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Acute haemolytic transfusion reactions (AHTR) are feared complications of packed red blood cell (PRBC) transfusions. This study aims to investigate the clinical consequences of the isolated enzyme-phase crossmatch incompatible PRBC transfusions by clinically observing all events during the study period at a single institution, with the primary aim of detecting AHTR. Ninety-four transfusions of interest were administered during the study period. Laboratory investigations were adequate in 73 episodes, where no AHTR developed and 1.1g/dl mean increment in haemoglobin concentration was documented. Three transfusions terminated prematurely; however, further investigations ruled out AHTR. The remaining 21 transfusions were also completed uneventfully without noteworthy clinical deterioration. This study's results provide clinical validation to omit pre-transfusion screening with the enzyme-phase crossmatch, document the safety and short-term efficacy of isolated enzyme-phase incompatible transfusions. The findings encourage future clinical research on understanding the long-term efficacy of such transfusions, which may be valuable for transfusion-dependant patients.

The purpose of the study was to analyze the expression of nucleophosmin (NPM1), CCAT/enhancer-binding protein alpha (CEBPA), and FMS-like tyrosine kinase 3 (FLT3) with immunohistochemistry and evaluate the relationship with clinicopathologic data with special emphasis on prognosis in bone marrow biopsy specimens diagnosed with acute myeloid leukemia (AML).Bone marrow biopsies of 104 patients who were diagnosed with AML were re-evaluated for diagnosis and subclassification. Immunohistochemically, anti-NPM1, anti-CEBPA, and anti-FLT3 antibodies were applied to slides prepared from formalin-fixed paraffin-embedded tissues. Sixty-three of these patients had their follow-up in our institutional hematology clinic and these patients' clinical, biochemical, and radiological data were obtained and analyzed from patient files. These data were analyzed with survival times statistically.Except for age, no significant effect of clinical data on prognosis was detected. Immunohistochemical results were also statistically compared with clinical data. No correlation was found between overall survival and disease-free survival with the expression of anti-CEBPA or anti-NPM1 antibodies. However, immunohistochemical reactivity for anti-FLT3 antibody was found to be a poor prognostic factor and statistically significant. Also, when the expression of FLT3 was analyzed with that of NPM1 or CEBPA, a correlation (dependent on the expression of FLT3) was found with disease-free survival.FLT3 is an independent prognostic factor for AML. CEBPA and NPM1 should be considered as good prognostic factors only in the absence of FLT3 abnormalities.

Objectives Immune thrombocytopenia (ITP) is an autoimmune disease with heterogeneous background. FCGR2C mutations were defined in one third of the patients but genetic players have not been fully elucidated yet. Although childhood ITP present as benign, ITP in adulthood is chronic disease with treatment challenges. This study aimed to focus on adult ITP patients using a whole genome genotyping that is valuable approach to identify the responsible genomic regions for the disease. Methods Herein 24 adult primary-refractory for ITP patients were evaluated using HumanCytoSNP12BeadChip,Illumina. Forty-six age and sex matched healthy individuals, and ptients awith nonhematological conditions were analyzed as controls. Identified CNV regions were verified by qRTPCR. T-cell receptor beta and delta (TCRB/TCRG) clonality were assessed by heteroduplex analysis in mosaic cases. Results Several CNV losses and gains were defined (losses:2q,7q,17q,19p, and gains: 1q,2p,3q,4q,7q,10q,12p,13q,14q,15q,17p,20q,21p,22q,Xp). Mosaic changes of different sizes (0.2-17.77Mb) were identified in five patients and three of them showed clonality. CNV regions that were unique to ITP patients were identified for the first time and among these genes, those related to immune regulation, and cellular trafficking were noteworthy. Conclusion: Identified CNV regions harbor several candidate genes, the functions of which might shed light on the pathogenesis of chronic ITP.

Hematopoietic stem cell transplantation (HSCT) is a risk factor for viral hepatitis reactivations because it affects lymphocyte number and functions. Latent hepatitis B virus (HBV) may stay in dormant form in hepatocytes and may be reactivated in prolonged immunosuppression. This study analyzes the incidence of reactivation of HBV infections in HSCT patients in a middle endemic country like Turkey. Five hundred and sixty-one HSCT patients from 1994 to 2015 were retrospectively evaluated. Sixty-six patients had a serologic feature of HBV infection. Fifteen patients were hepatitis B surface antigen (HBsAg)-positive patients (3 allogeneic and 12 autologous) while 51 of them were anti-hepatitis B core IgG (anti-HBc IgG)-positive patients (22 allogeneic and 29 autologous). Although under lamivudine prophylaxis, reactivation was seen in three of 12 (25%) chronic HBV (HBsAg positive) patients who received autologous HSCT and in two of the three HBsAg-positive patients who received allogeneic HSCT. Rate of reactivation in the whole HBsAg-positive group was 33%. Reactivation occurred on median 270th day (range: 60-730). Reverse seroconversion incidence was 10% on 133th day for HBsAg negative, but anti-HBc IgG-positive patients, which increased to 17% on 360th and to 23% on 1500th day. Cumulative incidence increased to 41% on 2280th day for isolated anti-HBc IgG-positive patients. Hepatitis B surface antibodies (anti-HBs) were found to be protective as reactivation did not exceed 11% on 5050th day when anti-HBs was positive. When anti-HBc IgG-positive cases were analyzed according to their transplantation types, allogeneic HSCT was found to have higher cumulative incidence (45% on 3258th day) for HBV reactivation than autologous HSCT (7% on 5050th day). Besides, HBV reactivation in anti-HBc IgG-positive patients who received allogeneic transplantation was related to mortality. Findings of this study suggest that HBV prophylaxis extending over 1 year should be prescribed for HBsAg-positive patients independent of the transplantation type. Prophylaxis should also be given to anti-HBc IgG-positive patients if an allogeneic HSCT is to be performed.

Simay Çokgezer,1 Tu&gbreve;rul Elverdi,2 Ay&scedil;e Saliho&gbreve;lu,2 Muhlis Cem Ar,2 &Scedil;eniz Öngören,2 Zafer Ba&scedil;lar,2 Ahmet Emre E&scedil;kazan2 1Department of Internal Medicine, Istanbul University-Cerrahpa&scedil;a, Cerrahpa&scedil;a Faculty of Medicine, Istanbul, Turkey; 2Division of Hematology, Department of Internal Medicine, Istanbul University-Cerrahpa&scedil;a, Cerrahpa&scedil;a Faculty of Medicine, Istanbul, TurkeyCorrespondence: Ahmet Emre E&scedil;kazan, Istanbul University-Cerrahpa&scedil;a, Cerrahpa&scedil;a Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Fatih, Istanbul, Turkey, Tel +90 533 722 73 76, Fax +90 212 589 79 34, Email emre.eskazan@iuc.edu.trIntroduction: The aim of this study was to evaluate treatment responses, toxicity, and survival among cHL patients aged ≥ 50 years.Methods: We retrospectively identified all newly diagnosed cHL patients and only included cases who were ≥ 50 years old at the time of diagnosis and with data available between 1999 and 2020.Results: There were 101 patients, of which 52 were between 50 and 59 years of age, and 49 patients were ≥ 60 years old. Sixty-two patients were male, and the most common histopathological subtype was mixed cellularity cHL (58.4%). ECOG PS, CCI, CIRS, and ACE-27 scores were significantly higher in patients aged ≥ 60 years than those of 50– 59 age group. While all patients aged 50– 59 years received ABVD as first-line therapy, 79% (n=39) of cases aged ≥ 60 years had ABVD. In patients receiving ABVD, 95% and 92.7% of the cases aged 50– 59 and ≥ 60 years had CR, respectively (p=0.999). Age groups were comparable in terms of hematological and non-hematological toxicities (p=0.369, p=0.127, respectively). Although not statistically significant, median survival was longer in patients receiving a transplant than in those without transplantation (108 months vs 52 months, p=0.069). In multivariate analysis, the risk of progression was higher in patients with lymphocyte ≤ 600/mm3 and in those who were unresponsive to first-line therapy (p=0.002 and p< 0.001, respectively). Patients with B symptoms, age ≥ 60 years, and CIRS > 3 had higher risk of mortality (p=0.001, p=0.012, p=0.038, respectively). By using these 3 parameters, we defined a new risk score, which divided our patient cohort into two as low- and high-risk groups. Low-risk patients had significantly higher survival rates than the high-risk group (83.9% vs 40.5%, p< 0.001).Discussion: This new prognostic score should be further tested and validated in other patient populations. Although our study has some limitations including the limited number of patients and its retrospective nature, there are not so many studies in elderly cHL patients and elderly and/or frail patients are generally excluded in most of the clinical trials. Thus, this real-life single-center experience would contribute to the literature.Keywords: classical Hodgkin lymphoma, cHL, elderly patients, survival, toxicity

