ABSTRACTIntroductionCyclosporine‐A (CsA) and post transplantation cyclophosphamide (PTCy) are common agents used for graft versus host disease (GVHD) prophylaxis in Haploidentical hematopoietic cell transplantation (haplo‐HCT). However, the impact of CsA cessation timing in the posttransplant setting on clinical outcomes is uncertain. We aimed to investigate the impact of a novel approach that integrated early CsA cessation with PTCy utilization.Patients and MethodsThis study was a single arm retrospective study carried out at a tertiary referral hospital hematology and bone marrow transplantation center between 2009 and 2022. The patients who received haplo‐HCT with ATG, PTCy and CsA as GVHD prophylaxis were included. CsA was planned for cessation starting at day 45 to day 60. Acute and chronic GVHD were evaluated and graded. CsA blood concentrations and its impact on acute and chronic GVHD was evaluated.ResultsThirty‐one patients composed of 19 (61.3%) male and 12 (38.7%) female patients with a median age of 31 years (20–58). Busulfan and TBI based conditioning regimens were the most utilized regimens. The majority of donors were first degree relatives. Stem cell origin was peripheral blood for all patients. GVHD prophylaxis consisted of ATG, CsA and PTCy. Acute GVHD was observed in 9 (29%) cases, whereas chronic GVHD was seen in 3 (9.7%) cases, with 2 of them having overlapping GVHD. Age, gender, number of chemotherapy lines, transplant characteristics, infused CD34 cell count, and engraftment durations were similar among patients with and without GVHD. Patients with GVHD had similar 1st, 2nd, 3rd and 4th week CsA concentrations compared to patients without GVHD (p > 0.05). The presence of GVHD was not associated with worse progression free survival and overall survival (p = 0.6, p = 0.5, respectively). CMV reactivation was more common in the GVHD group.ConclusionIn the current study, we did not find an impact of CsA concentration on GVHD and post‐transplant outcomes in Haplo‐HCT setting. Therefore, together with the use of PTCy, early CsA cessation can be an option; further studies are needed to understand all aspects of this approach.

Objectives: The Wilms’ tumor gene 1 (WT1) plays a critical role in cell development and the regulation of essential genes involved in cell growth and metabolism. In the context of hematopoietic tumors, including acute myeloid leukemia (AML), WT1 has been identified as a potential marker for measurable residual disease (MRD) assessment. Relapse after allogeneic hematopoietic stem cell transplantation (allo-SCT) remains a significant challenge in AML treatment, highlighting the importance of MRD monitoring for risk stratification and treatment decisions. This study aimed to investigate the clinical significance of WT1 as a molecular marker for MRD and its correlation with chimerism in AML patients post-allo-SCT setting. Methods: We have included 58 patients with WT1-expression-positive acute myeloid leukemia (AML) who received allo-SCT in our center between 2016–2022. The exclusion criteria are as follows: not having WT1 polymerase chain reaction (PCR) measurement at diagnosis, not receiving allo-SCT, and not having a serial measurement of WT1 post-transplant. Pre- and post-transplant assessments were made with flow cytometry, WT1 PCR, and bone marrow morphological evaluations. Statistical analyses were carried out to explore correlations between WT1 levels, MRD markers, and chimerism post-transplantation. Results: We found that WT1 had a significant correlation with flow cytometry and bone marrow morphological evaluation, but not with chimerism. Interestingly, high WT1 expressors exhibited a more robust correlation with chimerism compared to the general cohort. The negative predictive value for post-allo-SCT relapse was 91.8% for the whole WT1 cohort; for high WT1 expressors, it was similar, at 87.5%. The negative predictive value for post-allo-SCT relapse was high for the whole WT1 cohort; for high WT1 expressors, it was similar. The WT1 MRD assay showed a high negative predictive value for post-allo-SCT relapse, consistent across both the entire cohort (91.8%) and high WT1 expressors (87.5%). Conclusions: WT1 expression levels may serve as a valuable ancillary marker in MRD assessment and relapse prediction post-allo-SCT in AML patients, particularly for those lacking specific fusion genes or mutations. However, further large-scale, controlled studies are needed to standardize WT1 MRD assays and establish clear guidelines for their clinical application.

