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Objectives We measured the serum periostin levels in patients with DLBCL and determined whether the levels reflected the clinical findings. Methods This was a case-control study. DLBCL patients diagnosed between March 2021 and October 2021 (n=36) and healthy volunteers (n=36) (Control group) were included. The serum periostin levels of the two groups were compared. Moreover, subgroup analyses were conducted in the patient group. Results The serum periostin level was significantly higher in the patient than the control group (28.8 ± 3.2 vs. 15.1 ± 7.5 ng/mL, p=0.017). On subgroup analyses, the median serum periostin level of nine (25%) patients with bone marrow involvement was higher than that of the 27 (75%) lacking bone marrow involvement (12.7 vs. 21.7 ng/mL, p=0.018). On ROC analysis, the optimal periostin cutoff for bone marrow involvement was 17.3 ng/mL (sensitivity 77%, specificity 67%, AUC 0.765; 95% CI; 0.606–0.924, p=0.018). By the disease stage, the periostin level was higher in stage 4 patients than in those of other stages (21.3 vs. 12.0 ng/mL, p=0.029). Conclusions The periostin level correlated with such involvement; periostin may serve as a novel prognostic marker of DLBCL.

Hemolytic anemia is characterized by a decrease in the number of circulating erythrocytes due to an increase in their hemolysis. Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common erythrocyte enzyme defects related to hemolysis. The G6PD enzyme abrogates the hemolysis of erythrocytes by protecting them against oxidative stress due to its involvement in the glutathione metabolism. G6PD enzyme deficiency-related hemolytic anemia may present as neonatal jaundice or become manifest due to exposure to infections, favism and medications later in life. Dapsone is a medication that is preferred by doctors in the treatment of many dermatological disorders such as pemphigus vulgaris, and leads to hemolysis in the presence of G6PD enzyme deficiency. In this type of non-immune hemolysis, haptoglobulin is low and Coombs' tests are negative. Hemolytic anemia, a serious complication that may appear subsequent to dapsone use, can be prevented by testing G6PD enzyme levels prior to dapsone therapy. In this case, we emphasized that the hemolytic anemia in the patient using dapsone may be due to G6PD enzyme deficiency.

Objective:This study aimed to evaluate the effects of genetic characteristics on the survival in patients with myelodysplastic syndrome (MDS).Methods:This retrospective study reviewed the data on epidemiological features, main laboratory tests, International Prognostic Scoring System (IPSS) and revised-IPSS risk categories, genetic anomalies, genetic risk categories, and survival in patients who are diagnosed with MDS in our center. According to the IPSS risk categories, patients were classified into three groups as follows: “low risk,” “intermediate-1,” and “intermediate-2 risk and high risk.” The groups were compared using the ANOVA and Kruskal-Wallis tests.Results:The study reviewed the data of 99 patients. The mean age was 66±11.6 years. A genetic anomaly was detected in 30.3%, of which the most common was del20q (26.7%). The median survival was 61 months [95% confidence interval (CI): 50.9-71] in the study population. The 5-year survival rate was calculated as 64%, 41%, and 33% in “low risk,” “intermediate-1,” and “intermediate-2 risk and high risk” groups, respectively. The predicted median survival rate was 96 months (95% CI: 47.7-144.2), 56 months (95% CI: 34.1-77.8), and 18 months (95% CI: 15.1-20.8), respectively, which indicate a significant difference (log-rank chi-square: 6.6; p=0.035). The risk for mortality was 3.3-folds higher in the “intermediate-2 and high risk” group compared to the “low risk” group (RR: 3.3; 95% CI: 1.2-8.6; p=0.017).Conclusion:Our study supports that risk groups that are determined by several parameters, including genetic characteristics, provide predictive information about survival in MDS.

