International Forum: The Turkish perspective on apheresis activity: The Turkish apheresis registry report.

Therapeutic apheresis is an extracorporeal treatment that selectively removes abnormal cells or harmful substances in the blood that are associated with or cause certain diseases. During the last decades the application of therapeutic apheresis has expanded to a broad spectrum of hematological and non-hematological diseases due to various studies on the clinical efficacy of this procedure. In this context there are more than 30 centers performing therapeutic apheresis and registered in the apheresis database in Turkey. Herein, we, The Turkish Apheresis Registry, aimed to analyze some key articles published so far from Turkey regarding the use of apheresis for various indications.

The relationship between CHA2DS2VASc score and left ventricular apical thrombus formation in patients with acute anterior ST segment elevation myocardial infarction.

BACKGROUND: Left ventricular apical thrombus (LVAT) formation is a well-known complication of acute anterior myocardial infarction (AMI). The CHA2DS2VASc is a scoring system that has been used to estimate the risk of thromboembolism in patients with nonvalvular atrial fibrillation. This score has also been used for other clinical conditions. The aim of this study was to investigate the relationship between CHA2DS2VASc score and development of LVAT in patients with AMI. METHOD: The study population included 378 patients (mean age: 56.5 ± 12.3 years, male: 318) presenting with AMI between January 2016 and January 2020. Primary percutaneous coronary intervention procedure was performed in all patients. Initial echocardiogram was performed within 7 days of admission. All patients were evaluated with echocardiography at 3rd, 6th and 12th months. Patients were divided into two groups according to the presence of LVAT on echocardiography. RESULTS: The incidence of the LVAT was 8.5% (n = 32) during a mean follow-up time of 233.1 ± 66.7 days. The mean CHA2DS2VASc score was notably higher in patients with LVAT compared to patients in the control group (3.1 ± 1.9 vs. 1.9 ± 1.2, p < 0.001). In Cox regression analysis, high CHA2DS2VASc score, low left ventricular ejection fraction (LVEF) and the presence of LV apical akinesis/aneurysm were the independent predictors for LVAT formation. All of these parameters were associated with higher cumulative incidence of LVAT formation in Kaplan-Meier analyses (p < 0.001 for all). CONCLUSION: High CHA2DS2VASc score, low LVEF and the presence of LV apical akinesis/aneurysm may be used for LVAT risk prediction among patients presenting with AMI.

Comparison of all renal replacement therapy modalities in terms of COVID-19 infection rate & mortality in the COVID-19 pandemic and importance of home therapies.

BACKGROUND: This study aimed to compare the infection rate and infection-related mortality among all renal replacement therapies during the COVID-19 pandemics. METHODS: One thousand three hundred thirty-six end-stage renal disease (ESRD) patients who had applied for renal replacement therapy between March 2020 and January 2021 were included in the study. COVID-19 infection and mortality rates were compared between patient groups. RESULTS: The COVID-19 infection rate in the whole study group was 13.12% (n: 178). The highest infection rate was in the center hemodialysis, 16.33% (n: 139). There was no COVID-19 infection in home hemodialysis (HHD). Mortality rate was 2.87% (n: 39) in the whole cohort and 3.87% (n: 33) in center hemodialysis (CHD), 1.47% (n:5) in kidney transplant (Tx), and 0.81% (n: 1) in the peritoneal dialysis (PD) group. COVID-19 infection rate of home replacement therapy (HRT) (n: 39) patients was significantly lower than CHD (n: 139) (p < 0.001). CONCLUSION: The COVID-19 infection rate and mortality were significantly lower than those of CHD in all home-based modalities subgroups.

Evaluation of the relationship between diabetic retinopathy and left atrial deformation parameters.

