Therapeutic plasma exchange (TPE) is an alternative treatment approach for specific conditions in the nephrology field. TPE is utilized for the treatment of ANCA-associated vasculitis, anti-GBM disease, thrombotic microangiopathy syndromes, and acute kidney transplant rejection and as part of desensitization protocols in kidney transplant recipients. However, TPE indications are limited, efficacy remains a topic of debate. With this regard, we aimed to evaluate our clinical outcomes of TPE experience among non-transplant kidney diseases. Data from 36 patients (age 44.19±18.66 years; 20 females) underwent TPE were evaluated retrospectively. The number of TPE sessions, diagnosis, pre- and post-procedure laboratory results, vascular access routes, complications, and treatment responses were recorded retrospectively from the electronic file system. Overall, patients underwent an average of 7.42±3.77 TPE sessions. Vascular access was a central venous catheter for all. TPE indications were vasculitis (n: 10), thrombotic microangiopathy (n: 20), glomerulonephritis unresponsive to treatment (n: 4), and anti-phospholipid syndrome (n: 2). 25 patients required hemodialysis, and the dialysis requirement was resolved in 11 patients at the end of treatment. There were no reported serious adverse events. Regarding renal outcome, 10 had normal renal function, 9 had chronic kidney disease, and 10 were on chronic dialysis. Seven people died, 5 of whom required dialysis at the time of diagnosis. It has been observed that the TPE, which is used as an initial, complementary, or salvage treatment option depending on the underlying disease, gives a positive response in terms of kidney and patient survival in patients with favourable initial renal functions.

Myelodysplastic syndrome (MDS) is a clonal hematopoietic stem cell disease. Supportive treatments, such as erythropoiesis-stimulating agents (ESAs), are commonly used in patients with low-risk MDS. This study aimed to retrospectively assess the impact of bone marrow Mothers against decapentaplegic homolog 7 (SMAD-7) and transforming growth factor beta 1 (TGF-β1) protein expression on prognosis and response to ESA treatment in patients with low-risk MDS. We retrospectively analyzed patients diagnosed with low-risk MDS at the adult hematology department of Bursa Uludağ University Hospital. A total of 56 patients classified as low or very low risk were included in the study. Immunohistochemical analysis of bone marrow specimens at diagnosis showed that only five patients (9.8%) exhibited low SMAD-7 staining, while 51 patients (90.2%) showed no staining. Regarding TGF-β1 staining, 18 patients (32.1%) demonstrated moderate to high staining, whereas 38 patients (67.9%) exhibited low (36/38) or no staining (2/38). A statistically significant correlation was found between TGF-β1 staining levels and ESA treatment administration (P = 0.011). Additionally, a significant relationship was observed between lower erythropoietin (EPO) levels and moderate to high TGF-β1 staining (P = 0.04). However, when TGF-β1 staining status was compared with first- and third-month treatment responses in patients receiving ESA therapy, no significant difference was detected between groups. These findings suggest that while TGF-β1 alone may not be sufficient to predict ESA treatment response, additional parameters related to the TGF-β/SMAD pathway should be considered. Strong TGF-β1 staining, alongside EPO levels, may influence the decision to initiate ESA therapy.

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Myelodysplastic syndrome (MDS) is a heterogeneous spectrum of clonal hematopoietic disorders with varying degrees of cytopenia and morphologic dysplasia. The hemoglobin, albumin, lymphocyte, and platelet (HALP) score is a prognostic marker in several types of malignant tumors. Prognostic value of HALP score remains unclear for MDS. To determine the prognostic value of baseline HALP score in MDS. We retrospectively analyzed data from 130 newly diagnosed MDS patients evaluated and classified under HALP score. By the receiver operating characteristic (ROC) analysis, the optimal cut-off value of HALP was > 67.5 in predicting mortality. Patients were divided into two groups: with low and high HALP scores, and the characteristics were compared between both groups. Patients’ median age was 68 (19–84) years, and 79 (60.8%) were male. Higher HALP score was detected in MDS patients with intermediate-risk under IPSS score, and at high and very high risks under IPSS-R score, and those receiving azacitidine (AZA) treatment. The survival rates of those with a HALP score > 67.5 were significantly lower than those with low HALP score at 17.77 ± 3.98 (median ± SE) (p < 0.001). The 3-, 5- and 10-years survival rates of individuals with HALP scores > 67.5 were found as 25, 18, and 11%, respectively. Median overall survival (OS) was also determined as 33.10 (95% CI 16.34–49.88) months by the Kaplan–Meier method. HALP score has shown an ability to be a useful prognostic biomarker in various cancers, including MDS. The meaningful cut-off value of HALP is disease-specific and largely study-specific. High HALP score is associated with unfavorable clinicopathological characteristics. Also, it may be useful in predicting OS and mortality of MDS.

