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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.
A rare retrograde intrarenal surgery complication: Hemophagocytic syndrome
(Mary Ann Liebert Inc., 2020) Akgül, Murat; Yazıcı, Cenk Murat; Ateş, Hüseyin; Altın, Enes; Turgut, Burhan
Background: Hemophagocytic syndrome (HS) is a syndromic complex that is categorized in the group of histiocytic disorders associated with macrophages. Case Presentation: A 39-year-old male patient was admitted to the outpatient clinic with complaint of left flank pain. A 1 cm kidney stone was found in the upper pole of left kidney at radiologic imaging. The patient underwent retrograde intrarenal surgery (RIRS) with no peroperative complication. High fever and increasing of acute-phase reactants were observed at postoperative first day. Besides resistant fever, pancytopenia developed despite the appropriate antibiotherapy. The urine and blood cultures were sterile. After multidisciplinary consultation, bone marrow sampling was performed. Microscopic examination of the bone marrow material revealed that the macrophage cells phagocyted the erythrocytes, which was compatible with HS. Unfortunately despite the appropriate medical HS treatment, the patient died due to multiorgan failure at the 21st day of RIRS. Conclusion: HS is a significantly rare complication after RIRS, which was presented initially with postoperative fever. HS should be kept in mind if the patient had resistant fever and pancytopenia despite the appropriate antibiotherapy. ª Mary Ann Liebert, Inc.
Acute Kidney Injury in a Case of Purpura Fulminans Developing Secondary to Antithrombin 3 Deficiency
(Medical Assoc Nippon Medical Sch, 2018) Özkan, Gülsüm; Emeksiz, Gaye Kübra; Atar, Reşit Volkan; Sedef, Samet; Kara, Sonat Pınar; Öznur, Meltem; Turgut, Burhan
Purpura fulminans associated with antithrombin 3 (AT 3) deficiency is very rare in adults and neonates. It can be categorized into three principal forms - neonatal, idiopathic and acute infectious. Purpura fulminans has been reported to cause cardiac, pulmonary and renal damage in rare cases We describe an adult case of purpura fulminans developing in association with AT 3 deficiency without infection following a surgical procedure, and acute kidney injury (AKI) developing secondary to rhabdomyolysis and disseminated intravascular coagulation (DIC). To the best of our knowledge there have been no previous cases of purpura fulminans and AKI developing in association with acquired AT 3 deficiency without infection after surgery.
Acute Lymphoblastic Leukemia in Routine Practice: A Turkish Multicenter Study
(Galenos Yayincilik, 2019) Çiftçiler, Rafiye; Sevindik, Omur Gokmen; Tekgunduz, Ali Irfan Emre; Erkurt, Mehmet Ali; Vural, Filiz; Turgut, Burhan; Demirkan, Fatih
Objective: 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.
Adult Philadelphia Chromosome-Positive Acute Lymphoblastic Leukemia in Daily Practice: A Multicenter Experience
(Cig Media Group, Lp, 2016) Tekgündüz, Emre; Göker, Hakan; Kaynar, Leylagül; Sarı, İsmail; Pala, Çiğdem; Doğu, Mehmet Hilmi; Altuntaş, Fevzi; Turgut, Burhan
In this retrospective, multicenter study, we evaluated the real-life outcomes of adult Philadelphia-positive acute lymphoblastic leukemia patients. The best results in terms of survival are achieved in patients who were treated with tyrosine kinase inhibitors during induction and received allogeneic hematopoietic cell transplantation as part of consolidation. Background: The prognosis of Philadelphia-positive acute lymphoblastic leukemia (Ph+ ALL) is generally poor. Currently, allogeneic hematopoietic cell transplantation (allo-HCT) is the only accepted therapy with curative potential. Patients and Methods: Herein, we report our multicenter, retrospective experience with 46 (23 female; 23 male) Ph+ ALL patients, who were treated off-study between 2005 and 2012. Results: The median age of the patients was 46 years (range, 19-73 years). During induction, 30 (65%), 13 (28%), and 3 (7%) patients received tyrosine kinase inhibitors (TKIs) concurrent with chemotherapy (TKIs/chemotherapy), chemotherapy only, and TKIs only, respectively. Following induction, rates of complete remission (CR) of the study population were 85% (n = 39). CR rate in patients receiving TKIs during induction (n = 33) was significantly higher compared with patients who received chemotherapy only (n = 13; P = .011). Taking TKIs during induction significantly reduced induction mortality (3.3% vs. 38%; P = .01). Allo-HCT was performed subsequently in 21 (46%) patients. More patients who received TKIs with or without chemotherapy (19/33; 58%) during induction were able to undergo to allo-HCT compared with patients who received chemotherapy only (2/13; 15%; P = .005). Median overall survival of patients who were treated with TKIs during induction and received allo-HCT (not reached; NR) was significantly prolonged compared with patients who received allo-HCT but without TKIs during induction (23.2 months) and to the rest of the cohort (21.2 months; P = .019). Conclusions: Current state-of-the art management of Ph+ ALL in real-life seems to be incorporation of TKIs to chemotherapy regimens and proceeding to allo-HCT, whenever possible. (C) 2016 Elsevier Inc. All rights reserved.
