Aim: In this study, we investigated how splenectomy affects natural killer (NK) cell levels in patients with beta-thalassemia major (beta-TM). Materials and Methods: Seventy patients with beta-TM (38 splenectomized and 32 nonsplenectomized) and 25 healthy controls were included in this study. The hemogram parameters, ferritin, T lymphocyte, T-helper cell, T-suppressor cell, and NK cell numbers, were measured. Results: The T lymphocyte (CD3(+)) level was found to be significantly higher in the patient group (p < 0.05). CD3(+)/CD4(+) T lymphocytes were detected to be significantly higher in the patient group (p < 0.05). Although the CD3(+)/CD4(+) T lymphocyte level was significantly higher in the nonsplenectomy group (p < 0.05), this was not the case in the splenectomy group. When the patient and control groups were compared, no significant difference was detected regarding CD3(+)/CD8(+) T lymphocyte levels. CD3(-)/CD16(+)CD56(+) NK cell level was found to be significantly lower only in the splenectomy group than in the control group (p < 0.05). We found that there was a significant negative correlation between serum ferritin levels and both total lymphocyte (r = -0.617) and CD3(+) lymphocyte (r = -0.718) levels in the control group (p < 0.05). A significant negative correlation was detected between serum ferritin levels and CD3(-)/CD16(+)CD56(+) NK cell levels in the patient group (r = -0.410) (p < 0.05). Conclusion: Splenectomy reduces NK cell levels in patients with beta-TM. The negative relationship between ferritin levels and NK cells indicates that ferritin levels should be kept under control in patients with beta-TM.

Objectives: 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.

Aim: This study aimed to identify patient characteristics, treatment patterns and outcomes and to evaluate the effects of presence of comorbidities at diagnosis in chronic phase (CP)-chronic myeloid leukemia (CML) patients in Turkey. Materials & methods: Hospital records between 2005 and 2018 were retrospectively reviewed. Results: Of 861 CP-CML patients included, 31% had at least one comorbidity at diagnosis. Sex, cardiovascular disease status at diagnosis and molecular (at least major) and cytogenetic (partial and complete) responses were the independent predictors of survival. Conclusion: The response rates of CP-CML patients to the tyrosine kinase inhibitors were satisfactory. In addition to tolerability and side effect profiles of drugs, comorbidity status of patients should also be considered in treatment choice in CML patients.

Objectives: Patients with hematologic malignancies have a high risk of coronavirus disease 2019 (COVID-19) mortality. This study aimed to investigate the impact of COVID-19 on mortality rates in patients with various hematologic malignancies and to determine risk factors associated with all-cause mortality. Methods: A multi-center, observational retrospective analysis of patients with hematologic malignancies infected with COVID-19 between July 2020 and December 2021 was performed. Demographic data, clinical characteristics, and laboratory parameters were recorded. Patients were grouped as non-survivors and survivors. All-cause mortality was the primary outcome of the study. Results: There were 569 patients with a median age of 59 years. Non-Hodgkin lymphoma (22.0%) and multiple myelomas (18.1%) were the two most frequent hematologic malignancies. The all-cause mortality rate was 29.3%. The highest mortality rates were seen in patients with acute myeloid leukemia (44.3%), acute lymphoid leukemia (40.5%), and non-Hodgkin lymphoma (36.8%). The non-survivors were significantly older (p<0.001) and had more comorbidities (p<0.05). There were significantly more patients with low lymphocyte percentage (p<0.001), thrombocytopenia (p<0.001), and high CRP (p<0.001) in the non-survived patients. Cardiac comorbidities, (p=0.016), cytotoxic chemotherapy (p=0.024), low lymphocyte percentage (p=0.025), thrombocytopenia (p<0.0001), and high CRP values (p=0.017) were the independent risk factors for the prediction of mortality. Conclusions: In patients with hematologic malignancies, coexistent COVID-19 leads to a higher mortality rate in elderly patients with more comorbidities. Acute myeloid and lymphoid leukemia and non-Hodgkin lymphoma have the highest mortality rates. Cardiac diseases, cytotoxic chemotherapy, lymphopenia, thrombocytopenia, and high CRP are the independent risk factors for mortality in hematologic malignancy patients with COVID-19. Keywords: Covid; Hematologic Malignancy; Cytotoxic chemotherapy.