Background Tuberculosis (TB) is a systemic infectious disease that is caused by Mycobacterium tuberculosis and which can affect many tissues and organs. Despite the development of curative and preventive therapies in recent years, TB continues to be a serious health problem, in the developing countries in particular. Case presentation In this case report, an extraordinary case of miliary tuberculosis with unexplained fever, joint pain, weight loss, pancytopenia, lymphadenopathy and splenomegaly, who was clinically suspected of lymphoma and successfully treated with a multidisciplinary approach without any complications, was presented. This case has been reported not because it is a rare case, but to raise awareness. It is a case, where early diagnosis and initiation of treatment early, as well as an individualized and multidisciplinary treatment approach emerged as the most important factors resulting in an improvement prognosis. Conclusion Extrapulmonary TB, if with lymph node involvement in particular, can easily mimic lymphoma. Imaging methods and clinical findings may be insufficient to distinguish these two conditions at the time of diagnosis. In such a case, it will be beneficial for the patient to proceed with an experienced team in the management of the patient.

Multiple miyelomlu bireylerde semptom yönetimi, kemik hastalığı ve böbrek fonksiyon bozukluğuna bağlı semptomlar başta olmak üzere, enfeksiyon, anemi, ağrı ve pıhtılaşma bozukluğu gibi spesifik sorunları içermektedir. Diğer hastalıklarda olduğu gibi, miyelomlu hastanın tanı ve tedavi sürecinde hemşirelik bakımı önemli bir yer tutmaktadır. Hemşirelik bakım modelleri hastanın sistematik ve kapsamlı şekilde ele alınmasını sağlayarak bakımının kalitesinin arttırılmasına katkıda bulunmaktadır. Roy Adaptasyon Modeli bunlardan biridir. Roy Adaptasyon modelinde fizyolojik, benlik kavramı, rol fonksiyonu ve karşılıklı bağlılık olmak üzere dört uyum alanı vardır ve hemşireler hastalarına bu uyum alanları doğrultusunda bakım vermektedir. Olgu sunumunda, bel ağrısı nedeniyle başvuran radyolojik, laboratuvar, sitogenetik ve kliniği ile Durie Salmon’a göre lambda hafif zincir, evre III B multiple miyeloma tanısı almış ve ayaktan kemoterapi tedavi planı hazırlanmış bir hasta ele alınmaktadır. Bu olgu sunumu, Multiple miyelomlu bir hastaya Roy Adaptasyon Modeli doğrultusunda verilen bakımın North American Nursing Diagnosis Association hemşirelik tanılarıyla birlikte ele alınması konusunda, hematoloji ve onkoloji alanında çalışan hemşirelere rehber olmak amacıyla hazırlanmıştır.