Background In the European LeukemiaNet (ELN) 2013 recommendations, chronic myeloid leukemia (CML) patients with warning response (WR) were suggested to be monitored closely continuing with the same tyrosine kinase inhibitor (TKI). Differently, the guidelines of the National Comprehensive Cancer Network considers switching to another TKI as an option. Patients and Methods We retrospectively evaluated 73 CML patients receiving first-line imatinib, who were followed and managed in accordance with ELN recommendations. We compared patients with molecular WR with patients with optimal response (OR) and failure regarding short- and long-term outcomes. Results The cumulative major molecular response (MMR) rates in patients with OR were significantly higher at any time point than those achieved by the WR group. Patients with WR at 3 months had significantly inferior failure-free survival (FFS) than optimal responders, but overall survival (OS) was similar. For 6 and 12 months, the WR and OR groups had similar FFS and OS. Twenty of 23 patients with WR at 12 months achieved MMR during imatinib treatment. Conclusion It takes longer to get to ELN time points with imatinib than second-generation TKIs (2GTKIs). Treatment might fail in a small proportion of the patients with WR during imatinib treatment, but close and careful monitoring and timely switching to 2GTKIs might translate into favorable outcomes. Avoiding early switch to 2GTKIs would prevent patients from experiencing potential toxicities. There is still a need for prospective comparative studies (ie, continuing imatinib treatment vs. switching to 2GTKIs) in patients with WR, to justify the validity of this response category and to explore the benefit of treatment change in these patients.

The coronavirus disease 2019 (COVID-19) pandemic has brought life to a standstill globally. Intermittent quarantines were applied to control the pandemic and reduce contamination. During the pandemic, patients with hematological malignancies were among the most vulnerable population. Our aim was to compare in terms of demographic data, disease-related factors, symptom-to-diagnosis interval, diagnosis-to-treatment interval , and interim and end-of-treatment response in classical Hodgkin lymphoma patients diagnosed during the pandemic and in the pre-pandemic periods. A total of 90 patients were included, of which 65 and 25 were diagnosed in the 2 years before the pandemic and the 12-month period during the pandemic, respectively. Demographic features were comparable in both groups. Although the percentage of patients with advanced-stage disease was higher during the pandemic (64% vs 53.8%), this difference did not reach statistical significance (P = 0.384). The median symptom-to-diagnosis interval was significantly longer during the pandemic than was observed within the pre-pandemic era (16 weeks vs 8 weeks, P = 0.042). The median diagnosis-to-treatment intervals was similar in both groups (13 days vs 15 days, P = 0.253). In the pre-pandemic and pandemic periods, 85.2% and 72.7% of the patients had complete response at end-of-treatment evaluation, respectively (P = 0.208). We found that symptom-to-diagnosis interval was significantly prolonged during the pandemic. Higher percentage of patients with advanced-stage disease during the pandemic might also be due to this delay, nevertheless, this difference did not reach to a significant difference regarding treatment response in both groups.

Limited data exists to date on the predictors for the development of pneumonia in patients with mild and moderate coronavirus (COVID-19). In this study, it was aimed to evaluate the demographic characteristics and clinical findings of mild and moderate COVID-19 and to determine the risk factors for the development of COVID-19 pneumonia in patients admitted to the pandemic outpatient clinic of a university hospital. A total of 414 patients with laboratory confirmed COVID-19 were included. Of these, 220 (53.1%) were male, the mean age was 38.3 ± 12.7. Median duration of hospital admission from the onset of symptoms was three days (0-11). Of the confirmed COVID-19 cases, 154 (37.2%) had a history of family contact and the most common symptoms were weakness (68.4%), myalgia (61.8%), headache (56.5%), loss of smell (45.2%), loss of taste (43.2%) and anorexia (42.8%). Among females, weakness (p= 0.016), headache (p= 0.008), sore throat (p= 0.032), nausea (p= 0.003), anorexia (p= 0.045), loss of taste (p= 0.005) and loss of smell (p0.001) were more common. Loss of taste (47.6% vs. 25%, p0.001) and loss of smell (50% vs. 26.3%, p0.001) were more common in patients with under the age of 50 and cough (43.4% vs. 29.3%, p= 0.003) was more common in patients with above the age of 40. Among 46 (11.1%) patients with asymptomatic COVID-19, there was no significant difference (p= 0.500) between the genders. Pneumonia was detected in 150 (43.8%) of 339 patients who underwent thorax computed tomography. In the univariate analysis; advanced age (p0.001, odds ratio (OR)= 1.44), obesity (p0.001 OR= 2.5), not being actively smoking (p0.001, OR= 6.19), fever at first admission (p= 0.002, OR= 2.02), cough (p0.001, OR= 3.26), shortness of breath (p0.001, OR= 23.37), weakness (p= 0.042, OR= 1.63), anorexia (p= 0.009, OR= 1.79) and elevation of D-dimer (p= 0.014, OR= 1.92) were associated with the development of pneumonia. In multivariate analysis, obesity (p= 0.005, OR= 2.69), not being actively smoking (p0.001, OR= 5.43), cough at first admission p= 0.017, OR= 2.16) and shortness of breath (p= 0.008, OR= 16.22) was determined as an independent risk factor for the development of pneumonia. CRP (p0.001), D-dimer (p0.001), ferritin (p0.001) values among 108 (26.1%) patients with a body-mass index(BMI)30 were high, and 60.9% of the patients had pneumonia (p0.001) . CRP (p0.001), D-dimer (p= 0.010) values were low, lymphocyte count (p= 0.001) was high among 106 (25.6%) active smokers, and 15.6% of the patients had pneumonia (p0.001). Of the patients reported with persistent symptoms, 25.9% had loss of smell, 25% had weakness, and 23.1% had loss of taste on the seventh day; 21.1% had loss of smell, 21.1% had myalgia, and 19.7% had loss of taste on the 14th day. During their follow-up, the COVID-19 polymerase chain reaction (PCR) test was studied in 286 patients for control purposes. The median time of being negative for COVID-19 PCR test was eight days (3-56). In conclusion, symptoms may last longer than 14 days in 20- 30% of patients presenting with mild-moderate clinical findings. In addition, obesity should be considered as an important risk factor for COVID-19 pneumonia.