Amaç: Çalışmamızın amacı, kısıtlamaların uygulandığı COVID-19 pandemi sürecinde hematoloji klinik işleyişinin değerlendirilmesidir. Hastalar ve Yöntem: Pandeminin ilk döneminde sokağa çıkma kısıtlamalarının uygulandığı 13.03.2020-15.05.2020 ile bu tarih aralığına karşılık gelen 2019 döneminde Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi ve İstanbul Medipol Üniversitesi Tıp Fakültesi Erişkin Hematoloji kliniklerine yatışı yapılan hastalar retrospektif olarak değerlendirildi. Bulgular: Her iki dönemde de yatan hasta sayısı 266 idi. 65 yaş üstü hasta oranı anlamlı olmamakla birlikte 2020’de daha düşük saptandı (%33.1’e kaşın %40.6, p= 0.72). Pandemi döneminde 2019’a göre tanısal amaçlı yatışı yapılan hasta sayısı anlamlı olarak yüksek (OR: 2,1, %95 GA: 1.35-3.26, p< 0.001); herhangi bir enfeksiyon nedeniyle yatış oranı ise düşük (OR: 0,44, %95 GA: 0.27-0.71, p< 0.001) bulundu. Tanısal amaçlı yatış yapılan hastalarda 2020 yılında hem erkek hasta oranı yüksek (OR: 0.4, %95 GA: 0.18-0.92, p= 0.031) hem de yatış süresi daha uzun (medyan 7’ye 14 gün, p= 0.007) bulundu. Kemoterapi, destek ve mobilizasyon amaçlı yatışlar arasında fark saptanmadı. Replasman ihtiyacı nedeniyle yatışı yapılan hasta oranı yine pandemic döneminde yüksek iken (OR: 4.7, %95 GA: 1.7-12.6, p< 0.001), tüm hastalar değerlendirildiğinde kan ürünü kullanımı sıklığı iki yıl arasında farklı değildi. Sonuç: Çalışmamız, kısıtlamalar sürecinde hematoloji hasta yönetiminin önemini ve işlevselliğinin değişmediğini vurgulamaktadır. Objective: The aim of our study is to assess the clinical functioning of hematology during the COVID-19 pandemic when lockdown restrictions are enforced. Patients and Methods: Patients who were admitted to Necmettin Erbakan University Meram Medical Faculty and Istanbul Medipol University Medical Faculty Adult Hematology clinics between March 13, 2020, and May 15, 2020, when lockdown restrictions were enforced in the first phase of the pandemic were evaluated retrospectively by comparing them with those who were admitted to same clinics between March 13, 2019, and May 15, 2019. Results: The number of inpatients during both periods was 266. It was determined that during the period of the pandemic, the number of patients hospitalized for diagnostic purposes was significantly higher compared to 2019 (OR: 2.1, 95% CI: 1.35-3.26, p< 0.001), whereas the rate of hospitalization due to any infection was significantly lower (OR: 0.44, 95% CI: 0.27-0.71, p

Objective: Familial hypercholesterolemia (FH) is an autosomal dominant inherited genetic disorder that causes a significant increase in low-density lipoprotein (LDL) cholesterol levels and leads to early coronary heart disease and cardiac mortality. Although this disease has a heterozygous (HeFH) and homozygous (HoFH) form, the incidence of HeFH is reported to be 1: 500, while HoFH is reported to be 1: 1 000 000. This disease is often caused by LDL receptor (most common), apolipoprotein B (Apo B), Proprotein Convertase Subtilisin/Kexin 9 (PCSK9), and LDL receptor adaptor protein (LDLRAP) gene mutations. Patients with FH do not respond well to lipid-lowering therapies such as a statin, and so lipoprotein apheresis is the treatment of choice. Material and Methods: We compared the results of lipoprotein apheresis in a 20-year-old female patient diagnosed with HoFH with two different methods [double-filtration plasmapheresis (DFPP) and dextran sulfate column (DSC) methods]. 40 lipoprotein apheresis procedures including 20 sessions of DFPP and 20 sessions of DSC were evaluated. Results: When the two methods were compared the changes in high-density lipoprotein, white blood cells, platelets, potassium, calcium, prothrombin time (INR) and activated partial thromboplastin time values were statistically significant. Conclusions: In conclusion, our study suggests that it would be more appropriate to choose the apheresis method according to the clinical and laboratory findings of the patient since it shows that two different methods have different effects on serum electrolyte values, hemostasis criteria and leukocyte and platelet counts.