BACKGROUND: Left ventricular systolic dysfunction (LVSD) may develop without coronary artery disease, hypertension (HT), or valvular pathologies in patients with diabetes mellitus (DM), which is defined as diabetic cardiomyopathy (DCM) and its pathophysiology is still unclear. Diabetic retinopathy (DR) is a microvascular complication of DM, and patients with DR have increased risk for the development of heart failure (HF). Two-dimensional speckle tracking echocardiography (2D-STE) evaluates longitudinal deformation in left atrium (LA) myocardium and previous studies utilizing 2D-STE have revealed the detrimental effects of DM on LA functions. Although some studies have shown the association between DR and left ventricle (LV) systolic functions, as far as the researchers of this study investigated, there is no study evaluating the relationship between LA deformation parameters and DR. Hence, we aimed to investigate the relationship between the presence and the degree of DR and LA deformation parameters. RESULTS: LA deformation parameters were analyzed in terms of LA reservoir, conduit, and contractile functions according to the degree of DR. LA reservoir strain value was 14.2 ± 3.6 in normal retina group, 12.2 ± 4.1 in non-proliferative diabetic retinopathy (NPDR) group, and 13 ± 3.7 in proliferative diabetic retinopathy (PDR) group (P = 0.04). LA contractile strain was 15.9 ± 6.8 in normal retina group, 13.1 ± 47.4 in NPDR group, and 9.9 ± 4.7 in PDR group (P < 0.001). LA conduit strain was 30.1 ± 6.6 in normal retina group, 25.3 ± 6.5 in NPDR group, and 22.9 ± 4.9 in PDR group (P < 0.001). Proportional odds regression for association between clinical data, echocardiographic parameters, and LA contractile strain function showed that increasing creatinine (from 0.7 to 1.0; OR 0.71; 95% CI 0.51-0.99; P = 0.04), DR presence (OR 0.24; 95% CI 0.11-0.50; P = 0.001), and increasing left atrial volume index (LAVI) (from 33.5 to 52.6; OR 0.62; 95% CI 0.43-0.89; P = 0.01) were associated with decreasing LA function; however, other variables indicated no association. CONCLUSIONS: Our results showed the relationship between LA deformation parameters and DR, although microvascular involvement is not a certainly defined cardiovascular risk factor. Further prospective studies are needed to determine the clinical importance of DR presence and its degree for deformation parameters.

Mean Platelet Volume Significantly Decreases in the Remission Period of Systemic Lupus Erythematosus Patients with Renal Involvement.

Systemic lupus erythematosus (SLE) is a disease of the immune system with an unknown etiology. It is a unique disease that has a wide range of clinical and laboratory findings according to the organ or system involved and the activity of the disease. Mean platelet volume (MPV) is a simple parameter of the blood and is widely and easily available. It has been evaluated as a sign of inflammation in many kinds of diseases recently. In this study, we retrospectively analyzed the laboratory parameters and clinical features of 36 SLE patients with renal involvement and nephrotic-range proteinuria in the active and remission periods of the disease between 2005 and 2013. We found that the mean MPV in the active disease of the period was statistically significantly higher than in the remission period (8.30 ± 1.09 and 7.88 ± 0.7, respectively, P = 0.007).

Can keto/amino acids reduce oxidative stress in peritoneal dialysis patients with hypoalbuminemia?

INTRODUCTION: There is no consensus on an ideal marker of oxidative stress (OS). Disruption of the balance between free radical and antioxidant activity production by increasing oxidative markers results in OS. In this study, we aimed to investigate how OS, which increases mortality and morbidity due to various reasons, is affected by keto/amino therapy in patients with hypoalbuminemia undergoing peritoneal dialysis. MATERIALS AND METHOD: Twenty patients who underwent peritoneal dialysis were included in the study. Before starting keto/amino acid therapy, primary kidney diseases were determined, body mass indexes, serum total protein, albumin, C-reactive protein, ferritin, calcium, phosphorus, parathyroid hormone, paraoxonase-1 (PON-1), sialic acid levels, arylesterase (ARE) activities, and malondialdehyde (MDA) levels were measured, and Kt/V values were calculated. Keto/amino acid treatment was initiated for those with an albumin level of <3.5 g/dL. The same parameters of the patients, followed up for 3 months, were checked again at the end of the third month. RESULTS: Paraoxonase-1 and ARE activities, which are antioxidant enzyme activities, were found to be statistically significantly increased compared to the initial period (59 ± 59, 135 ± 69, 15.8 ± 19.7, and 44.7 ± 16.4, respectively; p < 0.00). MDA and sialic acid levels were significantly lower than the initial values (109 ± 99, 23 ± 9, 2.26 ± 0.44, and 2.04 ± 0.39, respectively; p < 0.01). CONCLUSION: In our study, after the initiation of keto/amino acid treatment, PON-1, which is a significant antioxidant marker, and ARE plasma activities increased and tissue destruction product MDA and sialic acid significantly decreased. In the light of all these data, we think that this treatment can reduce OS, improve hypoalbuminemia, which causes both mortality and morbidity in patients, improve survival in PD patients, and may be an antioxidant treatment in suitable patients.

