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Objective: Brucellosis has the ability to mimic a variety of multisystem illnesses, exhibiting a wide range of clinical polymorphism that frequently leads to misdiagnosis and treatment delays, thus raising the risk of complications. In cases of brucellosis, hematologic abnormalities might manifest as anemia, leukopenia, thrombocytopenia, lymphomonocytosis, hemolytic anemia, disseminated intravascular coagulation, and pancytopenia. Material and Methods: In this study, we presented the bone marrow biopsy findings of a brucellosis case. Case: For ten days, a 19-year-old male patient with fever, exhaustion, weight loss, loss of appetite, and stomach pain was taken to the emergency room. A bone marrow aspiration and biopsy were conducted because of the patient's indications and symptoms. Brucella melitensis was isolated in the blood and bone marrow cultures on the 7th day. Conclusion: Brucellosis, one of the most common zoonoses in the world and our country, can occur with a wide variety of complications.

Autologous stem cell transplantation (ASCT) is a significant and potentially curative treatment modality for patients with relapsed/refractory lymphoma. Insufficient mobilization and harvest of peripheral stem cells can be a major obstacle for performing ASCT. The aim of this study was to evaluate the factors that might influence mobilization failure in patients with lymphoma.Eighty-seven patients diagnosed with non-Hodgkin and Hodgkin lymphoma who underwent stem cell mobilization afterwards at the Hacettepe University Medical School Bone Marrow Transplantation Center, Turkey, between the years of 2000 and 2018 were evaluated.A total of 87 patients were included in this study. In 66 of 87 patients (75.9%), the first mobilization trial was successful. Adequate (≥2x106/kg) CD34+ cells were collected in the first apheresis for 66 patients (9.5±8.1). For 21 of 87 (24.1%), the first mobilization trial was unsuccessful. Therefore, a second mobilization trial was performed for these patients with plerixafor (5.5±3.3). The number of CD34+ cells was significantly higher in patients who were successful in the first mobilization (p=0.002).The success rate of the first mobilization trial was found to be higher in patients with high platelet counts before mobilization and patients who received chemotherapy-based mobilization protocols. In the patients who had mobilization failure in the first trial, plerixafor was used in a later mobilization, and those patients had an adequate amount of stem cells for ASCT. Parameters predicting mobilization failure would allow for preemptive, more cost-effective use of such agents during the first mobilization attempt; however, risk factors for mobilization failure are still not clear.Otolog kök hücre transplantasyonu (OKHT), relaps/refrakter lenfoma hastaları için önemli ve potansiyel olarak küratif bir tedavi yöntemidir. Yetersiz mobilizasyon ve periferik kök hücrelerin toplanması OKHT’nin gerçekleştirilmesi için büyük bir engel olabilir. Bu çalışmanın amacı lenfoma hastalarında mobilizasyon başarısızlığını etkileyebilecek faktörleri değerlendirmektir.Hacettepe Üniversitesi Tıp Fakültesi Kemik İliği Nakil Merkezi’nde 2000-2018 yılları arasında Hodgkin ve non-Hodgkin lenfoma tanısı alan ve sonrasında kök hücre mobilizasyonu yapılan 87 hasta değerlendirildi.Bu çalışmaya toplam 87 hasta dahil edildi. Seksen yedi hastanın 66’sında (%75,9) ilk mobilizasyon denemesi başarılı oldu. 66 hastada (9,5±8,1) ilk aferezde yeterli (≥2x106/kg) CD34+ hücre toplandı. Seksen yedi kişiden 21’i (%24,1) için ilk mobilizasyon denemesi başarısız oldu. Bu nedenle bu hastalara pleriksafor ile (5,5±3,3) ikinci bir mobilizasyon denemesi yapıldı. İlk mobilizasyonda başarılı olan hastalarda CD34+ hücre sayısı anlamlı olarak yüksekti (p=0,002).Mobilizasyon öncesi trombosit sayısı yüksek olan hastalarda ve kemoterapi bazlı mobilizasyon protokolleri alan hastalarda ilk mobilizasyon denemesinin başarı oranı daha yüksek bulundu. İlk denemede mobilizasyon başarısızlığı olan hastalarda daha sonraki mobilizasyonda pleriksafor kullanılmış ve bu hastalarda OKHT için yeterli miktarda kök hücre mevcuttu. Mobilizasyon başarısızlığını öngören parametreler, ilk mobilizasyon girişimi sırasında bu tür ajanların önleyici, daha uygun maliyetli kullanımına izin verecektir; ancak, mobilizasyon başarısızlığı için risk faktörleri hala net değildir.

This is the first study to evaluate both the dynamic thiol-disulfide homeostasis and ischemia-modified albumin (IMA) levels in patients with chronic lymphocytic leukemia (CLL). Twenty-nine patients with CLL and 20 controls were included in the study. The dynamic thiol-disulfide balance was determined by the newly developed colorimetric method by Erel. IMA levels were determined by the cobalt binding test. We found that total antioxidant status levels were lower while total oxidant status (TOS) and oxidative stress index (OSI) levels were significantly higher in patients with CLL than controls. Moreover, native and total thiol levels were found to be statistically significant between the study and control groups (p

