A single center cohort of 40 severe COVID-19 patients who were treated with convalescent plasma

Background/aim: A SARS-Cov2 infection which was first arised from Wuhan in December 2019 and named as COVID-19. Still there lacks either a specific treatment or a vaccine to treat COVID-19. Convalescent plasma (CP) was previously used successfully to treat SARS-CoV-1 and MERS infections. Health authority in Turkey has published a guideline to integrate this promising option in the treatment process of patients who are prone to high risk of developing severe COVID 19. Materials and Methods: Forty consecutive patients who had received CP at our center were included in the study. Demographics, COVID-19 specific parameters, biomarkers to detect the severity of COVID-19 infection and outcome variables were collected retrospectively. The correlation between outcome variables and the independent predictors of the outcome were reported. Results: Median age of the patients was 57.5 and 72.5% were male. At least one COVID-19 PCR test was confirmed to be positive in 75% of patients. Remaining 25% had a Chest-CT which was reported to be compatible with an ongoing COVID-19. All patients (100%) were classified as having severe COVID-19 infection. Over a half of the patients harbored an oxygen saturation of less than 90 despite of a continuous 5 L/min support of O2. 82.5% of the patients had a need for mechanical ventilation and 45.5% had a need for invasive mechanical ventilation. Nine out of 10 patients who have received CP outside ICU have totally recovered from COVID-19 at a median of 9 days, and a half of the patients who needed invasive mechanical ventilation were successfully free of mechanical ventilation support and managed to recover from COVID-19. Conclusion: According to the results of this study, CP is an efficient conjunct to conventional therapy against COVID-19 with a favorable safety profile.

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.

Charlson Comorbidity Index (CCI) in Diffuse Large B-cell Lymphoma: A New Approach in a Multicenter Study.

Purpose: Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of adult lymphomas. The incidence of DLBCL increases with age and has a fairly rapid fatal course without treatment. Patients often have difficulty tolerating standard chemotherapy regimens due to their comorbidities. Charlson Comorbidity Index (CCI), which is calculated by considering 19 different comorbidities, was developed in 1987 and is widely used for mortality prediction in cancer patients. Literature data on CCI and hematological malignancies are limited. Main aim in this study is to evaluate the effectiveness of CCI and compare to the International Prognostic Index (IPI) scoring system in the DLBCL patient group. Methods: A total of 170 patients diagnosed with DLBCL between 1.1.2002- 1.12.2020 were included in the study. Statistical analyzes were performed among patients whose IPI and CCI scores were recorded by considering baseline data. Results: The median age of patients was 58 (range: 17-84). Thirty-five (20.6%) patients had stage III and 76 (44.7%) had stage IV disease. When the CCI, IPI and ECOG scores were compared with the mortality status of the patients as a reference, AUCs were resulted as 0.628 (95% CI: 0.506-0.749), 0.563 (95% CI: 0.484-0.639) and 0.672 (95% CI: 0.596-0.743), respectively. There was no significant difference between the ROC curves of CCI, IPI and ECOG scores. Patients with a CCI score of ≥ 4 had shorter OS comperad to those with a score of < 4. Conclusion: Rather than claiming that CCI is superior to IPI, ECOG or another scoring system in a single-center patient population, it should be stated that CCI is also an effective scoring system in patients diagnosed with DLBCL. Supplementary Information: The online version contains supplementary material available at 10.1007/s12288-022-01567-5.

Prognostic Factors and Intensive Care Outcome in Post-Transplant Phase of Hematopoietic Stem Cell Transplantation: Intensive Care Outcome in Hematopoietic Stem Cell Transplantation.

