there was more hepatomegaly (p=0.035) and splenomegaly (p=0.013) in the MCD group. During the median 19.5 months follow-up period, there were no patients who died. Conclusions: It was observed that UCD and MCD are different clinical entities. Promising survival times can be achieved with surgical and systemic treatments in both subtypes of this extremely rare disease. However, this result should be supported by well-designed prospective comprehensive studies.

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

Classical Hodgkin lymphoma (cHL) is considered a curable disease; however, in approximately one-third of the responding patients, the disease relapses following completion of therapy. One of the drugs that have been approved for the treatment of relapsed/refractory cHL is nivolumab, an immune check point inhibitor that shows its effects by blocking the programmed death 1 (PD-1) receptor. In this study, we present a retrospective "real-life" analysis of the usage of nivolumab in patients with relapsed/refractory cHL that have joined the named patient program (NPP) for nivolumab, reflecting 4 years of experience in the treatment of relapsed/refractory cHL. We present a retrospective analysis of 87 patients (median age, 30) that participated in the NPP in 24 different centers, who had relapsed/refractory cHL and were consequently treated with nivolumab. The median follow-up was 29 months, and the median number of previous treatments was 5 (2-11). In this study, the best overall response rate was 70% (CR, 36%; PR, 34%). Twenty-eight of the responding patients underwent subsequent stem cell transplantation (SCT). Among 15 patients receiving allogeneic stem cell transplantation, 9 patients underwent transplantation with objective response, of which 8 of them are currently alive with ongoing response. At the time of analysis, 23 patients remained on nivolumab treatment and the rest discontinued therapy. The main reason for discontinuing nivolumab was disease progression (n = 23). The safety profile was acceptable, with only nine patients requiring cessation of nivolumab due to serious adverse events. The 24-month progression-free and overall survival rates were 58.5% (95% CI, 0.47-0.68) and 78.7% (95% CI, 0.68-0.86), respectively. Eighteen patients died during the follow-up and only one of these was regarded to be treatment-related. With its efficacy and its safety profile, PD-1 blockers became an important treatment option in the heavily pretreated cHL patients. C1 [Bekoz, Huseyin] Medipol Univ, Med Fac, Dept Internal Med, Div Hematol, Istanbul, Turkey. [Ozbalak, Murat] Istanbul Univ, Dept Internal Med, Div Hematol, Istanbul Med Fac, Istanbul, Turkey. [Karadurmus, Nuri] Gulhane Res & Training Hosp, Dept Internal Med, Div Med Oncol, Ankara, Turkey. [Paydas, Semra] Cukurova Univ, Dept Internal Med, Div Med Oncol, Adana, Turkey. [Turker, Alev; Barista, Ibrahim] Hacettepe Univ, Dept Internal Med, Div Med Oncol, Ankara, Turkey. [Toptas, Tayfur; Tuglular, Tulin Firatli] Marmara Univ, Dept Internal Med, Div Hematol, Istanbul, Turkey. [Altuntas, Fevzi; Cakar, Merih Kizil] Dr Abdurrahman Yurtaslan Ankara Oncol Res & Train, Div Hematol, Ankara, Turkey. [Sonmez, Mehmet] Karadeniz Tech Univ, Dept Internal Med, Div Hematol, Trabzon, Turkey. [Gulbas, Zafer] Anadolu Med Ctr, Div Hematol, Izmit, Turkey. [Demir, Nazli] Gazi Yasargil Res & Training Hosp, Dept Internal Med, Div Hematol, Diyarbakir, Turkey. [Kaynar, Leylagul] Erciyes Univ, Dept Internal Med, Div Hematol, Kayseri, Turkey. [Yildirim, Rahsan] Ataturk Univ, Div Hematol, Dept Internal Med, Erzurum, Turkey. [Karadogan, Ihsan] Medstar Antalya Hosp, Div Hematol, Antalya, Turkey. [Arat, Mutlu] Florence Nighthingale Hosp, Div Hematol, Istanbul, Turkey. [Kapucu, Irem] Koc Univ, Dept Internal Med, Sch Med, Istanbul, Turkey. [Aslan, Nevin Alayvaz] Dr Ersin Arslan Res & Training Ctr, Div Hematol, Gaziantep, Turkey. [Ozkocaman, Vildan] Uludag Univ, Dept Internal Med, Div Hematol, Bursa, Turkey. [Turgut, Mehmet] Ondokuz Mayas Univ, Dept Internal Med, Div Hematol, Samsun, Turkey. [Yuksel, Meltem Kurt; Ozcan, Muhit; Toprak, Selami K.] Ankara Univ, Dept Internal Med, Div Hematol, Ankara, Turkey. [Hacioglu, Sibel Kabukcu] Pamukkale Univ, Dept Internal Med, Div Hematol, Denizli, Turkey. [Demirkaya, Metin] Uludag Univ, Dept Pediat, Div Med Oncol, Bursa, 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

