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Öğe Akut miyeloid lösemi tanılı hastalarda remisyon indüksiyon kemoterapisi döneminde primer antifungal profilaksi alan ve almayan hastaların retrospektif olarak değerlendirilmesi(Lösemi Lenfoma Miyelom Derneği, 2020) Mutlay, Feyza; Sevindik, Ömür Gökmen; Solmaz, Şerife; Acar, Celal; Alpçavuş, Sema; Seyhanlı, Ahmet; Özcan, Mehmet Ali; Demirkan, Fatih; Özsan, Güner Hayri; Ündar, Bülent; Alacacıoğlu, İnciAmaç: Akut miyeloid lösemi (AML) hastalarında gelişen invaziv fungal enfeksiyonlar (İFE)mortalitenin en önemli nedeni olarak görülmektedir. İFE gelişimi için yüksek riskli dönem olanindüksiyon tedavisi döneminde hastalara primer antifungal profilaksi önerilmektedir. Bu çalışmada,posakonazol profilaksisi ile İFE gelişimi, antifungal tedavi ihtiyacındaki azalma ve sağkalımarasındaki ilişkinin incelenmesi amaçlandı.Hastalar ve Yöntem: Çalışmaya remisyon/indüksiyon tedavisi alan 71 erişkin AML hastası dahiledildi. Posakonazol profilaksisi alan ve almayan hastaların sonuçları karşılaştırıldı.Bulgular: Tüm hastaların 40’ı primer antifungal profilaksi olarak posakonazol kullanmakta olup,31 hasta profilaksi almamıştır. Hastaların antifungal süreleri karşılaştırıldığında primer antifungalprofilaksi alan hastalarda toplam parenteral terapötik antifungal tedavi süresi 9.9 ± 10.4 gündü.Profilaksi almayan grupta ise 21.4 ± 14.8 gün olarak saptanmıştır. Primer antifungal profilaksialan hastalarda terapötik antifungal tedavi süresi anlamlı ölçüde kısa bulunmuştur (p= 0.001).Hastaların profilaksi ajan kullanım süresi ve terapötik parenteral antifungal tedavi sürelerinin toplamınabakıldığında ise primer antifungal profilaksi alan grupta 26.9 ± 9.7 gün, almayan gruptaise 21.4 ± 14.8 gün olarak saptanmıştır. Her iki grup arasında profilaksi ve terapötik parenteralantifungal kullanım süreleri toplamı arasında belirgin farklılık yoktu (p= 0.057). Median sağkalımsürelerine göre karşılaştırıldığında hasta grupları arasında sağkalım yönünden anlamlı bir farklılıkgörülmemiştir (p= 0.61).Sonuç: İnvaziv fungal enfeksiyonlar açısından yüksek riskli hastalarda primer antifungal tedavistratejilerinin geliştirilmesi için çok sayıda hasta içeren çalışmanın yapılmasına ihtiyaç vardır.Öğe Can neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, and platelet-to-lymphocyte ratio at day+100 be used as a prognostic marker in multiple myeloma patients with autologous transplantation?(Blackwell Publishing Ltd, 2018) Solmaz Medeni, Şerife; Acar, Celal; Olgun, Aybüke; Acar, Alev; Seyhanlı, Ahmet; Taşkıran, Emin; Sevindik, Ömür Gökmen; Alacacıoğlu, İnci; Pişkin, Özden; Özcan, Mehmet Ali; Demirkan, Fatih; Ündar, Bülent; Özsan, Güner HayriBackground: Recent reports have showed that neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR) are predictors of progression-free survival (PFS) and overall survival (OS) in many types of cancer. This study evaluates the predictive value of NLR, MLR, and PLR for survival in MM patients treated with to ASCT. Methods: A set of data consisting of 150 patients who underwent autologous stem cell transplantation (ASCT) for MM was collected retrospectively. The prognostic value of NLR, MLR, and PLR was investigated with Kaplan-Meier method. Results: The prognostic value of NLR, MLR, and PLR was analyzed by a receiver operating characteristic (ROC) curve established to determine the cutoff. These cutoff values of NLR, PLR, and MLR were found 1.46, 86, and 0.27, respectively, on the 100th day of post-transplantation period. The overall survival (OS) and the post-transplantation OS of the patients with high NLR, MLR, and PLR levels on the 100th day of post-transplantation were shorter than the other group (P = 0.05, P = 0.018 [NLR], P = 0.05, P = 0.002 [MLR], P = 0.000, P = 0.001 [PLR]). The post-transplantation progression-free survival (PFS) of the patients with high NLR, MLR, and PLR levels on the 100th day of post-transplantation was shorter as well (P = 0.036, P = 0.001, P = 0.001, respectively). Conclusion: As increased NLR, MLR, and PLR predicted poor clinical outcome in MM patients with autologous transplantation in this study, they may serve as cost-effective and rapidly available prognostic biomarkers for these patients.