The prognosis of multiple myeloma (MM) patients is highly heterogeneous. The aim of this study is to determine the impact of patients’ renal functions on the prognostic performance of the International Staging System (ISS). In addition, we aimed to evaluate the results of survival of patients with ISS stages and normal renal functions and those with ISS stages and abnormal renal functions with this study.Two hundred and four patients with newly diagnosed MM who received an autologous stem cell transplantation after induction chemotherapy in our tertiary care center between the years of 2001 and 2018 were evaluated.There were 153 (75%) MM patients who had a glomerular filtration rate (GFR) of ≥60 mL/min and 51 (25%) MM patients who had GFR of60 mL/min at the time of diagnosis in this study. There was a strong correlation between ISS stage and GFR. The ISS stages were higher in patients who had GFR of60 mL/min than patients who had GFR of ≥60 mL/min (p0.001). Patients with GFR of60 mL/min were significantly more prevalent in the ISS III group than ISS I and II (p0.001).This study showed that the ISS provides significant prognostic information in MM patients with GFR of ≥60 mL/min at diagnosis. However, in patients with impaired renal function at the time of diagnosis, B2-microglobulin may not be a good prognostic indicator since it may be affected by renal dysfunction as well as tumor burden.Multipl miyelom (MM) hastalarının prognozu oldukça heterojendir. Bu çalışmanın amacı, hastaların böbrek fonksiyonlarının Uluslararası Evreleme Sistemi’nin (ISS) prognostik performansı üzerindeki etkisini belirlemektir. Ayrıca bu çalışma ile ISS evreli ve böbrek fonksiyonları normal ve anormal olan hastaların ISS evresine göre sağkalım sonuçlarını değerlendirmeyi amaçladık.2001-2018 yılları arasında üçüncü basamak merkezimizde indüksiyon kemoterapisi sonrası otolog kök hücre nakli yapılan yeni tanı konmuş MM’li 244 hasta değerlendirildi.Tanı anında glomerüler filtrasyon hızı (GFR) ≥60 mL/dak olan 153 (%75) MM hastası ve GFR’si60 mL/dak olan 51 (%25) MM hastası vardı. ISS evresi ile GFR arasında güçlü bir ilişki vardı. ISS evreleri, GFR değeri60 mL/dak olan hastalarda GFR’si ≥60 mL/dak olan hastalara göre daha yüksekti (p0,001). GFR değeri60 mL/dak olan hasta sayısı, ISS 3 grubunda ISS 1 ve 2’ye göre anlamlı olarak daha saptandı (p0,001).Bu çalışma, ISS’nin GFR’si ≥60 mL/dak olan MM hastalarında tanıda önemli prognostik bilgi sağladığını göstermiştir. Bununla birlikte, tanı anında böbrek fonksiyon bozukluğu olan hastalarda B2-mikroglobulin, böbrek fonksiyon bozukluğundan ve tümör yükünden etkilenebileceğinden iyi bir prognostik gösterge olmayabilir.

Objective: Patients presenting with various complaints to the hematology polyclinic may initially be diagnosed with an atypical lymphoproliferation in bone marrow or lymph node biopsy. The aim of this study was to determine whether a hematological disease, immunodeficiency syndrome, or other diseases were diagnosed during follow-up of patients with an initial diagnosis of atypical lymphoproliferation in bone marrow or in lymph node biopsy. Materials and Methods: Adult (≥18 years) patients who were admitted to the Hacettepe University Hospital, for various symptoms between 2002 and 2018 were searched for in our hematology department electronical database. Results: A total of 52 patients were found with atypical lymphoproliferation in lymph node or bone marrow biopsy. The patients had been followed for a median of 9.2 months (0.03-86.2). Hematological neoplasia developed in 32 (61.6%) of the 52 patients and primary immunodeficiency was detected in 6 (11.5%) of the 52 patients. Twenty-six patients (50%) were diagnosed Non-Hodgkin lymphoma during follow up, 1 patient (1%) was diagnosed chronic lymphocytic leukemia, 5 patients (9.6%) were diagnosed Hodgkin lymphoma and 6 patients (11.5%) were diagnosed primary immunodeficiency. Median time was 2.3 months (0.2-25 months) between atypical lymphoproliferation report in bone marrow or lymph node biopsy and the diagnosis of patients. Conclusion: In conclusion, patients who have atypical lymphoproliferation in the lymph node or bone marrow biopsy should be followed up in the hematology outpatient clinic. Because, during follow-up, diseases such as hematological neoplasia or immunodeficiency can be diagnosed in patients with atypical lymphoproliferation.

Objective: Advanced imaging techniques are increasingly used in the diagnostic workup of patients. The clinical significance of incidentally-detected signal alterations of the bone marrow on magnetic resonance imaging has not been widely studied. The purpose of this study was to determine whether bone marrow signal changing on magnetic resonance imaging could predict a hematologic disease. Materials and Methods: Thirty patients who were referred to Hematology department due to bone marrow signal alteration on magnetic resonance imaging between the years of 2011 and 2018 were evaluated. Results: There were 8 males and 22 females with a median age of 53 (range, 31–86) years at the time of presentation to the Hematology clinic. The magnetic resonance imaging studies had been taken because the patients had complaints of pain in extremities or lumbago (80%). The patients had been followed for median 4.5 months (0-71.7). Six (20%) cases had a bone marrow biopsy at presentation and a diagnosis was established in 5 (16.6%) of them (1 patient was diagnosed acute myeloid leukemia, 4 patients were diagnosed multiple myeloma). Marrow biopsy was done in 11 of the cases during follow-up median 3.8 months (1.3-11.5) after presentation. A diagnosis was made in 9 cases (5 patients were diagnosed multiple myeloma, 2 patients were diagnosed follicular lymphoma, 1 patient was diagnosed waldenstrom macroglobulinemia). Thirteen cases never had a biopsy. These cases had been followed for 1.3 months (0-71.7). None of them showed clinical abnormalities related to a lymphohematopoietic disorder and/or diagnosed with such a disorder. Only 1 patient was diagnosed with osteomalacia at follow-up. Conclusion: Incidentally-detected signal alterations of the bone marrow on magnetic resonance imaging should trigger investigations for a marrow problem. Most of the diagnosis patients were multiple myeloma. Extremity pain and findings like anemia may be associated with lymphohematological malignancies.