Thrombotic microangiopathy (TMA) associated with hematopoietic stem cell transplantation, remains a difficult complication due to its high mortality rate, lack of standardised diagnostic criteria, and limited treatment options. Although the etiology of the disease is not clear, medications, radiotherapy, graft-versus-host disease (GVHD), angioinvasive fungal, viral infections and complement activation have been implicated. Agents such as therapeutic plasma exchange (TPE), steroids, rituximab, defibrotide, eculizumab are used in its treatment. The use of treatments such as TPE, steroids, defibrotide, and rituximab did not yield satisfactory results in transplant-associated TMA (TA-TMA). Recent studies have reported successful results with eculizumab in the treatment of TA-TMA. As there is no standard dose for eculizumab in the treatment of TA-TMA, doses used in atypical hemolytic uremic syndrome (aHUS) were administered. In this paper, we present a case that was unresponsive to TPE and steroids, but which was successfully treated with eculizumab. Key Words: Acute myeloid leukemia, Stem cell transplantation, Thrombotic microangiopathy, Apheresis, Eculizumab.

Amac: Calismamiz multipl miyelom hastalarinda, tanida bakilan serum B12 vitamini duzeyi ile klinik ve laboratuvar bulgularin karsilastirilmasini amaclamaktadir. Gerec ve Yontemler: Hastalar vitamin B12 duzeylerine gore dusuk ve normal olmak uzere iki gruba ayrildi. Veriler dagilim ozelliklerine gore bagimsiz orneklem T, Mann Whitney U ve ki-kare testleri ile karsilastirildi. Bulgular: Retrospektif dosya incelemesi yapilan 212 hastadan calismaya dahil edilen 128 hastanin 41 (%32)’inde vitamin B12 eksikligi tespit edildi. Kemik iligi plazma orani bu grupta anlamli olarak daha dusuk bulundu; medyan %30’a karsin %50 (p: 0,024). Iki grup arasinda yas, total protein, laktat dehidrogenaz, s2-mikroglobulin, kalsiyum, kreatinin, albumin ve litik lezyon varligi acisindan fark saptanmadi. Ancak vit B12 duzeyi dusuk olan grupta 11 hastada (%26,8), normal olan grupta ise 44 hastada (%50,5) anemi tespit edildi. Normal olan grupta anemi sikliginin yuksekligi istatiksel olarak anlamli bulundu (p: 0,019). Ayrica ISS ve R-ISS evreleri arasinda da vitamin B12 duzeyleri acisindan fark saptanmadi. Sonuc: Dusuk vitamin B12 duzeyinde kemik iligi plazma hucre orani daha dusuk bulunmaktadir. Verilerimiz ile bunun klinik yansimasi gosterilememistir. Tedavi yaniti, sag kalim ve relaps oranlari gibi klinik verilerin degerlendirildigi calismalara ihtiyac duyulmaktadir.

Objective: Pomalidomide is a new generation thalidomide analogue. Effectiveness as a single agent or combination with low dose dexamethasone has been in the treatment of relapse/refractory Multiple Myeloma (MM). The aim of the present study was to share the experience of different oncology centres with pomalidomide treatment in patients with relapsed/refractory MM. Materials and Methods: Seventy-three patients from 16 centres were enrolled into the study. The patients were followed for a median of 6 months. Relapsed/refractory MM patients who received at least one line of treatment before pomalidomide were included into the study. ISS, R-ISS and Eastern Cooperative Oncology Group (ECOG) scores of the patients and treatment-related side effects were evaluated. Results: As a result of the median follow-up for 6 months, 36% (26/72) of the patients presented progression. The estimated median PFS was found 29 months. The Cox regression analysis revealed that ECOG affected PFS only, myeloma subtype; ISS and R-ISS scores did not affect PFS. The most common side effects with pomalidomide treatment in our population include neutropenia, infections, anaemia and thrombocytopenia. Conclusion: In our study, it was statistically shown that the ECOG score was effective in survival in relapsed / refractory MM patients treated by pomalidomide. Therefore, we recommend evaluation of the ECOG score for each patient before treatment in eligible cases.