Öğe Is the platelet-to-lymphocyte ratio a new prognostic marker in multiple myeloma?(Wolters Kluwer Medknow Publications, 2018) Solmaz, Şerife; Uzun, Özcan; Acar, Celal; Sevindik, Ömür Gökmen; Pişkin, Özden; Özsan, Hayri Güner; Demirkan, Fatih; Ündar, Bülent; Alacacıoğlu, Ahmet; Özcan, Mehmet Ali; Alacacıoğlu, İnciBACKGROUND: Recent reports showed neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR), as a predictor of progression-free survival (PFS) and overall survival (OS) in various malignancies. MATERIALS AND METHODS: We retrospectively examined the PLR, NLR, and MLR in a cohort of 186 newly diagnosed multiple myeloma (MM) patients. This study investigated the prognostic relevance of NLR, PLR, and MLR in MM patients. NLR, PLR, and MLR were calculated from whole blood counts before therapy. The Kaplan-Meier curves and multivariate Cox models were used for the evaluation of survival. RESULTS: Applying cutoff of 1.9 (NLR), 120.00 (PLR), and 0.27 (MLR), decreased PLR showed a negative impact on the outcome. Decreased PLR is an independent predictor for PFS and OS. There were no significant differences in median survival between the high and low NLR (P = 0.80) and MLR (P= 0.87) groups. CONCLUSIONS: In this study, thrombocytopenia and low PLR are associated with poor survival in MM patients does this P value apply to thrombocytopenia or low PLR and may serve as the cost-effective prognostic biomarker.Öğe What are the factors affecting survival after autologous stem cell transplantation in patients with multiple myeloma?(Wolters Kluwer Medknow Publications, 2020) Solmaz, Şerife; Acar, Celal; Seyhanlı, Ahmet; Sevindik, Ömür Gökmen; Pişkin, Özden; Özcan, Mehmet Ali; Demirkan, Fatih; Ündar, Bülent; Alacacıoğlu, İnci; Özsan, Güner HayriIntroduction: High-dose chemotherapy (HDC) and autologous stem cell transplantation(ASCT) still remains in the treatment of myeloma patients even during the period of new agents. Materials and Methods: We analysed the prognostic affect of pretransplant characteristics and transplant modalities on response, in 150 autologous transplant of 144 multiple myeloma (MM) patients who were transplanted in our centre between 2008 to 2017. We evaluated the affect of age, type of MM, previous treatment regimens, status pre and postfrom transplantation, time of ASCT, neutrophil and platelet engraftmant days, dose of reinfused CD34+ cells, plasma cell infiltration, international staging system(ISS) and Durie -Salmon stage at diagnosis. We examined the affect of these status on overall survival(OS) and eventfree survival(EFS). Results: The median OS and EFS after transplanation were 41 and 28 months, respectively. Median OS after the diagnosis was 57 months. Transplant-related mortality was 3,3%. We found that the lower beta 2- microglobulin levels,lower ISS stage,lower plasma cell infiltration, achievement good responds at the +100th day of post transplant were statistically significant independent predictor factors for longer EFS and OS. When the patients were given chemotherapy regimen with bortezomib before transplantation, these patients were seen to be a better response rate. There was showed a relationship between the using of bortezomib before transplantation with EFS(P = 0.017), but there was no relationship with OS. Conclusions: Our analysis confirms HDCT-ASCT as an effective and safe therapeutic strategy in multiple myeloma patients. This results were independent of age, first line treatment regimens and renal insufficiency. Patients with a high ISS stage were found to have shorter survival(P = 0.002). However, the EFS and OS were longer of the patients whose have good response at the 100th day of transplantation(P = 0,002, P = 0,02).