Amac: Istanbul Universitesi Cerrahpasa Tip Fakultesi Hematoloji Poliklinigi’nde takip edilen 49 Kronik Lenfositik Losemi (KLL) hastasi calismaya dahil edilmistir. Calismanin amaci, cesitli otoimmun hastaliklar ile iliskisi gosterilmis olan Killer Immunoglobuline Like Receptor (KIR) gen duzeylerini, otoimmun olay gozlenmis ve gozlenmemis KLL hasta gruplari arasinda karsilastirmaktir. Gerec ve Yontem: Bu dogrultuda otoimmun olay gozlenmis olan 25 ve otoimmun olay gozlenmemis 24 KLL hastasi calismaya dahil edilmistir. Hastalarin 32’si erkek, 17’si kadindir. Otoimmun hastalik gozlenen grup ile otoimmun olay gozlenmeyen KLL grubu arasinda tani anindaki yas (60 vs 64) ve ortanca takip suresi (59 ay vs 71 ay), tani anindaki parametreleri istatistiki olarak benzerdir. Bulgular: Gozlenen en sik otoimmun olay otoimmun hemolitik anemi (OIHA) iken onu immun trombositopeni (ITP) ve saf eritroid aplazi (PRCA) takip etmistir. Otoimmun olay gozlenmis hastalarin tani aninda direkt antiglobulin testi pozitiflik orani, otoimmun olay gozlenmemis KLL hastalarina gore artmis oldugu gozlenmistir (p=0.024). Ayrica otoimmun olay gozlenen hastalarin tani aninda KLL hastalik evrelerinin daha ileri oldugu gorulmustur (p=0.04). Otoimmun olaylar kendi aralarinda degerlendirildiginde ise, sayi az olmasina karsin, PRCA’da cevresel kanda CD38 pozitif hucre oraninin %30’un ustunde olma sikliginin arttigi gozlenmistir (p=0.008). Sonuc: Calismamizda KIR genlerinin otoimmun olaylarla iliskisi incelendiginde, otoimmunite gozlenmeyen gruba gore herhangi bir istatistiki fark tespit edilememistir. Daha iyi teknik sartlarda yeni calismalar yapilmasinda fayda vardir.

Background/aim: A proliferation-inducing ligand (APRIL) has been investigated as a prognostic marker in chronic lymphocytic leukemia (CLL) patients. However, there is no cut-off level for serum APRIL (sAPRIL) levels that predict time to treatment in CLL patients. Materials and methods: Between May and December 2012, 94 consecutive CLL patients and 25 healthy controls were assessed. sAPRIL levels were measured by ELISA. Demographic data and prognostic markers were obtained from the patients' files. Treatment-naive patients were followed up for 6.5 years for any treatment need. Results: Patients were divided into 3 groups: Treatment-naive (n = 47), chemotherapy receiving (n = 25), and those who had received chemotherapy previously (n = 22). There was no difference in median sAPRIL levels of patients who were receiving chemotherapy at the sampling time and the healthy controls, which indicates that sAPRIL levels might be influenced by treatment. For treatment-naive patients, the best cut-off in predicting time to treatment was found at the sAPRIL level of 2.04 ng/mL, with 78% sensitivity and 63% specificity. Time to treatment was significantly earlier in the APRIL high group (n = 27) than in the APRIL low group (n = 20) (P = 0.010, log-rank test). Conclusion: sAPRIL, a simple, promising blood test which can be measured by ELISA, will likely obtain a place in the wide range of prognostic markers in CLL. Prospective large-scale studies are required to validate and confirm the feasibility of the proposed cut-off level of 2.04 ng/mL as a predictor of time to treatment in treatment-naive CLL patients. Scientific Research Projects Coordination Unit of stanbul University [19694] Acknowledgments/Disclaimers/Conflict of interest The study was supported by an unrestricted grant by Scientific Research Projects Coordination Unit of stanbul University (Project No.: 19694) .

Amaç: Miyelodiplastik sendrom (MDS) olgularının %30-50’sinde kromozom anomalileri gözlenmektedir. En sık gözlenen anomaliler trizomi 8, monozomi 7/7q-, monozomi 5/5qve 20q- olarak belirlenmiştir. Bu anomalilerin saptanmasında konvansiyonel sitogenetik ve interfaz FISH (iFISH) yöntemleri kullanılmaktadır. Her iki yöntem için tercih edilen materyal kemik iliği olmakla birlikte, perifer kanının kullanılmasının uygunluğu da araştırılmaktadır. Bu çalışmada, laboratuvarımıza başvuran MDS hastalarının perifer kanı ve kemik iliği örneklerindeki anomalilerin sitogenetik ve iFISH yöntemleri ile karşılaştırılarak mevcut veri havuzuna katkı sağlanması amaçlanmıştır. Gereç ve Yöntem: MDS tanılı 19 olgunun perifer kanı ve kemik iliği örnekleri konvansiyonel sitogenetik ve 5q31, 7q22 ve 7q31 bölgelerine özgü delesyon problarının kullanıldığı iFISH yöntemleriyle incelenerek, elde edilen veriler örnek tipi ve kullanılan yönteme göre karşılaştırılmıştır. Bulgular: Konvansiyonel sitogenetik yöntemiyle olguların 5’inde periferik kan ve kemik iliği örneklerinde elde edilen sonuçlar arasında (iki olguda normal, üç olguda anormal karyotip) konkordans, 12 olguda diskordans gözlenmiş, iki olguda kemik iliğinde metafaz elde edilemezken, perifer kanında klonal sayı anomalileri saptanmıştır. iFISH yöntemiyle incelemede ise, olguların perifer kanı ve kemik iliği örnekleri arasında, -5/del(5q) incelemesinde 13 olguda (iki olguda pozitif, 11 olguda negatif), -7/del(7q) için 10 olguda (bir olguda pozitif, 9 olguda negatif) konkordans gözlenmiştir. Sitogenetik olarak tek olgunun kemik iliği örneğinde birlikte gözlenen del(5q) ve del(7q) bulguları, hem perifer kanı hem de kemik iliği örneklerinde uygulanan iFISH analizinde de pozitif olarak saptanmıştır. Sonuç: Elde ettiğimiz sonuçlar daha önce bildirilen çalışmalarla birlikte değerlendirildiğinde, her iki yöntem ve her iki örnek tipinin kendilerine özgü avantajlara ve dezavantajlara sahip oldukları gözlenmiştir. Bu durum bu iki yöntem ve örneğin birbirlerinin yerini almak yerine, paralel olarak kullanılmalarının yararlı olacağını düşündürmektedir., Objective: Chromosome abnormalities are observed in 30-50% of myelodysplastic syndrome (MDS) cases. The most common anomalies are trisomy 8, monosomy 7 / 7q-, monosomy 5 / 5q- and 20q-. Conventional cytogenetic and interphase FISH methods are used to detect these anomalies. Although bone marrow is the preferred material for both methods, the suitability of using peripheral blood is also being investigated. The aim of this study is to contribute to the data pool in this area by presenting comparative cytogenetic and interphase FISH examination results in peripheral blood and bone marrow samples of MDS patients who applied to our laboratory. Materials and Methods: Peripheral blood and bone marrow samples of 19 patients with MDS were examined with conventional cytogenetic and iFISH methods using deletion probes specific to the 5q31, 7q22 and 7q31 regions. The data obtained were used to compare the materials and techniques. Results: Conventional cytogenetics: In this technique, the results of peripheral blood and bone marrow samples were concordant in 5 cases (normal karyotypes in 2, and abnormal in 3 cases), and discordant in 12 cases, and in two cases, there was no metaphase in bone marrow samples, while abnormal karyotypes were observed in blood samples. iFISH: Between the results of peripheral blood and bone marrow; for -5/del(5q) there was concordance in 13 cases (positive in two, and negative in three cases), and for -7/del(7q), 10 cases were concordant (positive in one, and negative in 9 cases). The one case that del(5q) and del(7q) were observed together in conventional cytogenetic examination, was positive in iFISH analysis for both anomalies, too. Conclusion: When we evaluate our results together with previous reports, it seems that both methods and both materials have their own advantages and disadvantages. Therefore, we suggest that it would be beneficial to use these two methods and materials in parallel instead of replacing each other.

