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Öğe Acute Promyelocytic Leukemia Diagnosed at the End of First Trimester with a Successful Outcome(Kare Publ, 2018) Baysal, Mehmet; Umit, Elif G.; Ozdover, Ali Caner; Sutcu, Havva; Cilingir, Isil Uzun; Kirkizlar, Onur; Sayin, CenkThe treatment and management of patients with acute promyelocytic leukemia (APL) diagnosed in pregnancy can involve a wide range of difficulties and limitations. Thus, these cases are each unique and present challenges to physicians. The aim of this study was to present the case of a 24-year-old patient who was diagnosed with APL in the 14th week of pregnancy who was treated successfully with all-trans retinoic acid and chemotherapy.Öğe A case of refractory chronic lymphocytic leukaemia with an unusual course(All India Inst Medical Sciences, 2019) Umit, Elif G.; Baysal, Mehmet; Ozdover, Ali Caner; Kirkizlar, Onur; Demir, Ahmet MuzafferChronic lymphocytic leukaemia (CLL) is a heterogeneous disease with uncertain course. Treatment should be tailored to the patient's disease as well as the prognostic subgroup. With the increased use of rituximab as well as other selective and non-selective immunomodulatory agents, the incidence of infectious complications and second malignancies has also increased. Progressive multifocal leucoencephalopathy (PML) is a complication of rituximab in HIV-negative patients. A 56-year-old male with CLL had been treated and relapsed four times in 6 years. Rituximab was added to the combination after the second relapse and repeated in the third relapse in combination with bendamustine. In the seventh year of diagnosis, relapse of CLL and an ulcerated tumorous lesion was observed in the left index finger, which progressed in 3 months and was later diagnosed as angiosarcoma. The cancer was treated with local radiotherapy and combination chemotherapy. One year after the last rituximab exposure, progressive muscle weakness developed and polyoma JC virus DNA was observed with increased titres in the cerebrospinal fluid, and the patient was diagnosed as having PML. The patient died 2 months later. Our patient had an unusual course of CLL over 8 years, with relapses, complicated with a secondary malignancy and an infectious complication.Öğe Chronic myeloid leukaemia after chemoradiotherapy for solid malignancies(Wolters Kluwer Medknow Publications, 2020) Baysal, Mehmet; Ulutas, Gulcin; Gokyer, Ali; Umit, Elif; Atli, Emine Ikbal; Kirkizlar, Onur; Gurkan, HakanHaematological malignancies associated with chemoradiotherapy (CRT) are often acute myeloid leukaemias and myelodysplastic syndromes. Chronic myeloid leukaemia (CML) has been reported rarely in these situations. Cytogenetics of CRT-associated CML is not different from de novo CML, and there are not enough data about its prognosis. We report two patients who had CRT because of lung cancer and squamous cell carcinoma of head and neck, who subsequently developed CML.Öğe Cox-2 gene polymorphisms in Turkish patients with myelodysplastic syndrome(E-Century Publishing Corp, 2016) Ayer, Mesut; Aktuglu, Mehmet Burak; Acik, Hasan; Bireller, Elif Sinem; Velet, Mustafa; Kirkizlar, Onur; Osmanbasoglu, EmreCyclooxygenase-2 gene polymorphisms have been studied and known its role one on cancerogenesis even though there has not yet been any studies myelodysplastic syndrome. We aimed to provide the first data on COX-2 gene polymorphisms in myelodysplastic syndrome. A total of 39 patients with MDS and 50 healthy controls were recruited from undertaken hematology departmentand compared in terms of COX-2-765 G -> C and COX-2-1195 A. G genes. Statistically significant difference was observed between patients with MDS and controls in terms of COX-2-765 G -> C genotype and distribution of alleles and COX-2-765 GG genotype was more frequently found in the MDS group (P<0.001). Moreover, COX-2-765 C+(CC+CG) genotype was found to provide 5.6 times more protection against MDS. In conclusion, our results indicate that polymorphisms of the C allele of the COX-2 gene may provide protection against MDS; however, its predictive value and potential as a marker in oncology remain to be investigated in further trials.