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Öğe Anaplastic Multiple Myeloma with Multiple Genetic Anomalies(Coll Physicians & Surgeons Pakistan, 2022) Demircioglu, Sinan; Tekinalp, Atakan; Ceneli, Ozcan[Abstract Not Availabe]Öğe Bing-Neel syndrome: A case reports(Sage Publications Ltd, 2021) Demircioglu, Sinan; Oltulu, Pembe; Emlik, Ganime D.; Tekinalp, Atakan; Ceneli, OzcanIntroduction Bing-Neel syndrome (BNS) is a rare complication of of Waldenstrom 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 Waldenstrom 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.Öğe The Effects of Genetic Characteristics on the Survival in Myelodysplastic Syndrome Myelodisplastik Sendromda Genetik Ozelliklerin Sagkalim Uzerine Etkisi(Bezmialem Vakif Univ, 2022) Tekinalp, Atakan; Demircioglu, Sinan; Celik, Ahmet Faruk; Ceneli, OzcanObjective: 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.Öğe The Effects of Genetic Characteristics on the Survival in Myelodysplastic Syndrome Myelodisplastik Sendromda Genetik Ozelliklerin Sagkalim Uzerine Etkisi(Bezmialem Vakif Univ, 2022) Tekinalp, Atakan; Demircioglu, Sinan; Celik, Ahmet Faruk; Ceneli, OzcanObjective: 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.Öğe Efficacy of convalescent plasma therapy in severe COVID-19 patients(Pergamon-Elsevier Science Ltd, 2021) Cizmecioglu, Hilal Akay; Goktepe, Mevlut Hakan; Demircioglu, Sinan; Tekinalp, Atakan; Cizmecioglu, Ahmet; Tuna, Ali Kursat; Ozer, HuseyinIntroduction: The use of convalescent plasma (CP) transfusions is very valuable in the current COVID-19 outbreak, given that there are no specific preventive and therapeutic options. Materials and methods: 50 patients with severe COVID-19 disease treated with convalescent plasma transfusion were included in the study. The efficacy of CP and in which situations it was effective were investigated. Conclusion: 80 % of the patients recovered, and 20 % died in our study. The mean age of the patients who died was found to be higher than the patients who recovered. CRP, ferritin, D-dimer, neutrophil, MPV, and NLR counts were found to be higher, and lymphocyte and platelet counts were lower in the deceased group after CP. It was determined that patients who received CP within the first five days were hospitalized for a shorter period. Discussion: Administration of CP transfusion within the first five days in severe COVID-19 patients has been shown to reduce hospital stay length.Öğe The Long-Term Analysis of Hematological Malignancies: Patients with COVID-19 versus without COVID-19(Doc Design Informatics Co Ltd, 2022) Tekinalp, Atakan; Kars, Taha Ulutan; Dikici, Hatice Zeynep; Demircioglu, Sinan; Ceneli, OzcanObjective: The study aims to determine the frequency and clinical features of COVID-19 during the long-term follow-up of patients with hematological malignancies. Methods: Patients with hematological malignancies followed in our center were evaluated retrospectively. The patients were divided into two groups with having COVID-19 between April 01, 2020, and July 01, 2021: those who had COVID-19 [COVID (+)] and those who didn't have COVID-19 [COVID (-)]. Results: 1258 patients were evaluated. Of these, 288 (22.9%) were found to have had COVID-19. The most common and least common diagnoses in the COVID (+) group were non-Hodgkin lymphoma (NHL) (21.7%) and Hodgkin lymphoma (HL) (6.9%), respectively. The malignancies with the highest and lowest rates of COVID-19 (+) were multiple myeloma (MM) (35.6%) and chronic myeloid leukemia (CML) patients (17.8%), respectively. The median age was higher in COVID (+) chronic lymphocytic leukemia (CLL) patients than in COVID (-) patients (73 vs. 66; p= 0.001). All deaths were due to COVID in COVID (+) patients. The mortality rate for all patients was found to be significantly higher in the COVID (+) group than in the COVID (-) group (22.8% vs. 11.9%; p<0.001). Myelodysplastic syndrome (MDS) (39.5%) and acute leukemia (AL) (35.7%) had the highest mortality rates in the COVID (+) group. The mortality rates in COVID (+) CLL (26% vs. 7%), AL (35.7% vs. 17.7%) and MM (28.6% vs. 9.2%) were significantly higher than in the COVID (-) group. There were no deaths due to COVID-19 in CML patients. 79.8% of COVID (+) patients were hospitalized, and the mortality rate in these patients was significantly higher than in outpatients (34.6% vs. 2.8%; p<0.001). The patients with the highest need for mechanic ventilation had MDS (44.8%) and AL (36%). Conclusion: Our study provides important data to the literature comparing the effect of SARS-CoV-2 on all hematological malignancies with malignant patients who do not have COVID-19.Öğe Might periostin serve as a marker of bone marrow involvement in patients with diffuse large B-cell lymphoma?(Walter De Gruyter Gmbh, 2022) Tekinalp, Atakan; Kars, Taha Ulutan; Tuna, Ali Kursat; Kilinc, Ibrahim; Demircioglu, Sinan; Ceneli, OzcanObjectives 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.Öğe Might periostin serve as a marker of bone marrow involvement in patients with diffuse large B-cell lymphoma?