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.

We hereby report our multicentre, retrospective experience with CLARA in patients with fludarabine/cytarabine/GCSF (FLAG) refractory AML. The study included all consecutive R/R AML patients, who received CLARA salvage during October 2010-October 2015 period. All patients were unresponsive to FLAG salvage chemotherapy regimen and did not undergo previous allo-HCT. A total of 40 patients were included. Following CLARA 5 (12.5%) patients experienced induction mortality and 10 (25%) patients achieved CR. 25 (62.5%) patients were unresponsive to CLARA. 7 (17.5%) out of 10 patients in CR received allo-HCT. Median overall survival of patients who achieved CR after CLARA was 24.5 months (8.5-54.5) and 3 months (2.5-5), in patients who underwent and didn't allo-HCT, respectively. Our results indicate that CLARA may be good alternative even in FLAG refractory AML patients and can be used as a bridge to allo-HCT, who have a suitable donor and able to tolerate the procedure.

Thrombotic microangiopathies (TMAs) are rare, but life-threatening disorders characterized by microangiopathic hemolytic anemia and thrombocytopenia (MAHAT) associated with multiorgan dysfunction as a result of microvascular thrombosis and tissue ischemia. The differentiation of the etiology is of utmost importance as the pathophysiological basis will dictate the choice of appropriate treatment. We retrospectively evaluated 154 (99 females and 55 males) patients who received therapeutic plasma exchange (TPE) due to a presumptive diagnosis of TMA, who had serum ADAMTSI3 activity/antiADAMTS13 antibody analysis at the time of hospital admission. The median age of the study cohort was 36 (14-84). 67 (43.5%), 32 (20.8%), 27 (17.5%) and 28 (18.2%) patients were diagnosed as thrombotic thrombocytopenic purpura (TTP), infection/complement-associated hemolytic uremic syndrome (IA/CAHUS), secondary TMA and TMA-not otherwise specified (TMA-NOS), respectively. Patients received a median of 18 (1-75) plasma volume exchanges for 14 (153) days. 81 (52.6%) patients received concomitant steroid therapy with TPE. Treatment responses could be evaluated in 137 patients. 90 patients (65.7%) achieved clinical remission following TPE, while 47 (34.3%) patients had non-responsive disease. 25 (18.2%) non-responsive patients died during follow-up. Our study present real-life data on the distribution and follow-up of patients with TMAs who were referred to therapeutic apheresis centers for the application of TPE. (C) 2018 Elsevier Ltd. All rights reserved.

WOS: 000379164000412, …

As known, the world population is aging and as the life span increases the number of advanced-age lymphomas also shows an upward trend. Autologous hematopoietic stem cell transplantation (HSCT) is the standard treatment modality in chemotherapy-sensitive relapsed or refractory aggressive lymphomas. Increased morbidity and mortality related to both the transplant itself and comorbid diseases can be observed in elderly lymphoma patients. Patients who are 65 years or older and underwent autologous HSCT with B-cell non-Hodgkin lymphoma were retrospectively included in our study. In terms of survival analysis, median follow-up was 34.5 months (8-159) while the overall survival (OS) was 58%. In the univariate analysis of prognostic data in OS, patients who were referred to transplantation with complete response had a statistically significant survival advantage (p=0.043). In terms of the effect of pre-transplant conditioning regimens on survival, BEAM regimen yielded better results, though not statistically significant. Age, number of chemotherapy cycles received before mobilization and radiation therapy had no significant effect on the CD34 (+) cell count in the final product (p = 0.492, 0.746 and 0.078 respectively). In conclusion, autologous HSCT is a practicable treatment modality that provides survival advantage in suitable advanced-age patients with a diagnosis of B-cell non-Hodgkin lymphoma. (C) 2017 Elsevier Ltd. All rights reserved.