Öğe The first case of peripheral T cell lyphoma with a CSF3R variant resulted in relapsing febrile neutropenia and aplastic anemia(Springer Heidelberg, 2022) Kirkizlar, Onur; Can, NurayColony-stimulating factor 3 receptor (CSF3R) gene mutations have been previously identified in chronic neutrophilic leukemia, atypical chronic myeloid leukemia, chronic myelomonocytic leukemia, de novo acute myeloid leukemia, and severe congenital neutropenia, although there is limited data regarding lymphoid malignancies. Here, we present the first case of peripheral T cell lymphoma with CSF3R variant that developed persistent neutropenia in the follow-up visit and aplastic anemia after autologous hematopoietic stem cell transplantation. Next-generation sequencing (NGS) was performed on bone marrow aspiration (Qiagen clinical insight-QCI (TM)). CSF3R single nucleotide variant (transcript variant 4), 46.0% (of 1081 reads) of variant allele fraction on exon 16 (lying to intronic region), nucleotide NM_172313.3, g36932463A > g, c.2041-35 T > C was identified by NGS. The case study presented here is an example of use of NGS in diagnosis, classification, prognostic or response indicator of hematologic malignancies, and identification of targeted therapy options in clinical practice. Additional work is needed to understand the clinical significance of this mutation.Öğe Fusarium Endophthalmitis, Unusual and Challenging Infection in an Acute Leukemia Patient(Hindawi Ltd, 2018) Baysal, Mehmet; Umit, Elif; Boz, Ibrahim Bekir; Kirkizlar, Onur; Demir, MuzafferInvasive fungal infections bring serious mortality and morbidity during the treatment of acute myeloid leukemia. Especially, mold infections are challenging, and each case is unique in feature. These cases are usually fatal, and there is no consensus regarding optimal treatment. AML patients receive antifungal prophylaxis and may further require IFI (invasive fungal infection) treatments, but fusarium mold infections are often unrecognized and could be overlooked. In this case report, we try to emphasize the importance of this infection with a high-risk AML patient.Öğe Incidence and predisposing factors of infection in patients treated with hypomethylating agents(Pergamon-Elsevier Science Ltd, 2023) Kirkizlar, Tugcan Alp; Kirkizlar, Onur; Demirci, Ufuk; Umut, Aytug; Iflazoglu, Huseyin; Umit, Elif Gulsum; Demir, Ahmet MuzafferObjective: Hypomethylating agents may have adverse effects such as cytopenias, cytopenia associated infections and fatality due to infections despite their favorable effects in the treatment of acute myeloid leukemia (AML), myelodysplastic syndromes (MDS) and chronic myelomonocytic leukemia (CMML). The infection prophylaxis approach is based on expert opinions and real-life experiences. Hence, we aimed to reveal the frequence of infections, predisposing factors of infection and to analyse infection attributable mortality in patients with high -risk MDS, CMML and AML who received hypomethylating agents in our center where routine infection pro-phylaxis is not applied. Material-method: 43 adult patients with AML or high-risk MDS or CMML who received HMA >= 2 consecutive cycles from January 2014 to December 2020 were enrolled in the study. Results: 43 patients and 173 treatment cycles were analyzed. The median age was 72 years and 61.3 % of patients were males. The distribution of the patients' diagnoses was; AML in 15 patients (34.9 %), high risk MDS in 20 patients (46.5 %), AML with myelodysplasia-related changes in 5 patients (11.6 %) and CMML in 3 patients (7 %). 38 infection events (21.9 %) occurred in 173 treatment cycles. 86.9 % (33 cycles) and 2.6 % (1 cycle) of infected cycles were bacterial and viral infections, respectively and 10.5 % (4 cycles) were bacterial and fungal concurrently. The most common origin of the infection was respiratory system. Hemoglobin count was lower and CRP level was higher at the beginning of the infected cycles significantly (p values were 0.002 and 0.012, respectively). Requirement of red blood cell and platelet transfusions were found to be significantly increased in the infected cycles (p values were 0.000 and 0.001, respectively). While > 4 cycles of treatment and increased platelet count were found to be protective against infection, > 6 points of Charlson Comorbidity Index (CCI) were found to increase the risk of infection. The median survival was 7.8 months in non-infected cycles while 6.83 months in infected cycles. This difference was not statistically significant (p value was 0.077). Discussion: The prevention and management of infections and infection-related deaths in patients treated with HMAs is crucial. Therefore, patients with a lower platelet count or a CCI score of > 6 may be candidates for infection prophylaxis when exposed to HMAs.