Multiple myeloma (MM) associated with extramedullary (EM) plasmacytoma has a poor therapeutic response and poor outcomes when treated with conventional chemotherapy. EM plasmacytoma is divided into two groups: the first group comprises tumors that are extending directly from osteolytic bone lesions (EM-B, bone-related), while the second results from plasmacytoma infiltration into soft tissues with no relationship to the bone (EM-S, soft tissue-related). This study aimed to compare the general characteristics and survival outcomes of transplant-eligible MM patients who had EM-S or EM-B and MM patients who did not have plasmacytoma at the time of diagnosis.This study was performed in a retrospective manner. The MM patients who were treated at our tertiary care center between January 2003 and January 2017 were evaluated retrospectively for the presence of plasmacytoma at diagnosis.There were 141 (78.3%) MM patients who did not have plasmacytoma, 22 (12.2%) MM patients who had EM-B, and 17 (9.4%) MM patients who had EM-S at the time of diagnosis in this study. The 5-year overall survival was 63% in patients who had bone EM-B, 63% in patients who had EM-S, and 80% in patients who did not have plasmacytoma (p=0.02). The 5-year disease-free survival was 47% in patients who had EM-B, 35% in patients who had EM-S, and 54% in MM patients who did not have plasmacytoma (p=0.15).These findings lead us to suggest that MM patients with EM plasmacytoma at the time of diagnosis have poorer prognosis than patients without plasmacytoma, even if autologous stem cell transplantation is performed. The presence of EM involvement negatively affects survival outcomes.Ekstramedüller (EM) plazmasitom ile ilişkili multipl myelom (MM), geleneksel kemoterapi ile tedavi edildiğinde zayıf bir terapötik yanıta ve kötü sonuçlara sahiptir. EM plazmasitoma iki gruba ayrılır: ilk grup doğrudan osteolitik kemik lezyonlarından uzanan tümörlerden oluşurken, ikincisi yumuşak dokulara plazmasitom infiltrasyonundan, kemikle ilişkisi olmayan plasmasitomdur. Bu çalışma, kemikle ilişkili yada yumuşak doku ile ilişkili olan ve tanı anında plazmasitomu olmayan MM hastalarının genel özelliklerini ve sağkalım sonuçlarını karşılaştırmayı amaçladı.Bu çalışma retrospektif olarak yapılmıştır. Ocak 2003-Ocak 2017 tarihleri arasında üçüncü basamak merkezimizde tedavi gören MM hastaları tanı anında plazmasitom varlığı açısından retrospektif olarak değerlendirildi.Bu çalışmaya plazmositom olmayan 141 (%78,3) MM, kemik plasmasitomu olan 22 (%12,2) ve tanı anında yumuşak doku plasmasitomu olan 17 (%9,4) MM hastası alındı. Beş yıllık genel sağkalım, kemik plasmasitomu olan hastalarda %63, yumuşak doku plasmasitomu olan hastalarda %63 ve plazmositom olmayan hastalarda %80 saptandı (p=0,02). Beş yıllık hastalıksız sağkalım ise kemik plasmasitomu olanlarda %47, yumuşak doku plasmasitomu olanlarda %35 ve plazmasitom olmayan MM hastalarında %54 saptandı (p=0,15).Sonuç olarak, bu bulgular bizi, tanı anında EM plazmasitomu olan MM hastalarının, kök hücre nakli yapılsa bile, plazmasitomu olmayan hastalara göre kötü prognoza sahip olduğunu düşündürmektedir. EM tutulumunun varlığı sağkalım sonuçlarını olumsuz etkilemektedir.

The prognosis of patients with acute myeloid leukemia (AML) is affected by factors that are both patient- and disease-specific. The aim of this study is to evaluate the impact of early versus late platelet and neutrophil recovery after induction chemotherapy on survival outcomes of AML patients.A total of 181 patients with AML who were treated in our tertiary center between 2001 and 2018 were evaluated. Neutrophil and platelet recovery times were accepted as the periods from the beginning of induction chemotherapy to a neutrophil count of ≥0.5x10The 5-year overall survival (OS) rates for patients who had EPR and LPR after induction chemotherapy were 62% and 23%, respectively (p0.001). The 5-year disease-free survival (DFS) rates for patients who had EPR and LPR after induction chemotherapy were 57% and 15%, respectively (p0.001).Short bone marrow recovery time may indicate better healthy hematopoiesis and marrow capacity associated with longer OS and DFS.Akut myeloid lösemili (AML) hastaların prognozu, hem hastaya hem de hastalığa özgü faktörlerden etkilenmektedir. Bu çalışmanın amacı, indüksiyon kemoterapisi sonrası erken ve geç trombosit ve nötrofil iyileşmesinin akut myeloid lösemi hastalarının sağkalım sonuçları üzerindeki etkisini değerlendirmektir.2001-2018 yılları arasında üçüncü basamak sağlık merkezimizde tedavi edilen 181 AML hastası çalışmaya alındı. Nötrofil ve trombosit iyileşme süreleri, indüksiyon kemoterapisinin başlangıcından itibaren sırasıyla 3 gün süreyle nötrofil sayısının 0,5×10İndüksiyon kemoterapisi sonrası erken ve geç trombosit iyileşmesi olan hastalar için 5 yıllık genel sağkalım sırasıyla %62 ve %23 olarak saptandı (p0,001). İndüksiyon kemoterapisi sonrası erken ve geç trombosit iyileşmesi olan hastalar için 5 yıllık hastalıksız sağkalım sırasıyla %57 ve %15 saptandı (p0,001).Sonuç olarak, kısa kemik iliği iyileşme süresi, daha uzun genel ve hastalıksız sağkalım ile ilişkili daha sağlıklı bir hematopoez/kemik iliği kapasitesini gösterebilir.