(Walter De Gruyter Gmbh, 2022) Tekinalp, Atakan; Kars, Taha Ulutan; Tuna, Ali Kursat; Kilinc, Ibrahim; Demircioglu, Sinan; Ceneli, OzcanObjectives 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.Öğe A Real-life Turkish Experience of Venetoclax Treatment in High-risk Myelodysplastic Syndrome and Acute Myeloid Leukemia(Cig Media Group, Lp, 2021) Gemici, Aliihsan; Ozkalemkas, Fahir; Dogu, Mehmet Hilmi; Tekinalp, Atakan; Alacacioglu, Inci; Guney, Tekin; Ince, IdrisVenetoclax is a selective B-cell lymphoma 2 (BCL2) inhibitor, which is approved to treat elderly patients with newly diagnosed acute myeloid leukemia (AML) and high-risk myelodysplastic syndrome (MDS). A total of 60 patients with a median age of 67 years from different centers were included in the final analysis. Our real-life data support the use of venetoclax in patients with both newly diagnosed and relapsed high-risk MDS and AML. Introduction: Venetoclax is a selective B-cell lymphoma 2 (BCL2) inhibitor, which is approved to treat elderly patients with newly diagnosed acute myeloid leukemia (AML) and high-risk myelodysplastic syndrome (MDS) in combination with either low-dose cytarabine (ARA-C) or hypomethylating agents. We aimed to collect and share data among the efficacy and safety of venetoclax both as a monotherapy or in combination with other drugs used to treat high-risk MDS or AML. Materials and Methods: A total of 60 patients with a median age of 67 (30-83) years from 14 different centers were included in the final analysis. Thirty (50%) of the patients were women; 6 (10%) of the 60 patients were diagnosed with high-risk MDS and the remaining were diagnosed with AML. Results: The best objective response rate (complete remission [CR], complete remission with incomplete hematological recovery (CRi), morphological leukemia-free state [MLFS], partial response [PR]) was 35% in the entire cohort. Best responses achieved during venetoclax per patient number were as follows: 7 CR, 1 CRi, 8 MLFS, 5 PR, and stable disease. Median overall survival achieved with venetoclax was 5 months in patients who relapsed and not achieved in patients who were initially treated with venetoclax. Nearly all patients (86.7%) had experienced a grade 2 or more hematologic toxicity. Some 36.7% of these patients had received granulocyte colony stimulating factor (GCSF) support. Infection, mainly pneumonia (26.7%), was the leading nonhematologic toxicity, and fatigue, diarrhea, and skin reactions were the others reported. Conclusion: Our real-life data support the use of venetoclax in patients with both newly diagnosed and relapsed high-risk MDS and AML. (C) 2021 Elsevier Inc. All rights reserved.Öğe Rituximab-induced severe acute thrombocytopenia in a patient with splenic marginal zone lymphoma(Sage Publications Ltd, 2023) Kars, Taha Ulutan; Yorganci, Zahit Furkan; Yaskiran, Osman; Tekinalp, Atakan; Demircioglu, SinanIntroduction 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/mu L to 5000/mu L. 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/mu L. 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.Öğe Treatment with doxorubicin-based protocol in cardiac involvement diffuse large B-cell lymphoma: A case report(Sage Publications Ltd, 2022) Tekinalp, Atakan; Kars, Taha U.; Dikici, Hatice Z.; Yilmaz, Pinar D.; Demircioglu, Sinan; Ceneli, OzcanIntroduction 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 x 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.Öğe Utility of Different Scoring Systems for the Diagnosis of Thrombotic Microangiopathies(Coll Physicians & Surgeons Pakistan, 2023) Yilmaz, Seda; CenelI, Ozcan; Tekinalp, AtakanObjective: To investigate the appropriateness of Bentley and plasmic scores and ADAMTS-13 activity to distinguish between primary thrombotic microangiopathies (TMA) syndromes and other thrombotic microangiopathies, as well as primary thrombotic microangiopathies (TTP, complement-related TMA, etc).Study Design: Descriptive study.Place and Duration of the Study: Department of Hematology, Faculty of Medicine, from February 2013 to February 2020.Methodology: Data of patients with non-immune hemolytic anaemia (MAHA) and thrombocytopenia who had ADAMTS-13 test, were analysed. Clinical and laboratory findings, Bentley and plasmic scores, and ADAMTS activity levels were compared.Results: The patients were grouped as primary (n = 27) and secondary (n = 28) TMA, the age was median 38.0 (18-63) years in the primary TMA group and 49.5 (20-84) years in the secondary TMA group. Neurological findings were less in the secondary TMA group (p = 0.008). Plasmic score, lactate dehydrogenase, and total and indirect bilirubin levels were high and D-dimer levels were low in the primary TMA group. In the primary TMA group, a greater number of patients with high plasmic scores were found, whereas all patients in the secondary TMA group had low risk according to Bentley score. Calcium levels were high and platelet levels were low in those with ADAMTS activity level <10% (p = 0.006). The evaluation of primary TMAs demonstrated significant differences in platelet, urea, creatinine, and sodium values between the two groups.Conclusion: Laboratory data and clinical scores are valuable in differentiating primary and other TMA.
