Browsing by Author "PINAR, İBRAHİM ETHEM"

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A real-life Turkish experience of venetoclax treatment in high-risk myelodysplastic syndrome and acute myeloid leukemia
(Cig Media Group, 2021-08-10) Gemici, Aliihsan; Dogu, Mehmet Hilmi; Tekinalp, Atakan; Alacacioglu, Inci; Guney, Tekin; Ince, Idris; Geduk, Ayfer; Cağlıyan, Gulsum Akgun; Maral, Senem; Serin, Istemi; Gunduz, Eren; Karakus, Volkan; Bekoz, Huseyin Saffet; Eren, Rafet; Gunes, Ahmet Kursad; Sargin, Fatma Deniz; Sevindik, Omur Gokmen; Ozkalemkas, Fahir; ÖZKALEMKAŞ, FAHİR; Pinar, Ibrahim Ethem; PINAR, İBRAHİM ETHEM; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Hematoloji Anabilim Dalı.; JWP-2738-2024; AAA-5330-2022
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). 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.
Conventional amphotericin b associated nephrotoxicity in patients with hematologic malignancies
(Cureus, 2021-07-17) Gürsoy, Vildan; Özkalemkaş, Fahir; Özkocaman, Vildan; Yeğen, Zafer Serenli; Pınar, İbrahim Ethem; Ener, Beyza; Akalın, Halis; Kazak, Esra; Ali, Rıdvan; Ersoy, Alparslan; ÖZKALEMKAŞ, FAHİR; ÖZKOCAMAN, VİLDAN; PINAR, İBRAHİM ETHEM; ENER, BEYZA; AKALIN, EMİN HALİS; ALİ, RIDVAN; ERSOY, ALPARSLAN; Bursa Uludağ Üniversitesi/Tıp Fakültesi/İç Hastalıkları Anabilim Dalı/Hematoloji Bilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Mikrobiyoloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/İç Hastalıkları Anabilim Dalı/Nefroloji Bilim Dalı.; 0000-0001-9907-1498 ; 0000-0002-4803-8206; DLR-8474-2022 ; JIR-6730-2023 ; JGM-6601-2023 ; AAG-8523-2021 ; AAU-8952-2020; AAG-8459-2021; GXD-8209-2022; CPX-5894-2022
Introduction: Amphotericin B (AmB-d) is one of the most effective therapeutic options against frequently life-threatening systemic fungal infections in patients with hematologic malignancies. However, significant adverse effects including nephrotoxicity associated with its use limit its more widespread use. The objectives of our study were to determine the incidence of AmB-d associated nephrotoxicity, to evaluate clinical and epidemiological characteristics of patients, and to support the notion that conventional amphotericin B remains a valid therapeutic option among hematologic patients with proper patient selection.Materials and methods: A total of 110 patients with hematologic malignancies were admitted to our Hematology Unit between January 2014 and November 2017 who required anti-fungal therapy during intensive systemic chemotherapy. The incidence of AmB-d associated nephrotoxicity, side effect profile, time to nephrotoxicity, and clinical and epidemiological characteristics associated with treatment success were assessed retrospectively.Results: Of the 110 patients receiving AmB-d, 70 (63.6%) were male and 40 (36.4%) were female. The mean age of participants was 44 years. The most common diagnosis was acute myeloid leukemia (n=53, 48.2%), and the most common chemotherapy protocol was 7 + 3 remission-induction (cytarabine 100 mg/m(2) days 1-7, Idarubicin 12 mg/m(2) days 1-3; n=24, 21.8%). In 56.4% of the patients, antifungal therapy was given empirically. In 40 patients (36.4%), nephrotoxicity was observed following antifungal treatment, and only four patients had stage 3 renal failure. The mean duration of time to nephrotoxicity from initiation of amphotericin B was four days (min: 2, max: 31). All patients were found to receive at least one additional potential nephrotoxic treatment during the antifungal treatment process.Conclusion: AmB-d is associated with a significant risk of nephrotoxicity. In most hematological patients, antifungal treatment is initiated empirically, and patients received prolonged courses of treatment. Therefore, it is plausible to initiate such treatment with AmB-d, when one considers the already high treatment costs in this patient group as well as the fact that AmB-d offers similar efficacy to antifungal agents at a lower cost. AmB-d may be recommended as a first-line agent in this patient group with the introduction of newer and more costly antifungal agents when needed, on the basis of the fact that these patients can be closely monitored in a hospital setting, reversible nature of nephrotoxicity upon discontinuation, and rare occurrence of severe renal failure requiring dialysis.