İlk oral proteazom inhibitörü (PI) olan iksazomib, lenalidomid ve deksametazon (IRd) ile kombinasyon halinde relaps refrakter multipl miyelomun (RRMM) tedavisi için onaylanmıştır. Bununla birlikte, klinik çalışma sonuçları her zaman gerçek dünyadaki sonuçlarla örtüşmez. Bu çalışmanın amacı, gerçek yaşamda RRMM'li hastaların tedavisi için iksazomib bazlı kombinasyon tedavisinin sonuçlarını değerlendirmektir. Çalışmaya Bursa Uludağ Üniversitesi Tıp Fakültesi Hematoloji Bilim Dalı’ndan toplam 45 RRMM tanılı hasta retrospektif olarak dahil edildi. Medyan takip süresi 15.9 ay (0.3-53.8) ve medyan yaş 66 (40-84) idi. Hastaların %8.8’i 2. sırada, % 15.5’i 3. sırada, %35.5’i 4. sırada ve %40’ı da ≥5. sırada iksazomib aldı. Genel olarak, IRd’den önce hastaların %100’ü PI (bortezomib %100, karfilzomib %31.1), %88.8’i immünomodülatör ilaç (IMID) (lenalidomid %86.6, pomalidomid %33.3, talidomid %4.4) almış ve %55.5’ine de otolog kök hücre nakli yapılmıştır. Hastaların hepsi lenalidomid ve deksametazon ile kombinasyon halinde iksazomib almıştır. Tedavi, yan etki nedenli düşük bir kesilme oranıyla (%6.6) iyi tolere edilmiştir. En sık görülen yan etkiler sitopeni (%50) ve enfeksiyon (%25) olmuştur. Genel yanıt oranı %77.7, çok iyi kısmi yanıt oranı %20, tam yanıt oranı % 28,5 kısmi yanıt oranı %11.4, minimal yanıt oranı %5.7, stabil hastalık oranı %5.7, progresif hastalık oranı %28.5 saptandı. İksazomib tedavisinde medyan progresyonsuz sağkalım (PFS) 29.1 aydı (%95 GA 17.2–40.9). PFS 12 ve 24 ayda sırasıyla %75 ve %59 idi. Medyan genel sağkalım (OS) 22.6ay (%95 GA 18.8–40.9) idi; OS 12 ve 24 ayda sırasıyla %73 ve %49 idi. Gerçek yaşamda RRMM hastalarında IRd etkili, güvenli ve oral verilebilmesi nedeniyle kolay uygulanabilir bir rejimdir.

The impact of inflammatory markers such as systemic immune-inflammation (SII) index and systemic inflammation response index (SIRI) on myelofibrosis (MF) prognosis was evaluated for the first time in this study. Data from 60 patients diagnosed with MF between March 2011 and September 2022 were retrospectively analyzed. In addition to disease-related markers, the impact of SII and SIRI on prognosis was evaluated. In our study, the overall median survival (OS) was 64 months. OS was significantly shorter in patients older than 65 years, with high ferritin and lymphocyte levels, transfusion dependence at diagnosis, platelet count below 100 × 10 9 /L, Hb level below 8 g/dl, and high risk according to the dynamic international prognostic scoring system (DIPSS)-Plus score. When these variables were included in the multivariate Cox regression model, it was found that being older than 65 years, having a high ferritin value, being at high risk according to the DIPSS-plus score and Hb values below 8 increased the risk of death. Platelet-to-lymphocyte ratio (PLR) and SII index were lower in patients with a fatal outcome. No statistically significant relationship was found between SIRI and mortality. The findings of this study showed that low PLR and high ferritin were associated with poor prognosis in MF. Elevated SII and SIRI, evaluated for the first time in patients with myelofibrosis, did not predict prognosis. Since non-inflammatory variables play a role in the pathogenesis of MF, bone marrow indicators and systemic inflammation indicators derived from hematologic parameters may not be accurate.

Aims: This research aims to determine the impact of maximum tumor diameter and FDG PET CT status at the time of diagnosis on survival outcomes and to identify prognostic factors that influence treatment response and survival. Methods: 239 patients with a diagnosis of Hodgkin lymphoma participated in the study. Clinical characteristics, treatment responses, and prognostic factors influencing survival were retrospectively analyzed from patient medical records. Results: There were 136 (56.9%) male patients and 103 (43.1%) female patients, who participated in the study. Of these patients, 202 (84.5%) survived, while 37 (15.5%) died during the study period. When surviving patients and non-survivor patients were compared, the deceased patients had a higher mean age (p = 0.003), a higher prevalence of spleen involvement and B symptoms (p = 0.011 and p = 0.001, respectively), lower albumin levels (p = 0.008), higher beta-2 microglobulin levels (p = 0.001), and more bone marrow involvement (p = 0.006). A fourfold increase in mortality was seen in patients with beta-2 microglobulin levels > 2920 mg/L, and a 3.188-fold increase in mortality was seen in patients with spleen involvement. Conclusion: In conclusion, beta-2 microglobulin > 2920 mg/L, the presence of spleen involvement, the presence of relapse, and the presence of progressive or refractory disease in FDG PET CT were significant prognostic factors for 1st, 3rd, and 5th-year survival rates in patients with Hodgkin lymphoma. In addition, there was no correlation between survival rate and maximum tumor diameter as measured by FDG-PET or CT.