Central venous access is often used during apheresis procedure in stem cell collection. The aim of the present study was to evaluate whether central or peripheral venous access has an effect on stem cell yield and the kinetics of the procedure and the product in patients undergoing ASCT after high dose therapy. A total of 327 patients were retrospectively reviewed. The use of peripheral venous access for stem cell yield was significantly more frequent in males compared to females (p = 0.005). Total volume of the product was significantly lower in central venous access group (p = 0.046). As being a less invasive procedure, peripheral venous access can be used for stem cell yield in eligible selected patients. (c) 2016 Elsevier Ltd. All rights reserved.

Continuing education and standardization are of utmost importance in apheresis science as every field in medicine. Especially, the last 5 years witnessed remarkable progress in apheresis science in Turkey, both in terms of increased numbers of therapeutic apheresis centers, therapeutic apheresis procedures performed per year, and also in terms of quality and standardization. This brief report summarizes the current status of apheresis training in Turkey and milestones of its development. (C) 2016 Elsevier Ltd. All rights reserved.

Objective: P53, Bcl-2, and Fas proteins play significant roles in lymphoid cell apoptosis. These proteins affect the prognosis and treatment response of lymphoma and various malignancies. The aim of the present study was to investigate the effects of P53, Bcl-2, and Fas protein expression on treatment and prognosis in patients with primary gastrointestinal diffuse large B-cell lymphoma. Materials and Methods: Thirty-nine patients with primary gastrointestinal diffuse large B-cell lymphoma were included in the study. Immunohistochemical staining was performed to analyze P53, Bcl-2, and Fas protein expression levels in paraffin sections. Results: We examined 39 patients with primary gastrointestinal diffuse large B-cell lymphoma, 21 males and 18 females, with a median age of 54 years. P53 protein expression was detected in 24 patients (61.5%), Bcl-2 protein expression was detected in 26 (67%), and Fas protein expression was detected in 28 (72%). The five-year overall survival rate was significantly lower in patients with P53 and Bcl-2 expression; on the other hand, we did not find a significant difference in the five-year overall survival with respect to Fas protein expression. Conclusion: We found that P53 and Bcl-2 protein expression had a negative effect on prognosis and survival in patients with primary gastrointestinal diffuse large B-cell lymphoma. However, Fas protein expression had no effect on prognosis and survival. Taken together, patients with P53 and Bcl-2 expression should be considered to have a high risk from the beginning, and these patients should undergo aggressive treatments.

Introduction: During the last three decades, major advances have been made in the therapy of Hodgkin's lymphoma. However, despite these advances, Hodgkin's lymphoma has a poor prognosis in the elderly. The proportion of Hodgkin's lymphoma patients aged > 60 ranges in the different reports between 15% and 35%. This study aimed to examine clinical characteristics, treatment outcomes and prognostic factors affecting patient survival in Hodgkin's lymphoma patients aged 65 years or older. Material methods: Hodgkin's lymphoma patients at 65 years of age and older managed within last 5 years in a total of 5 centers in Turkey were retrospectively assessed. Results: The median age of a total of 32 patients was 71 (65-83) years. Elderly patients presented more frequently with B symptoms, elevated sedimentation rate, mixed cellularity histologic subtype and comorbid disease. Less frequent were bulky disease, bone marrow involvement, and the application of autologous stem cell transplantation. The nodular lymphocyte predominant subtype and lymphocyte rich subtype were not observed at all. Eastern Cooperative Oncology Group, ferritin, total protein, and histological type were significant predictors affecting survival (p