Background: The coronavirus disease 2019 (COVID-19) pandemic has brought life to a standstill all over the world. Especially in Istanbul, the most populated city in Turkey, many hospitals served as pandemic hospitals and suspended the examination of patients who were not infected with COVID-19. On the other hand, in this period, lockdown was applied frequently to control the pandemic and to reduce the transmission. It is known that the delay in the diagnosis and treatment of cancer can sometimes be fatal. Initial treatment choice in classical Hodgkin lymphoma (cHL) patients is determined by various factors including the stage of the disease. Therefore, detection of the disease at an early stage has prognostic importance. Our aim was to compare the time from symptom onset to diagnosis and period between diagnosis and treatment initiation, as well as the distribution of stages and treatment responses in cHL patients diagnosed and treated during the COVID-19 pandemic and in the pre-pandemic period. Methods: Patients who were diagnosed within the 2 years before the pandemic (between March 2018 and March 2020) and in a 12-month period during the pandemic (between March 2020 and March 2021) were compared in terms of demographic data, disease related factors, time interval between symptom to diagnosis, and interim treatment response. Clinical data were obtained from manual and electronic medical records retrospectively. PET scans were performed at baseline, after two cycles of chemotherapy, and end of treatment (EOT). The Deauville five-point scale (5-PS) was used in the initial staging and assessment of treatment response. The 5-PS; a score of 1, 2, or 3 was considered negative. The 5-PS score 4 or 5 was positive. Results: This single-center study included 90 newly diagnosed cHL patients, with a median age of 33.5 years (range, 17 - 70 years) and a male predominance (53.3%). The most common presenting symptom was a lump in the neck (41.1%), and also, 61.1% (n=55) of the cases had at least one B symptom. Patient characteristics were summarized in Table 1. Age and sex distributions were similar in both groups. Also, the number of patients >60 years was comparable (p=0.868). The most common histopathological subtype in both groups was nodular sclerosis (47.7% vs. 48%). In the pre-pandemic period and during the pandemic, the percentages of patients with early unfavorable disease were 66.7% and 77.8%, respectively (p=0.526). Although the percentage of patients with advanced-stage disease was higher during the pandemic than that observed in the pre-pandemic period (64% vs. 53.8%), this difference did not reach statistical significance (p=0.384). The median interval between symptom onset to diagnosis was significantly longer during the pandemic than was observed within the pre-pandemic era (16 weeks vs. 8 weeks, p=0.042). The median durations between diagnosis and treatment initiation were similar in both groups (13 days vs. 15 days, p=0.253). The majority of patients in both groups received ABVD as first-line therapy, and IFRT was performed in some patients with early-stage cHL (Figure 1). Among all patients (n=90), 85% of the cases had negative interim PET scan results, and this percentage was similar for both patient groups (84.6% vs. 88%, p=0.999). In the pre-pandemic period, 80% of the patients had complete response at EOT, on the other hand, no comparison was performed between two groups regarding response level at EOT, since nearly half of patients (48%) treated during the pandemic were not evaluated for the EOT response at the time of the analysis. Discussion & Conclusion: In our cohort, the time interval between symptom onset to diagnosis was significantly prolonged during the pandemic. Most probably the patients were afraid of admitting to the hospital due to the fear of contagion, or patients might have experienced difficulties in applying to a health facility, and lastly maybe they had tolerable symptoms, which might all have roles in the diagnostic delay during the pandemic. Higher percentage of patients with advanced-stage disease during the pandemic might also be associated with this delay, however, fortunately, this difference did not translate into a significant difference regarding interim treatment response in both groups. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

Introduction and Objectives: For patients (pts) with chronic myeloid leukemia in chronic phase (CML-CP), four baseline prognostic scores are commonly used including the Sokal score and the most recently introduced EUTOS long-term survival (ELTS) score. The ELTS score was shown to be superior to the Sokal score for predicting survival. The aim of the study is to evaluate the value of ELTS score on predicting disease progression and survival in Turkish pts with CML-CP. Material and Method: Demographic, laboratory and clinical features, disease responses to tyrosine kinase inhibitor (TKI) therapy and survival of CML-CP pts, who received upfront imatinib (IM) between 2003 and 2018 were analyzed retrospectively. Treatment responses were reevaluated according to European LeukemiaNet 2013 recommendations. Risk groups analysis, discrimination and hazard ratios (HRs) were evaluated with Cox regression and Kaplan-Meier survival analysis. Receiver operating characteristic (ROC) analysis was performed to examine the effects of scores on predicting overall survival (OS) and progression-free survival (PFS). Results: A total of 185 pts were included, of which 103 (55.7%) were male and median age was 47 years (range, 16 - 81 years) (Table 1). The percentages of pts with low-, intermediate-, and high-risk ELTS scores were 60.5%, 25.9%, and 13.5%, respectively. For the Sokal score, these percentages were 37.3%, 40.5%, and 22.2% respectively. For Sokal high-risk pts, only 46.3% were classified as high-risk according to the ELTS score. Similarly, 44% of pts with intermediate Sokal risk had low-risk ELTS score (Fig. 1). Seventy-seven pts (41.6%) had at least one comorbidity, and the most common comorbidities were hypertension (21.6%), diabetes mellitus (13%), and ischemic heart disease (12.4%) (Table 1). The median durations of IM therapy and follow-up were 2728 (range, 14 - 6320 days) and 3473 (range, 71 - 6320 days) days, respectively. Complete hematologic and early molecular (BCR-ABL1 IS Conclusion: In our study, we showed that the ELTS score could successfully predict high-risk pts compatible with the literature. With higher hazard ratios and better risk group stratifications, the ELTS score outperformed the Sokal score. The ELTS score can help clinicians to better discriminate poor prognostic pts and can promote optimal treatment strategies for these pts with potentially worse prognosis. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

PURPOSE Early comorbidity detection has been reported to be associated with treatment-related outcomes in several diseases. Two main goals of the present study were to investigate both the impact of comorbidities and transfusion frequencies on the survival and quality of life of patients with myelodysplastic syndromes (MDS). METHODS One hundred and four MDS patients with a median International Prognostic Scoring System (IPSS) score of 0.5 (range: 0-3) were included in the study. Almost half of the patients had more than one comorbidity. RESULTS Median short form health surveys (SF)-36 mental and physical scores were 42.1 (range: 20.6-66.1) and 38.7 (range: 18-59.7), respectively. Mean scores of the Eastern Cooperative Oncology Group (ECOG) performance scales at diagnosis and during recruitment were 1.0 (1.4 ± 1.0) and 2.0 (1.8 ± 1.1), respectively. The mean Charlson Comorbidity Index (CCI) score was 1.0 (1.4 ± 1.5). In the model that was constructed using variables with a p value < 0.100 in the univariate analysis, factors that predicted death were refractory anemia with excess blasts (RAEB) and ECOG scores at recruitment. When ECOG was removed from the model, RAEB and CCI at diagnosis moved to the forefront as mortality predictors. CONCLUSION This study demonstrated that both CCI and ECOG performance status had an impact on survival in MDS patients who had low IPSS scores. ECOG stood out as a better and more practical predictor of survival than CCI, especially after considering its (ECOG) ease of use.