Efficacy of plerixafor plus g-csf in patients with multiple myeloma and lymphoma who have had mobilization failure with at least two regimens. a retrospective study
(Springernature, 2022-11-01) Özkocaman, V.; ÖZKOCAMAN, VİLDAN; Pınar, İbrahim Ethem; PINAR, İBRAHİM ETHEM; Özkalemkas, Fahri; ÖZKALEMKAŞ, FAHİR; Ersal, Tuğba; ERSAL, TUBA; Buldu, Merve; BULDU, MERVE; Gürsoy,; GÜRSOY, VİLDAN; Bursa Uludağ Üniversitesi/Tıp Fakültesi.; 0000-0001-9907-1498; 0000-0002-0116-2082; JGM-6601-2023; M-1070-2014; JWP-2738-2024
Evaluation of using empiric glycopeptides in accordance with the idsa guidelines in hematologic malignancy patients with febrile neutropenia
(Mattioli 1885, 2022-05-01) Yalçın, Cumali; Özkalemkaş, Fahir; Özkocaman, Vildan; Ersal, Tuba; Pınar, İbrahim Ethem; Orhan, Bedrettin; Candar, Ömer; Çubukcu, Sinem; Koca, Tuba Güllü; Akyol, Merve Nur; Ada, Nevriye Gül; Özakın, Cüneyt; Kazak, Esra; Akalın, Halis; Ali, Rıdvan; YALÇIN, CUMALİ; ÖZKALEMKAŞ, FAHİR; ÖZKOCAMAN, VİLDAN; ERSAL, TUBA; PINAR, İBRAHİM ETHEM; ORHAN, BEDRETTİN; CANDAR, ÖMER; ÇUBUKÇU, SİNEM; GÜLLÜ KOCA, TÛBA; AKYOL, MERVE NUR; ADA, NEVRİYE GÜL; ÖZAKIN, CÜNEYT; KAZAK, ESRA; AKALIN, EMİN HALİS; ALİ, RIDVAN; Bursa Uludağ Üniversitesi/Tıp Fakültesi/İç Hastalıkları Anabilim Dalı/Hematoloji Bilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/İç Hastalıkları Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Mikrobiyoloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Mikrobiyoloji ve Enfeksiyon Hastalıkları Anabilim Dalı.; 0000-0001-9907-1498; 0000-0003-4168-2821; 0000-0001-7530-1279; 0000-0003-3970-2344; 0000-0001-5428-3630; KIE-5102-2024; JIW-1248-2023; FQG-8981-2022; AAJ-4354-2021; JGM-6601-2023; ACW-2157-2022; EOZ-1609-2022; JJB-0254-2023; GWQ-5007-2022; JYC-2094-2024; GNJ-2469-2022; AAG-8392-2021; AAG-8459-2021; AAU-8952-2020; GXD-8209-2022
Background: This study aimed to evaluate the effects of the appropriate use of empiric glycopeptide therapy in hematologic malignancy patients with febrile neutropenia (FN).Materials and Methods: Patients with FN who were hospitalized in our clinic and started empiric glycopeptide therapy were retrospectively analyzed. Empiric glycopeptide treatment initial indications were determined according to 7 specific criteria in the IDSA guidelines. In addition, the duration of glycopeptide use according to initial indications, causative pathogens in culture positivity, frequency of VRE infection, and the mortality rate was identified.Results: 87 patients were included. Of these, 102 episodes of FN were analyzed. Appropriate use of glycopeptides was observed in 98% of patients. The most common initial indication for glycopeptide was skin or soft-tissue infection, with 52% (n = 53). The mean duration of glycopeptide use was 11 (2-22) days. The time of glycopeptide use was longer in patients with catheter-related infections than in those with severe mucositis and hemodynamic instability (p = 0,041/p = 0,016). The duration of glycopeptide use was shorter in patients with consolidation therapy than in those without consolidation therapy. The mortality rate in culture-positive patients was significantly higher than in culture-negative patients (p = 0.041). At 72 h, glycopeptide therapy was discontinued in 8 of 79 FN episodes within culture-negative patients.Conclusion: This study showed that the mortality rate was higher in culture-positive patients. Additionally, glycopeptides should be discontinued early with no evidence of gram-positive infection.