Diagnostic accuracy of galactomannan measurements is highly variable depending on the study population, diagnostic procedures, and treatment procedures. We aimed to evaluate the effect of posaconazole prophylaxis and empiric antifungal treatment upon diagnostic accuracy of GM measurements in bronchoalveolar lavage (BAL), bronchial lavage (BL), and serum in hematological malignancy population. Patients hospitalized in a single tertiary care center with hematologic malignancies undergoing fiberoptic bronchoscopy (FOB) with a preliminary diagnosis of IPA were retrospectively included. In all the study population (n = 327), AUC for BAL, BL, and serum GM were as follows: 0.731 [0.666–0.790], 0.869 [0.816–0.912], and 0.610 [0.540–0.676] with BL samples having the best diagnostic value. GM measurements in patients under posaconazole prophylaxis (n = 114) showed similar diagnostic performance. While specificity was similar between patients with and without posaconazole prophylaxis, sensitivity of GM measurements was lower in patients with prophylaxis. Analyses with patient classified according to antifungal treatment at the time of FOB procedure (n = 166) showed a decreased diagnostic accuracy in serum GM and BAL GM measurements related with the duration of treatment. However, BAL, BL, and serum GM measurements presented similar sensitivity and specificity in higher cut-off values in longer durations of antifungal treatment. Our study shows that posaconazole prophylaxis and active short-term (3 days) antifungal treatment do not significantly affect overall diagnostic performance of GM measurements in bronchoalveolar lavage and bronchial lavage samples. However, using different cut-off values for patients receiving active treatment might be suggested to increase sensitivity.

OBJECTIVE The aim of the study was to evaluate the clinical importance and potential mechanisms of controlling nutritional status (CONUT) score as a prognostic tool for Hodgkin lymphoma (HL). PATIENTS AND METHODS Diagnosed with HL, 307 patients were included in the study. Patients' demographic data, stages, B symptoms, extranodal involvement, presence of bulky disease, laboratory findings, treatments, treatment responses, nutritional status, and overall survival (OS) rates were evaluated from the hospital records. The primary endpoint of our study was to evaluate and classify newly diagnosed HL patients under the CONUT score. The secondary endpoint was to indicate any relationship between nutritional status, CONUT score, and other prognostic factors and OS. RESULTS Of 307 patients (173 males, 134 females), the mean age was 41.58±16.26 (ranging between 18-82 years). The most common type of malignancy was nodular sclerosis (72.53%). To the receiver operating characteristic (ROC) curve analysis, the best cut-off point was 2.5 to predict mortality. Eigthy-five (27.7%) and 222 (72.3%) patients had ≥3 and ≤2 CONUT scores, respectively. Twenty-four (10.80%) and 23 (27.10%) cases were also mortal in the patients with ≤2 and ≥3 CONUT scores, respectively (p<0.001). Survival times were significantly lower in those with higher (≥3) CONUT scores (p<0.001) than among the other patients. CONCLUSIONS Evaluation of nutritional status plays an important role in the response and survival of those with hematological malignancies. Malnutrition can reduce patients' tolerance to chemotherapy and increase the risk of secondary infections. In this study, undernutrition evaluated with the CONUT score was demonstrated to be a potential independent prognostic factor for OS in patients with HL.

Background: Dapsone is a second-line therapy for immune thrombocytopenia (ITP). It is cost-effective, with a response rate comparable to other drugs used as second-line therapy, such as azathioprine, danazol, cyclophosphamide, cyclosporine, vincristine, rituximab, and eltrombopag. Material and Methods: This retrospective study analyzed ten adult patients who presented to our hematology division outpatient clinic between March 2013 and July 2021, was diagnosed with chronic/refractory ITP, did not respond to first-line therapy, and used dapsone. Results: Eight (80%) patients were female, and 2 (20%) were male. The median age was 50 (range, 24-64) years. The mean pre-treatment platelet value was 12.8x109/L (range: 4-22.1x109/L). The median duration of symptoms before dapsone treatment was 60 (6-360) months. The median number of treatments received before dapsone was 4 (range: 3-6). All patients were routinely treated with oral dapsone 50 mg for two weeks, followed by 100 mg. The median time to treatment response was 39 (range: 14-90) days. The response rate was 60% (complete response 40%, partial response 20%). Asymptomatic anemia was observed as a side effect in only one patient. Conclusions: Based on these results, it can be speculated that dapsone is an effective, inexpensive, and well tolerated treatment option. Considering the economic status of developing countries, it seems very attractive to use dapsone as the second-line therapy for chronic/refractory ITP. To the best of our knowledge, this is the first study in Turkey on the use of dapsone for chronic/refractory ITP.

