Yusuf Bilen

Background: Thrombocytopenia develops in roughly one in three intensive care unit (ICU) patients and is associated with worse outcomes. Most prognostic studies treat it as a single entity defined by platelet count (PLT) alone. We examined whether classifying the dominant pathophysiological direction (peripheral consumption versus impaired production), using admission mean platelet volume (MPV), adds prognostic information beyond the count itself. Methods: We analyzed 2188 consecutive adults admitted to a tertiary medical ICU between 2019 and 2023. Patients were classified as: normal platelet count (PLT ≥ 150 × 10⁹/L), consumption-like thrombocytopenia (PLT < 150 × 10⁹/L with elevated MPV), or production-like thrombocytopenia (PLT < 150 × 10⁹/L with normal or low MPV). The primary outcome was all-cause ICU mortality. Multivariable logistic regression adjusted for age, APACHE II score, albumin, creatinine, and malignancy. A prespecified malignancy subgroup analysis included a phenotype interaction term. Results: Of 2188 patients (median age 70 years; 57.6% male), 717 (32.8%) had thrombocytopenia; of these, 703 with available MPV were classified: 249 consumption-like and 454 production-like; the three groups were similar in age and sex distribution (p = 0.002 for age; p = 0.876 for sex). Active malignancy was present in 585 patients (26.7%) and was more frequent in the consumption-like group (34.5% vs. 25.2% PLT-normal; p = 0.008). Overall ICU mortality was 44.4% and differed across phenotypic groups (52.0% consumption-like vs. 46.7% production-like vs. 42.4% PLT-normal; p = 0.010). In the full cohort, consumption-like thrombocytopenia was independently associated with ICU death (OR 1.46, 95% CI 1.08–1.99; p = 0.016); production-like was not (OR 1.12; p = 0.302). In patients with malignancy, the adjusted OR was 2.48 (95% CI 1.37–4.48; p = 0.003); a formal interaction test was significant [interaction OR 2.12 (95% CI 1.08–4.15; p = 0.029)]. Among patients without malignancy, no association was found (OR 1.18; p = 0.397). Conclusions: Classifying thrombocytopenic ICU patients by mechanism rather than count alone identified a higher-risk subgroup. Consumption-like thrombocytopenia was independently associated with ICU death; production-like was not. The association was substantially stronger in patients with malignancy. The classification requires only the standard blood count and adds no testing burden.

Background/Objectives: The modified Endothelial Activation and Stress Index (mEASIX), derived from routinely available laboratory parameters, has emerged as a potential biomarker reflecting systemic inflammatory and endothelial stress. However, its prognostic value in myelodysplastic syndromes (MDS) remains incompletely defined. This study evaluated the association between the mEASIX and overall survival and explored its time-dependent prognostic pattern. Methods: This retrospective study included 151 patients with MDS. The mEASIX score was calculated using C-reactive protein, lactate dehydrogenase, and platelet count and was log-transformed for regression analyses. Overall survival was estimated using the Kaplan–Meier method. Univariable and multivariable Cox proportional hazards models were used to evaluate prognostic factors, including age, IPSS-R risk group, hypomethylating agent (HMA) exposure, and venetoclax exposure. The proportional hazards assumption was assessed, and landmark analyses were performed at the median follow-up time (29 months). Receiver operating characteristic analysis was used to determine the optimal mEASIX cut-off value for mortality prediction. Model comparison, internal validation, and sensitivity analyses were also performed. Results: During a median follow-up of 29 months, 85 deaths occurred. The mEASIX yielded an AUC of 0.767 for mortality prediction (95% CI 0.691–0.844; p < 0.001). Patients with a high mEASIX had inferior overall survival (log-rank p < 0.001). In multivariable Cox regression analysis including age, IPSS-R risk group, HMA exposure, and venetoclax exposure, log(mEASIX) remained independently associated with inferior overall survival (HR 1.325, 95% CI 1.166–1.506; p < 0.001). In landmark analyses, this association persisted during the early follow-up period (≤29 months; HR 1.347, 95% CI 1.172–1.548; p < 0.001) but was attenuated during the late period (>29 months; HR 1.287, 95% CI 0.930–1.782; p = 0.128). Conclusions: The baseline mEASIX was independently associated with overall survival in patients with MDS and appeared most prognostically relevant during early follow-up. These findings suggest that the mEASIX may complement established risk models, although further validation is needed before broader clinical use.