Impact of posaconazole prophylaxis and antifungal treatment on BAL GM performance in hematology malignancy patients with febrile neutropenia: A real life experience
(Springer, 2023-10-16) Acet-Öztürk, Nilüfer Aylin; Ömer-Topcu, Dilara; Vurat Acar, Kübra; Aydın-Güçlü, Özge; Pınar, İbrahim Ethem; Demirdoğen, Ezgi; Görek-Dilektasli, Aslı; Kazak, Esra; Özkocaman, Vildan; Ursavaş, Ahmet; Özkalemkaş, Fahir; Ener, Beyza; Ali, Rıdvan; Akalın, Halis; ACET ÖZTÜRK, NİLÜFER AYLİN; ÖMER TOPÇU, DİLARA; VURAT ACAR, KÜBRA; AYDIN GÜÇLÜ, ÖZGE; PINAR, İBRAHİM ETHEM; DEMİRDÖĞEN, EZGİ; GÖREK DİLEKTAŞLI, ASLI; KAZAK, ESRA; ÖZKOCAMAN, VİLDAN; URSAVAŞ, AHMET; ÖZKALEMKAŞ, FAHİR; ENER, BEYZA; ALİ, RIDVAN; AKALIN, EMİN HALİS; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Göğüs Hastalıkları Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/İç Hastalıkları Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Hematoloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Mikrobiyoloji Anabilim Dalı.; 0000-0002-6375-1472; 0000-0002-7400-9089; 0000-0001-7530-1279; AAI-3169-2021; JGM-6601-2023; Z-1424-2019; AAH-9812-2021; AAU-8952-2020; AAG-8459-2021; FRE-8778-2022; JQQ-5505-2023; GXD-8045-2022; JHW-9355-2023; FQG-8981-2022; JIW-1248-2023; CNK-0895-2022; GXD-8209-2022
BackgroundDiagnostic accuracy of galactomannan measurements is highly variable depending on the study population, diagnostic procedures, and treatment procedures. We aimed to evaluate the effect of posaconazole prophylaxis and empiric antifungal treatment upon diagnostic accuracy of GM measurements in bronchoalveolar lavage (BAL), bronchial lavage (BL), and serum in hematological malignancy population.MethodsPatients hospitalized in a single tertiary care center with hematologic malignancies undergoing fiberoptic bronchoscopy (FOB) with a preliminary diagnosis of IPA were retrospectively included.ResultsIn all the study population (n = 327), AUC for BAL, BL, and serum GM were as follows: 0.731 [0.666-0.790], 0.869 [0.816-0.912], and 0.610 [0.540-0.676] with BL samples having the best diagnostic value. GM measurements in patients under posaconazole prophylaxis (n = 114) showed similar diagnostic performance. While specificity was similar between patients with and without posaconazole prophylaxis, sensitivity of GM measurements was lower in patients with prophylaxis. Analyses with patient classified according to antifungal treatment at the time of FOB procedure (n = 166) showed a decreased diagnostic accuracy in serum GM and BAL GM measurements related with the duration of treatment. However, BAL, BL, and serum GM measurements presented similar sensitivity and specificity in higher cut-off values in longer durations of antifungal treatment.ConclusionOur study shows that posaconazole prophylaxis and active short-term (3 days) antifungal treatment do not significantly affect overall diagnostic performance of GM measurements in bronchoalveolar lavage and bronchial lavage samples. However, using different cut-off values for patients receiving active treatment might be suggested to increase sensitivity.
Impact of revised EORTC/MSGERC 2020 criteria on diagnosis and prognosis of invasive pulmonary aspergillosis in patients with hematological malignancies undergoing bronchoscopy
(Masson Editeur, 2022-06-14) Acet-Öztürk, N. A.; Ömer-Topcu, D.; Vurat-Acar, K.; Aydın-Güçlü, O.; Pınar, I. E.; Demirdoğen, E.; Görek-Dilektaşli, A.; Kazak, E.; Özkocaman, V; Ursavaş, A.; Akalın, H.; Özkalemkas, F.; Ener, B.; Ali, R.; ACET ÖZTÜRK, NİLÜFER AYLİN; ÖMER TOPÇU, DİLARA; VURAT ACAR, KÜBRA; AYDIN GÜÇLÜ, ÖZGE; PINAR, İBRAHİM ETHEM; DEMİRDÖĞEN, EZGİ; GÖREK DİLEKTAŞLI, ASLI; KAZAK, ESRA; ÖZKOCAMAN, VİLDAN; URSAVAŞ, AHMET; AKALIN, EMİN HALİS; ÖZKALEMKAŞ, FAHİR; ENER, BEYZA; ALİ, RIDVAN; Uludağ Üniversitesi/Tıp Fakültesi/Göğüs Hastalıkları Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/İç Hastalıkları Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Hematoloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Mikrobiyoloji Anabilim Dalı.; 0000-0001-9907-1498; 0000-0002-7380-2501; JII-3270-2023; FRE-8778-2022; GXC-7806-2022; GXD-8045-2022; JGM-6601-2023; JIA-5197-2023; CRM-4095-2022; CZK-6380-2022; JIR-6730-2023; AAI-3169-2021; EJJ-6847-2022; JIW-1248-2023; CNK-0895-2022; GXD-8209-2022