Bortezomib-induced peripheral neuropathy and neuronopathy in patients with multiple myeloma
(Springer Heidelberg, 2013) Turgut, Nilda; Turgut, Burhan; Oran, Musatfa; Yetişyiğit, Tarkan; Alp, Recep; Ünal, A.
[No Abstract Available]
Ccr2 Expression Was Increased in Patients with Ankylosing Spondylitis Independent From Disease Activity
(Bmj Publishing Group, 2015) Solmaz, Duygu; Tekinalp, Atakan; Avcı, Okan; Turgut, Burhan
[No Abstract Available]
CD4(+), CD25(+), FOXP3(+) T Regulatory Cell Levels in Obese, Asthmatic, Asthmatic Obese, and Healthy Children
(Springer/Plenum Publishers, 2015) Donma, Mustafa Metin; Karasu, Erkut; Özdilek, Burcu; Turgut, Burhan; Topçu, Birol; Nalbanto?lu, Burçin; Donma, Orkide
The aim of this prospective case control study is to determine CD4(+), CD25(+), and FoxP3(+) T regulatory cells (Tregs) and T helper cells (Ths) in obese, asthmatic, asthmatic obese, and healthy children. Obese (n = 40), asthmatic (n = 40), asthmatic obese (n = 40), and healthy children (n = 40) were included in this study. Blood samples collected from children were marked with CD4, CD25, ve Foxp3 in order to detect Tregs and Ths by flow cytometric method. Statistical analyses were performed. p a parts per thousand currency signaEuro parts per thousand 0.05 was chosen as meaningful threshold. Tregs exhibiting anti-inflammatory nature were significantly lower in obese (0.16 %; p a parts per thousand currency signaEuro parts per thousand 0.001), asthmatic (0.25 %; p a parts per thousand currency signaEuro parts per thousand 0.01), and asthmatic obese (0.29 %; p a parts per thousand currency signaEuro parts per thousand 0.05) groups than control group (0.38 %). Ths were counted higher in asthma group than control (p a parts per thousand currency signaEuro parts per thousand 0.01) and obese (p a parts per thousand currency signaEuro parts per thousand 0.001) groups. T cell immunity plays important roles in chronic inflammatory diseases such as obesity and asthma pathogeneses. Decreased numbers of Tregs found in obese, asthmatic, and asthmatic obese children might represent a challenge of these cells.
Comprehensive identification of erythrocyte membrane protein deficiency by 2D gel electrophoresis based proteomic analysis in hereditary elliptocytosis and spherocytosis
(Wiley-V C H Verlag Gmbh, 2012) Demiralp, Duygu Ozel; Peker, Selen; Turgut, Burhan; Akar, Nejat
Purpose Sodium dodecyl sulphate-polyacrylamide gel electrophoresis (1DE) may reveal qualitative or quantitative defects in red blood cell (RBC) membrane proteins, two-dimensional gel electrophoresis (2DE) can be used for determination of the protein changes caused by the disease process in a relatively high-throughput manner, because it permits an analysis of thousands of modified or unmodified proteins simultaneously. The principal aim of this study was to compare hereditary elliptocytosis (HE), hereditary spherocytosis (HS), and control RBC membrane protein profiles and identify proteins as a clinical marker by the sensitive methods. Experimental design RBC membrane proteins of HE, HS, and control groups were compared by 2DE and matrix-assisted laser desorption/ionization-time of flight (MALDI-TOF) MS analysis was obtained using peptide mass fingerprint for protein identification. Results Twenty proteins were identified with peptide mass fingerprint analysis and different expression levels were found in HE, HS, and controls for some proteins that includes three biomarker proteins (ankyrin, spectrin, band 3) that may have prognostic or predictive importance. Conclusions and clinical relevance 2DE of RBC proteins is a potentially valuable method for studying heritable disorders such as HE and HS. By identifying a deficiency in membrane proteins associated with the RBC cytoskeleton, the diagnosis of HE and HS can be confirmed.