Öğe The Incidence of Venous Thromboembolism and Impact on Survival in Hodgkin Lymphoma(Cig Media Group, Lp, 2020) Kirkizlar, Onur; Kirkizlar, Tugcan Alp; Umit, Elif Gulsum; Asker, Ismail; Baysal, Mehmet; Bas, Volkan; Gulsaran, Sedanur KaramanVenous thromboembolic events are associated with high morbidity and mortality in malignancy patients. We should be aware in terms of venous thromboembolism in patients who have involvement of spleen, advanced stage disease, or a central venous line, especially initial high fibrinogen levels, even with a good performance status. Background: Thrombosis increase the acute and long-term morbidity and mortality in malignancy patients. We analyzed venous thromboembolism (VTE) in patients with Hodgkin lymphoma, the impact of VTE on survival, predisposing factors for VTE, and predicting value of Khorana and ThroLy score models. Patients and Methods: We included 150 adult patients with Hodgkin lymphoma between January 2010 and 2018 at our university hospital. Results: VTE was observed in 31 patients (20.7%). The types of VTE were 18 upper and 3 lower extremity deep vein thrombosis and 10 pulmonary embolism (1 with lower extremity deep vein thrombosis). Twenty-nine patients developed VTE during the treatment with a median time of episode as 5 months. In logistic regression analysis, a body mass index of >32 kg/m(2), high fibrinogen levels, initial thrombocytosis and leukocytosis, splenic and extranodal involvement, presence of a central venous line, advanced stage, line of treatment status of thromboprophylaxis, VTE timing, and better Eastern Cooperative Oncology Group performance scores were observed to be related with VTE. Kaplan Meier survival analysis showed a negative impact of VTE on survival. Khorana and ThroLy risk assessment models were found predictive for VTE (P = .000 and P = .003, respectively), although only ThroLy score was associated with the survival. Conclusion: Thromboprophylaxis and precautions for VTE in patients with Hodgkin lymphoma according to validated risk assessment models can improve prognosis and quality of life owing to the impact of VTE on survival in the study. (C) 2020 Elsevier Inc. All rights reserved.Öğe Invasive fungal infection with a rare organism in a patient with acute myeloid leukaemia(Wolters Kluwer Medknow Publications, 2020) Baysal, Mehmet; Umit, Elif; Ozdover, Ali Caner; Kirkizlar, Onur; Demir, Ahmet MuzafferInvasive fungal infections are a major cause for morbidity and mortality in patients with acute myeloid leukaemia (AML). Long duration of hospitalization and increased costs are secondary burdens for patients and caregivers. The clinical manifestations are variable with a spectrum of different organs or systems. Factors related with invasive fungal infections may be categorized as host-related including the underlying disease, treatment and colonization status and pathogen-related including the capacity of the microorganism for defence, growth, tolerance and tissue affinity. The diagnosis of invasive fungal infection is confirmed with histopathological or microbiological demonstration of the microorganism, and commonly treatments are based on probability rather than definitive diagnosis due to patients fragile conditions preventing interventions. We aimed to present the less frequent yet difficult-to-treat organism, Verticillium causing invasive fungal infection in a patient with AML undergoing remission induction therapy.