Hyperleukocytosis has been associated with early mortality owing to the presence of complications including leukostasis, tumor lysis syndrome (TLS), and disseminated intravascular coagulation (DIC). Leukapheresis is a fast and effective cytoreductive procedure that removes leukocytes from the peripheral circulation. This single-center, retrospective, and observational study included 32 patients diagnosed with acute leukemia who underwent leukapheresis due to hyperleukocytosis between 2014 and 2020. This study primarily aimed to investigate the effect of prophylactic leukapheresis on early mortality and overall survival (OS). In the symptomatic group, seven and two patients died in the first and second weeks, respectively. In the prophylactic leukapheresis group, two and one patients died in the first and second weeks (p = 0.792), respectively. OS was significantly longer in the prophylactic leukapheresis group (p = 0.004). The leukapheresis procedure appears to be effective on early mortality and OS. Initiation of prophylactic leukapheresis before the appearance of leukostasis symptoms is effective on OS and possibly early mortality.

Background: Chronic myeloid leukemia is a clonal hematopoietic stem cell disorder that leads to an increase in myeloid cells, erythroid series, and platelets in peripheral blood and causes pronounced myeloid hyperplasia in the bone marrow. The treatment and follow-up criteria in patients with CML have changed significantly in the recent years. In the pre-imatinib period, CML has been treated with hydroxyurea, interferon therapy, chemotherapy, and most effectively, allogenic stem cell transplantation. The addition of imatinib mesylate, a tyrosine kinase inhibitor, to the treatment regime provided a superior overall survival rate compared to previous standard treatments. In this study, our aim is to demonstrate the demographic characteristics, clinical features, treatment and follow-up strategies, response status, and general survival rates of CML patients treated in our clinic. Materials and Methods: 110 patients who were diagnosed with chronic phase CML during 2003–2019 were included in this study. The demographic characteristics and clinical findings including laboratory values, ultrasound findings, and bone marrow pathology results were evaluated retrospectively from their medical records Results: Among the 110 patients included, 59 (53.6%) were male, and 51 (46.4%) were female, and the median age was 49.5 (18–82). At the time of diagnosis, only 32 (29.0%) patients were symptomatic, 71 (64.5%) had splenomegaly, and 51 (46.4%) had hepatomegaly. All patients were given 400 mg of imatinib as first-line therapy. With imatinib treatment, the rates of complete hematologic response (CHR), complete cytogenetic response (CyCR), and major molecular response (MMR) were 100.0%, 72.5% and 69.6%, respectively. In the follow-up, 3 (2.7%) patients were observed to progress to the blastic phase. The overall survival rate was 86.4%. Conclusions: Imatinib has proven to be a tolerable, effective and safe agent in the first-line treatment of CML patients. Treatment choice after imatinib should take into consideration the patients' comorbidities.

Hodgkin lymphoma is an uncommon neoplasm that characterized young age of onset, Hodgkin and Reed-Sternberg (HRS) cells derived from B-lymphocytes and a high cure rate, even when the patient presents with advanced metastatic spread. Lung cancer is the most common cancer worldwide and is still responsible for the most cancer deaths. We present an extremely rare case of coexisting Hodgkin lymphoma and lung cancer in a 67-year-old male patient. He initially presented with chest pain. Pet/ct revealed mass in the right lung and lymph nodes in the neck. Biopsy from the premaxillary lymph node was compatible with classical Hodgkin lymphoma. In terms of second primary malignancy, a biopsy was also performed from the mass in the right lung. Pathology showed a pulmonary adenocarcinoma and a right upper lobectomy was then performed. This patient was treated with gemcitabine plus docetaxel for lung cancer. At the end of treatment pet/ct was complete response including lymph nodes in the neck. Therefore, we did not give any treatment for Hodgkin lymphoma. The patient is still being followed up in remission.