Patients with solid malignancies are more vulnerable to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection than the healthy population. The outcome of SARS-CoV-2 infection in highly immunosuppressed populations, such as in patients with hematological malignancies, is a point of interest. We aimed to analyze the symptoms, complications, intensive care unit admissions, and mortality rates of patients with hematological malignancies infected with SARS-CoV-2 in Turkey.In this multicenter study, we included 340 adult and pediatric patients diagnosed with SARS-CoV-2 from March to November 2020. Diagnosis and status of primary disease, treatment schedules for hematological malignancies, time from last treatment, life expectancy related to the hematological disease, and comorbidities were recorded, together with data regarding symptoms, treatment, and outcome of SARS-CoV-2 infection.Forty four patients were asymptomatic at diagnosis of SARS-CoV- 2 infection. Among symptomatic patients, fever, cough, and dyspnea were observed in 62.6%, 48.8%, and 41.8%, respectively. Sixty-nine (20%) patients had mild SARS-CoV-2 disease, whereas moderate, severe, and critical disease was reported in 101 (29%), 71 (20%), and 55 (16%) patients, respectively. Of the entire cohort, 251 (73.8%) patients were hospitalized for SARS-CoV-2. Mortality related to SARS-CoV-2 infection was 26.5% in the entire cohort; this comprised 4.4% of those patients with mild disease, 12.4% of those with moderate disease, and 83% of those with severe or critical disease. Active hematological disease, lower life expectancy related to primary hematological disease, neutropenia at diagnosis of SARS-CoV-2, ICU admission, and first-line therapy used for coronavirus disease-2019 treatment were found to be related to higher mortality rates. Treatments with hydroxychloroquine alone or in combination with azithromycin were associated with a higher rate of mortality in comparison to favipiravir use.Patients with hematological malignancy infected with SARS-CoV-2 have an increased risk of severe disease and mortality.Solid malignite hastalarının şiddetli akut solunum yolu enfeksiyonu-koronavirüs-2 (SARS-CoV-2) enfeksiyonuna sağlıklı bireylerden daha yatkın oldukları gösterilmiştir. Bu verilerin ardından oldukça yoğun immünosupresif olan hematolojik malignite hastalarında SARS-CoV-2 infeksiyonu sonuçları ilgi konusu olmuştur. Biz de bu makalede Türkiye’de hematolojik malignite tanısı ile takip ve tedavi edilirken SARS-CoV-2 enfeksiyonu saptanan hastaların semptom, komplikasyon, yoğun bakım ünitesine yatış ve mortalite oranlarını değerlendirmeyi amaçladık.Çok merkezli çalışmamıza Mart-Kasım 2020 tarihleri arasında SARS-CoV-2 enfeksiyonu tanısı alan erişkin ve pediatrik 340 hastayı dahil ettik. Hastaların hematolojik malignite tanıları, hastalık statusları, tedavileri, son tedaviden enfeksiyona kadar geçen süre, komorbiditeleri, yaşam beklentileri değerlendirildi. Semptomları, oluşan komplikasyonlar ve sonuçlar analiz edildi.Kırk-dört hasta semptomsuz olarak enfeksiyonu geçirirken, semptomatik hastaların ateş, öksürük, ve dispne oranları sırasıyla %62,6, %48,8 ve %41,8 idi. Altmış altı hasta (%20) hastalığı hafif geçirirken, orta, ciddi ve kritik hastalık tanısı alanların oranı sırasıyla %29, %20 ve %16 idi. Tüm kohortta ölüm oranı %26,6 idi; ölüm hafif hastalığı olanlarda %4,4 , orta derece hastalık geçirenlerde %12 ve ciddi/kritik hastalık geçirenlerde ise %83 olarak saptandı. Aktif hematolojik hastalık olması, primer hematolojik hastalığa bağlı düşük hayat beklentisi, SARS-CoV-2 tanısı aldığında nötropenik olmak, yoğun bakıma alınmış olmak ve ilk sıra koronavirüs hastalığı-2019 tedavisi yüksek ölüm riski ile ilişkilendirilen faktörlerdendi. Tek başına veya azitromisin ile kombine olarak hidroksiklorokin kullanan hastaların sadece favipiravir kullananlara göre ölüm riskleri daha yüksek saptandı.SARS-CoV-2 infeksiyonu geçiren hematolojik malignite hastalarında daha yüksek oranda ciddi hastalık ve ölüm riski gözlenmektedir.

Aim:Cigarette smoking is associated with an increased risk of cardiovascular diseases, including coronary artery disease, peripheral vascular disease, ischemic heart disease, atherosclerosis, myocardial infarction, and stroke. Our aim was to define possible effects of smoking on hematological parameters as well as ferritin and transferrin saturation.Methods:This study was performed in a retrospective manner. One hundred and forty-nine patients, who were admitted to Hacettepe University Hospitals between September 2018 and November 2018, were evaluated.Results:There were 95 (63.7%) healthy non-smokers and 54 (36.3%) healthy smokers included in this study. The median age was 32 (18-61) years for all groups. There were 47 (31.5%) males and 102 (68.5%) females in this study. Hemoglobin (p

The majority of patients with acute myeloid leukemia (AML) receive intensive induction chemotherapy for obtaining a complete remission (CR). Despite consolidation chemotherapy and advances in allogeneic hematopoietic stem cell transplantation, most of these patients finally relapse and die from AML. The aim of this study is to determine the impact of duration of remission achievement on survival of patients with newly diagnosed AML who achieve CR after induction chemotherapy.We retrospectively analyzed patients with AML who received first induction chemotherapy between 2001 and 2018.The 5-year overall survival for patients who had early remission after induction chemotherapy and patients who had delayed remission after induction chemotherapy were 83% (95% confidence interval [CI], 0.79-0.87) and 35% (95% CI, 0.31-0.39), respectively (P .001). The 5-year disease-free survival for patients who had early remission after induction chemotherapy and patients who had delayed remission after induction chemotherapy were 81% (95% CI, 0.75-0.87) and 28% (95% CI, 0.21-0.35), respectively (P .001).In conclusion, time to entering CR is a predictor factor of overall survival and disease-free survival for patients with newly diagnosed AML who achieve CR after first induction chemotherapy. Patients achieving CR only after a lengthy time (eg, more than 29 days) should be considered to have high relapse rate and should undergo allogeneic hematopoietic stem cell transplantation.

Background and Aim Splenectomy is a frequent component of the diagnosis and treatment of hematological disorders. The aim of this study was to define the indications and outcomes of splenectomy for benign and malign hematological disorders. Materials and Methods One hundred and two patients with hematological disease who had splenectomy at Hacettepe University Hospital between the years of 2010 and 2018 were evaluated. Results A total of one hundred and two patients were included in this study. The median age was 52 (20-82) years at the time of splenectomy. Most of the patients were female (57.9%). The median follow up time was 11.0 (0.03-87.9) months after splenectomy. Splenectomy was performed to diagnose thirty patients (29.4%). Seventy-two patients underwent splenectomy for the treatment of hematological disease (70.6%). Twenty-seven patients (90%) were diagnosed with various lymphomas. Two patients (6.7%) were diagnosed with hairy cell leukemia and one patient (3.3%) was diagnosed with large granular lymphocytic leukemia. Conclusion In conclusion, an improvement in medical therapy, especially with monoclonal antibodies, the indications and outcomes of splenectomy for hematologic disorders have changed extremely in last years. Nevertheless, splenectomy has an important role for diagnosis and treatment of benign and malign hematological disorders.

Background Patients who achieve complete remission (CR) with incomplete blood count recovery (CRi) in acute myeloid leukemia (AML) have inferior overall survival and lower progression-free survival. The aim of this study was to define whether blood count recovery-based CR before allogeneic hematopoietic stem cell transplantation (alloHSCT) had an impact on survival in patients with AML. Materials and Methods This study has been performed in a retrospective manner. One hundred one patients with AML who received an alloHSCT in our transplant center at Hacettepe University Hospital between the years 2001 and 2018 were evaluated. CRi were defined as bone marrow CR with absolute neutrophil count Results A total of 101 patients were entered into the study between 2001 and 2018. Median follow-up for all survivors was 38 months (range, 6-220 months). The 5-year overall survival for patients who were in CRi and patients who were in CR before transplantation were 58% and 67%, respectively (P = .68). The 5-year progression-free survival for patients who were in CRi and patients who were in CR before transplantation were 68% and 64%, respectively (P = .99). Conclusion In conclusion, we observed equivalent posttransplant outcomes between patients who were in CR and patients who were in CRi before alloHSCT. We assume that alloHSCT eliminated the negative effect of pre-transplant blood count levels.