Introduction: Polycythemia vera (PSV), essential thrombocytosis (ET), and primary myelofibrosis (PMF) are BCR/ABL negative chronic myeloproliferative neoplasms (CMPNs).As a result of abnormal clonal proliferation of hematopoietic cells, these disorders have a higher risk of thrombosis, bleeding, leukemic transformation, and worsening in quality of life.While stem cell transplantation is the sole curative option for CMPNs, symptomatic therapies gain importance.The purpose of this study is to assess the results of patients with CMPNs treated with ruxolitinib at our center.Methods: The data from eighteen patients (six patients with PSV and twelve patients with PMF) who were treated with ruxolitinib at our center between January 2013 and January 2022 were analyzed in this retrospective cohort study.Results: Six PSV patients who received ruxolitinib were included in the study.Three patients with splenomegaly previous to ruxolitinib, had a response of spleen volume, median of 6 months.There were no hematological or non-hematological adverse effects, thrombolytic or cardiovascular complications, or leukemic transformation throughout a median of 6 (range 2-52) months of ruxolitinib treatment.Twelve patients with PMF used ruxolitinib were included in the study.Spleen volume response was observed in six patients (50%) at a median follow-up of 12 months, while symptomatic response was observed in nine patients (75%) during a median of 15.5 months of ruxolitinib treatment.Any thrombolytic or cardiovascular complications were observed.Discussion and Conclusion: Ruxolitinib is an appropriate and safe treatment option for patients who are not candidates for hematopoietic stem cell transplantation.

INTRODUCTION:Peripheral blood stem cells (PBSC) mobilization with granulocyte colony stimulating factor (G-CSF) for healthy donors is generally performed at 5th day. However, earlier collection is sometimes feasible, raising the question of whether to initiate apheresis early to limit further G-CSF exposure, while considering the risk of mobilization failure. In the current study, we examined the factors predicting successful 4th day collection and developed a model that can be used practically. PATIENTS AND METHODS:The study was carried out by obtaining the data of PBSC mobilizations performed between January 2009 and September 2022 in our transplantation center. RESULTS:A total of 141 healthy donors with a median donor age of 32 (18-64) were included. Adequate mobilization was achieved in 115 (81.6 %) patients. Median peripheral CD34 + cell count was 69.4/μL in the adequate mobilization group and 46/μL in the mobilization failure group (p < 0001). Multivariate analysis revealed that donor/recipient weight ratio and the 4th day peripheral CD34 + cell count≥ 50/μL were independent markers for 4th day collection success. A predictive model of our center including these parameters was available with 0.765 sensitivity and 0.968 specificity [(AUC):0.948 (95 % CI, 0.90-0.99), p < 0.001]. CONCLUSION:The result of the current study shows that peripheral 4th day collection can be performed in selected donors, taking into account peripheral CD34+ cell count and donor/recipient weight ratio. In addition, using these indicators, new predictive models can be created that may assist clinicians in daily practice.

Introduction: Chronic myelomonocytic leukemia (CMML) is a condition that overlaps with myelodysplastic syndrome and myeloproliferative neoplasms.The prognosis is generally poor, with a median survival of 20 to 40 months and approximately 15-30% of patients progressing to acute myeloid leukemia (AML).We aimed to evaluate the characteristics and outcomes of CMML patients who were treated at our institution. Material and methods:A retrospective cohort study examined data from 14 CMML patients between January 2013 and January 2022.Results: The median age of fourteen patients at diagnosis was 66 years (min 43-max 84 years).Only one patient (7.1%) had the JAK 2 V617F mutation.Most of the patients had CMML stage-0 disease (64.3%) and 13 patients had the proliferative type of disease.Nine patients were treated with hydroxyurea, which resulted in two responders.Eight patients were treated with azacitidine, which resulted in three responders.During follow-up, AML transformation was observed in five patients (35.7%) and the median duration between diagnosis and AML transformation was 12 months (10-33 months).In the AML-transformed group, at the time of diagnosis, the percentage of neutrophils was lower (52.5% vs 72.3%), and the percentage of monocytes was higher (27% vs 15.6%).In AMLtransformed group the total disease duration was longer (21 (11-44) vs 5 (2-48) months) than nontransformed group.Discussion and Conclusion: In patients receiving hypomethylating agents and hydroxyurea treatments for CMML, adequate response cannot be obtained.The rate of AML transformation increases with disease duration.

Introduction: Multiple Myeloma (MM) is a common hematological malignancy and various factors affect survival.Uric acid (UA) is an easily and quickly accessible laboratory test.UA has been found to affect prognosis and survival in many hematological diseases and its impact on myeloma is not widely investigated.Methods: Our retrospective study includes 106 MM patients between 2014 and 2021.The influence of UA level at diagnosis on treatment outcomes and survival of patients who received autologous stem cell transplantation (ASCT) was investigated. Results:The mean UA at diagnosis was 6.05 mg/dL, and 38.7% of our cohort relapsed after a median of 30 months of follow-up, with 22.7% dead.In survival analysis, the level of UA did not significantly differ in both progression-free survival (PFS) and overall survival (OS) (HR, 1.067; 95% CI, p=0.290,HR, 0.941; 95% CI, p=0.497, respectively).Discussion and Conclusion: In our study, regardless of the cut-off value for the UA level at the time of diagnosis, the UA level had no impact on PFS or OS in MM patients who received ASCT.