Convalescent plasma therapy in patients with COVID-19
(Pergamon-Elsevier Science Ltd, 2021) Altuntaş, Fevzi; Ata, Naim; Yigenoğlu, Tuğçe Nur; Başcı, Semih; Dal, Mehmet Sinan; Korkmaz, Serdal; Çelik, Osman; Turgut, Burhan
Introduction: Passive antibody therapy has been used to immunize vulnerable people against infectious agents. In this study, we aim to investigate the efficacy of convalescent plasma (CP) in the treatment of severe and critically ill patients diagnosed with COVID-19. Method: The data of severe or critically ill COVID-19 patients who received anti-SARS-CoV-2 antibody-containing CP along with the antiviral treatment (n = 888) and an age-gender, comorbidity, and other COVID-19 treatments matched severe or critically ill COVID-19 patients at 1:1 ratio (n = 888) were analyzed retrospectively. Results: Duration in the intensive care unit (ICU), the rate of mechanical ventilation (MV) support and vasopressor support were lower in CP group compared with the control group (p = 0.001, p = 0.02, p = 0.001, respectively). The case fatality rate (CFR) was 24.7 % in the CP group, and it was 27.7 % in the control group. Administration of CP 20 days after the COVID-19 diagnosis or COVID-19 related symptoms were associated with a higher rate of MV support compared with the first 3 interval groups (?5 days, 6-10 days, 11-15 days) (p=0.001). Conclusion: CP therapy seems to be effective for a better course of COVID-19 in severe and critically ill patients.
Convalescent plasma therapy in patients with COVID-19
(Wiley, 2020) Yigenoğlu, Tuğçe Nur; Hacıbekiroğlu, Tuba; Berber, İlhami; Dal, Mehmet Sinan; Baştürk, Abdulkadir; Namdaroğlu, Sinem; Altuntaş, Fevzi; Turgut, Burhan
There are currently no licensed vaccines or therapeutics for COVID-19. Anti-SARS CoV-2 antibody-containing plasmas, obtained from the recovered individuals who had confirmed COVID-19, have been started to be collected using apheresis devices and stored in blood banks in some countries in order to administer to the patients with COVID-19 for reducing the need of intensive care and the mortality rates. Therefore, in this review, we aim to point out some important issues related to convalescent plasma (CP) and its use in COVID-19. CP may be an adjunctive treatment option to the anti-viral therapy. The protective effect of CP may continue for weeks and months. After the assessment of the donor, 200-600 mL plasma can be collected with apheresis devices. The donation interval may vary between countries. Even though limited published studies are not prospective or randomized, until the development of vaccines or therapeutics, CP seems to be a safe and probably effective treatment for critically ill patients with COVID-19. It could also be used for prophylactic purposes but the safety and effectiveness of this approach should be tested in randomized prospective clinical trials.
Convalescent plasma therapy in patients with COVID-19 (Letter)
(Pergamon-Elsevier Science Ltd, 2021) Altuntaş, Fevzi; Yigenoğlu, Tuğçe Nur; Bascl, Semih; Dal, Mehmet Sinan; Korkmaz, Serdal; Turgut, Burhan; Erkurt, Mehmet Ali
[No Abstract Available]
COVID-19 clinical course and blood groups: Turkish population-based study
(Tubitak Scientific & Technical Research Council Turkey, 2021) Dal, Mehmet Sinan; Ata, Naim; Altuntaş, Fevzi; Başcı, Semih; Yigenoğlu, Tuğçe Nur; Korkmaz, Serdal; Birinci, Şuayip; Turgut, Burhan
Background/aim: SARS-CoV-2 enters the cell through the binding of the S glycoprotein on the surface of the virus to the angiotensin-converting enzyme 2 (ACE-2) in the host cells and also SARS-CoV S protein binding to ACE-2 was inhibited by anti-A antibodies. The aim of the study was to investigate the relationship between blood groups and the course of COVID-19 in Turkey. Materials and methods: Laboratory confirmed COVID-19 patients aged 18 and over (n = 39.850) were randomized in age and sex -matched groups according to blood groups Results: Advanced age, male sex and blood group A were found to be related with increased rate of intensive care unit (ICU) admission (OR = 1.089, 95% CI: 1.085-1.093 for age; OR = 1.963, 95% CI: 1.737-2.218 for male sex; OR = 1.216, 95% CI: 1.023-1.446 for blood group A). When blood group O individuals were compared to non-O individuals, no significant difference was observed regarding the rate of hospital and ICU admission, mechanical ventilation (MV) support, length of hospital and ICU stay, and case fatality rate (CFR). The CFR in patients with blood group A, B, O, and AB were 2.6%, 2.2%, 3.1%, and 2.3%, respectively. There were no significant differences between Rh-negative and positive patients regarding the rate of hospital and ICU admission (p = 0.280 and p = 0.741, respectively), also the rate of MV support and CFR was similar (p = 0.933 and p = 0.417). Conclusion: Our study revealed that ABO and Rh blood groups do not have any impact on the rate of hospital admission, hospital and ICU stay, MV support, and CFR.