Extramedullary plasmacytoma (EMP) occurs as a result of abnormal proliferation of plasma cells outside the bone marrow. Breast plasmacytomas are rare. Radiologically, they can be confused with benign and malignant lesions of the breast. It is important to be able to diagnose EMP in the breast since the treatment strategy is different from that of other lesions and allows for the diagnosis and early treatment of multiple myeloma (MM) relapse. We report imaging and clinicopathological findings of an EMP case in which a 65-year-old patient with MM in remission presented with breast masses.Ekstramedüller plazmositom (EMP), plazma hücrelerinin kemik iliği dışında anormal proliferasyonu sonucu meydana gelir. Meme plazmositomu nadir görülür. Radyolojik olarak memenin benign ve malign lezyonlarıyla karışabilmektedir. Memede EMP tanısını koyabilmek önemlidir, çünkü diğer lezyonlarla tedavi stratejisi farklıdır ve multipl miyelom (MM) relapsının tanınıp erken tedavisine olanak sağlar. Bu yazıda 65 yaşında MM tanılı hastanın meme lezyonuyla prezente olduğu EMP olgusunun görüntüleme ve klinikopatolojik bulguları sunulmuştur.

Introduction Bing-Neel syndrome (BNS) is a rare complication of of Waldenström macroglobulinemia (WM) identified by involvement of central nervous system (CNS) lymphoplasmacytic cells. Case report We present a patient who was diagnosed with Bing-Neel syndrome four years after the diagnosis of Waldenström macroglobulinemia. Management & outcome The patient was admitted with neurological symptoms. There were lesions associated with WM involvement on brain imaging. The diagnosis was made by brain biopsy. High dose methotrexate treatment was given. Discussion CNS infiltrating agents such as fludarabine, methotrexate and cytarabine are often used in BNS treatment. Ibrutinib, which is a new bruton tyrosine kinase inhibitor, has recently started to be used in BNS treatment, as it has been shown to be effective and penetrate the CNS.

Amaç: Çalışmanın amacı, COVID-19 enfeksiyonu sonrası hematolojik tanı alan hastalarda SARS-CoV-2 virüsü ve hematolojik hastalıklar arasındaki ilişkiyi değerlendirmektir. Hastalar ve Yöntem: 1 Nisan 2020 ile 1 Nisan 2021 tarihleri arasında, herhangi bir malign ya da otoimmün hematolojik hastalık tanısı alan hastalar arasında, öncesinde COVID-19 enfeksiyonu geçirenler retrospektif olarak değerlendirildi. Tanı öncesinde COVID-19 geçiren ve geçirmeyen hastalar karşılaştırıldı. Bulgular: Yeni tanı alan 305 hastanın 24 (%7,8)’ünün öncesinde COVID-19 öyküsü olduğu tespit edildi. İki hasta grubunda da en sık tanı non-Hodgkin Lenfoma (NHL)’ydı. NHL ve agresif seyirli NHL sıklığı istatistiksel olarak anlamlı olmamakla birlikte öncesinde COVID-19 öyküsü olan hasta grubunda daha yüksek bulundu (%25,1’e karşın %23,1, p=0,143 ve %66,6’ya karşın %56,9, p=0,094). Temel hematolojik değerler iki grup arasında benzerdi. COVID-19 tanısı ile hematololojik hastalık tanısı arasında geçen medyan süre 4,1 (0,6-11,8) ay olup en kısa süreli tanı İmmün Trombositopenik Purpura, en uzun süre ise Multipl Miyelom tanılı tanılı hastada saptandı. Malign hasta grubunda tanıya kadar geçen medyan süre daha uzun bulundu (4,5 aya karşılık 2,5 ay, p=0,070). Sonuç: Bu çalışma ile COVID-19 enfeksiyonunun, malign ve otoimmün patogenezli hematolojik hastalıklar için etyolojik bir faktör olabileceğini vurguladık.