Background: Chronic lymphocytic leukemia (CLL) is a biologically heterogeneous disease characterized by variable clinical outcomes. The introduction of targeted therapies, particularly the BCL-2 inhibitor venetoclax, has significantly improved treatment outcomes in patients with relapsed/refractory (R/R) CLL. However, real-world data on the safety and effectiveness of venetoclax-based regimens remain limited. Methods: In this multicenter retrospective study, 147 adult patients with R/R CLL treated with venetoclax between April 2019 and August 2025 were analyzed. Venetoclax was administered as monotherapy or in combination with rituximab, obinutuzumab, or ibrutinib. Adverse events were graded according to CTCAE v4.0, and treatment responses were assessed based on IWCLL criteria. Survival outcomes, including overall survival (OS) and progression-free survival (PFS), were evaluated using Kaplan–Meier analysis. Results: The median age at venetoclax initiation was 64 years, and patients had received a median of two prior lines of therapy. Combination therapy was administered in 78.9% of patients. The overall response rate was 83.0%, including complete remission in 65.3% of patients. Grade ≥ 3 hematologic adverse events included neutropenia (18.4%), thrombocytopenia (14.3%), and anemia (7.5%). Tumor lysis syndrome (TLS) occurred in 28.6% of patients, predominantly during the dose ramp-up phase. At a median follow-up of 61 months, median OS and PFS were both 60 months. Bulky disease was associated with inferior survival outcomes. Conclusions: Venetoclax-based therapy is effective and well tolerated in patients with R/R CLL in a real-world setting. High response rates and durable survival outcomes were observed despite the inclusion of patients with high-risk clinical and biological features. These findings support the use of venetoclax as a key component of modern CLL treatment strategies and highlight the importance of real-world evidence in optimizing patient management.

The purpose of this study was to assess dermatological lesions in hematologic malignancy patients. Patient file records pertaining to patients diagnosed with hematologic malignancies and followed up in our center between 2019 and 2024 will be retrospectively examined for demographic information, hematologic disease diagnoses, clinical features, dermatological examination data obtained with dermatology consultation, pathology results of biopsies taken from skin lesions, and the presence of other malignancies. The study comprised 241 participants with hematologic malignancies. The male to female ratio was 1.3, and the median age was 64. Acute myeloid leukemia (AML) accounted for 24.1% of diagnoses, while multiple myeloma (MM) came in second with 18.3%. With a rate of 14.9%, dermatitis was the most frequent form of lesion, followed by drug response (14.5%). In the AML group, dermatitis and fungal infection were the most frequent lesions, while in the MM group, medication reactions were more common. Patients with malignancy experienced urticaria considerably more frequently (p=0.004). At the time of lesion development, 81.7% of the patients were receiving chemotherapy, with alkylating drugs being the most frequently utilized agents (24.9%). Twenty percent of individuals who had biopsies reported having vasculitis and drug-related dermatological responses. 98.8% of the patients received local/topical supportive treatments without stopping systemic treatment. According to this study, dermatological lesions in hematologic malignancies may be connected to the course of the disease as well as treatment. These results imply that routine follow-up for hematologic patients should include a dermatological evaluation.

Background/Objectives: Real-world data on the therapeutic use of FLT3 inhibitors in Turkey remain limited. Therefore, we retrospectively evaluated outcomes from 13 academic centers nationwide, focusing on the multikinase inhibitor midostaurin in patients with newly diagnosed FLT3-mutated acute myeloid leukemia (AML). Methods: We collected comprehensive information regarding treatment efficacy, safety, and tolerability. Results: The overall response rate to intensive chemotherapy (3 + 7) plus midostaurin was 87.7%, with a complete remission rate of 84.2%, consistent with previously reported clinical trial results. Treatment discontinuation due to intolerance or toxicity was low (3.5%). One patient discontinued therapy because of septic shock during induction, and another due to a drug–drug interaction during consolidation. Median overall survival was 21.4 months. Allogeneic stem cell transplantation was performed in first remission in 52.6% of patients. Five patients (8.8%) were refractory to induction therapy, and relapse occurred in 21.1% (12 patients). Conclusions: These findings support the effectiveness and acceptable tolerability of midostaurin in routine clinical practice for FLT3-mutated AML.

To validate patient responses to imatinib mesylate, which induces hematologic and cytogenetic remission and, consequently, modifies the progression of chronic myeloid leukemia (CML). Materials and methods: Between January 2006 and July 2009, 31 patients with chronic-phase CML were treated with imatinib therapy in the hematology unit of Atatürk University Medical Faculty Training Hospital. Imatinib treatment was begun at the standard dose of 400 mg/day, as either first-line or second-line therapy. Results: At the end of the second month of treatment, all of the patients had achieved complete hematologic response. After 12 months, the rate of complete cytogenetic response was 71%, and after 24 months, the rate of complete molecular response was 85%. The most commonly observed adverse event was edema (facial and/or peripheral). No grade 3 or 4 hematological adverse events were observed during the study period. Conclusion: Our CML patients' responses to imatinib therapy were similar to those seen in other countries, although our group had a lower rate of adverse events.