The overall survival (OS) in patients with multiple myeloma (MM) has increased in the last decade due to the introduction of proteasome inhibitors, immunomodulatory drugs and monoclonal antibodies as well as an extensive combination of autologous stem cell transplantation (ASCT) for suitable patients. The objective of this study was to examine the impact of pre-transplant and post-transplant remission status of patients on survival in newly diagnosed multiple myeloma. Two hundred and four patients with newly diagnosed MM who received an ASCT in our HSC transplant center at Hacettepe University Hospital between the years of 2001 and 2018 were evaluated in a retrospective manner. The median follow-up period was 35.9 months (range 4.2–206.4) for the entire group. The 5-year OS for pre-transplant remission status CR/VGPR patients and pre-transplant remission status PR or less patients were 79% and 68%, respectively (p = 0.09). The 5-year PFS for pre-transplant remission status CR/VGPR patients and pre-transplant remission status PR or less patients were 62% and 45%, respectively (p = 0.23). The 5-year OS for post-transplant remission status CR/VGPR group was 72% and for post-transplant remission status PR or less group was 60% (p = 0.02). The 5-year PFS in post-transplant remission status CR/VGPR patients was 48% and post-transplant remission status PR or less patients was 36% (p = 0.03). This study focuses on determination of survival outcome based on the best response obtained before and after ASCT and particularly highlights the significance of reaching CR and VGPR.

Background/aim:Ankaferd hemostat (ABS; Ankaferd blood stopper, İstanbul, Turkey) is a prohemostatic agent affecting erythrocytes. The hemostatic action of ABS depends upon fibrinogen gamma chain, prothrombin, and red blood cells. The aim of this study was to assess the effects of ABS on erythrocyte aggregation via hemorheological analyses.Materials and methods: To measure erythrocyte aggregation, blood samples were obtained from healthy, nonsmoker volunteers who had not taken any medication in the previous 10 days. One mL of blood was placed into the laser-assisted optical rotational cell analyzer (LORCA), into the chamber formed by the gap between two concentric glass cylinders. The solution prepared with ABS and saline was added to blood in incremental amounts of 10 μL, 20 μL, 30 μL, 40 μL, 50 μL, 60 μL, 70 μL, and 100 μL. Erythrocyte aggregation was determined by laser-assisted optical rotational cell analyzer at 37 °C. Results: AMPwas found to be 17.7 ± 2.1 au in the blood without ABS, whereas it was lower in the blood with ABS. AMP was 16.0 ± 3.3 in the ABS-added blood group. RBC aggregates did not form faster when cells contacted ABS. The t t½ value was 4.6 ± 2.6 in the ABS-added blood group and 1.9 ± 0.20 in the control group. Aggregation was faster in the control group (P = 0.03). AI, which is a combination of AMP and t½, was lowered in the ABS group (48.7 ± 12.3) compared to the control group (65.8 ± 1.6) (P = 0.02). It was notable that the γIsc max (sec-1) value of the control was higher (200 ± 106) than the ABS-added blood group (141 ± 51.0). Conclusion: ABS has antierythroid aggregation effect. ABS inhibits pathological aggregation of red blood cells. Antithrombotic clinical effects of ABS may be ascribed to the antierythroid aggregan actions of the drug.

Background and aim In the past, acute promyelocytic leukemia (APL) was considered as one of the most rapidly lethal form of acute myeloid leukemia (AML). The objective of this study was to assess clinical parameters affecting early death (ED) in patients with APL. Materials and methods Forty-three patients with APL who were diagnosed at Hacettepe University Hospital between the years of 2005 and 2018 were evaluated. Results In univariate analyses, presentation with hemorrhage, DIC or infection at diagnosis, ECOG performance score, blast percentage on bone marrow, Sanz score, leukocyte, thrombocyte, fibrinogen and LDH levels were found to be statistically significantly different between patients with ER and patients without ED. In multivariate analysis, presentation with hemorrhage, DIC or infection at diagnosis, ECOG performance score, blast percentage on bone marrow, Sanz score, leukocyte, thrombocyte, fibrinogen, and LDH levels were found to be independent factors that are related with higher rate of ED in 30 days after treatment. Conclusion Induction chemotherapy should be started as soon as possible after diagnosis of APL. Improving ED rates may become the greatest challenge for the future treatment of the diseases.

Diyabetes Mellitus, gozun cesitli yapilarini (kornea, ektra-okuler kaslar, intra-okuler kristalin lens, optik sinir, retina ve koroid) etkileyerek gormeyi ciddi sekilde azaltan, giderek prevelansi artan ve birden cok organ sistemini etkileyen kompleks metabolik bir hastaliktir. Pro-aktif ve multi-disipliner yaklasim hastalarda hem gormeyi tehdit eden komplikasyonlari azaltmakta hem de hayat kalitesinde anlamli duzelmeler saglamaktadir. Ciddi gorme kayiplarinin onlenmesi; optimal glisemik kontrol, hipertansiyon vb. gibi sistemik risk faktorlerinin tedavisi ve duzenli taramalar ile okuler komplikasyonlarin erken tani ve tedavisi ile mumkun olabilmektedir.

Whilst particular infectious bacteria are well-established to be associated with hematological diseases, more recent interest has focused on the entire microbial community of mucosal surfaces. In particular, the link between hematology and the microbiota (defined as the total assemblage of microorganisms in a mucosal environment)/ microbiome (i.e. the entire ecological habitat, including organisms, their genomes and environmental conditions) is becoming more well-known. Dysbiosis, or a change in the microbiome, has been linked to the development of neoplasms, infections, inflammatory illnesses, and immune-mediated disorders, according to growing data. Microbiota may influence distant tumor microenvironment through a variety of methods, including cytokine release control, dendritic cell activation, and T-cell lymphocyte stimulation. There are numerous major implications to study the microbiome in patients with benign and malignant hematologic disorders. In this review, we investigated the structure and function of the microbiome in patients with benign and malignant hematological diseases. Chemotherapy and immunosuppressive agents used in treatment of these benign and malignant hematological diseases may cause or exacerbate dysbiosis and infectious problems. After understanding the importance of microbiota in hematological diseases, we think that use of probiotics and dietary prebiotic substances targeting microbiota modification aiming to improve hematological disease outcomes should be investigated in future studies.

