Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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Item The Clinicopathologic Features and the Factors Associated with the Survival in Light -Chain Amyloidosis Patients: A Single Center Descriptive Study(2020) Aytan, Pelin; Yeral, Mahmut; Gereklioglu, Cigdem; Kasar, Mutlu; Korur, Asli; Buyukkurt, Nurhilal; Asma, Suheyl; Kozanoglu, Ilknur; Ozdogu, Hakan; Boga, Can; 0000-0002-5086-5593; 0000-0003-3856-7005; 0000-0002-0895-4787; 0000-0002-8902-1283; 0000-0002-5268-1210; 0000-0002-9680-1958; AAD-6222-2021; AAD-5616-2021; AAL-3906-2021; AAE-1457-2021; AAD-5542-2021; AAE-1241-2021Objective: To present the clinicopathologic features and assess the factors related to the survival in light- chain amyloidosis (AL) patients. Method: All the patients with AL diagnosis being followed-up in the hematology department were recruited in the study. Clinicopathologic data were obtained. Factors related with overall survival (OS) including systemic inflammatory response markers were analyzed. Results: In 16 AL patients, the estimated OS was 58.6 +/- 10.8 months, with a-5-year- survival rate of 52.1%. While, 43.8% of the patients died during the study period. Gastrointestinal and respiratory complaints were the most frequent symptoms. Myocardial and renal biopsies were amyloid positive in 31.3% and 25% of the patients respectively. Myeloma was diagnosed in 18.8% and amyloid was positive in 31.3% of the bone marrow biopsies. There was no difference between surviving and deceased patients with respect to laboratory findings including systemic inflammatory markers. Only immunoglobulin M was significantly lower in the deceased patients and IgM was found to be the only factor independently associated with OS. Lower IgM levels were associated with decreased OS. An IgM value of 75.4 mg/dL was found as a cut-off value with a sensitivity and specificity of 71.4% and 66.7% respectively for the prediction of survival status. Conclusion: AL is a rare, progressive, systemic disease with a wide spectrum of clinical presentations. The disease most commonly presents with gastrointestinal and respiratory complaints. IgM level seems to be an independent predictor of survival and may be used as a prognostic marker.Item A Multi-Center Study on the Efficacy of Eltrombopag in Management of Refractory Chronic Immune Thrombocytopenia: A Real-Life Experience(2019) Noyan, Figen; Aytan, Pelin; 31327186Objective: The aim of the present study was to evaluate the efficacy and safety of eltrombopag, an oral thrombopoietin receptor agonist, in patients with chronic immune thrombocytopenia (ITP). Materials and Methods: A total of 285 chronic ITP patients (187 women, 65.6 %; 98 men, 34.4%) followed in 55 centers were enrolled in this retrospective cohort. Response to treatment was assessed according to platelet count (/mm(3)) and defined as complete (platelet count of >100,000/mm(3)), partial (30,000-100,000/mm(3) or doubling of platelet count after treatment), or unresponsive (<30,000/mm(3)). Clinical findings, descriptive features, response to treatment, and side effects were recorded. Correlations between descriptive, clinical, and hematological parameters were analyzed. Results: The median age at diagnosis was 43.9 +/- 20.6 (range: 3-95) years and the duration of follow-up was 18.0 +/- 6.4 (range: 6-28.2) months. Overall response rate was 86.7% (n=247). Complete and partial responses were observed in 182 (63.8%) and 65 (22.8%) patients, respectively. Thirty-eight patients (13.4%) did not respond to eltrombopag treatment. For patients above 60 years old (n=68), overall response rate was 89.7% (n=61), and for those above 80 years old (n=12), overall response rate was 83% (n=10). Considering thrombocyte count before treatment, eltrombopag significantly increased platelet count at the 1st, 2nd, 3rd, 4th, and 8th weeks of treatment. As the time required for partial or complete response increased, response to treatment was significantly reduced. The time to reach the maximum platelet levels after treatment was quite variable (1-202 weeks). Notably, the higher the maximum platelet count after eltrombopag treatment, the more likely that side effects would occur. The most common side effects were headache (21.6%), weakness (13.7%), hepatotoxicity (11.8%), and thrombosis (5.9%). Conclusion: Results of the current study imply that eltrombopag is an effective