INTRODUCTION:Thrombotic thrombocytopenic purpura (TTP) is a life-threatening occlusive disease of the microcirculation characterized by systemic platelet plugs, organ ischemia, deep thrombocytopenia, and fragmentation of erythrocytes. One of the widely used scoring system to determine the clinical probability of TTP is the PLASMIC scoring system. This study aimed to evaluate the contribution of PLASMIC score modifications to sensitivity and specificity in patients with microangiopathic hemolytic anemia (MAHA) undergoing plasma exchange with a prediagnosis of TTP at our center.MATERIALS AND METHODS:The data of patients who were hospitalized with a previous diagnosis of MAHA and TTP and underwent plasma exchange at Bursa Uludag University, Faculty of Medicine, Department of Hematology between January 2000 and January 2022 were retrospectively analyzed.RESULTS:Overall, 33 patients (including 15 and 18 with and without TTP, respectively) were included in this study. Receiver operating characteristic (ROC) analysis revealed that the area under the curve (AUC) for the original PLASMIC score was 0.985 (95% confidence interval [95% CI]: 0.955-1.000), and AUC for the PLASMIC score without mean corpuscular volume (MCV) was 0.967 (95% CI: 0.910-1.000), which is close to the original AUC. With the removal of MCV from the scoring system, the sensitivity decreased from 100% to 93%, whereas the specificity increased from 33% to 78%.CONCLUSIONS:Based on the results of this validation study, removing MCV from the PLASMIC score led to the categorization of eight non-TTP cases in the low-risk category, and this could avoid unnecessary plasma exchange. However, in our study increasing the specificity was at the expense of the sensitivity by missing one patient with this new scoring system without MCV. Further multicenter studies with large sample sizes are required owing to the fact that different parameters may be effective in TTP prediction among different populations.

Concrete is a material that mainly consists of coarse aggregate and mortar. The forming of cracks is an existing problem in Reinforced Concrete (RC) slab. In this research, hybrid fibres namely steel and polypropylene fibres in suitable combinations are identified and incorporated to concrete to regulate the formation and development of cracks in RC slabs. In Hybrid Fibre Reinforced Concrete (HFRC), 1 per cent of steel fibre and 0.30 per cent of polypropylene fibre is added, which is the effective amount of reinforced concrete added based on information obtained from the various research studies. In addition, now-a-day use of re-Cycled Aggregate (RCA) is strongly recommended to address the lack of traditional coarse aggregate. By using RCA as a partial substitution of coarse aggregate with an inclusion of 1 % of steel fibre and 0.30 % of polypropylene fibre to the concrete volume in the study, a typical approach is recommended. One-way type of RC slab, 1350 mm × 500 mm × 100 mm in dimension, is cast and tested in the laboratory in compliance with the Indian standard code IS 456: 2000 [1]. The compressive strength of concrete, load carrying capacity, load versus deformation characteristics, stiffness and ductility relationship properties of the RC slabs was compared and discussed between control specimens and 0 to 50 percent of partially substituted RCA specimens.

While autoimmune hemolytic anemia (AIHA) is expected in non-Hodgkin’s lymphomas, it is less common in marginal zone lymphoma. Sixty-year-old male patient was followed up with hemolytic anemia in our clinic and while the etiology was investigated, scattered nodes in the mediastinum and abdomen compatible with lymphoproliferative disease were observed on CT, and positive detection of CD5, CD19, CD20, CD22, CD45, HLA-DR, FMC-7 on flow cytometry sent from peripheral blood and a diagnosis of low grade B cell lymphoma (MZL) was made with the result of bone marrow pathology. We found it appropriate to present our MZL case because of its response to steroid treatment and its rare presentation with AIHA.