Immune thrombocytopenia (ITP) is the most frequent cause of acquired thrombocytopenia. In adult ITP patients, corticosteroids and intravenous immunoglobulin (IVIg) are used as first-line treatment. The aim of the present study was to investigate retrospectively the demographic and etiologic characteristics of patients with ITP admitted to the emergency room at our hospital. Seventy-five adult patients with ITP were included, and demographic data, bleeding characteristics, etiologic features and responses to treatments were evaluated retrospectively. Fifty-six patients (75 %) were female, and the median age was 43 years. Eighteen patients had a history of ITP, whereas in 57, thrombocytopenia was identified for the first time. During admission, the median platelet count was 5 × 10(9)/L. Cutaneous and/or mucosal bleeding was the most common clinical feature. High-dose dexamethasone was administered in 60 episodes, whereas IVIg and conventional-dose methylprednisolone were used in nine and six episodes, respectively. The overall response rate of the entire cohort following first-line treatments was 67 %, and complete remission was achieved in 31 patients, 19 patients achieved partial remission, and 25 patients were non-responders. In cases with life-threatening bleeding, concomitant infection, post-traumatic bleeding and need for emergency surgery, IVIg can be used as the first line of treatment option in addition to platelet transfusions.

Background Thrombotic thrombocytopenic purpura is a potentially life-threatening condition. Although the introduction of therapeutic plasma exchange has reduced mortality rates from over 90% to 10%-20%, approximately 40% of patients relapse, and outcomes may be fatal in refractory patients. There is clearly a need for additional therapeutic approaches. Aims To describe the outcomes of relapsed/refractory thrombotic thrombocytopenic purpura patients treated with vincristine as an adjunct to therapeutic plasma exchange. Study design Cross-sectional study. Methods The medical records of all relapsed/refractory patients with thrombotic thrombocytopenic purpura treated with vincristine adjunct to therapeutic plasma exchange between October 2000 and December 2016 were retrospectively reviewed. Diagnosis of thrombotic thrombocytopenic purpura was based on clinical history, physical examination, and laboratory examinations. Patient demographics, laboratory findings, initial date and duration of therapeutic plasma exchange, dosage and time of administration of vincristine, and outcomes were recorded. Results The study included 15 patients [median age: 37 years (range: 26-65); 7 women and 8 men] with either relapsed or refractory thrombotic thrombocytopenic purpura who were treated with vincristine as an adjunct to therapeutic plasma exchange for a total of 22 episodes. Eighty-seven percent of patients achieved remissions in 20 of 22 episodes, with a median duration of remission of 29.5 months (range: 3-105). After a median follow-up of 55 months, 11 patients were alive. Vincristine was well tolerated with no safety concerns. Conclusion Vincristine offers a reasonable option for the treatment of patients with relapsed/refractory thrombotic thrombocytopenic purpura. Further studies evaluating vincristine in the front-line setting and in the relapsed/refractory setting are needed to validate the role of vincristine in thrombotic thrombocytopenic purpura patients.

Tyrosine kinase inhibitor (TKI) therapy is the current treatment of choice for patients with chronic phase chronic myeloid leukemia (CML) leading to rapid and durable hematological as well as molecular responses. However, emergence of resistance to TKIs has been the major obstacle to treatment success on long term. In this regard kinase domain mutations are the most common mechanism of therapy failure. In this study, we analyzed peripheral blood samples from 17 CML patients who had developed resistance to various TKIs by using next-generation sequencing parallel to Sanger sequencing. BCR-ABL1 kinase domain mutations have been found in 59% of the cohort. Our results demonstrate that next-generation sequencing results in a higher mutational detection rate than reported with conventional sequencing methodology. Furthermore, it showed the clonal diversity more accurately.

Congenital dyserythropoietic anemias are a rare group of inherited anemias characterized by ineffective erythropoiesis and distinct morphological abnormalities in the erythroblasts. Interferon alpha has been shown to be effective in type 1 congenital dyserythropoietic anemia but the optimal duration of therapy is undefined. We present here a 32-years-old female patient diagnosed with type 1 congenital dyserythropoietic anemia precipitated by pregnancy and treated successfully with a short course of interferon alpha resulting in a durable response. A literature search including PubMed database on previously published articles regarding congenital dyserythropoietic anemia type 1 patients treated with interferon is conducted.

Newer tyrosine kinase inhibitors (TKIs) (bosutinib, ponatinib) and allogeneic hematopoietic stem cell transplantation (allo-HSCT) can be utilized as a salvage therapy in patients with chronic myeloid leukemia (CML) who failed two lines (imatinib → nilotinib or imatinib → dasatinib) of TKI therapy. However, these TKIs are not available in many countries and not all patients can undergo allo-HSCT.In this study, CML patients who received dasatinib or nilotinib as a third-line treatment were retrospectively evaluated.Out of 209 patients, third-line dasatinib/nilotinib was administered in 21. During the follow-up, 16 out of 21 patients gained and/or maintained an optimal response, and 4 patients died due to progression. Seventeen patients were alive at the time of the analysis, of which 13 were still on TKI, whereas 4 patients quit treatment.In patients failing two lines of TKI, dasatinib or nilotinib can be beneficial and safely administered as a third-line treatment especially in nations with restricted resources.

Background The molecular response at 3 months of the original imatinib (OI) in patients with chronic myeloid leukemia has prognostic significance; however, this has never been tested for generic imatinib (GI). Patients and Methods We evaluated the BCR-ABL1 [international reporting scale ( IS )] transcript levels at 3 and 6 months to determine whether an early molecular response (EMR) had a prognostic effect on the outcome among chronic myeloid leukemia patients receiving GI. Ninety patients were divided into 2 groups, according to the imatinib they received, as OI (group A) and GI (group B). Results Two groups were equally balanced for age, gender, Sokal risk score, and optimal response. The 2 groups did not differ in achieving an EMR at 3 months, and patients with EMR at 3 months had significantly superior complete cytogenetic response and major molecular response rates compared with patients who did not achieve an EMR in both groups. The percentage of an optimal response [ BCR-ABL1 ( IS ), BCR-ABL1 ( IS ), 1%-10%] at 6 months was 93% and 95% for groups A and B, respectively ( P = .553). Patients with an optimal response (OR) at both 3 and 6 months had significantly superior event-free survival rates compared with patients without an OR in groups A and B. Conclusion The results of the present study have demonstrated most probably for the first time that an OR at 3 and 6 months in patients receiving either first-line GI and OI is clearly associated with greater response and event-free survival rates. Prospective randomized trials with larger numbers of patients and longer follow-up periods are needed to address the effect of EMR in patients receiving GI.