therapeutic option even in elderly patients with chronic ITP. However, patients must be closely monitored for response and side effects during treatment. Since both response and side effects may be variable throughout the follow-up period, patients should be evaluated dynamically, especially in terms of thrombotic risk factors.Item Non-Hematologic Malignancies Metastasing to the Bone Marrow: A Record-Based Descriptive Study From A Tertiary Center(2019) Aytan, Pelin; Kocer, Nazim Emrah; Yeral, Mahmut; Gereklioglu, Cigdem; Kasar, Mutlu; Buyukkurt, Nur Hilal; Asma, Suheyl; Ozdogu, Hakan; Boga, CanThe aim of this study is to assess the cases of nonhematologic maiignancies that had bone marrow (BM) metastasis with respect to hematologic abnormalities, radiologic findings and pathologic findings. All of the patients with BM investigation were retrospectively evaluated. The patients with BM metastasis by a non-hematologic malignancy were assessed. Data regarding patient characteristics including peripheral blood evaluation findings, imaging findings, BM evaluation results and survival were obtained from patient files and computer based electronic database. 30 cases were detected among 1831 BM aspirations and biopsies. The most common malignancies were breast (36.7%), prostate (13.3%), gastric(13.3%) and lung (13.3%) adenocarcinomas. 90.9% and 75% of the cases had positive radiologic findings with PET/CT and CT respectively. 43.3% of the patients died during the study period and the median time from BM assessment to death was 2 months. Anemia, thrombocytopenia and leukopenia were present in 90%, 73.3% and 20% respectively. Lactate dehydrogenase and alkaline phosphatase were elevated in 90% and 80% respectively. In 76.2% a leukoerythroblastic blood picture was present. All the cases were diagnosed with biopsy and aspiration detected infiltration in 40% and in 4 metastatic patients (13.3%) the aspiration was false negative. In 46.7% the aspiration resulted with dry tap. Grade 3 fibrosis was present in 76.7%. BM assessment is a minimally invasive technique and provides very beneficial clinical data, however, because the survival is very short after BM assessment and the PET/CT has a considerable sensitivity it is not necessary to confirm BM metastasis in patients whose tumor stage is already known.Item Is the Game Over or Starting Again? The Role of the Transplant Team in Genetic Counseling for Adult Sickle Cell Disease Recipients(2017) Aytan, Pelin; Gereklioglu, Cigdem; Yeral, Mahmut; Korur, Asli; Asma, Suheyl; Kozanoglu, Ilknur; Ozdogu, Hakan; Boga, Can; 0000-0002-5086-5593; 0000-0002-5268-1210; 0000-0001-5335-7976; 0000-0002-8902-1283; 0000-0002-2553-7715; 0000-0002-9680-1958; 0000-0002-9580-628X; 27956368; AAD-5616-2021; AAE-1241-2021; AAL-6544-2020; ABC-4148-2020; AAI-7831-2021; AAD-5542-2021; AAE-3833-2019; AAD-6222-2021Item Isolated Tuberculous Epididymoorchitis Developing After Allogeneic Haematopoietic Stem Cell Transplantation: A Case Report(2017) Yeral, Mahmut; Demiroglu, Yusuf Ziya; Gul, Umit; Aytan, Pelin; 0000-0002-2553-7715; 0000-0003-3249-0895; 0000-0002-9866-2197; AAE-3833-2019; AAK-8394-2021; AAZ-9711-2021; ABC-4148-2020We report a case of isolated tuberculous epididymoorchitis developing in a patient after haematopoietic stem cell transplantation (HSCT). Forty-four-year-old male was admitted to the hospital with scrotal pain and swelling 6 months after an allogeneic HSCT using a fullymatched sibling donor because of his acute myeloid leukemia. There were scrotal tenderness, thickening and erythema on the right side. Brucella standard tube agglutination test was negative. Increased scrotal skin thickening, edema in the right epididymis and increased testicular vascularization were detected on ultrasonography. He was readmitted to our hospital with recurrent scrotal pain after 3 months of partial improvement with oral ciprofloxacin administered for a diagnosis of right epididymoorchitis. Pelvic magnetic resonance imaging revealed bilateral epididymoorchitis and scrotal abscess. Acid fast bacilli were detected on Ehrlich-Ziehl-Neelsen staining of the content of abscesses drained under local anesthesia. Mycobacterium tuberculosis complex was isolated on the 24th day of quadruple anti-tuberculosis therapy. Scrotal fistula developed on the first month of therapy which healed spontaneously after discontinuation of immunosuppressive agents. Full