Buğra Sağlam

Background: Whether patients with relapsed multiple myeloma (MM) should proceed directly to a second autologous stem cell transplantation (ASCT2) or receive re-induction chemotherapy beforehand remains uncertain. In real-world practice, treatment allocation is highly heterogeneous, and comparative data addressing the impact of pre-ASCT2 strategy on survival outcomes are limited, partly because ASCT2 is reserved for selected patients and is not routinely performed in all relapsed MM cases. We aimed to evaluate real-world outcomes of ASCT2 performed either directly at relapse or following re-induction chemotherapy in patients with relapsed MM, with a focus on progression-free survival after ASCT2 (PFS2) and overall survival (OS). Methods: We conducted a multicenter retrospective cohort study including 42 patients with relapsed MM who underwent ASCT2 between 2012 and 2024 across eight centers. Patients were grouped according to pre-ASCT2 management: those proceeding directly to ASCT2 without additional systemic therapy (direct-ASCT2, n = 21) and those receiving ≥ 1 line of salvage chemotherapy prior to ASCT2 (re-induction, n = 21). Survival outcomes were estimated using Kaplan–Meier methods and explored using multivariable Cox regression analyses. Results: The median PFS2 for the entire cohort was 19.7 months (95% CI, 7.8–31.6), with no statistically significant difference between the direct-ASCT2 and re-induction groups (21.3 vs. 13.8 months; p = 0.790). Median OS was 48.2 months (95% CI, 41.3–55.1). Although OS was significantly longer in the unadjusted analysis (51.7 vs. 39.6 months; p = 0.019), this difference was not maintained after multivariable adjustment. Post-ASCT2 response rates were comparable between groups, and day-100 transplant-related mortality was low at 2.4%. Conclusions: In this multicenter real-world cohort, pre-ASCT2 re-induction chemotherapy was not associated with a clear improvement in PFS2 compared with proceeding directly to ASCT2. Observed differences in unadjusted OS likely reflect confounding by indication and selection bias inherent to retrospective treatment allocation. These findings should therefore be interpreted as hypothesis-generating, but they add to the limited real-world evidence base on ASCT2, a salvage strategy that is typically applied to highly selected patients.

Background: The aim of the study was to investigate the impact of nutritional status, comorbidity, and performance status on patients with diffuse large B-cell lymphoma (DLBCL). Methods: A retrospective study was conducted on 112 DLBCL patients who were diagnosed at our center between 2009 and 2018. Demographic and disease characteristics and laboratory test results were recorded. Assessments were made using the age-adjusted Charlson comorbidity index (CCI-A) for comorbidity, albumin level for nutritional status, and Eastern Cooperative Oncology Group (ECOG) score for performance status. Results: The mean age of the patients was found to be 62.63 ± 15.16 years. The ECOG score of 65 patients (69.1%) was in the range of 0–1. The mean follow-up time of the patients was determined to be 25.24 ± 25.11 months, and at the end of the follow-up period, 64 patients (57.1%) were survivors. The progression-free survival (PFS), overall survival (OS), and 5-year OS rates of those with CCI-A > 4 were found to be significantly lower than those with CCI-A score ≤4 (P < 0.05). As a result of the Cox-Regression (Backward: LR method) analysis, ECOG and albumin levels were found to be independent risk factors for both OS and PFS (P < 0.05). Conclusion: This study demonstrated that CCI-A, ECOG, and nutritional status are independent prognostic markers for DLBCL patients. Initial evaluation of these patients should include all these parameters, which are easily available at the time of diagnosis.

Aim: Febrile neutropenia (FEN) is one of the most serious and commonly seen complications of patients receiving chemotherapy for a diagnosis of hematological malignancy. FEN is an emergency condition with mortality rates reaching 40% because of an increase in antimicrobial-resistant pathogens in particular. In a situation with such high mortality rates, parameters that can predict prognosis play an important role in the approach to the patient. The aim of this study was to investigate the parameters that could affect prognosis in the follow-up of FEN. Material and Methods: The study included 58 patients hospitalised in the Hematology Clinic with a diagnosis of FEN. The patients were evaluated in respect of the recorded demographic characteristics, blood group, MASCC score, hemogram, procalcitonin, C-reactive protein (CRP), Interleukin-6 (IL-6), D-dimer, fibrinogen, pre-albumin, albumin, HbA1c, anthropometric measurements and length of stay in hospital. Results: According to the statistical analysis results, patients with a length of hospital stay of ≥14 days were determined to have a significant decrease in the MASCC score and thrombocyte count and the procalcitonin, Il-6, D-dimer values and the number of antibiotics used were higher. No significant difference was determined between the groups in respect of the other parameters. Conclusion: In the management of febrile neutropenia, the most important points are the establishment of indications for hospitalisation, rapid and early recognition of a worsening status and intervention made in the right place at the right time. Parameters with prognostic benefit will help the clinician in decision-making.