Introduction: To identify new clinical and biologic parameters associated with short-term survival in allogeneic or autologous hematopoietic stem cell transplantation (HSCT) patients who were admitted to the intensive care unit (ICU) during their post-transplant period. Materials and methods: 40 patients who were admitted to the ICU in our center during their post-transplant period were evaluated retrospectively between Jan 2014 - Jun 2021. Baseline patient characteristics before the transplant, reasons for ICU admissions, laboratory and clinical findings, supportive treatment in ICU and short-term survival were analyzed. Results: We found 8.8% ICU admission rate in all patient group (n = 450). Mortality rate of the patients who were admitted to ICU was 75%. Invasive mechanic ventilation, need for vasopressor, heart rate was significantly different between survivor and non-survivor group (p = 0.001, p = 0.001, p = 0.004). Elevated INR was associated with poor survival on ICU (p = 0.033). APACHE II score was an independent predictor of ICU mortality (p = 0.045). Conclusion: Despite the recent advances in transplant conditioning protocols, prophylaxis strategies and improvements of management in ICU, overall survival for HSCT patients in ICU is still poor. In this study INR level was described as a new prognostic factor in ICU for first time in the literature.

Survival outcomes of hypomethylating agents maintenance therapy in new diagnosed AML patients: Real experience data.

OBJECTIVE: Acute myeloid leukemia (AML) is a hematological malignancy that frequently affects elderly population. With introducing the hypomethylating agents (HMAs) in elderly AML treatment, survival rates and quality of life have improved. However, long-term management in elderly and frail patients is still a challenge. In the present study, we aimed to determine whether HMA maintenance therapy is required until disease progression in frail and elderly AML patients by examining with a real-life data. METHODS: In a multicenter study, we analyzed non-promyelocytic elderly AML patients who were treated with first-line azacitidine or decitabine monotherapy in two different groups, retrospectively. While patients were treated with HMA until progression in the maintenance group, 6+3 cycles of azacitidine or decitabine were administered as a standard care of elderly AML patients in the non-maintenance group. Survival outcomes were compared between the groups. RESULTS: HMA therapy was maintained until progression in 20 patients, and HMA therapy was terminated after 6+3 cycles in 21 patients. Patients received a median of 6 (1-14) HMA cycles during follow-up time. The median 7.5 months of overall survival were observed (2-17 months) in maintenance and 3 months (1-13 months) in non-maintenance groups (p=0.001). CONCLUSION: Despite long-term exposure to HMA may appear as a risk factor for complications and toxicities in elderly and frail AML patients, the maintenance of therapy until disease progression provides a significant survival advantage. Therefore, we suggest that HMA therapy should continue until disease progression regardless the sort of HMA.

A Real-life Turkish Experience of Venetoclax Treatment in High-risk Myelodysplastic Syndrome and Acute Myeloid Leukemia.

INTRODUCTION: Venetoclax is a selective B-cell lymphoma 2 (BCL2) inhibitor, which is approved to treat elderly patients with newly diagnosed acute myeloid leukemia (AML) and high-risk myelodysplastic syndrome (MDS) in combination with either low-dose cytarabine (ARA-C) or hypomethylating agents. We aimed to collect and share data among the efficacy and safety of venetoclax both as a monotherapy or in combination with other drugs used to treat high-risk MDS or AML. MATERIALS AND METHODS: A total of 60 patients with a median age of 67 (30-83) years from 14 different centers were included in the final analysis. Thirty (50%) of the patients were women; 6 (10%) of the 60 patients were diagnosed with high-risk MDS and the remaining were diagnosed with AML. RESULTS: The best objective response rate (complete remission [CR], complete remission with incomplete hematological recovery (CRi), morphological leukemia-free state [MLFS], partial response [PR]) was 35% in the entire cohort. Best responses achieved during venetoclax per patient number were as follows: 7 CR, 1 CRi, 8 MLFS, 5 PR, and stable disease. Median overall survival achieved with venetoclax was 5 months in patients who relapsed and not achieved in patients who were initially treated with venetoclax. Nearly all patients (86.7%) had experienced a grade 2 or more hematologic toxicity. Some 36.7% of these patients had received granulocyte colony stimulating factor (GCSF) support. Infection, mainly pneumonia (26.7%), was the leading nonhematologic toxicity, and fatigue, diarrhea, and skin reactions were the others reported. CONCLUSION: Our real-life data support the use of venetoclax in patients with both newly diagnosed and relapsed high-risk MDS and AML.