20th Congress of European-Hematology-Association - JUN 11-14, 2015 - Vienna, AUSTRIA Kaynar, Leylagul/0000-0002-2035-9462; CETIN, MUSTAFA/0000-0003-4512-1124 WOS: 000361204904059 [No abstract available]

Therapeutic plasma exchange (TPE), is a procedure, changing pathologic substances in the plasma of patients with replacement fluid. TPE has an increasing list of indications in recent years such as neurological, connective tissue, hematological, nephrological, endocrinological and metabolic disorders. We report our multicenter data about therapeutic plasma exchange in patients with neurological diseases. Six University Hospitals' aphaeresis units medical records about neurologic diseases were reviewed retrospectively. Hundred and fifteen patients and 771 TPE sessions from six aphaeresis units' were included to this study. Of the 115 patients, 53 (46%) were men and 62 (54%) were women. The median age was 50 (range: 5-85) years. Of these patients 58.3% were Guillain-Barre syndrome (GBS), 17.4% were acute disseminated encephalomyelitis (ADEM), 10.4% were chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), 7% were multiple sclerosis, 6.1% were myasthenia gravis (MG) and 0.9% were Wilson disease (WD). The median number of TPE sessions per patient was 5 (range 1-72). Human albumin was used as a replacement fluid in 66% and fresh frozen plasma was used in 34% of cases. TPE was done through central venous catheters in 66%, and peripheral venous access in 34% of patients. Some complications were seen in patients (18.3%) during TPE sessions. These complications were, complications related to catheter placement procedure (8.7%), hypotension (3.5%), hypocalcaemia (3.5%) and allergic reactions (1.7%). The complication ratios were 2.7% in total 771 TPE procedures. TPE procedure was terminated in 6% of sessions depending on these complications. Overall responses to TPE were noted in 89.5% of patients. In conclusion: Therapeutic plasma exchange is an effective treatment option in several neurologic diseases. (C) 2013 Elsevier Ltd. All rights reserved.

Plerixafor in conjunction with G-CSF (G-P) is an effective strategy for hematopoietic stem cell mobilization in patients with previously failed mobilization attempt. Here we report our results with G-P among patients with at least one mobilization failure with G-CSF alone (G) or G-CSF plus chemotherapy (G-C). The study included 20 consecutive patients with lymphoma and myeloma from five centers. In 14 (70%) patients, a minimum of 2 x 10(6)/kg CD34+ stem cells were collected and 16 out of 20 patients (80%) were able to proceed to ASCT. Our study indicates that plerixafor can safely rescue patients with a history of mobilization failure. (C) 2012 Elsevier Ltd. All rights reserved.

High dose chemotherapy causes increased free radical formation and depletion of tissue antioxidants. Whether allogeneic hematopoietic stem cell transplantation (HSCT) has an effect on oxidative stress is uncertain. The aims of the study were to determine the effect of allogeneic HSCT on plasma concentrations of antioxidants and oxidative stress biomarkers, and to investigate their relationships with graft-versus-host disease (GVHD), conditioning regimens, and transplant-related mortality (TRM) in patients with hernatological malignancies. Patients (n=25) undergoing allogeneic HSCT from HLA-matched sibling donors were enrolled in the study. Plasma oxidant and antioxidant status were measured at day -1 before transplantation and 30 days after HSCT. In both myeloablative (n=14) and non-myeloablative (n=11) transplant groups, the mean levels of plasma malondialdehyde (MDA) and nitric oxide (NO) increased after allogeneic HSCT (p < 0.01), whereas superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), and catalase (CAT) activities decreased compared with baseline values (p < 0.01). No significant relationships were found between either the pretransplant or post-transplant mean levels of the oxidative stress parameters and the existence of graft-versus-host disease (GVHD), the type of conditioning regimen, or transplant related mortality (TRM). This study documents a significant disturbance of pro-oxidative/antioxidative balance in the plasma of patients undergoing allogeneic HSCT regardless of the intensity of the conditioning regimen.