COVID-19 in hematopoietic cell transplant recipients
(Springernature, 2021) Altuntaş, Fevzi; Ata, Naim; Yigenoğlu, Tuğçe Nur; Başcı, Semih; Dal, Mehmet Sinan; Korkmaz, Serdal; Birinci, Şuayip; Turgut, Burhan
In this study, we aim to report the outcome of COVID-19 in hematopoietic cell transplant (HCT) recipients. HCT recipients (n = 32) with hematological disease and hospitalized for COVID-19 were included in the study. A cohort of age and comorbid disease-matched hospitalized COVID-19 patients with hematological malignancy but not underwent HCT (n = 465), and another cohort of age and comorbid disease-matched hospitalized COVID-19 patients without cancer (n = 497) were also included in the study for comparison. Case fatality rate (CFR) was 5.6% in patients without cancer, 11.8 in patients with hematological malignancy and 15.6% in HCT recipients. The CFR in HCT recipients who were not receiving immunosuppressive agents at the time of COVID-19 diagnosis was 11.5%, whereas it was 33% in HCT recipients who were receiving an immunosuppressive agent at the time of COVID-19 diagnosis. In conclusion, our study reveals that for the current pandemic, HCT recipients, especially those receiving immunosuppressive drugs, constitute a special population of cancer patients.
Differences in platelet-leukocyte aggregates among subtypes of acute cerebral ischemia
(Elsevier, 2011) Turgut, Burhan; Turgut, Nilda; Çelik, Yahya; Tekgündüz, Emre; Pamuk, Gülsüm Emel; Demir, Muzaffer
Background: Acute cerebral ischemia is caused by different pathophysiological mechanisms. The role of platelets and other blood cells can be different among the stroke subtypes. Methods: Seventy-two patients with acute ischemic cerebrovascular disease, including 31 patients with large vessel disease, 21 patients with cardioembolic disease, and 20 patients with small vessel disease, were evaluated. P-selectin (CD62P) expression and platelet leukocyte aggregates were measured with flow cytometry at the acute phase after the ischemic event. Markers were also measured in 37 control subjects. In all subjects, the serum high-sensitivity C-reactive protein (CRP) was also measured. Results: The platelet-monocyte aggregates (PMA) and platelet-granulocyte aggregates (PGA) in the large vessel disease group were higher than in control group (P=0.002, and P < 0.0001, respectively). The PMA and PGA in the small vessel disease group were also higher than in the control group (P=0.004 and P < 0.0001, respectively). In contrast, in the cardioembolic disease group, the PMA and PGA were not significantly different from the control group. CD62P expression was higher in all of the patient groups relative to the control group (P < 0.05 for all comparisons). Serum CRP levels were also higher in all of the patient groups than in the control group (P < 0.0001 for all comparisons). Conclusions: In contrast to large vessel and small vessel disease, it seems that platelet-leukocyte association does not play a crucial role in the pathogenesis of cardioembolic stroke. (C) 2011 Elsevier B.V. All rights reserved.