Monitoring minimal residual disease has become increasingly important in clinical practice of ALL management. Break-point fusion regions of leukaemia related chromosomal aberrations and rearranged immunoglobulin (Ig) and T cell-receptor (TCR) genes, which can be detected by polymerase chain reaction (PCR), are used as leukaemia specific markers in genetic studies of MRD. A total of 31 consecutive patients with newly diagnosed ALL were screened for eligibility criteria. Of those 26 were included in the study. One patient with partial response following induction therapy and four patients who were lost to follow-up after induction were excluded from the study; thus 21 patients were evaluated for MRD. Chromosomal aberrations were detected in 5 (24%) of the patients and were used for MRD monitoring. Three patients had t(9;22) translocation, the other 2 had t(4;11) and t(1;19). MRD-based risk stratification of the 16 patients analysed for Ig/TCR rearrangements revealed 3 low-risk, 11 intermediate-risk and 2 high-risk patients. MRD monitoring is progressively getting to be a more important predictive factor in adult ALL patients. As reported by others confirmed by our limited data there is a good correlation between MRD status and clinical outcome in patients receiving chemotherapy. The pilot-study presented here is the first that systematically and consecutively performs a molecular MRD monitoring of ALL patients in Turkey.Minimal rezidüel hastalığın (MRH) takibi, ALL tedavisinin klinik uygulamalarında giderek önem kazanmaktadır. Lösemide sıklıkla görülen kromozomal kırık noktaları, immunglobulin (Ig) ve T-hücre reseptörleri (THR), polimeaz zincir reaksiyonu (PCR) kullanılarak, MRH takibinde lösemiye özgü marker olarak kullanılmaktadır. Yeni ALL tanısı almış toplam 31 hasta çalışmaya alındı, kriterlere uygun 26 hasta ile çalışma gerçekleştirildi. 5 hasta çalışma sürecinde takip dışı kaldı ve 21 hasta MRH açısından değerlendirilmeye alındı. Bu hastalardan 5 (%24) tanesinde kromozomal translokasyonlar tespit edildi. 3 hastada t(9;22), 1 hastada t(4;11) ve 1 hastada da t(1;19) translokasyonları belirlendi. MRH’a dayalı risk tespitinde 16 hasta Ig/THR yeniden yapılanmaları için analiz edildi ve 3 tanesi düşük risk gurubu, 11 tanesi orta risk gurubu ve 2 tanesi de yüksek risk gurubuna dahil edildi. Elde ettiğimiz sonuçlar, kemoterapi alan hastalarda klinik sonuçların, MRH durumları ile iyi korelasyon gösterdiğini desteklemektedir. Bu pilot çalışma ile ülkemizde ilk defa sistematik olarak tanı ve takip örneklerinde MRH takibi gerçekleştirilmiştir.

t(1;3)(p36;p21) is a recurrent reciprocal translocation found in a subset of myelodysplastic syndrome (MDS)/acute myelogenous leukemia (AML) characterized by trilineage dysplasia, especially dysmegakaryopoiesis and poor prognosis. In the literature, some authors have suggested that this recurrent translocation is closely associated with prior chemotherapy including alkylating agents in various hematologic malignancies. We identified a recurring translocation, t(1;3)(p36;p21), in our patient with MDS/AML(M2), although she had not been given any kind of treatment previously.(1;3)(p36;p21) sitogenetik bulgusu, Myelodisplastik Sendrom (MDS)/Akut Myeloid Lösemi (AML) olgularının özellikle dismegakaryopoez ve kötü prognoz ile seyreden bir kısmında gözlenen tekrarlayan bir resiprokal translokasyondur. Bazı yazarlar bu translokasyonun değişik hematolojik kanserlerde alkilleyici ajanlarla yapılan kemoterapiyle sıkı bir ilişkisi olduğunu ileri sürmüşlerdir. Bu çalışmada, daha önce kemoterapi uygulanmamış t(1;3)(p36;p21) bulgulu bir MDS/AML(M2) olgusu sunulmaktadır.

Chronic graft-versus-host disease (GVHD) of the liver usually presents as an indolent cholestatic syndrome associated with abnormalities in the skin, oral mucosa, and lacrimal glands observed beyond day 100 after allogeneic bone marrow transplantation. Because of its cholestatic nature, chronic liver GVHD is not generally considered in the differential diagnosis of markedly elevated serum transaminases and jaundice. However, sudden rise in serum transaminase levels after day 70 posttranplant should always raise the question of chronic liver GVHD. We report here two cases, in whom the presentation of chronic graft-versus-host disease of the liver strongly resembled acute viral hepatitis. Chronic GVHD of the liver should also be taken into account in the differential diagnosis of marked elevations of liver enzymes in allogeneic stem cell transplant recipients and appropriate diagnostic and therapeutic measures should be applied.Karaciğerde kronik graft-versus-host hastalığı (GVHH) genellikle allogeneik kemik iliği transplantasyonunu izleyen 100. günden sonra ortaya çıkan kolestatik karaciğer fonksiyon bozukluğu, cilt ve oral mukoza lezyonları ile karakterize bir tablodur. Kolestatik komponentin ön planda olması sebebiyle, akut gelişen sarılık ve artmış transaminaz düzeyleri söz konusu olduğunda ayırıcı tanıda kronik GVHH öncelikli olarak yer almaz. Ancak bazen posttransplant geç dönemde gelişen akut hepatit kronik GVHH’nin ilk bulgusu olabilir. Bu yazıda, kronik GVHH’nin akut viral hepatit benzeri bir tablo ile ortaya çıktığı iki olgumuzu sunuyoruz.

At our institution 94 transplantations have been performed in an 8 year period up to December 2001. Forty-three females and 49 males with ages ranging from 14 to 61 years received 67 allogeneic (allo) and 27 autologous (auto) transplants; 2 patients were transplanted twice. The diagnosis of allo transplants were AML (27 patients-pts), CML (17 pts), ALL (16 pts) and AA (5 pts); those of auto transplants were NHL (13 pts), HD (10 pts), MM (3 pts) and AML (l pt). Of the patients with acute leukemia 69.7% were in first CR and ali but öne of the patients with CML were in first chronic phase. Source of hematopoetic stem cells were bone marrow (BM) in 61.9% (allo 81.5%, auto 14.8%) and peripheral blood (PB) in 38.1% (allo 18.5%, auto 85.2%). Ail donors were HLA-full matched siblings with öne exception. Conditionİng regimens were BU-CY (31 pts), TBI-CY (28 pts) and Flag-lda (öne pî) for leukemia, CY-ATG for AA, CBV for lymphoma and Mel-200 for MM. Median 2.69 x 108 nucieated celIsAg (BM) and 21.7 x 106 CD34 + celIsAg (PB) were infused to allo transplant recipients; 4 patients faiied to engraft and öne patient was inevaluable due to early death. Acute GVHD was observed in 11 patients (16.9% - grade ll-IV in 10.7%) and chronic GVHD was documented in 18 patients (33.9%- extensive in 9.43%). VOD was seen in 8 patients (12.3%). Early response was CR in 91.6% in patienîs wîth leukemia; patients with lymphoma showed a 73.1% response (CRPR) rate and 23.1% had resistant disease. So far 27.6% of the patients have relapsed ör showed progression and 45.7% have died (disease-related 27.2%, transplant-related 18.5%). At a median follow-up time of 32 months (range 0.6-96) DFS is 50.8% and OS is 53.9% in the allo transplant group. With a shorter follow-up (median 16 months, range 1-65) the same figures for the auto transplant group are 51.9 and 55.5%, respectively, in this cohort overall, OS and DFS are significantly superior in patients with early-stage disease: 71.7% vs. 26.7% in advanced-stage disease for OS and 71.4% vs. 36.8% for DFS, respectively and this trend applies to both transplant groups (p0.001 for ali comparisons).