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.

Introduction Rituximab, which is widely used in the treatment of B-cell lymphoma, is a chimeric monoclonal antibody directed against the CD20 antigen. Rituximab has many side effects, mainly allergic and neurological. Rituximab may cause thrombocytopenia in the long term after administration. Rare cases of rituximab-induced acute thrombocytopenia have been reported in the literature. Case Report A 51-year-old female patient who was newly diagnosed with splenic marginal zone lymphoma received rituximab as first-line therapy. Petechiae occurred in the lower extremities on the day following rituximab administration. The blood test showed a severe drop in the platelet count from 112,000/μL to 5000/μL. Blood peripheral smear evaluation confirmed severe thrombocytopenia. Management and outcome There was no change in hemoglobin or white blood cell levels. After the diagnosis of rituximab-induced acute thrombocytopenia, thrombocyte suspension was administered due to the risk of bleeding. Close clinical and laboratory observations were made. The platelet count began to rise gradually in the following period. Before the second week of rituximab administration, the platelet count was 122,000/μL. No complications developed after premedication and slow rituximab administration, and subsequent treatments were continued in the same way. Discussion Rituximab has widespread use, especially in malignancies and autoimmune diseases. Like many monoclonal antibodies, rituximab has several side effects. Thrombocytopenia is a long-term side effect associated with rituximab, and rituximab-induced severe acute thrombocytopenia has been rarely reported. Therefore, it should be kept in mind that severe acute thrombocytopenia may develop after rituximab administration.

Introduction Cardiac involvement in diffuse large B-cell lymphoma is a rare entity in non-Hodgkin lymphomas. Symptoms are usually related to heart failure. Patients who are severely symptomatic due to cardiac mass could be considered treatment as soon as possible. In this report, we present a patient diagnosed with diffuse large B-cell lymphoma with cardiac involvement. Case Report A 61-year-old female patient was admitted to our unit with gastric biopsy diffuse large B-cell lymphoma. Computerized tomography of the chest and positron emission tomography/computed tomography demonstrated a neoplastic mass in the intra-atrial septum extended to inferior vena cava (5 × 4 cm in size and standardized uptake value maximum 24.6). She was in stage III and in the high-risk group. Because of pronounced heart failure findings associated with the mass-specific chemotherapy was planned early. Management & Outcome Although a fraction of ejection was 60% by echocardiography before the treatment, she had a cardiac risk for doxorubicin due to being over 60 years old and hypertension. Complete remission was achieved after three cycles of rituximab–cyclophosphamide–doxorubicin–vincristine and methylprednisolone protocol including doxorubicin. Treatment was completed with six cycles and she was followed up for three months. Discussion Because of the cardiotoxicity of doxorubicin-based protocols, patients should be evaluated according to cardiac functions before and during the chemotherapy.

