Person: PINAR, İBRAHİM ETHEM
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PINAR
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İBRAHİM ETHEM
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Publication 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-5894-2022Introduction: 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.Publication 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-8981-2022Publication 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-5330-2022Venetoclax 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.Publication 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-7463-2023IntroductionThrombotic 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.Publication 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