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    A Multi-Center Study on the Efficacy of Eltrombopag in Management of Refractory Chronic Immune Thrombocytopenia: A Real-Life Experience
    (Galenos Yayincilik, 2019) Çekdemir, Demet; Güvenç, Serkan; Özdemirkıran, Füsun; Eser, Ali; Topts, Tayfur; Özkocaman, Vildan; Küçükkaya, Reyhan Diz; Tekinalp, Atakan; Turgut, Burhan
    Objective: 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.
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    Relationship of Lymphocyte to Monocyte Ratio at Diagnosis with Prognosis in Patients with Diffuse Large B-cell Lymphoma: A Retrospective Study
    (2021) Eser, Ali
    Aim: Although there is a complete response and increase in survival rates with rituximab in diffuse large-B-cell lymphoma (DLBCL), approximately30% of the patients face with relapse or refractory disease. International prognostic index (IPI) is the most widely used method used for identifyingrelapse and refractory disease. Recently, the lymphocyte monocyte ratio (LMR) that can be used in place of or in combination with IPI has beenproposed as an effective prognostic factor to predict clinical survival in DLBCL patients.Materials and Methods: Two hundred twenty three patients diagnosed with DLBCL at our center between 2012 and 2020 were included in thestudy. The age, gender, absolute lymphocyte count (ALC), absolute monocyte count (AMC), and follow-up time were recorded from the files of thepatients. Patients were divided into two groups as: exitus group and alive group. LMR was calculated.Results: The median age at diagnosis was 58 years. The median ALC was 1.5x103/uL, the median AMC was 0.6x103/uL, and the median LMR was 2.6.The median follow-up time was 53 months. Five-year overall survival and progression-free survival were 78% and 69%, respectively. The age wassignificantly higher in the exitus group than in the alive group (p<0.05). ALC, before and after treatment, was significantly higher in the exitusgroup than in the alive group (p<0.05). Pre-treatment AMC did not show a significant difference (p>0.05). Pre-treatment LMR level did not show asignificance difference in the exitus and alive groups (p>0.05).Conclusion: LMR alone has low prognostic determinacy. Therefore, it should be evaluated with other prognostic determinants.