Purpose: Ruxolitinib is an oral JAK-1/2 inhibitor approved for the treatment of splenomegaly and/or constitutional symptoms in intermediate and high-risk myelofibrosis patients. The aim of our study is to evaluate the efficacy and safety of ruxolitinib in primary MF, post-ET MF and post-PV MF patients, to evaluate the relationship between response and JAK-2 allele burden and to compare them with literature data. Materials and methods: In our single centered and retrospective study, we investigated the data of 30 MF patients diagnosed in our clinic between May 2015 and December 2019. We reported demographic features, laboratory values, and spleen sizes. Results: 18 patients (60%) with a median age of 67.5 (45-78) had primary myelofibrosis. Spleen sizes decreased significantly 3 and 6 months after treatment. Constitutional symptoms have disappeared in 28 patients (93.3%). No association was found between JAK-2 allele burden and treatment response success. Conclusion: Ruxolitinib MF is very safe and effective to relieve constitutional symptoms and decrease spleen size. Despite JAK-2 inhibition, no linear relationship was found between JAK-2 allele burden and treatment efficacy.

Background Morphologically and immunophenotypically, the number of B-lymphocyte progenitor cells, so-called hematogones increases after chemotherapy and allogeneic stem cell transplantions. It is thought that hematogones can be used as a prognostic marker in these patients. It is aimed to determine the prognostic significance and factors affecting the development of hematogones, which can be seen after autologous stem cell transplantation in multiple myeloma (MM) patients. Methods This retrospective and single center study includes 80 patients who underwent autologous stem cell transplantation with the diagnosis of MM in our clinic between January 2013 and December 2019. The primary endpoint of the study was the relationship between the presence and rate of hematogone (HG) and progression free survival (PFS) and overall survival (OS). The secondary endpoint was to identify the factors affecting the development of HG. Results HG was detected in 61.2% of the patients. There was a moderate and positive linear correlation between the amount of stem cells given and HG ratio (r = 0.387, p = 0.000). PFS and OS were significantly shorter in the group with HG (p = 0.000 and p = 0.012). Conclusions HG positivity after autologous stem cell transplantation was found to be an independent prognostic marker for PFS and OS in patients with MM. There is a positive relationship between the amount of stem cells used during transplantation and the ratio of HG. As the amount of stem cells increases, the ratio of HG increases and when the ratio of HG increases, PFS and OS become shorter.

Multiple myeloma (MM) is a cytogenetically heterogeneous and incurable plasma cell disease with unknown etiology. It is thought that the ABO blood groups may play a role in the etiology of many diseases. The purpose of this study is to determine whether there is a relationship between the ABO blood groups and the development of MM, clinical findings and overall survival. In this single-center, retrospective and observational study, 198 patients with known blood types who diagnosed with MM between January 2012 and June 2020 were included. It was shown that individuals with blood group 0 had a significantly lower risk of MM (OR = 0.575, 95% confidence interval 0.416–0.794, P = 0.001). The incidence of extramedullary lesion was significantly higher in those with 0 blood group compared to other blood groups (P = 0.000). Overall survival was significantly shorter in patients with 0 blood group than those without 0 blood group (P = 0.007). Individuals with 0 blood group had a lower risk of developing MM. It was determined that having 0 blood group is a predisposing factor for the development of extramedullary lesion in MM patients. However, it was shown that having a blood group of 0 was a very significant prognostic factor for MM patients and was associated with short OS.