Introduction: The first consensus definitions for invasive fungal diseases (IFD) were published in 2002. Advan-ces in diagnostic tests and a clear need for improvement in certain areas led to a revision of these definitions in 2008. However, growing data on Aspergillus galactomannan (GM) thresholds and the introduction of new polymerase chain reaction-based diagnostic tests resulted in a further update by EORTC and Mycoses Study Group Education and Research Consortium (MSGERC) in 2020. Compared to the 2008 version, the 2020 EORTC/MSGERC criteria have stricter definitions, especially regarding GM levels, which should lead to improved specificity. Thus, our study aimed to evaluate diagnostic changes, based on GM levels, resulting from these new definitions and ascertain the impact of the new classification on mortality rates. Method: Patients hospitalized in a single tertiary care center with hematologic malignancies and undergoing bronchoscopy for suspected IPA between April 2004 and December 2019 were included in this retrospective study. Results: The study population consisted of 327 patients with 31 patients (nine patients with proven IPA and 22 patients with no IPA) excluded from the study. 194 patients were classified as probable IPA cases according to 2008 EORTC/MSG criteria. However, 53 (27.3%) of these patients were re-classified as possible IPA according to 2020 EORTC/MSGERC criteria, due to novel galactomannan cut-off levels. Compared to re-classified possible IPA patients, those remaining in the probable IPA category experienced a higher incidence of septic shock (34.0% vs 16.9%, p=0.02), and required more non-invasive (12.0% vs 0.0%, p=0.004) and invasive (44.6 vs 24.5%, p=0.01) mechanical ventilation. There was a higher in-hospital mortality rate in probable IPA patients than in the re-clas-sified possible IPA group (42.5% vs 22.6%, p=0.01). Patients reassigned to possible IPA had similar underlying dis-eases, radiological features and prognosis to patients already classified as possible IPA. Independent risk factors for mortality were classification as probable IPA according to 2020 EORTC/MSGERC criteria, lack of remission from hematologic malignancy, and number of nodules in Thorax CT. Conclusion: The use of 2020 EORTC/MSGERC criteria resulted in a 27.3% significant reduction in probable IPA diagnoses and created a more homogeneous category of patients with respect to treatment response, prog-nosis and mortality. Therefore, 2020 EORTC/MSGERC criteria afford more reliable mortality prediction than 2008 EORTC/MSG criteria.(c) 2022 SFMM. Published by Elsevier Masson SAS. All rights reserved.
Impact of the revised EORTC/MSGERC 2020 criteria upon prognosis in patients with hematologic malignancies undergoing bronchoscopy
(European Respiratory Soc Journals, 2021-09-05) Topcu, Dilara Omer; Acer, Kubra Vurat; Guclu, Ozge Aydin; Pinar, Ibrahim Ethem; Demirdogen, Ezgi; Dilektasli, Asli Gorek; Kazak, Esra; Ozkocaman, Vildan; Ursavas, Ahmet; Akalin, Halis; Ozkalemtas, Fahir; Ener, Beyza; Ali, Ridvan; Ozturk, Nilufer Aylin Acet; ACET ÖZTÜRK, NİLÜFER AYLİN; ÖMER TOPÇU, DİLARA; VURAT ACAR, KÜBRA; AYDIN GÜÇLÜ, ÖZGE; PINAR, İBRAHİM ETHEM; DEMİRDÖĞEN, EZGİ; GÖREK DİLEKTAŞLI, ASLI; KAZAK, ESRA; ÖZKOCAMAN, VİLDAN; URSAVAŞ, AHMET; AKALIN, EMİN HALİS; Ozkalemtas, Fahir; ENER, BEYZA; ALİ, RIDVAN; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Göğüs Hastalıkları Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/İç Hastalıkları Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Hematoloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Tıbbi Mikrobiyoloji Anabilim Dalı.; 0000-0002-6375-1472; 0000-0003-1005-3205; 0000-0002-7400-9089; 0000-0001-7530-1279; 0000-0002-6375-1472; 0000-0003-1005-3205; 0000-0002-4803-8206; JGM-6601-2023; KHE-5423-2024; AAU-8952-2020; JPK-7012-2023; JWP-2738-2024; AAI-3169-2021; Z-1424-2019; JIF-7772-2023; CBS-8892-2022; AAG-9930-2019; CNP-1063-2022; AAG-8459-2021; FQG-8981-2022; FQJ-3657-2022; AAG-8523-2021; GXD-8209-2022
Macrophage polarization capacity of peripheral blood monocytes and monocytic cell line THP-1 in response to secreted factors from COVID-19 patients