Introduction Essential thrombocythemia (ET) is a chronic myeloproliferative neoplasm (MPN), characterized by the clonal proliferation of megakaryocytes in the bone marrow and high platelet count in the peripheral blood. ET has been associated with transformation to acute myeloid leukemia, myelodysplastic syndrome, chronic lymphoytic leukemia, and other MPNs, especially primary myelofibrosis. The association between multiple myeloma (MM) and ET is infrequent. Only a few cases in the medical literature have been demon

Cold agglutinin disease (CAD) is an autoimmune hemolytic anemia (AIHA) generally caused by IgM autoantibodies which exhibit maximal reactivity at 4°C. CAD can be idiopathic or secondary to some diseases and/or conditions. Only a minority of cases of secondary AIHA in non-Hodgkin’s lymphoma (NHL) are associated with cold antibodies. Diffuse large B cell lymphoma (DLBCL) is the most common subtype of NHLs with a proportion of nearly 30% of all adult cases. 40% of patients with DLBCL have an extranodal disease or at least disease initially confined to extranodal sites. The most common extranodal site is the gastrointestinal tract. We present a patient with primary gastrointestinal DLBCL who presented with CAD and was treated with a CHOP-Rituximab regimen.

Chronic myeloid leukaemia (CML) is a clonal haematological disease characterised by t(9;22)(q34;q11) which is called Philadelphia (Ph) chromosome. Highly improved haematological and cytogenetic results were obtained in chronic phase CML with the introduction of imatinib. Occurrence of additional cytogenetic abnormalities in Ph(+) cells is defined as clonal evolution (CE) and considered to be a preceding sign for acceleration. The most common additional chromosomal changes are +8, +Ph, i(17q), +19, -Y, +21, +17 and-7. The aims of this study were to delineate the occurrence pattern of cytogenetic clonal evolution in our cohort of CML patients and to investigate the impact on the course and prognosis of CML. Additional clonal chromosomal changes in Ph(+) cells were observed in 20 cases (19%). The abnormalities seen were monosomy 21 (%35), -17 (%30), -19 and +8 in (%25), -7, -8, -13, -15, -22, +Ph, and different marker chromosomes (%20), -Y, -12, -14, -16, -20 (%15), +Y, -10, -18 (%10), and -X, -3, -9...

The addition of the immunotherapeutic agent rituximab (R) to chemotherapy improved the response rates in diffuse large B cell lymphoma (DLBCL) [1]. However, despite major progress in the treatment,...

Febrile neutropenic episodes (FNEs) are among major causes of mortality in patients with hematological malignancies. Secondary infections develop either during the empirical antibiotic therapy or one week after cessation of therapy for a FNE. The aim of the study was to investigate the risk factors associated with secondary infections in febrile neutropenic patients.We retrospectively analyzed 750 FNEs in 473 patients between January 2000 and December 2006.Secondary infections were diagnosed in 152 (20%) of 750 FNEs. The median time to develop secondary infection was 10 days (range 2-34 days). The duration of neutropenia over 10 days significantly increased the risk of secondary infections (p0.001). The proportion of patients with microbiologically documented infections was found to be higher in primary infections (271/750, 36%) compared to secondary infections (43/152, 28%) (p=0.038). Age, sex, underlying disease, antibacterial, antifungal or antiviral prophylaxis, blood transfusion or bone marrow transplantation, central venous catheter or severity of neutropenia did not differ significantly between primary and secondary infections (p0.05) While fever of unknown origin (FUO) (p=0.005) and catheter-related bacteremia (p0.001) were less frequently observed in secondary infections, the frequency of microbiologically (p=0.003) and clinically (p0.001) documented infections, fungal pneumonias (p0.001), infections related with gram positive bacteria (p=0.04) and fungi (p0.001) and 30-day mortality rate (p0.001) were significantly higher in secondary infections (p0.001).Secondary infections should be regarded as life-threatening complications of febrile neutropenia. Secondary infections represent a more severe and mortal complication and cannot be regarded just as another febrile neutropenic episode.Amaç: Febril nötropenik atak (FNA) hematolojik hastalığı olan hastalarda ölümlerinin başlıca nedenleri arasında yer almaktadır. İkincil enfeksiyonlar FNA’nın ampirik antibiyotik tedavi ya da bu tedavinin kesilmesinden bir hafta sonrasına kadar gelişebilir. Bu çalışmada amacımız, febril nötropenik hastalarda ikincil enfeksiyonları ile ilişkili risk faktörlerini araştırmaktır. Yöntem: Kliniğimizde Ocak 2000 ile Aralık 2006 tarihleri arasında 73 hastada 750 FNA geriye dönük olarak incelenmiştir. Bulgular: Enfeksiyonlar 750 FNA’nın 152 sinde (% 20) tespit edilmiştir. Sekonder enfeksiyon gelişmesi için geçen medyan süre 10 gün (1-34 gün) idi. Nötropeni süresinin 10 günün üzerinde olması ikincil enfeksiyon riskini anlamlı derecede artırmaktadır (p0.001). Mikrobiyolojik dökümante enfeksiyon oranı primer enfeksiyonu (271/750, % 36) olan hastalarda sekonder enfeksiyonlu hastalara (43/152, % 28) göre daha yüksek olduğu bulunmuştur (p=0.038). Yaş, cinsiyet, altta yatan hastalık, antibakteriyel, antifungal veya antiviral profilaksi, kan transfüzyonu veya kemik iliği nakli, santral venöz kateter ya da nötropeni şiddeti açısından primer ve sekonder enfeksiyonu olan hastalar arasında anlamlı farklılık yoktu (p0.05). Katetere bağlı bakteremi (p0.001) ve nedeni bilinmeyen ateş (p=0.005) ikincil enfeksiyonlu hastalarda daha az sıklıkta gözlenirken, mikrobiyolojik (p=0.003) ve klinik olarak dökümante enfeksiyonlar (p0.001), fungal pnömoniler (p0.001), gram-pozitif bakteriler ile ilgili enfeksiyonlar (p=0.04) ve mantar enfeksiyonları (p0.001) ve 30-günlük mortalite oranı (p0.001) ikincil enfeksiyonlarda (p0.001) anlamlı olarak yüksek bulunmuştur. Sonuç: İkincil enfeksiyonlar febril nötropenik hastada hayatı tehdit eden komplikasyonlar olarak kabul edilmelidir. Enfeksiyonlar daha ağır ve ölümcül şekilde ortaya çıkabilir ve yeni bir febril nötropenik atak olarak kabul edilmemelidir.Amaç: Febril nötropenik atak (FNA) hematolojik hastalığı olan hastalarda ölümlerin başlıca nedenleri arasında yer almaktadır. İkincil enfeksiyonlar FNA’nın ampirik antibiyotik tedavi ya da bu tedavinin kesilmesinden bir hafta sonrasına kadar gelişebilir. Bu çalışmada amacımız, febril nötropenik hastalarda ikincil enfeksiyonları ile ilişkili risk faktörlerini araştırmaktır. Gereç ve Yöntemler: Kliniğimizde Ocak 2000 ile Aralık 2006 tarihleri arasında 73 hastada 750 FNA geriye dönük olarak incelenmiştir. Bulgular: Enfeksiyonlar 750 FNA’nın 152’sinde (%20) tespit edilmiştir. Sekonder enfeksiyon gelişmesi için geçen medyan süre 10 gün (1-34 gün) idi. Nötropeni süresinin 10 günün üzerinde olması ikincil enfeksiyon riskini anlamlı derecede arttırmaktadır (p0,001). Mikrobiyolojik dökümante enfeksiyon oranı, primer enfeksiyonu (271/750, %36) olan hastalarda sekonder enfeksiyonlu hastalara (43/152, %28) göre daha yüksek olduğu bulunmuştur (p=0,038). Yaş, cinsiyet, altta yatan hastalık, antibakteriyel, antifungal veya antiviral profilaksi, kan transfüzyonu veya kemik iliği nakli, santral venöz kateter ya da nötropeni şiddeti açısından primer ve sekonder enfeksiyonu olan hastalar arasında anlamlı farklılık yoktu (p0,05). Katetere bağlı bakteremi (p0,001) ve nedeni bilinmeyen ateş (p=0,005) ikincil enfeksiyonlu hastalarda daha az sıklıkta gözlenirken, mikrobiyolojik (p=0,003) ve klinik olarak dökümante enfeksiyonlar (p0,001), fungal pnömoniler (p0,001), gram-pozitif bakteriler ile ilgili enfeksiyonlar (p=0,04) ve mantar enfeksiyonları (0,001) ve 30-günlük mortalite oranı (p0,001) ikincil enfeksiyonlarda (p0,001) anlamlı olarak yüksek bulunmuştur. Sonuç: İkincil enfeksiyonlar febril nötropenik hastada hayatı tehdit eden komplikasyonlar olarak kabul edilmelidir. Enfeksiyonlar daha ağır ve ölümcül şekilde ortaya çıkabilir ve yeni bir febril nötropenik atak olarak kabul edilmemelidir.