Purpose: Ruxolitinib is an oral JAK-1/2 inhibitor approved for the treatment of splenomegaly and/or constitutional symptoms in intermediate and high-risk myelofibrosis patients.The aim of our study is to evaluate the efficacy and safety of ruxolitinib in primary MF, post-ET MF and post-PV MF patients, to evaluate the relationship between response and JAK-2 allele burden and to compare them with literature data.Materials and methods: In our single centered and retrospective study, we investigated the data of 30 MF patients diagnosed in our clinic between May 2015 and December 2019.We reported demographic features, laboratory values, and spleen sizes.Results: 18 patients (60%) with a median age of 67.5 (45-78) had primary myelofibrosis.Spleen sizes decreased significantly 3 and 6 months after treatment.Constitutional symptoms have disappeared in 28 patients (93.3%).No association was found between JAK-2 allele burden and treatment response success.Conclusion: Ruxolitinib MF is very safe and effective to relieve constitutional symptoms and decrease spleen size.Despite JAK-2 inhibition, no linear relationship was found between JAK-2 allele burden and treatment efficacy.

This study was conducted to determine long-term survival rates and the factors associated with mortality in Turkish primary Sjögren syndrome (pSS) patients. All patients diagnosed with pSS between 2004 and 2014 were included in this study. By January 2019, all subjects still living by the end of the study, as well as any death, were identified. Survival rates and standard mortality rates (SMRs) using general population mortality data were calculated. Mortality-related factors were determined by univariate and multivariate analysis. During follow-up, 33 cases of 372 pSS patients resulted in death (8.9%). Of those patients, they were typically older at disease onset, at recruitment, and had shorter follow-up times (p < 0.001 for all). The overall SMR of all pSS patients compared with the general population was 2.11 (95% confidence interval (CI) 1.39–2.83). Male pSS patients had a higher SMR than that of general male patients. Overall survival rates were 97.8% at five years, 90.2% at 10 years, and 87.1% at 15 years in patients with pSS. The survival rate of pSS patients was significantly lower than the general Turkish population (p = 0.011). Multivariate Cox regression analysis showed that older age at disease onset and the presence of interstitial lung disease (ILD) were independent risk factors for mortality. Based on these data, mortality rates of Turkish pSS patients are higher compared with the general population. Survival significantly decreased in the pSS patients with ILD, especially in older male patients at disease onset. Male gender and malignancy may also be associated with a worse prognosis in pSS patients.

CD56 is believed to play a major role in MM pathogenesis with a 70% to 80% expression rate in malignant plasma cells at the time of diagnosis. Our objective in this study was to investigate the relationship between the characteristics of CD56 expression in bone marrow aspiration material at the time of diagnosis and the success of stem cell mobilization in patients diagnosed with MM.

We aimed to identify whether the fluorodeoxyglucose (FDG) uptake in the Waldeyer ring (WR)/nasopharyngeal (NP) region by positron emission tomography-computed tomography (PET-CT) was physiologic or pathologic in the follow-up of patients with lymphoma receiving postchemotherapy treatment. When deciding whether resampling is appropriate after treatment completion, it should be taken into account that, apart from the standardized maximum uptake value value of the lesion, a crucial criterion is whether the FDG uptake has a counterpart finding by CT. Purpose: To identify whether fluorodeoxyglucose (FDG) uptake in the Waldeyer ring (WR)/nasopharyngeal (NP) region by positron emission tomography-computed tomography (PET-CT) was physiologic or pathologic in the follow-up of lymphoma patients receiving postchemotherapy treatment. Patients and Methods: We retrospectively examined FDG uptake in the WR/NP region in 534 patients with lymphoma as assessed by PET-CT used for both diagnosis and follow-up. Results: Forty-nine patients had FDG uptake in the WR/NP region by PET-CT performed after completion of a chemotherapy regimen. Biopsy was performed for 11 of these patients in whom the uptake was considered to be pathologic, and results indicated the presence of reactive follicular hyperplasia. It was considered to be physiologic in 38 patients. PET-CT was repeated after 1 year, and no significant difference was identified between the standardized maximum uptake values (SUVmax; P = .107). The initial diagnosis of 20 patients was made via biopsy performed in the WR/NP region. The SUVmax for the FDG uptake in these patients, asymmetry, SUVmax of the coexisting lymphad-nopathies in the neck, and FDG uptake with a counterpart finding by CT were significantly higher than other groups (P = .047, .001, and .005). Conclusion: When deciding whether to resample after treatment completion, it should be taken into account that, in addition to the SUVmax of the lesion, asymmetry, and the SUVmax of the coexisting lymphadenopathy in the neck, a crucial criterion is whether the FDG uptake has a counterpart finding by CT. (C) 2020 Elsevier Inc. All rights reserved.