recovery was achieved after six months of antituberculosis therapy. As a result, tuberculous epididymoorchitis should be kept in mind in the presence of chronic epididymoorchitis developing in patients receiving immunosuppressive therapy.Item Implementation of an ISBT 128-Compatible Medical Record System to Facilitate Traceability of Stem Cell Products(2017) Boga, Can; Maytalman, Erkan; Gereklioglu, Cigdem; Asma, Suheyl; Kandemir, Fatih; Aytan, Pelin; Korur, Asli; Yeral, Mahmut; Kozanoglu, Ilknur; Ozdogu, Hakan; 0000-0002-5268-1210; 0000-0002-5086-5593; 0000-0002-2553-7715; 0000-0001-5335-7976; 0000-0002-8902-1283; 0000-0001-5284-7439; 0000-0002-9680-1958; 0000-0002-9580-628X; 28443818; AAL-6544-2020; AAE-1241-2021; AAD-5616-2021; AAE-3833-2019; AAI-7831-2021; AAD-5542-2021; AAD-6222-2021; F-6265-2019; ABC-4148-2020Item Organ damage mitigation with the Baskent Sickle Cell Medical Care Development Program (BASCARE)(2018) Boga, Can; Ozdogdu, Hakan; Asma, Suheyl; Kozanoglu, Ilknur; Gereklioglu, Cigdem; Yeral, Mahmut; Buyukkurt, Nurhilal Turgut; Solmaz, Soner; Korur, Asli; Aytan, Pelin; Maytalman, Erkan; Kasar, Mutlu; 0000-0002-5086-5593; 0000-0002-0895-4787; 0000-0002-8902-1283; 0000-0003-3856-7005; 0000-0001-5335-7976; 0000-0002-5268-1210; 0000-0002-2553-7715; 0000-0001-5284-7439; 0000-0002-9680-1958; 0000-0002-9580-628X; 29419693; AAD-5616-2021; AAE-1457-2021; AAL-6544-2020; AAD-6222-2021; AAD-5542-2021; AAL-3906-2021; AAI-7831-2021; AAE-1241-2021; AAE-3833-2019; ABC-4148-2020; F-6265-2019The Eastern Mediterranean is among the regions where sickle cell disease (SCD) is common. The morbidity and mortality of this disease can be postponed to adulthood through therapies implemented in childhood. The present study focuses on the organ damage-reducing effects of the Baskent Sickle Cell Medical Care Development Program (BASCARE), which was developed by a team who lives in this region and has approximately 25 years of experience. The deliverables of the program included the development of an electronic health recording system (PRANA) and electronic vaccination system; the use of low citrate infusion in routine prophylactic automatic erythrocyte exchange (ARCE) programs including pregnant women; the use of leukocyte-filtered and irradiated blood for transfusion; the use of magnetic resonance imaging methods (T2(*)) for the management of transfusion-related hemosiderosis; and the implementation of an allogeneic hematopoietic stem cell transplantation protocol for adult patients. The sample was composed of 376 study subjects and 249 control subjects. The hospital's Data Management System and the central population operating system were used for data collection. BASCARE enabled better analysis and interpretation of complication and mortality data. Vaccination rates against influenza and pneumococcal disease improved (21.5% vs 50.8% and 21.5% vs 49.2%, respectively). Effective and safe ARCE with low citrate infusion were maintained in 352 subjects (1003 procedures). Maternal and fetal mortality was prevented in 35 consecutive pregnant patients with ARCE. Chelating therapy rates reduced from 6.7% to 5%. Successful outcomes could be obtained in all 13 adult patients who underwent allogeneic peripheral stem cell transplantation from a fully matched, related donor. No patients died by day 100 or after the first year. Cure could be achieved without graft loss, grades III to IV acute graft versus host disease, extensive chronic graft versus host disease, or other major complications. The BASCARE program significantly improved patient care and thereby prolonged the life span of SCD patients (42 +/- 13 years vs 29 +/- 7 years, P < .001). We may recommend using such individualized programs in centers that provide health care for patients with SCD, in accordance with holistic approach due to the benign nature but malignant course of the disease.Item Use of Plerixafor to Mobilize a Healthy Donor Infected with Influenza A(2018) Yeral, Mahmut; Aytan, Pelin; Boga, Can; 0000-0002-2553-7715; 0000-0002-9680-1958; 0000-0002-9580-628X; 0000-0002-8902-1283; 29391335; ABC-4148-2020; AAD-6222-2021; AAE-3833-2019; AAD-5542-2021Item Demodicidosis Accompanying Acute Cutaneous Graft-Versus-Host Disease after Allogeneic Stem Cell Transplantation(2018) Aytan, Pelin; Yeral, Mahmut; Gereklioglu, Cigdem; Kocer, Nazim Emrah; Buyukkurt, Nurhilal; Kazanoglu, İlknur; Ozdogu, Hakan; Boga, Can; 29983401