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Öğe Acute lymphoblastic leukemia in routine practice: A Turkish multicenter study(Turkish Society of Hematology, 2019) Çiftçiler, Rafiye; Sevindik, Ömür Gökmen; Tekgündüz, Ali İrfan Emre; Erkurt, Mehmet Ali; Vural, Filiz; Turgut, Burhan; Kaynar, Leylagül; Payzın, Bahriye; Doğu, Mehmet Hilmi; Karakuş, Volkan; Altuntaş, Fevzi; Büyükaşık, Yahya; Demirkan, FatihObjective: Significant developments occurred in the clinical management of acute lymphoblastic leukemia (ALL) in adults in recent decades. However, treatment results are still not satisfactory, especially in routine practice. The objective of this study was to evaluate the general clinical features, treatment details, and outcomes of a large group of patients followed in multiple centers in Turkey with a diagnosis of ALL. Materials and Methods: A retrospective analysis of the data of patients with ALL was made, the patients having been diagnosed and treated between January 2003 and June 2017 by different protocols in the hematology clinics of ten different centers. A total of 288 patients, aged between 17 and 76 years old, were included in the study. In this retrospective multicenter analysis of patients with ALL, classification of patients was performed based on treatment period, Philadelphia chromosome positivity, treatment regimen, and administration of allogeneic hematopoietic stem cell transplantation (allo-HSCT). Results: The majority of cases were B-cell in origin, while 224 patients had B-ALL and 64 of the patients had T-ALL. Median follow-up duration for all patients was 18.2 months (range: 0.03-161 months). Philadelphia chromosome positivity was determined in 49 patients (21.9%), and 54 patients (18.8%) were receiving allo-HSCT. After induction chemotherapy, 219 patients (76.0%) achieved complete remission, 32 patients (11.2%) were evaluated as treatment refractory, and 37 patients (12.8%) were deceased. Median overall survival was 47.7 months (95% confidence interval: 36.1-59.2) and median disease-free survival was 23.4 months (95% confidence interval: 6.7-40.0) for all patients. Conclusion: Multicenter studies are extremely important for defining the specific clinical features of a particular disease. The results of this study will make a significant contribution to the literature as they reflect real-life data providing valuable information about the Turkish ALL patient profile.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 Clinical outcomes and treatment patterns of primary central nervous system lymphoma: Multicenter retrospective analysis(Kare Publishing, 2023) Güven, Serkan; Yavuz, Boran; Erdoğan Yücel, Elçin; Karataş, Aylin Fatma; Özsan, Güner Hayri; Demirkan, Fatih; Ündar, Bülent; Özcan, Mehmet Ali; Kiper, Hatice Demet; Çetintepe, Tuğba; Göçer, Mesut; Kurtoğlu, Erdal; Balık Aydın, Berrin; Sevindik, Ömür Gökmen; Yiğit Kaya, Süreyya; Alacacıoğlu, İnciObjectives: Primary central nervous system lymphoma (PCNSL) is a rare malignant disease with poor prognosis. Its low incidence leads to challenges in decision-making for treatment. As a matter of fact, there is still no consensus on the appropriate treatment modalities. In this context, the objective of this study is to investigate and comparatively assess the efficacies of several treatment modalities in the treatment of PCNSL. Methods: Thirty-four patients diagnosed with PCNSL at 5 different hematology centers between 2007 and 2021 were included in the study. Patients’ data from all five centers were collected retrospectively. Since ibrutinib is not approved for this indication in Turkey, consent for off-label use of ibrutinib is obtained from each patient. Ethics committee ap-proval was obtained on June 9, 2021 with decision number 2021/18-05. Results: The median age of the patients was 59 (min.: 22, max.: 78) years. The male-to-female ratio was 1.26/1. Nineteen (55.9%) patients had Eastern Cooperative Oncology Group (ECOG) performance score of ?2. Fifteen (44.1%) patients had normal lactate dehydrogenase (LDH) levels and only 14.7% of the patients had B symptoms at the time of diagnosis. Magnetic resonance imaging (MRI) revealed a single mass lesion in 14 (41.2%) patients. As an induction therapy, meth-otrexate-based regimen was administered in 29 (85.3%) patients. Only 