We aimed to demonstrate whether PET–CT can replace bone marrow biopsy in detecting bone marrow involvement in subtypes of lymphoma. In addition, we aimed to also reveal whether there is a difference between the mean survival of patients with bone marrow involvement via PET–CT or biopsy. A total of 276 newly diagnosed lymphoma patients who underwent bone marrow biopsy and PET–CT prior to the treatment were scanned retrospectively. Bone marrow biopsy was used as the standard method to investigate the presence of bone marrow involvement in PET–CT. The relationship between bone marrow involvement and mean survival was compared using both methods. Out of the 276 patients, bone marrow involvement was detected with PET–CT and with biopsy, respectively in 56 patients (20.2%) and in 78 patients (28.2%). In terms of PET–CT’s accuracy with respect to revealing bone marrow involvement, the highest rates were achieved respectively in diffuse large B cell lymphoma (DLBCL) (87.4%) and Hodgkin lymphoma (HL) (77.7%). In both the PET–CT and bone marrow biopsy methods, Overall Survival (OS) was found to be significantly shorter in patients with involvement than in patients without involvement (P: 0.001). PET–CT may replace bone marrow (BM) biopsy in detecting the bone marrow involvement in aggressive lymphoma subtypes such as DLBCL and HL. The presence of BM involvement at the time of diagnosis in both PET–CT and BM biopsy is associated with poor prognosis, and OS is short in this group.

Aim: We aimed to show whether easily accessible NLR, PLR, PNR and MPV values can be used as prognostic markers in lymphoma subtypes and whether they can contribute to existing prognostic scoring systems. Material and Methods: The records of all lymphoma patients between 2005-2019 were reviewed retrospectively. NLR, PLR, PNR and MPV values at the time of diagnosis were compared with Progression-Free Survival (PFS) and Overall Survival (OS) durations. Results: PLR and NLR values in Marginal Zone Lymphoma (MZL) and PNR and MPV values in Diffuse Large B-cell Lymphoma (DLBCL) were found to be associated with prognosis and to have a direct effect on PFS and OS. Except for these parameters, we found that lactate dehydrogenase (LDH), MPV, age, stage and histological subtype had an effect on prognosis for all patients. Conclusion: It has been concluded that PLR and NLR can be used as prognostic factors in MZL, whereas PNR and MPV can be used as prognostic factors in DLBCL, and that these values can be used as easily accessible methods in disease prognosis scores.

Background Ibrutinib is an oral irreversible Bruton’s tyrosine kinase inhibitor. Here, we demonstrate the efficacy and safety of ibrutinib using real-life data from patients with marginal zone lymphoma (MZL), diffuse large B-cell lymphoma (DLBCL), Waldenström macroglobulinemia (WM), and follicular lymphoma (FL), especially in chronic lymphocytic leukemia (CLL) and mantle cell lymphoma (MCL). Methods This is a retrospective, observational, non-interventional, and single-center study on 32 patients who received ibrutinib treatment between January 2017 and March 2020 regardless of their diagnosis. Results Of the 32 patients, 11 had CLL and 21 had other B-cell lymphomas. Patients with CLL were prescribed ibrutinib for a median of 4 months (range, 2‒18). In this group, diarrhea was observed in 3 (27.3%), pneumonia in 3 (27.3%), and thrombocytopenia and/or neutropenia in 2 (18.2%) patients. The overall response rate (ORR) was 85.6 % [28.5 % complete response (CR) and 57.1 % partial response (PR)] in the final response assessment during treatment with ibrutinib. Among other types of B-cell lymphoma, seven (33.4%) of the 21 patients were diagnosed with MCL, 5 (23.8%) with DLBCL, 4 (19.0%) with MZL, 3 (14.3%) with WM, and 2 (9.5%) with FL, upon follow-up. The median treatment duration was 4 months (range, 1‒28) in this group. The most common adverse event was diarrhea 8 (38.1%) patients. The ORR was 66.6% (20.0% CR and 46.6% PR) in the final response assessment during the treatment. Conclusion Ibrutinib is a good treatment option for CLL and other B-cell lymphomas, with an acceptable side effect profile, and high and promising CR/PR response rates. Ibrutinib treatment at an early stage decreases the burden of cytotoxic therapy in fragile patients, thereby, increasing their quality of life.