The aim of the study is to review the clinical manifestations and the hematological findings of brucellosis and pancytopenia, with or without hematological malignancies. The records of 202 patients with brucellosis were evaluated retrospectively. Among these cases of brucellosis seen in a 6 year period between April 1999 and June 2005, 30 patients with pancytopenia were identified. The most common manifestation was fever, followed by weight loss, anorexia, malaise, arthralgia, and hepatosplenomegaly. Bone marrow biopsies revealed hypercellularity or normocellularity. The most common findings in the bone marrow evaluation were histiocytic hemophagocytosis and granulomas. Among all cases, we diagnosed 5 hematological malignancies (1 acute myelogenous leukemia, 2 acute lymphoblastic leukemia, and 2 multiple myeloma) concurrently with brucellosis. The clinical symptoms and findings were similar in patients with and without malignancies. In cases with malignancies, the bone marrow biopsy revealed predominant primary disease involvement. Significant increases in ESR and CRP, severe anemia and thrombocytopenia were observed in patients with malignancies. Peripheral blood counts in patients without malignancies returned to normal after antibiotic treatment for brucellosis. However, pancytopenia in two patients with malignancies did not recover because of primary resistant disease. We conclude that while histiocytic hemophagocytosis may be considered as a major cause of pancytopenia, leukemic infiltration can also be an extreme and unusual cause of pancytopenia in patients in whom brucellosis was concurrently diagnosed with hematological malignancies.

Brucellosis can mimic several primary hematological diseases. Mild anemia and leukopenia have been frequently associated with acute brucellosis, but pancytopenia, thrombocytopenia, and hemolysis are less frequently seen. To our knowledge, brucellosis has not previously been described in association with Coombs-positive autoimmune hemolytic anemia. Here, we report a case of acute brucellosis presenting with coombs-positive autoimmune hemolytic anemia. The patient responded well to short-term pulse corticosteroid therapy followed by antibrucellosis treatment. We suggest that Brucella infection may be the probable cause of the immune hemolytic anemia in this patient. Therefore, the differential diagnosis of Coombs-positive autoimmune hemolytic anemia should include brucellosis, especially in areas where the disease is endemic.

Background: Thrombotic thrombocytopenic purpura (TTP) is a rare disease that is fatal if it is not treated. Therapeutic plasma exchange (TPE) has resulted in excellent remission and survival rates in TTP patients. Material and methods: We describe our experience with 52 TTP patients treated with TPE during the past eight years (65% of the patients were females; patient median age =34 years, range: 17-73). TPE was carried out 1-1.5 times plasma volume. Fresh frozen plasma (FFP) or cryosupernatant plasma (CSP) was used as the replacement fluid. TPE was performed daily until normalization of serum LDH and recovery of the platelet count to > 150 x 10(9)/dL; TPE was then slowly tapered. Clinical, laboratory data, the number of TPE, other given therapy modalities, treatment outcomes and survival rate were evaluated retrospectively. Results: Overall response (OR) and complete response (CR) rates were 77% and 60%, respectively. Response was excellent in 82.8% of the patients with primary TTP among whom 74.2% were CR. Additionally, there were statistical differences in terms of CR rate between patients with primary TTP and secondary TTP (74.2% vs. 29.4%; p=0.005). OR and CR rates were 79 /o and 57.9% in patients on TPE alone and 75.8% and 60.6% in patients on TPE+prednisolone, respectively (p= 1 and p = 0.8). Additionally, there were no statistical differences in terms of OR and CR rates between patients on TPE with FFP and CSP (p=0.25 and p=0.16, respectively). The presence of fever and the number of TPE were statistically important factors influencing the probability of response in multivariate logistic regression analysis (p < 0.01 and p < 0.01, respectively). Additionally, in multivariate Cox's regression analysis, the probability of survival was higher in patients who were responsive to treatment compared to patients who were unresponsive (p < 0.001). Conclusion: TPE is an effective treatment for primary TTP; however, it may be used as adjunctive therapy for secondary TTP until it is under control. The addition of steroids to TPE had no advantage compared to TPE alone. CSP as replacement fluid is not superior compared to FFP. Fever appears to be a bad prognostic indicator. Therefore, prolonged treatment with TPE may be needed in patients with fever. (c) 2006 Elsevier Ltd. All rights reserved.