Introduction: Anemia is a serious health problem affecting one-third of the world's population. The most common etiology is iron deficiency anemia (IDA). The oral iron absorption test (OIAT) is a method that has been used for a long time to demonstrate the level of iron absorption in patients, but it has not reached widespread use in clinical practice. The study aims to analyze predictive factors of iron absorption in patients with IDA. Material and methods: A total of 108 patients between the ages of 18–65 who were diagnosed with IDA were included and patients with concomitant inflammatory bowel disease, celiac disease, history of gastrointestinal surgery, malignancy, using iron therapy, and patients with unavailable data were excluded from the study. OIAT applied to 108 patients. Results: Female patients form the majority of the cohort (n = 100, 92.6%). OIAT was administered to 54 patients in tablet form and 54 patients in capsule form. The following study compared 88 patients with adequate oral iron absorption and 20 patients with insufficient oral iron absorption. Less iron absorption was found in male patients (p = 0.04) with increasing age, and it was statistically significant (p = 0.02). Conclusion: The result of the current study demonstrated that male gender and older age have a significant impact on iron absorption. OIAT is recommended at the time of diagnosis in elderly patients and male patients so that the underlying cause can be identified without delay in the insufficient iron absorption group. Additionally, patients with oral iron absorption disorders can be diagnosed at an early stage by applying the OIAT.

Background Erdheim Chester disease (ECD) is a rare disease with multisystemic involvement in the group of non-langerhans cell histiocytosis. Although nearly 100 years have passed since its definition, the number of cases reported all over the world is below 1000. In addition to the rarity of the disease, low awareness seems to play a role in this. Case presentation 47-year-old white caucasian women patient who presented to our clinic with symptoms of weakness-fatigue as well as increasing pain in the knees and ptosis in the left eye. Result of the patient's bone biopsy, ECD was considered pathologically and BRAF V600E mutation was shown molecularly. After presenting the clinical, laboratory and other examination results of the case, the dramatic response seen with targeted therapy will be discussed. Conclusions BRAF V600E mutation is frequently seen in ECD. Vemurafenib plays an active role in targeted therapy.

OBJECTIVES To determine the frequency of head and neck lymphadenopathy (LAP) and intraoral findings (non-dental/dental) in patients with newly diagnosed acute leukemia (AL). SUBJECTS AND METHODS Twenty-eight (52.8%) females and 25 (47.2%) males in a total of 53 patients with newly diagnosed AL with a mean age of 46 years were included in the study. Personal information, the type of AL (AML [acute myelogenous leukemia]/ALL [acute lymphocytic leukemia]), and hematological findings (anemia, neutropenia, and thrombocytopenia) were obtained from medical records. One of two calibrated oral diagnosis and maxillofacial radiology specialists performed extraoral (head and neck LAPs) and intraoral (non-dental and dental) clinical examinations. The Chi-square (χ2 ) test was used to evaluate categorical variables. RESULTS LAP was observed in 22.6% and intraoral findings in 30.2% of the patients. LAP was most commonly observed in the neck and none in the parotid glands. The most intraoral findings were gingival/mucosal bleeding and oral petechiae/ecchymosis. While there was no statistical difference between AML and ALL patients in terms of LAP (p > .05), intraoral findings were observed more in patients with AML (p < .05). Only two (3.8%) patients had dental findings. With a slight difference, intraoral findings were more with thrombocytopenia and LAP with neutropenia. CONCLUSION In AL, especially non-dental intraoral findings are common. The fact that dentists working in the oral cavity are often the first specialists to encounter the oral manifestations of AL imposes an important role in early diagnosis and treatment.