Objectives: We aimed to evaluate the potential prognostic factors of patients with primary central nervous system lymphoma (PCNSL). Methods: Thirty-two patients with PCNSL were retrospectively analyzed. Results: All the patients received high doses of methotrexate-based chemotherapy as the first-line treatment. Overall survival was 30.0 ± 7.2 months. Those with partial response and without response had a higher risk of mortality. The increased leukocyte and neutrophil levels were associated with high mortality. Besides, the SIIL as a product of the systemic immune inflammation (SII) and lactate dehydrogenase (LDH); the SIRIL as a product of systemic immune response index (SIRI) and LDH; and the NLL as a product of neutrophil-lymphocyte ratio and LDH were taken into consideration for the first time for the purposes of the present study. Elevated NLL, SIIL, and SIRIL indexes were associated with mortality. Elevated SIIL level, radiotherapy, and partial and no response were the independent predictors of mortality on the basis of the multivariable regression model including the risk factors associated with mortality. Conclusions: SIIL, SIRIL and NLL are prognostic factors in PCNSL. Determining the prognostic factors and risk profile may predict the requirement for more intensive treatment, especially in young patients at high risk.

Background Hairy cell leukemia (HCL) is an uncommon neoplasm representing approximately 2% leukemias and

In cancer treatment, efficient therapeutic strategies could be impeded by cellular mechanisms such as the multidrug resistance. Recently, drug-loaded nanoparticles have been reported to be useful, since they allow entering the cancer cell and act as an intracellular anti-cancer drug reservoir. A new approach is proposed here by the use of lipid nanocapsules (LNC) which were hypothesized to reverse multidrug resistance additionally by their P-glycoprotein (P-gp) inhibiting surfactant. LNC (mean diameter 25 to 100 nm) were loaded with etoposide, tested for the drug release and their efficiency to reduce cell growth in cell culture for C6, F98, and 9L glioma cell lines. Sustained etoposide release can be provided over a period of 1 week (t10%: 1.4+/-0.1h; t50%: 15.9+/-2.8h). The P-gp inhibiting activity in-vitro was found to be independent from the LNC size. In cell culture, an internalization of LNC was observed in all glioma cell types. Etoposide LNC showed a generally higher efficiency than the drug solution while blank LNC were found to be less inhibitory than the pure drug at equivalent concentrations (IC50: C6: etoposide: 25.2 microM; LNC: 2.6-8.9 microM, F98: etoposide: 46.5 microM; LNC: 1.4-14.7 microM, 9L: etoposide: 58.2 microM; LNC: 4.4-12.7 microM). This effect was found to be particle size dependent within a range of an 8- (C6) to 33-fold (F98) increased cytotoxicity for smallest particles. When cells were incubated with etoposide solution in the presence of blank LNC, a slight growth inhibition was observed, however, distinctly lower than the drug-trapping particles. Moreover, cell toxicity on astrocytes was similar for etoposide LNC and etoposide solution. The mechanism of action of etoposide LNC was proposed to be a cell uptake followed by a sustained drug release from the LNC in combination with an intracellular P-gp inhibition ensuring a higher anticancer drug concentration inside the cancer cells.

Background and Objective Infections are the most common cause of anal and perianal pathologies in patients with hematological malignancies. Perianal infection diagnosis in this group of patients is difficult; thus, a careful anorectal examination is necessary with imaging modalities. In addition, the literature reveals a knowledge gap in the approach to anal pathologies in patients with neutropenia during diagnosis or chemotherapy. This study aimed to examine our institutional data on perianal complications and investigate the relationship between the white blood cell-neutrophil count, perianal lesion, and the type of treatment in patients with hematologic malignancies during the neutropenic period. Methods Patients with a hematologic malignancy, hospitalized for cytotoxic chemotherapy, complicated by perianal pathology, documented by at least one imaging method, were included in the study. Results A total of 42 patients were included in the study. Most of them had acute leukemia, 31 were affected by acute myeloid leukemia (AML), and 7 by Acute lymphoid leukemia (ALL). There was no statistically significant relationship between the anal abscess formation, the neutrophil count, and a previous perianal pathology. Anal abscess development was significantly more frequent in acute myeloid leukemia. An inverse relationship was found between the total white blood cell number at onset and having a surgical intervention for anal pathology. In conclusion, this article has shown that white blood cell count at the time of hospitalization can affect the surgical intervention in patients with hematological malignancy (in the majority with acute leukemia) affected by anal pathologies occurring in the neutropenic period.