Objective: Primary Immune Thrombocytopenia (ITP, idiopathic thrombocytopenic purpura, immune thrombocytopenic purpura) is an acquired thrombocytopenia caused by anti-platelet antibodies. The diagnosis of ITP may be challenging due to the various potential causes of thrombocytopenia, some of which are overlooked. Immunodeficiencies are also a rare cause of ITP. Although autoimmunity and, therefore, ITP are a common complication in primary immunodeficiency (PI) patients, there are not many publications in the literature that examine the frequency of PI in ITP patients and the immune abnormalities in these patients. Materials and Methods: Forty-five patients with ITP (F: 37 [78.7%], M: 10 [21.3%]) were included in the study (age 42.9 ± 15.9). Results: At least one antibody deficiency was detected in 7 patients (14.9%), and following further investigations, 2 patients (4.3%) were diagnosed with CVID, 3 (6.4%) with IgG deficiency, 1 (2.1%) with selective IgA deficiency and 1 (2.1%) with possible IgM deficiency. Immunoglobulin levels were normal while at least one abnormality was detected in 20 patients (42.6%) in peripheral lymphocyte subset analyses. The most common abnormality in this patient group was a reduced percentage of CD4+ T-cells (9 patients, 45% of patients with PLS abnormalities, 19.1% of all patients). CD3+ T-cell rates in 8 patients (17.8%), CD19+ B-cell rates in 6 (12.8%), CD3-CD16+56+ natural killer cell rates in 4 (8.5%), and CD4/CD8 cell ratios in 7 (14.9%) were reduced. In addition, the CD8+ T-cell rate in 8 patients (17%) was above the reference ranges. Conclusion: Adult patients who are diagnosed with ITP may develop a variety of immunological abnormalities in addition to hypogammaglobulinemia. Therefore, clinicians should not overlook immunological evaluation in the etiological investigation of ITP and should closely monitor patients with immunological abnormalities.

Karakus, Volkan/0000-0001-9178-2850; Demirkan, Fatih/0000-0002-1172-8668; Demircioglu, Sinan/0000-0003-1277-5105; Arat, Mutlu/0000-0003-2039-8557; Cagliyan, Gulsum Akgun/0000-0002-2073-1949; Ozturk, Hacer Berna Afacan/0000-0001-9386-7604; WOS: 000473249400014 PubMed: 31036516 Therapeutic plasma exchange (TPE) is used to treat more than 60 diseases worldwide and has drawn growing interest. Little is known about the current situation of TPE activity in Turkey, so we developed a survey to obtain information about this timely topic. We collected data on TPE from 28 apheresis units throughout Turkey. We performed a total of 24,912 TPE procedures with 3203 patients over the past decade. Twenty years ago, the majority of procedures were performed for neurological and hematological disorders, and today, most TPE procedures are done for the same reasons. The only historical change has been an increase in TPE procedures in renal conditions. Currently, renal conditions were more frequently an indication for TPE than rheumatic conditions. Fresh frozen plasma was the most frequently used replacement fluid, followed by 5% albumin, used in 57.9% and 34.6% of procedures, respectively. The most frequently used anticoagulants in TPE were ACD-A and heparin/ACD-A, used with 1671 (52.2%) and 1164 (36.4%) patients, respectively. The frequency of adverse events (AEs) was 12.6%. The most common AEs were hypocalcemia-related symptoms, hypotension, and urticaria. We encountered no severe AEs that led to severe morbidity and mortality. Overall, more than two thirds of the patients showed improvement in the underlying disease. Here, we report on a nationwide survey on TPE activity in Turkey. We conclude that there has been a great increase in apheresis science, and the number of TPE procedures conducted in Turkey has increased steadily over time. Finally, we would like to point out that our past experiences and published international guidelines were the most important tools in gaining expertise regarding TPE.

Hemophagocytic lymphohistiocytosis (HLH) is a rare disorder of the mononuclear phagocytic system, characterised by histiocyte and lymphocyte activation. It can be classified as primary and secondary HLH. Primary HLH usually presents in childhood, and is associated with gene mutations. Secondary HLH usually presents in adulthood, and is due to an underlying infection, autoimmune disease or malignancy. We describe a case of HLH secondary to acute hepatitis-A virus infection, which was characterised by persistent fever, pancytopenia, splenomegaly, hyperferritinemia, and hemophagocytosis observed in the bone marrow. Key Words: Hemophagocytic lymphohistiocytosis, Hepatitis-A, Mononuclear phagocytes.