Case Report: Severe COVID-19 Pneumonia in a Patient With Relapsed/Refractory Hodgkin's Lymphoma.

First identified in China in December 2019, coronavirus disease 2019 (COVID-19) has rapidly evolved into a global pandemic. The presence of haematological malignancies are expected to increase the risk of adverse outcomes from this viral infection due to the immunosuppression brought about by the underlying cancer and the effects of therapy. We present a 55-year-old woman diagnosed with relapsed/refractory Hodgkin's lymphoma (HL) who had been heavily pretreated with multiagent chemotherapy, autologous hematopoietic stem cell transplantation (autoHCT), allogeneic hematopoietic stem cell transplantation (alloHCT) and was complicated with EBV associated posttransplant lymphoproliferative disease (PTLD) and chronic graft-versus-host-disease (GVHD). The patient was recently treated with brentuximab and donor lymphocyte infusion (DLI) for relapse after alloHCT. She suffered from severe COVID-19 pneumonia and eventually succumbed to acute respiratory distress syndrome (ARDS) and multiorgan failure. Of note, this is the first reported case of COVID-19 in a HL patient who was being treated with brentuximab for relapse after alloHCT.

Right ventricular free wall perforation during pericardiocentesis, and an inappropriate device selection for percutaneous treatment.

Right ventricular (RV) perforation is a rare but life-threatening complication of pericardiocentesis and is usually treated surgically. We presented a case of RV free wall perforation, which occurred during pericardiocentesis and tried to be closed percutaneously with the Amplatzer vascular plug-III (AVP-III) device. The occluder device sealed the perforation, but it was in an insecure position; therefore, the patient underwent surgical repair. As an AVP-III device, with a middle disk thicker than the RV myocardium, it may cause the RV myocardium to stretch outwards, so it should not be used for the treatment of RV perforation by the transcatheter way.

Nodular lymphocyte predominant Hodgkin's lymphoma in daily practice: A multicenter experience.

Nodular lymphocyte predominant Hodgkin's lymphoma (NLPHL) is a rare subtype of Hodgkin's lymphoma. In this study, we aimed to investigate the clinical features and therapeutic outcomes of patients with NLPHL who were diagnosed at different institutes in Turkey. We retrospectively reviewed the records of the patients diagnosed with NLPHL. Adult patients who were diagnosed after 2005 with histological confirmation were selected for the study. Forty-three patients were included in the study. Median age of patients was 37.5 years (18-70) at the time of diagnosis. About 60.5% patients were diagnosed as stage I and II NLPHL, and remaining 39.5% had stage III and IV disease. Median follow-up was 46 months. During follow-up, none of the patients died. Seven patients relapsed or progressed after initial therapy at a median of 12 months. Five of 7 relapsed/refractory patients (71.4%) were salvaged with chemotherapy only (DHAP, ICE), and the remaining 2 (28.6%) were salvaged with chemoimmunotherapy. All of relapsed/refractory patients were able to achieve complete remission after salvage therapy. Lactate dehydrogenase levels were significantly higher in patients with progressive disease compared with nonprogressive disease. Our study showed an excellent outcome with all patients alive at last contact with a median follow up of 46 months despite a wide range of different therapeutic approaches. All relapsed and refractory patients were successfully salvaged despite a low frequency of patients received immunotherapy in conjunction with chemotherapy. Our results suggest that immunotherapy may be reserved for further relapses.

The effects of dual and triple combinations of trandolapril, telmisartan, and verapamil on overt proteinuria in the patients with diabetic nephropathy.