(Wiley, 2021-08-01) Etgü, Onur; Karaçay, Mehmet; Dombaz, Fatma; Kızmaz, Muhammed Ali; Şimsek, Abdurrahman; Asan, Ali; Yılmaz, Emel; Kazak, Esra; Pınar, İbrahim Ethem; Bal, Salih Haldün; Özkocaman, Vildan; Özkalemkaş, Fahir; Akalın, Emin Halis; Budak, Ferah; Oral, Haluk Barbaros; Ermiş, Diğdem Yöyen; Etgü, Onur; Karaçay, Mehmet; Dombaz, Fatma; Kızmaz, Muhammed Ali; ŞİMŞEK, ABDURRAHMAN; YILMAZ, EMEL; KAZAK, ESRA; PINAR, İBRAHİM ETHEM; BAL, SALİH HALDUN; ÖZKOCAMAN, VİLDAN; ÖZKALEMKAŞ, FAHİR; AKALIN, EMİN HALİS; BUDAK, FERAH; ORAL, HALUK BARBAROS; YÖYEN ERMİŞ, DİĞDEM; Bursa Uludağ Üniversitesi/Tıp Fakültesi/İmmünoloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/İç Hastalıkları Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Temel Tıp Bilimleri Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Dr Raşit Durusoy Kan Bankası.; 0000-0001-7288-3250; 0000-0001-5334-7911; 0000-0001-8850-0269; 0000-0002-8856-7356; 0000-0003-1785-3539; 0000-0001-9907-1498; 0000-0001-7530-1279; 0000-0001-7625-9148; 0000-0003-0463-6818; JIJ-1849-2023; JHB-7829-2023; DWR-5356-2022; HKN-2347-2023; AAG-7381-2021; GDP-0005-2022; AAG-8459-2021; JGM-6601-2023; KBR-5535-2024; FQG-8981-2022; JIW-1248-2023; AAU-8952-2020; IZP-9398-2023; K-7285-2012; GYL-2038-2022
Potential modifications of the plasmic scoring system for predicting thrombotic thrombocytopenic purpura: Sometimes, less is more
(Wiley, 2023-05-27) Orhan, Bedrettin; Özkocaman, Vildan; Akdemir, Çiğdem; Ersal, Tuba; Pınar, İbrahim Ethem; Yalçın, Cumali; Çandar, Ömer; Çubukcu, Sinem; Koca, Tuba Güllü; Ambarcıoğlu, Pınar; Ali, Rıdvan; Özkalemkaş, Fahir; ORHAN, BEDRETTİN; ÖZKOCAMAN, VİLDAN; AKDEMİR, ÇİĞDEM; PINAR, İBRAHİM ETHEM; YALÇIN, CUMALİ; CANDAR, ÖMER; ÇUBUKÇU, SİNEM; GÜLLÜ KOCA, TÛBA; ALİ, RIDVAN; ÖZKALEMKAŞ, FAHİR; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Hematoloji Anabilim Dalı/Dahiliye Bilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/İç Hastalıkları Anabilim Dalı.; 0000-0003-4168-2821; 0000-0003-3970-2344; 0000-0001-9907-1498; 0000-0001-7602-6926; ACW-2157-2022; JWP-2738-2024; KHE-5423-2024; KIE-5102-2024; JGM-6601-2023; JJP-2815-2023; EJN-7496-2022; AAJ-4354-2021; EOZ-1609-2022; JJB-0254-2023; GWQ-5007-2022; GXD-8209-2022; JJW-7463-2023
IntroductionThrombotic thrombocytopenic purpura (TTP) is a life-threatening occlusive disease of the microcirculation characterized by systemic platelet plugs, organ ischemia, deep thrombocytopenia, and fragmentation of erythrocytes. One of the widely used scoring system to determine the clinical probability of TTP is the PLASMIC scoring system. This study aimed to evaluate the contribution of PLASMIC score modifications to sensitivity and specificity in patients with microangiopathic hemolytic anemia (MAHA) undergoing plasma exchange with a prediagnosis of TTP at our center.Materials and MethodsThe data of patients who were hospitalized with a previous diagnosis of MAHA and TTP and underwent plasma exchange at Bursa Uludag University, Faculty of Medicine, Department of Hematology between January 2000 and January 2022 were retrospectively analyzed.ResultsOverall, 33 patients (including 15 and 18 with and without TTP, respectively) were included in this study. Receiver operating characteristic (ROC) analysis revealed that the area under the curve (AUC) for the original PLASMIC score was 0.985 (95% confidence interval [95% CI]: 0.955-1.000), and AUC for the PLASMIC score without mean corpuscular volume (MCV) was 0.967 (95% CI: 0.910-1.000), which is close to the original AUC. With the removal of MCV from the scoring system, the sensitivity decreased from 100% to 93%, whereas the specificity increased from 33% to 78%.ConclusionsBased on the results of this validation study, removing MCV from the PLASMIC score led to the categorization of eight non-TTP cases in the low-risk category, and this could avoid unnecessary plasma exchange. However, in our study increasing the specificity was at the expense of the sensitivity by missing one patient with this new scoring system without MCV. Further multicenter studies with large sample sizes are required owing to the fact that different parameters may be effective in TTP prediction among different populations.