Clinicopathologic features of 21 patients with T-cell-rich B-cell lymphoma (TCRBCL) were reviewed and compared to 43 patients with diffuse large B-cell lymphoma (DLBCL) to determine if there were distinguishing clinical characteristics and differences in response or survival to CHOP therapy. For the diagnosis of TCRBCL, the current WHO criteria was used. In all of our cases, the majority of cells are non-neoplastic T cells and10% large neoplastic B cells are present. The initial pathologic diagnosis was nodular lymphocyte predominant Hodgkin's lymphoma (NLPHL) in two cases. Patients with TCRBCL were significantly younger (median: 46 years) and had a significantly higher incidence of B symptoms (62%), hepatomegaly (33%) and marrow infiltration (33%) at presentation when compared to DLBCL (P0.03). The CR rate after treatment was 48% for TCRBCL patients versus 79% for the DLBCL (P0.003). Although the CR rates in between the two groups are significant, the difference in 3 years survival rates in each CR groups was insignificant (80% versus 77%). The overall survival time in the two groups was 17 months. Event-free survival time in TCRBCL was 12 months, compared with 17 months in the DLBCL (P0.05). The frequency of patients with TCRBCL achieving CR was 52.6% whereas that of patients with DLBCL was 79% (P0.003). The TCRBCL 3 years event-free survival 48% and overall survival 64% were 63 and 72% for DLBCL, respectively.

Background In this study, the clinical characteristics, survival, and prognostic factors of 200 patients diagnosed as having chronic lymphocytic leukemia (CLL) were analyzed. Methods The medical charts of 200 CLL patients registered to our center between 1984 and 2000 were retrospectively evaluated. Results Of all patients, 129 were men and 71 were women (male/female ratio, 1.82). The median age at the time of initial diagnosis was 63 years (range, 38-90 years). Sixty patients were classified as Binet's Stage A, 49 as Stage B, and 91 as Stage C. Sixty-two cases were diagnosed during routine laboratory examinations when they were asymptomatic. Forty-three patients were lost to follow-up, and 157 patients have been followed regularly until the end of the study period. Hemolytic anemia developed in nine (5.7%) patients, second primary cancer in six (3.8%), and Richter's syndrome in two (1.2%). Forty-eight percent of CLL patients were treated immediately after initial diagnosis. The overall response (complete or partial) to first-line and second-line therapies was 61.6% and 54.4%, respectively. The median time of follow-up for patients followed up regularly was 47 months (range, 1-195 months). Sixty-three patients died during the follow-up: the deaths of 39 (62%) of these were attributable to CLL-related causes. The median survival time was 48 months. The 5-year survival rate was 36.5% and the 10-year survival rate was 8%. Stage according to Rai's classification, lymphocyte count, and age showed a significant prognostic effect on survival by univariate analysis. On multivariate analysis, advanced age and lymphocyte count were independent prognostic parameters. Conclusion In our study, more asymptomatic CLL patients have been diagnosed in recent years. The survival, especially of our early-stage patients, was shorter than that in other CLL series of Western origin. Rai's staging system was seen to determine prognosis better than Binet's staging system.

In this retrospective study, we evaluated the clinical features and the effects of various treatment modalities on the clinical course in patients diagnosed with idiopathic thrombocytopenic purpura (ITP) at our center between 1984-2000. We retrospectively examined the medical records of 321 (229 females, 92 males) ITP patients. One hundred and seventy-one (53.3%) patients were lost to follow-up. When evaluating the clinical features, all 321 patients were included; however, when the response to treatment modalities was evaluated only 150 patients followed up regularly were considered. The median age of the patients on initial diagnosis was 34 years (range: 14-78). At initial diagnosis, 235 (73.2%) patients had signs of bleeding. Of patients diagnosed with ITP initially, six later turned out to have systemic lupus erythematosus (SLE) and two myelodysplastic syndrome (MDS). The median follow-up of 150 patients followed up regularly was 30 months (range: 4-396). One hundred and thirty-seven of these subjects had an indication for treatment and 94.2% of them were administered either standard or high-dose steroids as the first-line therapy. Complete remission (CR) was defined as any platelet count >100,000/mm(3) lasting for 3 months or longer without treatment. CR was achieved in 51.9% of the patients given steroids as the initial therapy. During a median follow-up of 33 months, relapse occurred in 58.2% of these patients, and after a median follow-up of 11 months the rest of them were still in remission. Ninety-eight patients followed up regularly were administered second-line therapies. CR was obtained in 44.4% of the patients who used steroids as second-line therapy. Within a median follow-up of 15 months, 20.8% of these patients relapsed. Splenectomy was performed in 76 patients and CR was obtained in 68.4% of the regularly followed up patients. Relapse occurred within a median of 96 months in 15.4% of the patients who had CR. Kaplan-Meier curves showed that the duration of CR obtained by splenectomy was significantly higher than that obtained by steroids (p