Introduction: Passive antibody therapy has been used to immunize vulnerable people against infectious agents. In this study, we aim to investigate the efficacy of convalescent plasma (CP) in the treatment of severe and critically ill patients diagnosed with COVID-19. Method: The data of severe or critically ill COVID-19 patients who received anti-SARS-CoV-2 antibody-containing CP along with the antiviral treatment (n = 888) and an age-gender, comorbidity, and other COVID-19 treatments matched severe or critically ill COVID-19 patients at 1:1 ratio (n = 888) were analyzed retrospectively. Results: Duration in the intensive care unit (ICU), the rate of mechanical ventilation (MV) support and vasopressor support were lower in CP group compared with the control group (p = 0.001, p = 0.02, p = 0.001, respectively). The case fatality rate (CFR) was 24.7 % in the CP group, and it was 27.7 % in the control group. Administration of CP 20 days after the COVID-19 diagnosis or COVID-19 related symptoms were associated with a higher rate of MV support compared with the first 3 interval groups (?5 days, 6-10 days, 11-15 days) (p=0.001). Conclusion: CP therapy seems to be effective for a better course of COVID-19 in severe and critically ill patients.

Objective: This study aimed to retrospectively evaluate the efficacy, safety, and survival outcome of single-agent ibrutinib therapy in chronic lymphocytic leukemia patients. Materials and Methods: A total of 136 patients (mean age +/- standard deviation: 64.6 +/- 10.3 years, 66.9% males) who had received at least one dose of ibrutinib were included in this retrospective multicenter, noninterventional hospital-registry study conducted at 33 centers across Turkey. Data on patient demographics, baseline characteristics, laboratory findings, and leukemia-cell cytogenetics were retrieved. Treatment response, survival outcome including overall survival (OS) and progression-free survival (PFS), and safety data were analyzed. Results: Overall, 36.7% of patients were categorized as Eastern Cooperative Oncology Group (ECOG) class 2-3, while 44.9% were in Rai stage 4. Fluorescence in situ hybridization revealed the presence of del(17p) in 39.8% of the patients. Patients received a median of 2.0 (range: 0-7) lines of pre-ibrutinib therapy. Median duration of therapy was 8.8 months (range: 0.4-58.0 months). The 1-year PFS and OS rates were 82.2% and 84.6%, respectively, while median PFS time was 30.0 (standard error, 95% confidence interval: 5.1, 20.0-40.0) months and median OS time was 37.9 (3.2, 31.5-44.2) months. Treatment response (complete or partial response), PFS time, and OS time were better with 0-2 lines versus 3-7 lines of prior therapy (p, Janssen Pharmaceutica Turkey, This study was supported by Janssen Pharmaceutica Turkey. The authors would like to thank Prof. Sule Oktay, MD, PhD, and Cala Ayhan, MD, from KAPPA Consultancy Training Research Ltd. (stanbul, Turkey) , who provided editorial support.

This study aims to evaluate the COVID-19 pandemic consultations requested from the division of hematology in the hospital. We recorded the following features of the patients: demographic information, the status of outpatient or inpatient, the clinic requested consultation, the result of the consultation, having a hematological disease, diagnosis and COVID-19 suspicion. In this study, 82 cases were evaluated. The median age of the patients was 49,5. Females were mild higher (56,1% vs. 43,9%). Eight of the patients was suspected with COVID-19. The frequency of suspicion in patients with the previously diagnosed hematological disorder was higher significantly than patients without previously diagnosed (42,9% vs. 6,7% p=0,018). The frequency of suspicion was higher significantly inpatients than outpatients (19,4% vs. 2,2%, p=0,019). Only two of the patients who was suspected with COVID-19 were PCR-positive and these patients were diagnosed with concomitant hematologic malignancy; CLL and MCL. The most common clinic and cause of this consultation of this clinic were gynecology and thrombocytopenia, respectively, and most of the patients were diagnosed with pseudothrombocytopenia. After the consultation for all patients, the diagnosis was drug-related cytopenia; however, detailed evaluation for cytopenia was delayed to period which after the pandemic because any patients had no deep levels of cytopenia. Although our study has some limitations, this study is remarkable because this is the first study that has investigated hematology consultation during the pandemic. We think that more significant results will be achieved as new data become available, as long as the pandemic continues.