Results of allogeneic stem cell transplantation in bone marrow failures: A single-center experience
(Springernature, 2022-11-01) ERSAL, TUBA; ÖZKOCAMAN, VİLDAN; ÖZKALEMKAŞ, FAHİR; PINAR, İBRAHİM ETHEM; ORHAN, BEDRETTİN; CANDAR, ÖMER; ALİ, RIDVAN; Yalçın, Cihan; Bursa Uludağ Üniversitesi/Tıp Fakültesi/İç Hastalıkları Anabilim Dalı.; 0000-0001-9907-1498; 0000-0002-0510-2992; ACW-2157-2022; JGM-6601-2023; JWP-2738-2024
Severe aplastic anemia and a healthy pregnancy immediately following syngeneic transplantation: An extremely rare case report
(Elsevier Science Inc, 2023-04-27) Gürsoy, Vildan; PINAR, İBRAHİM ETHEM; Pınar, İbrahim Ethem; Özkalemkaş, Fahir; ÖZKALEMKAŞ, FAHİR; Ersal, Tuba; ERSAL, TUBA; GÜLDEREN, ESRA; Özkocaman, Vildan; ÖZKOCAMAN, VİLDAN; Bursa Uludağ Üniversitesi/Tıp Fakültesi/İç Hastalıkları Anabilim dalı.; 0000-0001-9907-1498; JWP-2738-2024; JGM-6601-2023
Aplastic anemia is potentially fatal, particularly if the disease does not respond to immunotherapy and progresses to severe pancytopenia. Allogeneic hematopoietic stem cell transplant from an HLA-matched sibling donor, the first-line treatment in patients younger than 40 years, is used as a curative treatment option in severe aplastic anemia. The availability of an identical twin donor is infrequent, and there is limited experience in this context. Additionally, the choices for a conditioning regimen for a syngeneic transplant to prevent engraftment failure and the necessity of graft-vs-host disease prophylaxis are controversial. Although long-term survival gradually increases after an allogeneic hematopoietic stem cell transplant, hypogonadism and infertility are the main problems that significantly affect patients' quality of life. We present a patient diagnosed with severe aplastic anemia who has had a healthy pregnancy immediately after a syngeneic transplant.
Systemic inflammatory indices for predicting prognosis of myelofibrosis
(Nature Portfolio, 2023-08-02) Ersal, Tuba; Özkocaman, Vildan; Pınar, İbrahim Ethem; Yalçın, Cumali; Orhan, Bedrettin; Candar, Ömer; Çubukcu, Sinem; Koca, Tuba Güllü; Hunutlu, Fazıl Çağrı; Yavuz, Şeyma; Ali, Ridvan; Özkalemkaş, Fahir; ERSAL, TUBA; ÖZKOCAMAN, VİLDAN; PINAR, İBRAHİM ETHEM; YALÇIN, CUMALİ; ORHAN, BEDRETTİN; CANDAR, ÖMER; ÇUBUKÇU, SİNEM; GÜLLÜ KOCA, TÛBA; HUNUTLU, FAZIL ÇAĞRI; YAVUZ, ŞEYMA; ALİ, RIDVAN; ÖZKALEMKAŞ, FAHİR; Bursa Uludağ Üniversitesi/Tıp Fakültesi/İç Hastalıkları Anabilim Dalı/Hematoloji Bilim Dalı.; 0000-0001-9907-1498; 0000-0003-4168-2821; 0000-0003-3970-2344; 0000-0002-4991-9830; AAJ-4354-2021; FQG-8981-2022; JGM-6601-2023; KIE-5102-2024; ACW-2157-2022; EOZ-1609-2022; JJB-0254-2023; GWQ-5007-2022; KCK-7512-2024; GXS-5860-2022; GXD-8209-2022; JIW-1248-2023
The impact of inflammatory markers such as systemic immune-inflammation (SII) index and systemic inflammation response index (SIRI) on myelofibrosis (MF) prognosis was evaluated for the first time in this study. Data from 60 patients diagnosed with MF between March 2011 and September 2022 were retrospectively analyzed. In addition to disease-related markers, the impact of SII and SIRI on prognosis was evaluated. In our study, the overall median survival (OS) was 64 months. OS was significantly shorter in patients older than 65 years, with high ferritin and lymphocyte levels, transfusion dependence at diagnosis, platelet count below 100 x 10(9)/L, Hb level below 8 g/dl, and high risk according to the dynamic international prognostic scoring system (DIPSS)-Plus score. When these