The treatment landscape and clinical outcome of multiple myeloma (MM) patients have changed in the last decades, with an improved median survival of 8–10 years. This study aimed to evaluate the bortezomib, cyclophosphamide and dexamethasone (VCD) regimen versus bortezomib and dexamethasone (VD) regimen in patients with newly diagnosed MM. This study has been performed in a retrospective manner. One hundred and three patients with newly diagnosed MM who received chemotherapy at our tertiary care center between the years of 2009 and 2018 were evaluated. A total of 103 patients were included. The 5-year overall survival (OS) for patients who received VD regimen and patients who received VCD regimen were 75% and 83%, respectively. The OS for VD patients was 113.1 ± 12.5 versus 122.2 ± 9.5 months for VCD patients with no statistically significant difference (p = 0.47). The 5-year PFS (progression free survival) for patients who received VD regimen and patients who received VCD regimen were 66% and 75%, respectively. The PFS for VCD patients was higher than the PFS for VD patients (67.1 ± 7.4 versus 97.7 ± 13.4 months), but no statistically significant difference was observed (p = 0.59). Relapse rate (p = 0.002) and mortality rate (p = 0.01) were higher in VD group than VCD group and they were statistically significant. The OS and PFS were clinically longer in patients receiving VCD regimen than in patients receiving VD regimen, although not statistically significant. Cyclophosphamide should be given to patients at physician discretion and depending on patient’s frailty function.

The treatment landscape and clinical outcome of multiple myeloma (MM) patients have changed in the last decades, with an improved median survival of 8-10 years. This study aimed to evaluate the bortezomib, cyclophosphamide and dexamethasone (VCD) regimen versus bortezomib and dexamethasone (VD) regimen in patients with newly diagnosed MM. This study has been performed in a retrospective manner. One hundred and three patients with newly diagnosed MM who received chemotherapy at our tertiary care center between the years of 2009 and 2018 were evaluated. A total of 103 patients were included. The 5-year overall survival (OS) for patients who received VD regimen and patients who received VCD regimen were 75% and 83%, respectively. The OS for VD patients was 113.1±12.5 versus 122.2±9.5 months for VCD patients with no statistically significant difference (P=0.47). The 5- year PFS (progression free survival) for patients who received VD regimen and patients who received VCD regimen were 66% and 75%, respectively. The PFS for VCD patients was higher than the PFS for VD patients (67.1±7.4 versus 97.7±13.4 months), but no statistically significant difference was observed (P=0.59). Relapse rate (P=0.002) and mortality rate (P=0.01) were higher in VD group than VCD group and they were statistically significant. The OS and PFS were clinically longer in patients receiving VCD regimen than in patients receiving VD regimen, although not statistically significant. Cyclophosphamide should be given to patients at physician discretion and depending on patient’s frailty function.

The treatment landscape and clinical outcome of multiple myeloma (MM) patients have changed in the last decades, with an improved median survival of 8-10 years. This study aimed to evaluate the bortezomib, cyclophosphamide and dexamethasone (VCD) regimen versus bortezomib and dexamethasone (VD) regimen in patients with newly diagnosed MM. This study has been performed in a retrospective manner. One hundred and three patients with newly diagnosed MM who received chemotherapy at our tertiary care center between the years of 2009 and 2018 were evaluated. A total of 103 patients were included. The 5-year overall survival (OS) for patients who received VD regimen and patients who received VCD regimen were 75% and 83%, respectively. The OS for VD patients was 113.1±12.5 versus 122.2±9.5 months for VCD patients with no statistically significant difference (P=0.47). The 5- year PFS (progression free survival) for patients who received VD regimen and patients who received VCD regimen were 66% and 75%, respectively. The PFS for VCD patients was higher than the PFS for VD patients (67.1±7.4 versus 97.7±13.4 months), but no statistically significant difference was observed (P=0.59). Relapse rate (P=0.002) and mortality rate (P=0.01) were higher in VD group than VCD group and they were statistically significant. The OS and PFS were clinically longer in patients receiving VCD regimen than in patients receiving VD regimen, although not statistically significant. Cyclophosphamide should be given to patients at physician discretion and depending on patient’s frailty function.

This study aimed to evaluate real-life data on patterns of hydroxyurea prescription/use in polycythemia vera (PV).This retrospective chart review study included PV patients who had received hydroxyurea therapy for at least 2 months after PV diagnosis. Data were collected from 10 representative academic medical centers.Of 657 patients, 50.9% were in the high-risk group (age ≥60 years and/or history of thromboembolic event). The median duration of hydroxyurea therapy was 43.40 months for all patients; 70.2% of the patients had ongoing hydroxyurea therapy at last follow-up. Hydroxyurea was discontinued in 22.4% of the patients; the most common reason was death (38.5%). The predicted time until hydroxyurea discontinuation was 187.8 months (standard error: ±21.7) for all patients. This duration was shorter in females (140.3±37.7 vs. 187.8±29.7) (p=0.08). This trend was also observed in surviving patients aged ≥50 years at hydroxyurea initiation (122.2±12.4 vs. 187.8±30.7, p=0.03). Among the patients who were still on hydroxyurea therapy, 40.3% had a hematocrit concentration of ≥45% at their last follow-up visit, and the rate of patients with at least one elevated blood cell count was 67.8%.Hydroxyurea prescription patterns and treatment aims are frequently not in accordance with the guideline recommendations. Its discontinuation rate is higher in females.Polistemia vera’da (PV) hidroksiüre reçete etme/kullanma şekilleri hakkındaki gerçek yaşam verilerini değerlendirmek.Bu retrospektif kayıt çalışmasına tanıdan sonra en az 2 ay hidroksiüre almış olan hastalar dahil edildi. Veriler ülkeyi temsil ettiği düşünülen 10 akademik tıp merkezinden toplandı.Altı yüz elli yedi hastadan %50,9’u yüksek risk (yaş ≥60 yıl ve/veya tromboembolik olay öyküsü) grubundaydı. Tüm hastalarda ortanca hidroksiüre tedavi süresi 43,4 aydı. Hastaların %70,2’si son kontrol tarihlerinde halen hidroksiüre kullanmaktaydı. Hidroksiüre en sık neden (%38,5) ölüm olmak üzere hastaların %22,4’ünde kesilmişti. Tüm hasta grubunda hidroksiüre kesmek için ortanca süre 187,8 ay ±21,7 standart hata olarak hesaplandı. Bu süre kadınlarda (140,3±37,7) erkeklere (187,8±29,7) göre daha kısa idi (p=0,08). Bu eğilim hidroksiüre başlandığında 50 yaş ve üstünde olan ve son durumda hayatta olan hastalarda da gözlendi (122,2±12,4 ve 187,8±30,7, p=0,03). Hidroksiüre devam etmekte olan hastalarda son kontrolde ≥%45 hematokrit %40,3 ve en az bir artmış kan hücre düzeyi %67,8 oranında gözlendi.Hidroksiüre reçete etme şekli ve tedavi hedefleri sıklıkla rehber önerilerine uymamaktadır. Hidroksiüre kesme oranı kadınlarda daha yüksektir.