Amaç: Çalışmamızda farklı hematolojik maligniteleri olan hasta gruplarında tanı anındaki serum siyanokobalamin (Vitamin B12) düzeylerinin tanıları ön görmede etkisini araştırmayı planladık.. Gereç ve Yöntemler: Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi Hematoloji poliklinik ve kliniğine 2010-2014 yılları arasında başvurmuş olan 18-75 yaş arası hematolojik malignite tanısı almış olan 201 hasta ve 30 sağlıklı kontrol grubu çalışma kapsamına alındı. Çalışma kapsamına dahil edilen hastaların demografik, klinik ve laboratuar verileri retrospektif olarak kayıt altına alınmıştır. Bulgular: Çalışmamıza 132’si erkek (%57,1) ve 99’u kadın (%42,9) olmak üzere toplam 201 hasta ve 30 sağlıklı kontrol grubu olmak üzere 231 kişi dahil edildi. Tüm hastaların ortalama serum Vitamin B12 konsantrasyonu 344,9±279,0 pg/mL olarak gözlendi. Tanı gruplarına göre Vitamin B12 düzeylerinin değerlendirmesinde ise; KML (596,0±428,3 pg/mL) ve ALL (524,5±442,6 pg/mL) hastalarında en yüksek, AML (240,9±178,0 pg/mL) hastalarında ise en düşük olduğu ve bu farklılığın istatistiksel olarak anlamlı olduğu gözlendi (p<0,001). Hastalık gruplarının Vitamin B12 düzeylerinin sağ kalım üzerine anlamlı fark saptanmamıştır. Sonuç: Hematolojik malignitesi olan hastalarda ve özellikle KML hastalarında siyanokobalamin düzeyi yüksek bulunmuştur. KML hastalığının tanısı için yüksek siyanokobalamin düzeyi hastalığı ön görmede yardımcı olabilir ancak bunun prospektif çalışmalarla deseklenmesi gerekmektedir. Anahtar Kelimeler: siyanokobalamin, KML, ALL,AML, Vitamin B12 ABSTRACT Aim: In our study, we planned to investigate the effect of serum cyanocobalamin (Vitamin B12) levels at the time of diagnosis in patients with various hematological malignancies. Patients and Methods: Two hundred and one patients between 18-75 years old diagnosed with various hematological malignancies and 30 healthy controls applying to outpatient and inpatient clinics of Hematology Department in Necmettin Erbakan University Meram Faculty of Medicine between 2010-2014 years were included in the study. Demographic and clinical data and laboratory findings of the patients included in the study were recorded retrospectively. Results: A total of 231 patients, 132 men (57.1%) and 99 women (42.9%), were included in our study, of which 201 were patients and 30 were healthy controls. The mean serum vitamin B12 concentration of all patients was found as 344.9 ± 279.0 pg/mL. When vitamin B12 levels were analyzed according to diagnostic groups, it was found to be highest in CML (596.0 ± 428.3 pg / mL) and ALL (524.5 ± 442.6 pg / mL) patients and lowest in AML patients (240.9 ± 178, 0 pg / mL); the difference was statistically significant (p <0.001). Vitamin B12 levels of diagnostic groups were found to have no significant effect on survival. Conclusion: Cyanocobalamin levels were found to be high in patients with hematological malignancies, especially in CML patients. A high level of cyanocobalamin may be helpful in prediction of CML, however prospective studies are required to support this finding.

Introduction Predictive parameters that can affect the course of this infection have been the main topic of research since the beginning of the COVID-19 (Coronavirus disease 2019) pandemic. Since the discovery of blood groups, the effect of these on infectious diseases has always been of interest. Objectives To analyze the effect of ABO blood group on mortality, hospitalization duration and hematological and cytokine storm parameters in patients with COVID-19. Patients and methods: This retrospective study was conducted on 140 patients diagnosed with COVID-19. Demographic characteristics, laboratory parameters including ABO blood group, complete blood count (CBC) parameters, biochemical tests, cytokine storm parameters, duration of hospitalization, and final status (discharge or death) were recorded. Results: The 140 patients included in the analysis comprised 72 (51.4%) males and 68 (48.6%) females with a mean age of 66.3±14.0 years. . Age and gender, hospitalization duration and mortality rates were similar in all blood group types. Only D-dimer levels were found to be higher in blood group A compared with other blood groups. Conclusion: Although no difference in mortality was determined between groups, the D-dimer level was statistically significantly higher in COVID-19 patients with A blood group. Larger studies are needed to reflect D-dimer levels on the clinical course of infection, and thus on daily practice.

Introduction Coronavirus disease 2019 (COVID-19) were declared as pandemic by World Health Organization. With this study, we aimed to define our patients who were followed up with malign or benign hematological diagnoses and diagnosed with COVID-19; determine the distribution of this infection in patient groups and contribute to the literature by creating descriptive statistics with its clinical and demographic features. Patients and methods: It is planned to retrospectively examine patients with a history of COVID-19 who were followed up in Hematology Department of Dışkapı Yıldırım Beyazıt Training and Research Hospital with benign and malignant diagnoses. Results: 88 patients who had COVID-19 infection while being followed in our clinic due to hematological diseases were included in the study. 77 patients had been followed by hematologic malignancies and 11 patients had been followed by benign hematological disease.In the group with malignancy, COVID was found most frequently in patients diagnosed with Philadelphia chromosome negative myeloproliferative neoplasms (22%), nonhodgkin lymphoma (19%) and multiple myeloma (16%). ITP (64%) was the most common disease in patients with benign hematological disorder who had COVID history. 52 (67%) of the malignant cases and 8 (73%) of the bening cases were found to be followed up with the disease in remission. The all patient's most common symptoms at COVID-19 diagnosis were fever (77%), cough (70%) and weakness (65%). 45% of the patients were isolated at home, 48% were required hospitalization. 49% of patients had mild; 27% had moderate and 24% had severe COVID-19 infection. Almost all of the patients in the moderate and severe disease group were followed up in patients diagnosed with malignant hematological disease. 16 (18%) patients received mechanical ventilation and 16 (18%) patients was transferred intensive care unit. All of the patients who were intubated and needed intensive care were diagnosed with malignant hematological disease. 17 patients died due to COVID-19 infection. The mortality rate was 22% in patients with diagnosis of malignant hematological diseases, and 19% when all patients (malignant and bening) were included. Conclusion: In conclusion, the COVID-19 pandemic is a problem all over the world. Determining the course of the disease in certain diagnostic groups is important in the management of both the main disease and the COVID-19 infection. Therefore, the contribution of such recording studies to the literature is important and valuable.