variables were included in the multivariate Cox regression model, it was found that being older than 65 years, having a high ferritin value, being at high risk according to the DIPSS-plus score and Hb values below 8 increased the risk of death. Platelet-to-lymphocyte ratio (PLR) and SII index were lower in patients with a fatal outcome. No statistically significant relationship was found between SIRI and mortality. The findings of this study showed that low PLR and high ferritin were associated with poor prognosis in MF. Elevated SII and SIRI, evaluated for the first time in patients with myelofibrosis, did not predict prognosis. Since non-inflammatory variables play a role in the pathogenesis of MF, bone marrow indicators and systemic inflammation indicators derived from hematologic parameters may not be accurate.
The distribution of mature and/or immature myeloid cells and their role in effective anti-viral immune responses in COVID-19 positive patients
(Wiley, 2021-08-01) Ermiş, Diğdem Yöyen; Dömbaz, Fatma; Karaçay, Mehmet; Etgü, Onur; Kızmaz, Muhammed Ali; Şimşek, Abdurrahman; Çağan, Eren; Aşan, Ali; Yılmaz, Emel; Kazak, Esra; Pınar, İbrahim Ethem; Bal, Salih Haldun; Arslan, Gözde; Karaca, Mert; Özkocaman, Vildan; Özkalemtaş, Fahir; Akalın, Emin Halis; Budak, Ferah; Oral, Haluk Barbaros; YÖYEN ERMİŞ, DİĞDEM; Dombaz, Fatma; Karaçay, Mehmet; Etgü, Onur; Kızmaz, Muhammed Ali; ŞİMŞEK, ABDURRAHMAN; YILMAZ, EMEL; KAZAK, ESRA; PINAR, İBRAHİM ETHEM; BAL, SALİH HALDUN; Arslan, Gözde; KARACA, MERT; ÖZKOCAMAN, VİLDAN; Özkalemtaş, Fahir; AKALIN, EMİN HALİS; BUDAK, FERAH; ORAL, HALUK BARBAROS; Bursa Uludağ Üniversitesi/Tıp Fakültesi/İmmünoloji Ana Bilim Dalı.; Bursa Uludağ Üniversitesi/Sağlık Bilimleri Enstitüsü.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Rasit Durusoy Kan Bankası.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Hemotoloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı.; 0000-0001-7288-3250; 0000-0001-5334-7911; 0000-0001-8850-0269; 0000-0002-8856-7356; 0000-0003-1785-3539; 0000-0001-7530-1279; 0000-0001-7625-9148; 0000-0003-0463-6818; KHE-5423-2024; AAU-8952-2020; HKN-2347-2023; JGM-6601-2023; JFS-2013-2023; AAG-7381-2021; K-7285-2012; IZP-9398-2023; F-4657-2014; JWP-2738-2024; GYL-2038-2022; DWR-5356-2022; CXY-4200-2022; CPT-2053-2022; GDP-0005-2022; AAG-8459-2021; FQJ-3657-2022; FQG-8981-2022
The effect of the time from diagnosis to induction therapy on prognosis in patients with acute leukemia undergoing leukapheresis for symptomatic hyperleukocytosis
(Wiley, 2023-04-11) Pınar, İbrahim Ethem; Özkocaman, Vildan; Ersal, Tuba; Dağtekin, Mehmet Emin; Yalçın, Cumali; Orhan, Bedrettin; Candar, Ömer; Çubukcu, Sinem; Koca, Tuba Güllü; Gürsoy, Vildan; Özkalemkaş, Fahir; PINAR, İBRAHİM ETHEM; ÖZKOCAMAN, VİLDAN; ERSAL, TUBA; DAĞTEKİN, MEHMET EMİN; YALÇIN, CUMALİ; ORHAN, BEDRETTİN; CANDAR, ÖMER; ÇUBUKÇU, SİNEM; GÜLLÜ KOCA, TÛBA; ÖZKALEMKAŞ, FAHİR; Bursa Uludağ Üniversitesi/Tıp Fakültesi/İç Hastalıkları Anabilim Dalı/Hematoloji Bilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/İç Hastalıkları Anabilim Dalı.; 0000-0001-9907-1498; 0000-0003-4168-2821; ACW-2157-2022; JGM-6601-2023; KIE-5102-2024; JWP-2738-2024; FQG-8981-2022; IRQ-4413-2023; EOZ-1609-2022; JJB-0254-2023; GWQ-5007-2022; JIW-1248-2023