Objective: Waldenstrom macroglobulinemia (WM) is a rare indolent neoplastic disease characterized by a wide range of clinical presentations related to the direct tumor infiltration. The disease is characterized by monoclonal immunoglobulin M protein in the serum and infiltration of bone marrow with lymphoplasmacytic cells. Case report: We, herein, present an unusual case of WM. A 77-year-old woman admitted to the hospital with fatigue, anorexia, and fever. She had white blood cell elevation and splenomegaly. The patient had no peripheral lymphadenopathy. A large number of plasmablast-like cells were seen in the peripheral blood smear. Laboratory studies revealed a white blood cell count of 54.8 × 103/µl, hemoglobin level of 8.2 g/dl and platelet count was 120 × 103/µl. The diagnosis of WM was established after immunohistochemical analysis of the patient's bone marrow that revealed the presence of a lymphoid/lymphoplasmacytoid-like bone marrow infiltrate along with an elevated serum IgM level. The patient responded to the chemotherapy both clinically and serologically. This case is unusual since numerous plasmablast like cells were seen in peripheral blood smear like plasma cell leukemia at the admission to the hospital. Conclusion: This is the case report of a patient with Waldenstrom macroglobulinemia presenting like plasma cell leukemia in the first admission adding to the spectrum of clinical presentations seen in this disease. This adds to the wide variety of clinical presentations of Waldenstrom macroglobulinemia.

Background and Aim: Recently, acute promyelocytic leukemia (APL) has shifted from the most hazardous to the best curable type of acute myeloid leukemia. Anthracyclines, all-trans retinoic acid (ATR...

61st Annual Meeting and Exposition of the American-Society-of-Hematology (ASH) -- DEC 07-10, 2019 -- Orlando, FL, Kaynar, Leylagul/0000-0002-2035-9462; Erkurt, Mehmet Ali/0000-0002-3285-417X, WOS:000577164605146, [No Abstract Available], Amer Soc Hematol

Ankaferd hemostat (ABS; Ankaferd Blood Stopper®, Istanbul, Turkey) is a hemostatic agent having an impact on red blood cell– fibrinogen interactions. The hemostatic effect of ABS depends upon the quick promotion of a protein network, particularly fibrinogen gamma, in relation to the erythrocyte aggregation. The entire physiological process involves ABS-induced formation of the protein network by vital erythrocyte aggregation. Vital erythrocyte aggregation occurs with the spectrine, ankyrin, and actin proteins on the membrane of the red blood cells. ABS notably affects cell metabolism and cell cycle mechanisms. Meanwhile, ABS has antiproliferative effects on cancer cells. The aim of this review is to assess molecular basis of ABS as a hemostatic drug. The literature search on ABS was performed in PubMed, Web of Science (SCI expanded), and Scopus with particular focus on the studies of molecular basis of ABS, in vivo research, case series, and controlled randomized clinical studies. Current perspective for the utilization of ABS is to provide hemostasis with accelerating wound healing. Future controlled trials are needed to elucidate the pleiotropic clinical effects of ABS such as antineoplastic, antiinflammatory, antiinfective, antifungal, and antioxidative effects.

Background/aim: High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) has become the standard approach for patients with relapsed/refractory Hodgkin's lymphoma (HL) or non-Hodgkin's lymphoma (NHL). In this study, we report the outcome of the mitoxantrone-melphalan conditioning regimen for lymphoma. Materials and methods: The study group included 53 patients who were relapsed/refractory HL (n = 14) and NHL (n = 39) and received mitoxantrone and melphalan followed by ASCT. The transplant regimen consisted of mitoxantrone (60 mg/m2) and melphalan (180 mg/m2) followed by peripheral blood stem cell infusion (PBSC). Results: Prior to high-dose chemotherapy, 37.7% of the patients were in complete remission (CR) and 45.3% were in partial remission (PR), and 17% had stable or progressive disease. After high-dose chemotherapy and PBSC, 44 out of 51 patients achieved CR (86.2%). CR was achieved in 24 out of 33 patients (72.7%) who were transplanted in a marginally active phase of the disease. At a median followup of 25.4 months (1.8-131.3 months) after ASCT, 13 patients relapsed/progressed and 8 patients died. The estimated 2-year overall survival (OS) was 81.9%, and event-free survival (EFS) was 59.3%.Conclusion: High-dose chemotherapy followed by ASCT is an effective conditioning regimen in relapsed/refractory lymphoma patients who are undergoing ASCT.

WOS: 000482629200004, PubMed ID: 31131598, Objective: Significant developments occurred in the clinical management of acute lymphoblastic leukemia (ALL) in adults in recent decades. However, treatment results are still not satisfactory, especially in routine practice. The objective of this study was to evaluate the general clinical features, treatment details, and outcomes of a large group of patients followed in multiple centers in Turkey with a diagnosis of ALL. Materials and Methods: A retrospective analysis of the data of patients with ALL was made, the patients having been diagnosed and treated between January 2003 and June 2017 by different protocols in the hematology clinics of ten different centers. A total of 288 patients, aged between 17 and 76 years old, were included in the study. In this retrospective multicenter analysis of patients with ALL, classification of patients was performed based on treatment period, Philadelphia chromosome positivity, treatment regimen, and administration of allogeneic hematopoietic stem cell transplantation (allo-HSCT). Results: The majority of cases were B-cell in origin, while 224 patients had B-ALL and 64 of the patients had T-ALL. Median follow-up duration for all patients was 18.2 months (range: 0.03-161 months). Philadelphia chromosome positivity was determined in 49 patients (21.9%), and 54 patients (18.8%) were receiving allo-HSCT. After induction chemotherapy, 219 patients (76.0%) achieved complete remission, 32 patients (11.2%) were evaluated as treatment refractory, and 37 patients (12.8%) were deceased. Median overall survival was 47.7 months (95% confidence interval: 36.1-59.2) and median disease-free survival was 23.4 months (95% confidence interval: 6.7-40.0) for all patients. Conclusion: Multicenter studies are extremely important for defining the specific clinical features of a particular disease. The results of this study will make a significant contribution to the literature as they reflect real-life data providing valuable information about the Turkish ALL patient profile.