Öğe Patient characteristics and management practices in chronic myeloid leukemia in Turkey: reflections from an expert meeting(Taylor & Francis Ltd, 2022) Eskazan, Ahmet Emre; Ali, Ridvan; Alnigenis, Ebru; Ayyildiz, Orhan; Haznedaroglu, Ibrahim; Kirkizlar, Onur; Kurtoglu, ErdalIntroduction The therapeutic landscape of chronic myeloid leukemia (CML) has evolved significantly since the introduction of imatinib. The European LeukemiaNet (ELN) recommendations serve as a guide for diagnosis, treatment, and monitorization of CML, but availability and accessibility of diagnostic tools and medications affect their applicability. Areas covered This article provides an overview of the current clinical management of CML in Turkey with reference to the key outputs of the online expert meeting held in November 2020. The applicability of the ELN 2020 recommendations for treating CML in clinical practice was also discussed. Expert opinion Imatinib is the only reimbursed and the most preferred first-line treatment in CML restricting the upfront use of second-generation tyrosine kinase inhibitors (TKIs), thereby limiting the applicability of treatment-free remission approach in Turkey. The ELN recommendations about using the EUTOS Long-Term Survival (ELTS) score for risk assessment and focusing on patient reported outcomes and quality of life can be enhanced with educational activities. The widespread availability of standardized technical infrastructure for diagnosing and monitoring CML will contribute to better disease management. Establishing a sustainable national database for CML is valuable for observing patient characteristics and disease outcomes as well as the impact of treatment patterns over time.Öğe Polypharmacy and potentially inappropriate medication use in older patients with multiple myeloma, related to fall risk and autonomous neuropathy(Sage Publications Ltd, 2020) Umit, Elif G.; Baysal, Mehmet; Bas, Volkan; Asker, Ismail; Kirkizlar, Onur; Demir, Ahmet M.Purpose Multiple myeloma is a chronic, uncurable hematological cancer with the involvement of multiple organ systems. As a disease affecting older patients, the treatment of multiple myeloma should be based on individual patient characteristics. Polypharmacy is an increasing problem in the care of older patients and in patients with multiple myeloma, polypharmacy is almost inevitable. We aimed to evaluate the applicability of polypharmacy definitions and the relation of polypharmacy with disease outcomes in patients with multiple myeloma. Methods Eighty patients older than 65 years and diagnosed with multiple myeloma were retrospectively enrolled. Patient files, prescriptions, evaluations for polypharmacy were determined according to Beers and START/STOPP criteria. Outcomes were recorded from files in terms of fractures, autonomous neuropathy, and renal functions. Results Polypharmacy with >= 4 drugs was observed in 65 patients while polypharmacy with >= 5 drugs was observed in 51 patients. Autonomous neuropathy, polypharmacy with more than four or five medications, and use of multiple medications in the same category were related with poor ECOG performance status in women, while prolonged use of benzodiazepines and central nervous system (CNS) affecting drugs and inappropriate polypharmacy were more frequent in men with poor ECOG performance status. The majority of patients aged 75-84 years were observed to use inappropriate polypharmacy. Autonomous neuropathy and fall risk were observed to be significantly related with inappropriate polypharmacy. Conclusions Drugs affecting balance and perception should be reconsidered in patients with multiple myeloma.Öğe The Relationship Between Factor VIII and Coronary Artery Diseases(Galenos Yayincilik, 2012) Meral, Cenk Emre; Aktuglu, Mehmet Burak; Hassoy, Hur; Karaali, Zeynep; Alioglu, Taner; Kirkizlar, Onur; Acar, SencanAim: Cardiovascular diseases are the major cause of morbidity and mortality worldwide. There are some evidences showing a possible role for hemotostatic system in the pathogenesis of atherosclerotic vascular diseases. In our study, we aimed to show the relationship between coronary artery diseases and factor VIII (F VIII). Methods: 60 patients were included in the study. Blood samples for F VIII were taken before and after the standard Bruce treadmill stress test. Patients with positive stress test underwent coronary angiography. Results: The F VIII levels after the treadmill test were statistically significantly high (p: 