IntroductionOur study investigated leukapheresis's effect on delayed induction therapy outcomes in patients with acute leukemia presenting with symptomatic hyperleukocytosis.MethodsThis retrospective cohort study included 30 adult patients diagnosed with acute leukemia who underwent leukapheresis for leukostasis. The patients were divided into the first 24 h and >24 h groups, according to the time from diagnosis to induction therapy (TDT).ResultsThere was no significant difference between the TDT groups regarding complete remission (CR), 4-week mortality, and overall survival (OS) at a median follow-up of 409 days. Tumor lysis syndrome, disseminated intravascular coagulation, and hemoglobin levels were significant in early mortality. In univariate analysis, age, hemoglobin levels, patients' eligibility for intensive chemotherapy, and achieving CR were critical factors for OS.ConclusionThe study findings suggest that waiting for the clinical and laboratory results may be a safe and reasonable approach before assigning patients the best treatment option with leukapheresis.
The role of white blood cell count in perianal pathologies: A retrospective analysis of hematologic malignancies
(Mattioli 1885, 2022-07-01) Orhan, Bedrettin; Özkalemkaş, Fahir; Özkocaman, Vildan; Gürbüz, Büsra; Ersal, Tuba; Pınar, İbrahim Ethem; Yalçın, Cumali; Candar, Ömer; Çubukcu, Sinem; Koca, Tuba Güllü; Ali, Rıdvan; ORHAN, BEDRETTİN; ÖZKALEMKAŞ, FAHİR; ÖZKOCAMAN, VİLDAN; GÜRBÜZ, BÜŞRA; ERSAL, TUBA; PINAR, İBRAHİM ETHEM; YALÇIN, CUMALİ; CANDAR, ÖMER; ÇUBUKÇU, SİNEM; GÜLLÜ KOCA, TÛBA; ALİ, RIDVAN; Bursa Uludağ Üniversitesi/Tıp Fakültesi/İç Hastalıkları Anabilim Dalı/Hematoloji Bilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/İç Hastalıkları Anabilim Dalı.; 0000-0001-9907-1498; 0000-0003-4168-2821; 0000-0002-5129-2977; 0000-0002-5564-8862; 0000-0001-7602-6926; JWP-2738-2024; ACW-2157-2022; GWQ-5007-2022; KIE-5102-2024; JGM-6601-2023; GMY-8535-2022; FQG-8981-2022; JJB-0254-2023; GWQ-5007-2022; GXD-8209-2022; AAJ-4354-2021
Background and Objective: Infections are the most common cause of anal and perianal pathologies in patients with hematological malignancies. Perianal infection diagnosis in this group of patients is difficult; thus, a careful anorectal examination is necessary with imaging modalities. In addition, the literature reveals a knowledge gap in the approach to anal pathologies in patients with neutropenia during diagnosis or chemotherapy. This study aimed to examine our institutional data on perianal complications and investigate the relationship between the white blood cell-neutrophil count, perianal lesion, and the type of treatment in patients with hematologic malignancies during the neutropenic period.Methods: Patients with a hematologic malignancy, hospitalized for cytotoxic chemotherapy, complicated by perianal pathology, documented by at least one imaging method, were included in the study.Results: A total of 42 patients were included in the study. Most of them had acute leukemia, 31 were affected by acute myeloid leukemia (AML), and 7 by Acute lymphoid leukemia (ALL). There was no statistically significant relationship between the anal abscess formation, the neutrophil count, and a previous perianal pathology. Anal abscess development was significantly more frequent in acute myeloid leukemia. An inverse relationship was found between the total white blood cell number at onset and having a surgical intervention for anal pathology.In conclusion, this article has shown that white blood cell count at the time of hospitalization can affect the surgical intervention in patients with hematological malignancy (in the majority with acute leukemia) affected by anal pathologies occurring in the neutropenic period.