Ankaferd hemostat (Ankaferd Blood Stopper; ABS) is a pro-hemostatic agent affecting erythrocytes. In this article, we report a 50-year-old male patient who presented with a non-healing leg ulcer for one year. He had a past medical history of Behcet's disease (BD) diagnosed at the age of 29 and therapy was started. Patient's leg ulcer did not respond to any treatment. Topical ABS was applied to the patient's leg ulcer daily. Our experience suggested that local treatment of ABS can be a potentially successful therapy for the management of intractable or incurable chronic ulcers in patients with BD or for other ischemic or vasculitic skin problems.

Ghosal hematodiaphyseal dysplasia (GHDD) is an autosomal recessive inherited disorder associated with biallelic mutations in the TBXAS1 gene located on the chromosome 7q33-34, which encodes thromboxane-A-synthase. GHDD is characterized by defective hematopoiesis due to bone marrow fibrosis and metadiaphyseal dysplasia of long bones. The accurate diagnosis of this rare syndrome is critical since it reduces the need of blood transfusions by corticosteroid therapy, leading to a significant improvement in anemia and bone changes. The aim of this study is to report two adult siblings diagnosed as GHDD, who admitted with pancytopenia and treated with steroids treatment in adult hematology clinic.

Ciftciler, Rafiye/0000-0001-5687-8531; okay, mufide/0000-0001-5317-0597 WOS: 000527888600012 PubMed: 31492570 Background and aim: High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) has been considered the standard of treatment care for patients with multiple myeloma (MM). Insufficient mobilization and harvest of peripheral stem cells can be a major obstacle for performing ASCT. This is resulting in a lacking opportunity of cure in patients with MM. The aim of this study was to evaluate the factors which influence mobilization failure in patients with MM. Materials and methods: This study has been performed in a retrospective manner. Two hundred and thirty-four patients with diagnosed MM who underwent stem cell mobilization after induction chemotherapy at Hacettepe University Hospital between the years of 2003 and 2018 were evaluated. Results: A total of 234 patients were included in this study. The median age was 54 (32-76) years at the time of diagnosis. In 209 of 234 patients (89.3%) first mobilization trial was successful. At univariate analysis, among parameters identifiable before mobilization, male gender (p = 0.03), number of chemotherapy cycle before stem cell mobilization (p < 0.001), second ASCT (p < 0.001) and immunomodulatory treatment before stem cell mobilization (p < 0.001) predicted mobilization failure. At multivariate analysis, number of chemotherapy cycle before stem cell mobilization (p = 0.03), second ASCT (p < 0.001) and immunomodulatory treatment before stem cell mobilization (p = 0.02) retained independent predictive power. Conclusion: Detectable different clinical characteristics of MM patients before initiating mobilization may be predictors of poor mobilization. Therefore, the mobilization protocol should be evaluated on a patient basis. Minimization of exposure to chemotheraputic agents in MM patients, especially immunomodulatory agents, may increase CD34+ cell harvest yields.

Chronic myeloid leukemia (CML) is a clonal myeloproliferative disorder characterized by the dysregulated production and uncontrolled proliferation of myeloid neoplastic cells. CML is associated with the fusion of BCR (on chromosome 22) and ABL1 (on chromosome 9) resulting in the BCR-ABL1 fusion gene. The translocation of chromosomes (9;22)(q34;p15) is present in almost 90–95% of patients with CML and only 5–8% CML patients have established variant complex translocation due to the participation of one or more chromosomes other than 9 and 22 chromosome. In the present study, a unique case of a pH chromosome-positive CML is reported with a new variant pH translocation involving three chromosomal aberrations 6p22, 9q34, 22q11.2 and derivation 19 which has not been described previously. The complex variant translocation with pH chromosome was 46,XY,t(6;9;22)(p22:q34;q11.2), der(19)[48]/46,XY[2] in this newly diagnosed CML patient. Additional cytogenetic anomalies may be seen in patients which are not controlled by the tyrosine kinase inhibitor in CML patients or in accelerated/blastic phase. In this case, the patient’ treatment was switched to dasatinib because the IS-NCN could not be controlled with imatinib. In conclusion, complex translocations in unusual locations of the BCR / ABL gene appear to indicate a poor prognosis.

Background/aim: Ankaferd hemostat (ABS; Ankaferd blood stopper, İstanbul, Turkey) is a folkloric medicinal plant extract. The aim of this study was to determine the effect of Ankaferd hemostat (ABS) on the fate of Helicobacter pylori strains. The study also aims to determine alterations in the antimicrobial resistance of three different H. pylori strains in response to ABS exposure.Materials and methods: H. pylori Strain 1 was obtained from the culture collection ATCC 43504 and passaged three times for viability. Strain 2 was isolated from a gastric ulcer patient and Strain 3 was isolated from a gastritis patient. 1% of ABS was added to all of the strains and antimicrobial susceptibility was observed on 30 and 60 min after application.Results: The efficacy of ABS solutions in achieving significant logarithmic reduction in foodborne pathogens of H. pylori was observed in this study. This study showed that ABS has antibacterial (Anti-H. pylori) effects. Conclusion: Our present study indicated, for the first time, that ABS could act against H. pylori. ABS is clinically used for the management of GI bleeding due to benign and malignant GI lesions. Thus, the possible anti-H. pylori effect of ABS shall expand the therapeutic spectrum of the drug in GI lesions in relation to H. pylori infection such as peptic ulser disease (PUD) and lymphoid tissue (MALT) lymphomagenesis.

A genetic mutation was detected by our clinic in two sisters in a family with low iron levels and mild symptoms. We identified this missense mutation in the FTL gene (c.473T > C; p.Pro158Leu, rs374486686) of the sisters who had weakness symptom and low serum ferritin level. This mutation causes the codon CCG changing into CTG, thus composing an amino acid substitution in which proline 158 is replaced by leucine. The patients with this mutation had unmeasurable serum ferritin levels while other iron parameters’ levels are normal. As a result of this mutation, we demonstrated that ferritin connects iron however it can not store iron.