0.0001) compared to that before the test. A significant difference was determined in favor of female patients both before (p= 0.002) and after (p= 0.009) the treadmill exercise test when F VIII levels were assessed by gender. Conclusion: Since the discovery of the important role of thrombosis in the pathogenesis of atherosclerotic diseases, investigators are working on whether the haemostatic status is the primary risk factor in coronary artery disease (CAD). Our study results, similar to the literature, showed that F VIII levels in women can be helpful in the diagnosis and follow-up of CAD. But as shown in other studies, F VIII levels may increase in an inflammatory state. Therefore, further studies are needed to determine whether CAD is caused by high levels of F VIII or risk factors for CAD cause endothelial damage and, thus, high levels of F VIII are the result of an inflammatory process.Öğe Sticky Platelet Syndrome in Patients with Uninduced Venous Thrombosis(Galenos Yayincilik, 2013) Tekgunduz, Emre; Demir, Muzaffer; Erikci, Alev Akyol; Akpinar, Seval; Ozturk, Erman; Kirkizlar, OnurObjective: Sticky platelet syndrome (SPS) is a common autosomal dominant inherited platelet disorder. SPS is characterized by platelet hyperreactivity and is associated with arterial and venous thrombosis. The aim of this study was to determine the role of SPS in patients with uninduced venous thrombosis. Material and Methods: The study included 28 patients (15 male and 13 female) with uninduced venous thrombosis. SPS was defined according to Mammen's aggregation method, which is described in detail elsewhere. Results: According to the defined ranges for platelet hyperreactivity, 3 (50%) patients, 2 (33%), and 1 (17%) (n =6 [21%]) with a confirmed diagnosis were classified as type II, I, and III SPS, respectively. In 1 patient SPS was the only hereditary abnormality noted. The other 5 patients carried other inherited coagulation defects, in addition to SPS. Conclusion: The present findings indicate that the prevalence of SPS was 21% in the patients with uninduced venous thrombosis. We therefore suggest that SPS should be considered in the differential diagnosis of such cases.Öğe Vancomycin-resistant enterococci infection and predisposing factors for infection and mortality in patients with acute leukaemia and febrile neutropenia(Pergamon-Elsevier Science Ltd, 2020) Kirkizlar, Tugcan Alp; Akalin, Halis; Kirkizlar, Onur; Ozkalemkas, Fahir; Ozkocaman, Vildan; Kazak, Esra; Ozakin, CuneytBackground: Vancomycin-resistant enterococcus (VRE) is an infectious agent that can increase morbidity and mortality, especially in patients with neutropenia in haematology departments. We analysed VRE infections and mortality rates among VRE colonized patients with acute leukaemia, defined predisposing risk factors for infection and mortality, and investigated the influence of daptomycin or linezolid treatment on mortality. Patients-Methods: We included 200 VRE colonized adult acute leukaemia patients with febrile neutropenia between January 2010 and January 2016. Data were collected from electronic files. Results: There were 179 patients in the colonized group, and 21 patients in the infected group. Enterococcus faecium (van A) was isolated from all patients. The infection rate was 10.5 %, and the types of infections noted were as follows: bloodstream (n = 14; 66.7 %), skin and soft tissue (n = 3; 14.3 %), urinary (n = 2; 9.5 %), and others (9.5 %). In the multivariate logistic regression analysis, exposure to invasive procedures, coinfection status, and 15 days of VRE positivity were independent risk factors for VRE infections. In hospital mortality rates were 57.1 % in the infected group, and 9.5 % in the colonized group (p < 0.001). Older age, female gender, absolute neutropenia, and coinfection status were statistically significant predictor of survival. Conclusion: Vancomycin-resistant enterococcus infections are associated with high morbidity and mortality in haematology patients with neutropenia. Clinicians should be aware of predisposing risk factors for VRE infection to avoid unfavourable outcomes. We believe that larger studies are necessary regarding the influence of treatment with daptomycin and linezolid.