Effects of idiopathic erythrocytosis on the left ventricular diastolic functions and the spectrum of genetic mutations: A case control study
(Lippincott Williams & Wilkins, 2022) Yeşilaltay, Alpay; Değirmenci, Hasan; Bilgen, Türker; Şirin, Duygu Yaşar; Bayır, Duygu; Değirmenci, Pelin; Turgut, Burhan
Background: We have aimed at exposing left ventricular diastolic functions and the presence of known genetic mutations for familial erythrocytosis, in patients who exhibit idiopathic erythrocytosis. Methods: Sixty-four patients with idiopathic erythrocytosis (mean age, 46.4 +/- 2.7 years) and 30 age-matched healthy subjects were prospectively evaluated. The regions of interest of the erythropoietin receptor, hemoglobin beta-globin, von Hippel-Lindau, hypoxia-inducible factor 2 alpha, and Egl-9 family hypoxia-inducible factor genes were amplified by PCR. Left ventricular (LV) mass was measured by M-mode and 2-dimensional echocardiography. LV diastolic functions were assessed by conventional echocardiography and tissue Doppler imaging. Results: As a result of genetic analyses, genetic mutations for familial erythrocytosis were detected in 5 patients. It has been observed in our study that the risk of cardiovascular disorders is higher in patients. Interventricular septum thickness, left atrial diameter, and some diastolic function parameters such as deceleration time and isovolumetric relaxation time have been found to be significantly higher in idiopathic erythrocytosis group than in the controls. Conclusion: This study has shown that LV diastolic functions were impaired in patients with idiopathic erythrocytosis. In this patient group with increased risk of cardiovascular disorders, the frequent genetic mutations have been detected in 5 patients only. Therefore, further clinical investigations are needed as novel genetic mutations may be discovered in patients with idiopathic erythrocytosis because of cardiovascular risk.
Efficacy and Safety of Ibrutinib Therapy in Patients with Chronic Lymphocytic Leukemia: Retrospective Analysis of Real-Life Data
(Galenos Yayincilik, 2021) Tombak, Anıl; Pepedil Tanrıkulu, Funda; Durusoy, Salih Sertaç; Dinçyürek, Hüseyin Derya; Kaya, Emin; Ümit, Elif Gülsüm; Ferhanoğlu, Burhan; Akpınar, Seval; Turgut, Burhan
Objective: This study aimed to retrospectively evaluate the efficacy, safety, and survival outcome of single-agent ibrutinib therapy in chronic lymphocytic leukemia patients. Materials and Methods: A total of 136 patients (mean age +/- standard deviation: 64.6 +/- 10.3 years, 66.9% males) who had received at least one dose of ibrutinib were included in this retrospective multicenter, noninterventional hospital-registry study conducted at 33 centers across Turkey. Data on patient demographics, baseline characteristics, laboratory findings, and leukemia-cell cytogenetics were retrieved. Treatment response, survival outcome including overall survival (OS) and progression-free survival (PFS), and safety data were analyzed. Results: Overall, 36.7% of patients were categorized as Eastern Cooperative Oncology Group (ECOG) class 2-3, while 44.9% were in Rai stage 4. Fluorescence in situ hybridization revealed the presence of del(17p) in 39.8% of the patients. Patients received a median of 2.0 (range: 0-7) lines of pre-ibrutinib therapy. Median duration of therapy was 8.8 months (range: 0.4-58.0 months). The 1-year PFS and OS rates were 82.2% and 84.6%, respectively, while median PFS time was 30.0 (standard error, 95% confidence interval: 5.1, 20.0-40.0) months and median OS time was 37.9 (3.2, 31.5-44.2) months. Treatment response (complete or partial response), PFS time, and OS time were better with 0-2 lines versus 3-7 lines of prior therapy (p<0.001, p=0.001, and p<0.001, respectively), with ECOG class 0-1 versus class 2-3 (p=0.006, p=0.011, and p=0.001, respectively), and with Rai stage 0-2 versus 3-4 (p=0.002, p=0.001, and p=0.002, respectively). No significant difference was noted in treatment response rates or survival outcome with respect to the presence of comorbidity, bulky disease, or del(17p). While 176 adverse events (AEs) were reported in 74 (54.4%) patients, 46 of those 176 AEs were grade 3-4, including pneumonia (n=12), neutropenia (n=11), anemia (n=5), thrombocytopenia (n=5), and fever (n=5). Conclusion: This real-life analysis confirms the favorable efficacy and safety profile of long-term ibrutinib treatment while emphasizing the potential adverse impacts of poorer ECOG performance status, heavy treatment prior to ibrutinib, and advanced Rai stage on patient compliance, treatment response, and survival outcomes.