The vast majority of cases of thrombotic thrombocytopenic purpura (TTP) are the result of acquired antibodies which inhibit the activity of the ADAMTS13 enzyme. Acquired TTP is more frequently seen in young females or in individuals with autoimmune disease. The development of antibodies against ADAMTS13 may also result from the administration or consumption of drugs and other substances. However, specific laboratory tests to identify the pathogenic mechanism of a particular drug may not be available, and the role of a potentially implicated drug or other ingested substance may not be clear. In this report we present 2 acquired TTP cases involving the consumption of a large amount of energy drink.

Background:2016 WHO classification divides myeloprolipherative neoplasms into bcr‐abl positive and bcr‐abl negative neoplasms, not only because of treatment difference also because of the heterogeneity of clinical presentations in Chronic Myeloid Leukemia (CML) patients. Classical CML patients present very high leukocyte count with or without thrombocytosis and splenomegaly. In literature there are few CML cases that have first presentations as Essential Thrombocythemia (ET) with not remarkable leukocytosis.Aims:We report three CML cases presented as classical ET.Methods:54 years old female patient referred to our hematology clinic because of very high platelet count. Platelet count was 2,578,000/mm3 and WBC count was 15,800/mm3. She had no clinical history of thrombosis and no splenomegaly. After bone marrow biopsy we started hydroxyurea 2000 mg/day. After 20 days platelet count was still higher than 2,000,000/mm3. PCR results of JAK‐2 was negative but bcr‐abl IS‐PCR was positive so we started imatinib 400 mg/day. After 10 days of imatinib, platelet count decreased to 1.400,000/mm3 and after one month of the imatinib treatment platelet count decreased to normal levels. The patient had no thrombosis during this period. After three months her PCR‐IS level decreased to 0,16%.Second case is 25 years old female patient that is referred from internal medicine because of high platelet count (678,000/mm3). Her WBC count was normal and JAK‐2 mutation test was negative, so we searched for CALR and MPL mutations for Essential Thrombocytosis and results were negative. Proceeding from the experience of former patient, although there was no leukocytosis, we tested bcr‐abl with PCR‐IS and result was positive. After bone marrow biopsy we started imatinib 400 mg per day. In cytogenetic analysis Philadelphia chromosome was positive. One month later platelet count decreased to normal level. Minimal leukopenia observed. After three months PCR‐IS value decreased to 0.45%.Third patient is 40‐year‐old female patient that is referred our clinic with high platelet count (747,000/mm3) WBC count was 8,800/mm3 and JAK‐2 mutation was negative. Although her WBC count was normal we tested bcr‐abl with IS‐PCR and result was 12% positive. After bone marrow biopsy we started imatinib 400 mg/day. After 20 days her platelet count decreased to normal level. After three months IS‐PCR result was 0.14%.Results:Here we discussed three CML patients with marked thrombocytosis without remarkable leukocytosis. All three female patients had similar clinical findings. All patients had no splenomegaly, had no thrombosis event. They all had minimal basophilia at presentation (1600/mm3, 600/mm3, 600/mm3) that was underestimated because in peripheral smears findings were normal. They all had very good response to imatinib treatment.Summary/Conclusion:CML patients that presents as ET are supposed to be rare but all three patients came to our center at dates between June and August 2018. Two of them had diagnosis of CML because of the experience from first patient. WHO classifications need bcr‐abl negativity for diagnosis of ET. With experience of these three patients we suggest to test all ET patients about bcr‐abl. Even tough normal WBC count and normal peripheral smear findings, absolute basophile count must be reconsidered.