a single center.The chimeric antigen receptor (CAR) T-cell therapy tisagenlecleucel targets and eliminates CD19-expressing B cells and showed efficacy against B-cell lymphomas.Patients: Between November 2020 and December 2022, a total of 25 patients with relapsed or refractory DLBCL to ≥2 lines of therapy received an infusion and were included in the analysis.Of the 25 patients, 64% were male, the median age was 48 (20-73), and ECOG was 0-1.The disease subtype includes germinal center B-cell (GCB) 52% (n=12) and activated B-cell (ABC) 48% (n=12); the disease stage was III (44%, n=11) and IV (52%, n=13).All patients received at least 2 lines of therapy; 52% received ≥ 3 lines.Relapsed after autologous stem cell transplantation in 24% (n=6).Three patients (12%) have CNS involvement which was controlled at the infusion time.All patients received lymphodepletion (LD) therapy with fludarabine and cyclophosphamide (Flu/Cy).20% (n=5) required bridging therapy before LD.Main Outcome Measures: Overall response rate (ORR), complete responses (CR), partial responses (PR).The respective toxicities include cytokine release syndrome (CRS) and neurologic events namely ICANS.Results: The best ORR was 52%; 32% of the patients had CR, and 20% had PR.The disease progression (DP) was 48%.The 2 years overall survival was 72% with 69.2% for GCB subtype.Overall progressive free survival (PFS) was 44%, and the best PFS was observed in GCB subtype 53.8%.Day-90 PET/CT ORR 44% (CR/PR) 36%/8%.DP at day 90 was 36%.The main toxicities post CAR-T cell infusion including cytokines release syndrome (CRS) was 88% with 12% grade ≥ 3, and the neurotoxicity (NT) namely was 24% with 20% grade ≥ 3. Tocilizumab was used in 60%.Two patients died from disease progression within 30 days after infusion.Conclusions: In this single-center retrospective analysis of CAR T-cell therapy in relapsed or refractory diffuse large B-cell lymphoma in adults, the rates of durable responses were like the real-world data and JULIET NCT02445248 trial outcome using tisagenlecleucel therapy

Objective: In our study, we aimed to evaluate the factors that affect the prognosis of patients with transformed lymphoma who are followed up in our clinic.Materials and Methods: Forty-five patients with transformed lymphoma who were eligible for our study were retrospectively analyzed.The preparations of the patients were confirmed by experienced pathologists with second look.Results: The majority of the primary diagnosis of the patients was follicular lymphoma.The most common type of transformed lymphoma was diffuse large B-cell lymphoma (DLBCL).The time to transformation was measured as 31 months (2-312).The number of patients who responded to the first rescue treatment after transformation was 32 (71%), and the number of refractory patients was 9 (20%).Median survival in transformed patients was 4.5 months (1-102). Conclusion:The time to transformation was measured as 31 months.In addition, heterogeneity in the diagnosis type of primary diseases and the treatments received are other reasons that may explain the difference in transformation times between studies.More studies are needed for more accurate prognostic assessment.

Background Diffuse large B-cell lymphoma (DLBCL), a heterogeneous type of lymphoma, encompasses various biologic abnormalities and numerous morphologic variants, showing several clinical findings and responses to treatments. Lactate dehydrogenase (LDH) is a well-established diagnostic and prognostic marker for DLBCL, and neutrophil/lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and mean platelet volume (MPV) have been shown to have prognostic values in several malignancies. Objectives In the study, we examined the prognostic value of LMR, NLR, LDH, and MPV in the stage and prognosis of DLBCL by analyzing the data of patients treated with rituximab-based chemotherapies. Patients and methods A total of 188 patients diagnosed as having DLBCL between January 2012 and January 2020 were selected. DLBCL stages were categorized as early and late, international prognostic index was categorized as below and above 4, and the treatment response was categorized as responders and nonresponders. NLR, LMR, LDH, MPV, and other factors predicting these outcomes were analyzed. Results Logistic regression analysis showed that the factors influencing stage of DLBCL were NLR [P=0.009, odds ratio (OR)=1.220, 95% confidence interval (CI): 1.050–1.417] and LDH (P=0.001, OR=0.286, 95% CI: 0.146–0.561). The factor influencing international prognostic index score was LMR (P=0.001, OR=6.226, 95% CI: 2.092–18.533). Factors influencing response were R-CHOP treatment (P=0.001, OR=0.181, 95% CI: 0.068–0.478) and stage (P=0.005, OR=18.306, 95% CI: 2.383–140.607). Conclusion The pretreatment LMR, NLR, LDH, and MPV values may affect the stage and prognosis of DLBCL, which showed influences on the treatment response.