Diabetic nephropathy (DN) is one of the most important causes of the end-stage renal failure and its prevalence is found to be increasing. The presence of hypertension and progressive proteinuria is among the important findings. In this study, the effects of double and triple combinations of trandolapril, telmisartan, and verapamil on proteinuria were investigated in diabetic patients with nephropathy. Seventy-eight patients (mean age: 56.11 ± 11.26 years; 47 females and 31 males) with overt proteinuria and DN were included in this study. The patients were divided into four groups: Group I (n: 18, trandolapril + telmisartan), Group II (n: 20, trandolapril + verapamil), Group III (n: 20, trandolapril +telmisartan + verapamil), and Group IV (n: 20, telmisartan + verapamil). At the end of a three-month therapy, within and between group comparisons were done about the effects of the use of double or triple drug combinations on proteinuria, glomerular filtration rate (GFR), electrolytes, serum albumin, low-density lipoprotein (LDL)- cholesterol, and HbA1C. There was no significant difference among groups in terms of age, gender, diabetes duration, body mass index, and retinopathy frequency. The decreases in proteinuria and mean arterial blood pressure (MABP) were significant in all groups. The decrease in proteinuria was independent of the decrease in MABP [the reduction rate in proteinuria was 39% (P <0.001) in Group I, 37% (P <0.001) in Group II, 42% (P <0.001) in Group III, and 43% (P <0.001) in Group IV; the reduction rate in MABP was 10.6% (P <0.001) in Group I, 13.7% (P <0.001) in Group II, 17.5% (P <0.001) in Group III, and 15.4% (P <0.001) in Group IV]. Decrease in HbA1C (before and after treatment) was significant in Groups III and IV when com- pared to Groups I and II. Any adverse event, like hyperkalemia, was not observed. There was no significant difference among the groups in terms of GFR, LDL-cholesterol, albumin, and potassium. All the patients tolerated the drugs well. In conclusion, in patients with DN, both double or triple combinations of trandolapril, telmisartan and verapamil resulted in significant decreases in proteinuria and MABP. Triple combinations did not have any superiority over double combinations. Therefore, the suitable drug combinations may be chosen according to the clinical status of a patient.

Cystic isolated lymphoma of the base of the tongue: A case report.

Isolated lymphoma of the base of the tongue is a relatively rare condition. The clinical presentation may vary from a submucosal mass with a cystic appearance to an ulcerated lesion. In the present case, a cystic mass was identified in a patient admitted with a sore throat. Pathological examination confirmed diffuse large B-cell lymphoma. The clinical and pathological picture of lymphomas covers a wide spectrum and the rate of occurrence in the oral cavity is 3-5%. Among all malignant tumors of the oral cavity, lymphomas represent the third most common type of tumor, following squamous cell carcinoma and salivary gland neoplasms. Lymphomas of the oral cavity mostly arise from the Waldeyer ring, which is a lymphoid tissue. In our case, no recurrence was observed during the 8-month follow-up period after the patient was administered chemotherapy followed by radiotherapy. In conclusion, although isolated lymphoma of the base of the tongue is extremely rare, it should always be considered in patients presenting with a sore throat and the sensation of a foreign body in the throat.

Primary central nervous system lymphoma in daily practice and the role of autologous stem cell transplantation in relapsed disease: A retrospective multicenter study.

We investigated the course of 54 patients presenting with primary central nervous system lymphoma, who were treated in daily practice. The patients were treated with chemotherapy and/or radiotherapy and/or intrathecal chemotherapy. At a median follow-up period of 23 months (range 1-71), median relapse-free survival (RFS) and overall survival (OS) were not reached. Estimated 2-year RFS and OS rates were 42% and 48%, respectively. Ten relapsed PCNSL patients underwent ASCT. Complete remission rate of these patients was 40%, with 20% treatment-related mortality. Estimated 2-year RFS and OS rates were 37% and 40%, respectively. The prognosis of patients with PCNSL, who received off-study treatment, is still dismal.

Prognostic Value of Baseline Neutrophil-Lymphocyte and Platelet-Lymphocyte Ratios in Local and Advanced Gastric Cancer Patients.

BACKGROUND: We aimed to investigate the prognostic value of baseline neutrophil, lymphocyte, and platelet counts along with the neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) in local and advanced gastric cancer patients. MATERIALS AND METHODS: In this retrospective cross-sectional study, a total of 103 patients with gastric cancer were included. For all, patient characteristics and overall survival (OS) times were evaluated. Data from a complete blood count test including neutrophil, lymphocyte, monocyte, white blood cell (WBC) and platelet (Plt) count, hemoglobin level (Hb) were recorded, and the NLR and PLR were obtained for every patient prior to pathological diagnosis before any treatment was applied. RESULTS: Of the patients, 53 had local disease, underwent surgery and were administered adjuvant chemoradiotherapy where indicated. The remaining 50 had advanced disease and only received chemotherapy. OS time was 71.6±6 months in local gastric cancer patients group and 15±2 months in the advanced gastric cancer group. Univariate analysis demonstrated that only high platelet count (p=0.013) was associated with better OS in the local gastric cancer patients. In contrast, both low NLR (p=0.029) and low PLR (p=0.012) were associated with better OS in advanced gastric cancer patients. CONCLUSIONS: This study demonstrated that NLR and PLR had no effect on prognosis in patients with local gastric cancer who underwent surgery and received adjuvant chemoradiotherapy. In advanced gastric cancer patients, both NLR and PLR had significant effects on prognosis, so they may find application as easily measured prognostic factors for such patients.

