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Chronic myeloid leukemia (CML) is a clonal hematologic disorder characterized by t(9;22) translocation, in which cytogenetic aberrations can occur in Ph(+) and (-) clones. These aberrations develop due to clonal evolution as well as treatment and they have prognostic significance. They are grouped as major and minor route anomalies in terms of their effects on prognostic parameters, such as treatment response, overall survival (OS), disease stage, complete cytogenetic response (CCyR), and major molecular response (MMR). It is stated that major route anomalies have unfavorable prognostic effects compared to minor route anomalies. We aimed to investigate the frequency and prognostic effects of cytogenetic anomalies detected in Ph(+) and (-) clones. In this study, we retrospectively analyzed the cytogenetic results of 450 patients diagnosed with CML between 2005 and 2020. We detected cytogenetic aberrations in Ph-positive and negative clones in 41 of 450 patients. The most common anomalies were trisomy 8 (+8), additional Ph chromosome (+Ph), and loss of chromosome Y. Rarely, aneuploidy of the Y chromosome, dup (22), +11, and +6 were seen in CML patients. We observed that these identified aberrations negatively affected MMR and CCyR, and generally resulted in changing imatinib treatment for second-generation tyrosine kinase activity inhibitors. Our results are compatible with the literature. We suggest that cytogenetic aberrations detected in Ph(+) and (-) clones should be a warning sign in terms of treatment and require close observation. The use of cytogenetic methods for the identification of these anomalies is also important.

Pegylated interferon (PEG-IFN) alpha and ribavirin therapy has become the standard treatment in chronic hepatitis C virus (HCH)-infected patients. While thrombocytopenia associated with IFN use is frequently observed among these patients, autoimmune thrombocytopenia is one of the rarely observed adverse effects. In the present report, we present a case with chronic HCV infection in which autoimmune thrombocytopenia developed at week 7 of PEG-IFN alpha 2b plus ribavirin therapy. The patient subsequently received ursodeoxycholic acid (UDCA) treatment. Although there is not an adequate number of studies on this subject, it was concluded that the use of UDCA in cases of autoimmune thrombocytopenia that have developed due to PEG-IFN treatment in chronic HCV infection is a favorable option.

Multiple myeloma (MM) is characterized by the accumulation and proliferation of malignant plasma cells, secreting monoclonal immunoglobulins and genetic abnormalities in MM have implications for disease progression and survival. In the present study, we investigated the frequency of chromosomal abnormalities (CA) in Turkish patients with MM, using interphase FISH and CC and evaluated the relationship between the rearrangements detected, prognosis and stage of disease. We performed conventional cytogenetic and FISH studies in 50 patients to detect chromosome anomalies associated with MM. FISH probes were used to detect 13q14, 13q34, 17p13 deletions, IGH rearrangements, and monosomy and/or trisomy of chromosomes 5, 9, and 15. CC studies could be performed in 32 of 50 cases and five patients (15.6%) showed chromosomal aberrations while 27 (84.3%) had normal karyotypes. By FISH, eighteen percent (9/50) of cases were found to be normal for all parameters evaluated. Eighty-two percent (41/50) of the patients were positive for at least one abnormality. Chromosome 13 anomalies were detected in 54% (27/50) of cases. The second most common aberration observed is chromosome 15 aberrations (50%). Median survival rate was shorter in patients with one of the abnormalities including chromosome 13 aberrations, IGH rearrangements or P53 deletions. Chromosome 15 aberrations were significantly higher in patients with stage III disease (p=0.02). We conclude that FISH studies should be performed in conjunction with conventional cytogenetic analysis for prognosis in multiple myeloma patients.

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). 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 ) and defined as complete (platelet count of >100,000/mm ), partial (30,000-100,000/mm or doubling of platelet count after treatment), or unresponsive (<30,000/mm ). Clinical findings, descriptive features, response to treatment, and side effects were recorded. Correlations between descriptive, clinical, and hematological parameters were analyzed. 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 1 , 2 , 3 , 4 , and 8 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%). 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.

Amaç: Dalak hem hümoral ve hem de hücresel bağışıklıkta görev alan bir organdır. Bu nedenle organizmayı enfeksiyonlara karşı korumada önemli fonksiyonları vardır. Bu çalışmada, splenektomi yapılmış hastaların aşılanma öyküleri ve bu konudaki bilgi düzeylerinin değerlendirilmesi amaçlanmıştır. Hastalar ve Yöntem: Bu çalışmada, Mart 2010-Ekim 2013 tarihleri arasında hastanemiz ve/veya hastanemiz dışında splenektomi yapılıp da hastanemiz Enfeksiyon Hastalıkları, Hematoloji ve Genel Cerrahi polikliniklerine başvuran 51 hastanın verileri değerlendirilmiştir. Bulgular: Hastaların 26’sı (%50,9) kadın ve 25’i (%49,1) erkek olup, yaş ortalaması 53,3 yıl (yaş aralığı, 21–83 yıl) idi. Splenektomi nedenleri incelendiğinde en sık idiyopatik trombositopenik purpura (n= 23, %45), tümör metastazı (n=8, %15,7) ve otoimmün hemolitik anemi (n=7, %13,7) tespit edildi. Pnömokok aşısı, hastaların %64’üne operasyon öncesi, %23’üne operasyon sonrası uygulanmışken %13’üne (n=7) hiç uygulanmadığı saptandı. Diğer merkezlerden gelen yedi hastaya aşılanma konusunda hekimlerince hiç bilgi verilmediği saptanırken, diğer yedi hasta sadece pnömokok aşısı hakkında bilgilendirilmekle birlikte bilgilerin ve uygulama süreçlerinin hatalı olduğu saptandı. Sonuç: Çalışmamızda görüldüğü gibi, splenektomi yapılmış hastalara, yalnızca değişen sıklıkta pnömokok aşısı uygulandığı ve diğer aşılar hakkında bilgilendirme yapılmadığı belirlenmiştir. Bu durum, hem konu ile ilgili sağlık çalışanlarının ve hem de hastaların bilgi düzeylerinin yeterli olmadığını, bu neden ile, erişkin aşılamada multidisipliner çalışmaların gerekliliğini ortaya koymaktadır.