BACKGROUND: Polycythemia is a common reason for patients' admissions. With the introduction of COVID-19, face masks reached very common usage in the population. Masks may cause some degree of hypoxia that may result in high hemoglobin in healthy individuals. Here, we aimed to investigate the frequency of patients applying for high hemoglobin and tested for possible polycythemia vera (PV) in the pandemic era. MATERIALS AND METHODS: We collected patients who applied to the hematology outpatient clinic between March 2019 and April 2021 for the study. The research was carried out at a single center at Ankara Oncology Training and Research Hospital. We collected demographic data such as age and sex, laboratory parameters such as complete blood count and erythropoietin level, concomitant diseases, smoking history, and spleen size. RESULTS: The median age of the cohort was 41 (16–83). Groups were different regarding age (P = 0.04). Groups were similar regarding gender (P = 0.350). Comorbidities were similar in both groups. Smoking was more frequent in the pre-COVID era group (P = 0.046). The frequency of the Janus kinase 2 (JAK2) test order was 102 examinations out of 7920 for the pre-COVID era and 152 examinations out of 6087 for the COVID era; this was statistically significant (P < 0.001). CONCLUSION: Clinicians may need to re-evaluate the threshold of hemoglobin levels to order JAK2 tests in the pandemic era, and the significance of mildly elevated hemoglobin may be neglected while testing for potential PV.

BACKGROUND: Febrile neutropenia (FN) is a serious problem, especially in hematologic malignancies, and can cause high mortality rates and it occurs in 10%–20% of patients with lymphoma. The aim of this research is to assess the risk factors for FN, and the impact of FN on overall survival (OS) in patients with diffuse large B-cell lymphoma (DLBCL). MATERIALS AND METHODS: The study included 263 patients who were diagnosed with DLBCL and treated with mostly R-CHOP-based chemotherapy. Data including gender, age, Ann Arbor stage, International Prognostic Index (IPI) score, immunohistologic subtype, treatment regimens, response to treatment, and any FN episode were recorded. The factors predicting FN were analyzed. RESULTS: Significant predictors of FN were the number of chemotherapy lines received and IPI score. The median OS was significantly different between DLBCL patients who had at least one FN episode during the first-line chemotherapy and those who did not (P < 0,001). Significant predictors of OS in the multivariate analysis were the number of chemotherapy lines received, stage, Eastern Cooperative Oncology Group, and disease status. CONCLUSION: Our study reveals that OS is significantly shorter in patients who had an FN episode than those who did not. Therefore, it is crucial to demonstrate all factors related to FN to prevent FN episodes. In our study, the number of chemotherapy lines received and IPI score was found to be significant predictors of FN. Close follow-up should be done in these patients as the risk of FN is higher.

Introduction: Complementary and alternative medicine (CAM) is often used by cancer patients, but not many studies had been published on the prevalence of CAM use in patients with hematological cancers.This study aims to determine the prevalence of CAM and type of CAM used in this group of patients.Methods: Patients who were followed up in Ankara Oncology Hospital hematology and stem cell transplant clinic were asked some questions about CAM, art therapy and spiritual support.Results: A total of 238 patients participated.The prevalence of CAM use was 29,4%.The most common types of CAM used is phytotherapy.There is no significant association of CAM use with age and gender.A higher rate of CAM use was observed in those with a low education level.It was found that those living in the provincial centers also used these treatments at a higher rate.Discussion and Conclusion: It is noteworthy that the use of CAM is less common in patients with hematologic cancer compared to other studies, patients are confused about CAM and want to get information from their physicians.It was observed that they were also interested in art therapy and spiritual support therapies.

Introduction: Immune thrombocytopenia (ITP) is an autoimmune disease and characterized with isolated low platelet count (<100x10 9 ).There is no single golden standard test for ITP diagnosis.Treatment is not indicated for all ITP patients.Corticosteroids are the first line of treatment.Rituximab, splenectomy, eltrombopag, azathioprine, cyclosporin, cyclophosphamide, dapsone, mycophenolate mofetil, and vinca alkaloid are some of the other therapeutic options.Here, we aimed to present our experience on ITP patients and treatment outcomes. Materials and methods:The data of the patients were retrieved from retrospective records between 2015-2021.The study included patients over the age of 18 who had a regular follow-up diagnosis of ITP.Patients with primary hematological malignancy and patients with unavailable data or lost follow-up were excluded from the study Results: A total of 62 patients with a diagnosis of ITP were included in the study.Treatment was indicated in 51 (82.3%) patients.All of the patients with treatment inclusion were given steroids in the first step.In ten patients who didn't respond to steroid treatment, the factors that predicted resistant treatment were explored.Age, mean platelet volume (MPV), C-reactive protein (CRP), ferritin, B12 and folic acid values were taken for analysis, no predictive factor was detected.Discussion: While steroid treatment is effective in the initial step, recurrences are common.Factors that predict steroid refractoriness seems to require larger studies.Other step treatments should be evaluated on a case-by-case basis at the time of recurrence.Patients should also be encouraged to participate in clinical trials.