Multicenter retrospective analysis regarding the clinical manifestations and treatment results in patients with hairy cell leukemia: twenty-four year Turkish experience in cladribine therapy.

In this multicenter retrospective analysis, we aimed to present clinical, laboratory and treatment results of 94 patients with Hairy cell leukemia diagnosed in 13 centers between 1990 and 2014. Sixty-six of the patients were males and 28 were females, with a median age of 55. Splenomegaly was present in 93.5% of cases at diagnosis. The laboratory findings that came into prominence were pancytopenia with grade 3 bone marrow fibrosis. Most of the patients with an indication for treatment were treated with cladribine as first-line treatment. Total and complete response of cladribine was 97.3% and 80.7%. The relapse rate after cladribine was 16.6%, and treatment related mortality was 2.5%. Most preferred therapy (95%) was again cladribine at second-line, and third line with CR rate of 68.4% and 66.6%, respectively. The 28-month median OS was 91.7% in all patients and 25-month median OS 96% for patients who were given cladribine as first-line therapy. In conclusion, the first multicenter retrospective Turkish study where patients with HCL were followed up for a long period has revealed demographic characteristics of patients with HCL, and confirmed that cladribine treatment might be safe and effective in a relatively large series of the Turkish study population.

Combined immune thrombocytopenic purpura and immunoglobulin A nephropathy: a similar pathophysiologic process?

IgA nephropathy is one of the most common forms of glomerulopathies. It is an immune complex-mediated glomerulonephritis diagnosed by the presence of mesangial IgA deposits that are often associated with mesangial cell proliferation. The IgG, C3, IgM, or other immunoglobulin light chains may be co-existed with IgA. Its pathogenesis suggested that it is responsible for enhancing the production of proinflammatory cytokines, chemokines, and growth factors. Platelet-derived growth factor (PDGF) has also been implicated as a modulator of disease activity. Immune thrombocytopenic purpura (ITP) is a bleeding disorder caused by thrombocytopenia that is not associated with a systemic disease. Its pathogenesis suggested an autoimmune disease in which IgG is thought to damage megakaryocytes, which are the precursors of platelet cells. Several studies reported that PDGF levels were higher in normal subjects than in patients with ITP. Moreover, ITP is a disease related to the antibody. Thus, our aim is to examine whether a similar pathophysiological relationship exist between ITP and IgAN that may be mediated by PDGF and/or IgG.

DCE-MRI findings of invasive aspergillosis in patient with acute myeloid leukemia.

Thoracic radiography and high resolution computerized tomography is used to diagnose pulmonary infections in immunosuppressed patients, although in some cases these do not provide enough information about the lesion. Dynamic contrast-enhanced magnetic resonance imaging may be useful in these cases, especially for the characterization of cavitary lesions and assessment of their contrast diffusion.

Does decreased mean platelet volume predict inflammation in chronic renal failure, dialysis, and transplanted patients?

OBJECTIVES: Increased platelet activation contributes to cardiovascular mortality in chronic kidney disease patients (CKD). Larger platelets are more active and this increased activity had been suggested as a predictive biomarker for cardiovascular disease. In this study, we aimed to evaluate mean platelet volume (MPV) as an inflammatory marker in a broadened group of CKD patients. Our study is unique in literature as it covers all types of CKD including renal replacement therapies. MATERIALS AND METHODS: 200 patients (50 renal transplanted, 50 hemodialysis, 50 peritoneal dialysis, 50 chronic renal failure stages 3-4) were investigated who were between 18 and 76 years of age. The collected data included demographic properties, platelet count, MPV, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and hemoglobin. All of the patients had at least 12 month of therapy of either renal replacement modality. RESULTS: The mean CRP value was detected statistically significantly higher in hemodialysis (HD) patients compared to the resting three groups of patients (p < 0.01). Mean CRP level was detected significantly higher in the pre-dialysis group compared to transplanted and peritoneal dialysis (PD) patients (p < 0.01). There is no statistically significant difference detected among the mean MPV values of all patient groups (p > 0.05). CONCLUSIONS: ESR and CRP were significantly increased in hemodialysis patients compared to the other groups. We did not detect a significant difference among MPV between the groups. ESR was detected lowest in transplanted patients. Transplantation is coming forward as the favorable choice of renal replacement therapy which decreases inflammation.