14 of the 34 patients received 4 or more cycles of high-dose methotrexate (MTX). About 32.4% of the patients received radiation therapy (RT) during follow-up as a part of induction therapy. Five patients received only RT due to poor performance status. Ibrutinib was administered in 5 patients for refractory disease. It was determined that four or more cycles of MTX treatment increased progression-free survival (PFS) (p=0.031) and overall survival (OS) (p=0.012). Moreover, RT improved PFS (p=0.023). Considering that the complete response achieved by induction therapy influences long-term survival, achievement of the best response to the treatment regimens administered in combination with new agents may prolong survival (PFS: p=0.01, OS: p=0.023). Conclusion: The findings of this study indicate that the initial response to treatment is crucial. Additionally, it was found that high-dose MTX treatment should be administered for 4 cycles or more in order to achieve the best results. Furthermore, it was determined that ibrutinib monotherapy was well-tolerated in our patients with relapsed/refractory disease, with excellent clinical benefits. In conclusion, a combination therapy consisting of high-dose MTX, ibrutinib, and rituximab appears to be a promising initial treatment approach in appropriate patients.Öğe Current practice of autologous hematopoietic progenitor cell mobilization in adult patients with multiple myeloma and lymphoma: The results of a survey from Turkish hematology research and education group (ThREG)(Pergamon-Elsevier Science Ltd., 2017) Tekgündüz, Emre; Demirkan, Fatih; Vural, Filiz; Göker, Hakan; Özdoğu, Hakan; Kiki, İlhami; Aydoğdu, İsmet; Kaynar, Leylagül; Erkurt, Mehmet Ali; Çağırgan, Seçkin; Beşışık, Sevgi; Dağdaş, Simten; Koca, Ebru; Kadıköylü, Gürhan; Gündüz, Eren; Yılmaz, Mehmet; Beköz, Hüseyin; Ural, Ali Uğur; Baştürk, Abdulkadir; Arat, Mutlu; Albayrak, Murat; Öztürk, Erman; Akyol, Alev; Bolaman, Ali Zahit; Nevruz, Oral; Özkan, Hasan Atilla; Özgür, Gökhan; Altuntaş, FevziAutologous hematopoietic cell transplantation (AHCT) is an established treatment option for adult patients presenting with multiple myeloma (MM), Hodgkin lymphoma (HL) and various subtypes of non-Hodgkin lymphoma (NHL) in upfront and/or relapsed/refractory disease settings. Although there are recently published consensus guidelines addressing critical issues regarding autologous hematopoietic progenitor cell mobilization (HPCM), mobilization strategies of transplant centers show high variability in terms of routine practice. In order to understand the current institutional policies regarding HPCM in Turkey and to obtain the required basic data for preparation of a national positional statement on this issue, Turkish Hematology Research and Education Group (ThREG) conducted a web-based HPCM survey. The survey was designed to include multiple-choice questions regarding institutional practice of HPCM in adults presenting MM, HL, and NHL. The representatives of 27 adult HCT centers participated to the study. Here we report the results of this survey shedding light on the real world experience in Turkey in terms of autologous HPCM mobilization strategies in patients presenting with MM and lymphoma. (C) 2017 Elsevier Ltd. All rights reserved.Öğe Extracorporeal photopheresis in the treatment of acute and chronic graft-versus-host disease: A position statement from the Turkish Society of Apheresis (TSA)(Pergamon-Elsevier Science Ltd, 2022) Kaynar, Leylagül; Tekgündüz, Emre; Kozanoğlu, İlknur; Özkan, Hasan Atilla; Aksu, Salih; Özkalemkaş, Fahir; Demirkan, FatihGraft versus host disease (GVHD) is still the most important cause of mortality and morbidity after allogeneic stem cell transplantation. Though perfect response rates are not achieved, steroids are still the first-line treat-ment. In the face of the presence of the drugs approved by FDA in recent years for acute and chronic GVHD as second-line therapy in the steroid-refractory group, there exists no standard approach. Extracorporeal photopheresis (ECP) with an immunomodulatory effect, is favored in the treatment of both acute and chronic steroid refractory GVHD as it does not increase the risk of relapses or infections. Having a low profile of side effects, ECP is also generally well-tolerated by patients. Being a time requiring procedure, the fact is that it is not able to be practiced in all health centers and requires central venous catheters in patients unfit for venous access may be enumerated among its shortcomings. No complete standard is available with respect to ECP application frequency-time; it varies from one center to another. The Turkish Society of Apheresis established the Turkish ECP (TECP) group and sought some answers to the questions regarding the use of ECP in the treatment of GVHD, and issued a position statement.