ETİYOLOJİSİ BELİRLENEMEYEN DEMİR EKSİKLİĞİ ANEMİLERİNDE MUTASYON ANALİZİ
(Namık Kemal Üniversitesi, Tıp Fakültesi, 2016) Dulundu, Banu Çiçek Yalçın; Turgut, Burhan
Demir eksikliği tüm dünyada karşılaşılan en sık anemi nedenidir. Demir eksikliği anemisi (DEA), alım yetersizliği (ihtiyacın arttığı durumlarda ya da normal şartlarda) ya da alımın karşılayamadığı kayıp durumlarında gelişebilmektedir. Emilimin yetersiz olduğu ya da belirli gen defektleri varlığındaki gibi nadir durumlar sonucunda da DEA görülebilmektedir. Genelde menstruasyon gibi fizyolojik yolla olan kayıpların arttığı durumlarda, dolayısıyla daha çok kadınlarda demir eksikliğine rastlanır. Erişkin bir erkek veya postmenapozal dönemdeki kadında ise etiyoloji sıklıkla gastrointestinal kanamadır. Kanamaların etyolojisinde ise çoğunlukla GİS’teki bir tümoral oluşum bulunmaktadır. Eğer etyoloji açısından rutin taramalarla neden bulunamazsa nadir sebepler akla gelmelidir; hematüri, hemosiderozis, çölyak hastalığı, pica, demir kullanımını etkileyen genetik bozukluk gibi. Biz çalışmamızda demir eksikliği kriterlerini karşılayan 455 hasta taradık. Bu hastalardan 10’ unda, demir tedavisine cevap alınmamış ve tedavi sonrasında DEA’sı tekrarlamakta idi. Bütün araştırmalara rağmen etiyolojisi belirlenemeyen bu 10 hastada, matriptaz-2 proteinini kodlayan TMPRSS6 geninin 13. eksonuna Sanger metodu ile dizileme analizi yapıldı. Bu hastalarda TMPRSS6 geninde mutasyon izlenmese de bazı hastalarda tekli gen polimorfizmi görüldü. TMPRSS6’daki tekli gen polimorfizmleri toplumda sık görülmekle beraber DEA gelişiminde rol oynadığı bilinmektedir. Bizim seçtiğimiz 10 kişinin 5’inde de D521D tekli gen mutasyonu izlendi.
GX-G3, a long-acting G-CSF, compared with pegfilgrastim in reducing duration of severe neutropenia after chemotherapy for non-Hodgkin's lymphoma.
(Amer Soc Clinical Oncology, 2019) Ertan-Ahmed, Senem; Kiehl, Michael G.; Radinoff, Atanas; Graklanov, Vasko; Tzvetkov, Nikolay; Mihaescu, Rodica; Sung, Young Chul; Turgut, Burhan
[No Abstract Available]
Hypofibrinolysis Is Associated with the Severity of COVID-19 Infection: the Role of Obesity
(Carbone Editore, 2021) Oran, Mustafa; Akpınar, Seval; Doğan, Mustafa; Avcı, Burcu Altındağ; Çelikkol, Aliye; Turgut, Burhan
Introduction: Obesity, by causing hypofibrinolysis and thrombotic complications, ought to be a risk factor in terms of disease severity and mortality in COVID-19 infection. We aim to investigate the effects of obesity on fibrinolytic system in coronavirus patients while studying the changes of major fibrinolytic inhibitors plasminogen activator inhibitor (PAI-1) and thrombin activatable fibrinolysis inhibitor (TAFI). Material and methods: Sixty-six patients and 21 healthy donors were investigated and observed until either their recovery or death. Body mass index (BMI) was calculated for each person and peripheral blood used for PAI-1 and TAFI measurements. PAI-1 antigen and TAFI activated/inactivated (TAFIa/i) were measured using ELISA kits. Results: PAI-1 antigen and TAFIa/i plasma levels are higher in patients than in control group (P<00001 for both). Patients needing ICU had higher TAFIa/i values than non-ICU patients. The 15 patients who died had higher TAFIa/i levels than those staying alive. Obese patients (BMI >= 30) had higher PAI-1 levels than non-obese patients. TAFIa/i is associated with D-dimer, C-reactive protein (CRP), ferritin, creatinine and neutrophile count, whereas PAI-1 is associated only with the serum creatinine level. Conclusion: Our study shows that the levels of the major fibrinolytic inhibitors PAI 1 and TAFI increase in patients with COVID-19 infection, and proves for the first time that PAI 1 levels increase more in obese patients than in non-obese ones. It is also revealed that the plasma TAFI level is associated with the severity of COVID-19 infection, which suggests that the inhibitory treatments against TAFI should be effective in preventing thrombotic complications in the course of COVID-19 infection.

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