Peritonitis incidence was correlated with duration of peritoneal dialysis rather than leptin or neutrophil to lymphocyte (n/l) ratio in peritoneal dialysis patients.

OBJECTIVE: End stage renal disease (ESRD) has a high worldwide prevalence and incidence. Peritonitis is one of the leading causes of hospitalization in peritoneal dialysis patients. Although inflammatory markers show increased inflammatory responses, cellular immune response was decreased in ESRD patients. Leptin is an adipocyte-derived hormone that has activity in energy, nutrition and immune system. Neutrophil to lymphocyte ratio (N/L) was emerged as a predictive and prognostic criterion in many instances. In this study, we aimed to investigate the relationships between increased inflammation in peritoneal dialysis patients and leptin, N/L ratio. MATERIALS AND METHODS: Forty-one ESRD patients, who were been at least 12 months of peritoneal dialysis therapy, were included in the study. Patients' demographic properties were recorded. Serum leptin level, WBC count, C-reactive protein, erythrocyte sedimentation rate and biochemical markers were measured. Patients with active viral or bacterial infection, malignancy, inflammatory disease, immunosuppressive medication users were all excluded from the study. Age and sex-matched healthy control group was included in the study only for their leptin levels. RESULTS: The measured mean serum leptin level of the patient group was statistically significantly higher than control group (1624.88±1608.16 and 416±439.85). The calculated mean peritonitis incidence was 0.041±0.047 peritonitis/per year. The number of peritonitis attack was significantly correlated with duration of peritoneal dialysis, body mass index (BMI), age and presence of cardiovascular disease. Serum leptin level was significantly correlated with sex, age, primary cause of ESRD, BMI, blood glucose level and duration of peritoneal dialysis (PD). CONCLUSION: We detected that ESRD patients have higher serum leptin levels compare to healthy adults. Increased leptin was correlated with sex, age, BMI, primary cause of ESRD and serum glucose level. Number of peritonitis attack and peritonitis incidence was significantly correlated with the duration of PD, BMI and sex. We weren't able to show the predictive N/L value in PD patients in case of peritonitis.

Treatment of pure red-cell aplasia with cyclosporine in a renal transplant patient.

Acquired pure red-cell aplasia is a rare disorder that can be either idiopathic or associated with certain autoimmune diseases, pregnancy, lymphoproliferative disorders, nutritional deficiencies, or medicines. We present a deceased-donor renal transplant patient who developed pure red-cell aplasia associated with mycophenolate mofetil or tacrolimus and was treated with cyclosporine. A 20-year-old woman was transplanted from a deceased donor 1 month earlier and presented to us with symptoms of fatigue, prostration, and palpitation. The results of a laboratory examination revealed anemia. A diagnostic work-up resulted in a diagnosis of pure red-cell aplasia. Mycophenolate mofetil was discontinued. Tacrolimus also was replaced with cyclosporine 2 months after mycophenolate mofetil was halted because of a lack of improvement in anemia. Three months later, her anemia improved with cyclosporine. Starting cyclosporine instead of tacrolimus or mycophenolate mofetil showed good improvement in our patient within 6 months of therapy.

Low-dose cytosine arabinoside-induced syptomatic bradycardia in a patient with acute myeloid leukemia.

Cytosine arabinoside (Ara-C) is one of the critical agents for the treatment of acute myeloid leukemia (AML). The toxicity profile of Ara-C is highly dependent on the dose and schedule of administration. Cardiologic complications associated with Ara-C are rare. These side effects were reported with high doses of cytarabine (1-3 g/m2, 6-12 doses) in the literature. Herein, we report a patient who developed symptomatic sinus bradycardia while receiving low-dose Ara-C therapy for AML. A 45-year-old female patient diagnosed with AML was treated with standard remission induction chemotherapy protocol that includes 3 days of anthracycline and 7 days of low-dose (100-200 mg/m2 2-1) Ara-C. The same chemotherapy regimen was applied again on the 15th day of admission. During the second chemotherapy cycle, the patient developed symptomatic sinus bradycardia. All causes except Ara-C were excluded after required investigational procedures. Ara-C infusion was discontinued for a while and after her symptoms passed chemotherapy was completed with atropine support. Cardiac toxicity is scarce with Ara-C. We want to remind that clinicians should be aware of this potential toxic manifestation even in low doses of the medication, especially as Ara-C is widely used in the treatment of leukemia. .