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 Post-authorization safety of lenalidomide plus dexamethasone in patients with relapsed/refractory multiple myeloma in Turkey(CIG Media Group, 2022) Fıratlı Tuğlular, Ayşe Tülin; Pehlivan, Mustafa; Sönmez, Mehmet; Kabukçu Hacıoğlu, Sibel; Saydam, Güray; Ayyıldız, Orhan; Kaynar, Leylagül; Demirkan, Fatih; Beksaç, Meral[Abstract Not Available]Öğe Real-world data from the Turkish national chronic lymphocytic leukemia registry(CIG Media Group, 2020) Demirkan, Fatih; Sevindik, Ömür GökmenObjective: We have previously established a nationwide registry to obtain real-world data to document the demographics and treatment outcomes of Turkish CLL patients. Patients or other participants: Patients who were diagnosed with CLL and over 18 years of age were included in the study. Data were collected starting from January 2017 from 20 centers that were located in different geographic parts of Turkey. Results: A total of 652 patients were enrolled in the study.Öğe The effect of haemoglobin, albumin, lymphocyte and platelet score on the prognosis in patients with multiple myeloma(John Wiley and Sons Inc, 2023) Solmaz, Şerife; Uzun, Özcan; Sevindik, Ömür Gökmen; Demirkan, Fatih; Özcan, Mehmet Ali; Özsan, Güner Hayri; Alacacıoğlu, İnciIntroduction In multiple myeloma cases, a variety of prognostic parameters have been identified, which contain the Durie-Salmon classification and the international staging system (ISS) that takes the serum ss2 microglobulin and albumin levels, platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), and monocyte-to-lymphocyte ratio (MLR). This study investigates the effect of haemoglobin, albumin, lymphocyte and platelet (HALP) score which is a marker of inflammation status and nutrition, at the time of diagnosis for the patients with multiple myeloma on prognosis. Methods A total of 200 multiple myeloma patients with HALP scores calculated from serum haemoglobin, albumin, lymphocyte count and platelet levels at the time of diagnosis were retrospectively examined. The effect of HALP score on overall survival (OS) and progression-free survival and its relationship between the previously evaluated prognostic parameters were investigated. Results The optimal cut-off value with the ROC curves for the HALP score was 28.8. The patients were divided into two groups according to the optimal value of the HALP score (low-score group: HALP <= 28.8 [n: 134] and high-score group HALP >28.8 [n: 66]). In the group with the high HALP score, the OS was statistically longer than the low HALP score group (84 months and 53 months; p = 0.0001). In addition, when the effects of NLR, PLR, HALP score and ISS stage on OS were examined by multivariate analysis, all these markers were found to be statistically significant predictors. Conclusions HALP score may be a valuable prognostic marker for patients with multiple myeloma.Öğe Turkish acute lymphoblastic leukemia registry, retrospective phase data(The American Society of Hematology, 2019) Demirkan, Fatih; Çiftçiler, Rafiye; Sevindik, Ömür Gökmen; Tekgündüz, Emre; Erkurt, Mehmet Ali; Vural, Filiz; Turgut, Burhan; Kaynar, Leylagül; Payzin, Kadriye Bahriye; Doğu, Mehmet Hilmi; Karakuş, Volkan; Altuntaş, Fevzi; Büyükaşık, YahyaBackground and Aim: Significant developments have occurred in clinical management of acute lymphoblastic leukemia (ALL) in adults over recent decades. However, treatment results are still not satisfactory especially in routine practice. The aim of the study was to evaluate the general clinical features, treatment details and outcomes of a large group of patients followed up in multiple centers in Turkey with a diagnosis of ALL.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).
