Is neutropenic fever an obstacle to effective stem cell harvesting?

INTRODUCTION: Autologous stem cell transplantation (ASCT) is a well-established consolidation treatment for many hematologic cancers which delivers prolonged survival. A subset of patients' adequate stem cell harvest is not achievable with a solitary use of granulocyte colony-stimulating agents (G-CSF). Generally, chemomobilization is employed for patients failing G-CSF and its most feared complication febrile neutropenia (FN). MATERIALS AND METHODS: Here, we aimed to investigate the impact of the FN in chemomobilization on apheresis outcomes and engraftment. One hundred and eighty-three patients with the diagnosis of lymphoma or myeloma who underwent chemomobilization between 2015 and 2020 were included in the study. RESULTS: Forty-three patients experienced FN. All patients received G-CSF. All myeloma patients were mobilized with 4 g/m2 cyclophosphamide, but it was heterogeneous for lymphoma patients. The precollection blood counts, harvested CD34+ hematopoietic stem cells (HSCs)/kg, apheresis count, and engraftment durations were recorded. Preapheresis leukocyte and platelet were lower in the FN group (P = 0,004 and P = 0,001). Peripheral CD34 HSCs and total harvested CD34 HSCs were similar among groups (P = 0.25 and P = 0.9). More apheresis was needed in the FN group, but it was not significant (P = 0.07). Undergoing ASCT was similar (P = 0.7); however, platelet and neutrophil engraftment durations were slower in the FN group (P = 0.05 and P = 0.001). CONCLUSION: Harvesting sufficient CD34+ HSCs from patients with FN is still feasible; however, FN treatment should begin promptly, and further apheresis sessions may be required.

The impact of using SGLT-2 inhibitor on left ventricular longitudinal strain and NT-proBNP levels during six-month follow-up in diabetic patients with and without coronary artery disease with preserved ejection fraction.

BACKGROUND: Optimal glycemic control is necessary to prevent cardiovascular events in patients with type 2 diabetes. The positive impact of sodium-glucose cotransporter-2 inhibitors (SGLT2i) on cardiovascular events and mortality in these patients has been demonstrated by previous studies although the mechanism is unclear. AIMS: We aimed to compare the influence of SGLT2i on left ventricular remodeling and strain in diabetic patients with coronary artery disease (CAD) and without CAD during 6-month follow-up. METHODS: Between October 2021 and June 2022, 100 diabetic patients with preserved ejection fraction (HbA1c levels 6.5-10%) were started on SGLT2i (empagliflozin or dapagliflozin) and were prospectively followed up. Conventional and speckle-tracking echocardiography was performed by blinded sonographers, at baseline and then at 1 month and 6 months of treatment. After 6 months, the initial and biochemical blood tests were administered, and N-terminal pro-B-type natriuretic peptide levels of the patients were measured. RESULTS: Patients with CAD were older (P = 0.008), more frequently hypertensive (P = 0.035), and had dyslipidemia (P = 0.021). N-terminal pro-B-type natriuretic peptide levels did not change significantly after treatment in both groups. Left ventricular ejection fraction, global, 2-chamber, and 3-chamber strain values were improved significantly following SGLTi administration for the overall patient cohort, regardless of CAD status (P < 0.05 for all groups). CONCLUSIONS: Treatment with SGLT2i resulted in improvement in left ventricular strain parameters, which indicates that they might have a positive impact on outcomes for diabetic patients with preserved EF.

Prevalence of hazardous alcohol consumption and evaluation of associated factors in university students.

PURPOSE: The aim of the study was to determine the prevalence of hazardous alcohol consumption (HAC) according to gender among university students and associated factors. METHODS: This is a cross-sectional study conducted on undergraduate students. We used a stratified sampling technique to represent 26036 students from all grade levels and 11 faculties, and the survey was administered to 2349 undergraduate students. The prevalence of HAC was determined with the Alcohol Use Disorders Identification Test (AUDIT). HAC was defined as getting 8 points or more from the AUDIT. Multivariate logistic regression analyses were performed to examine HAC related factors in both genders. RESULTS: In this study, 53.2% of the participants were male. The prevalence of HAC in the study group was 13.5% and prevalence of lifetime drinker was 65.3%. In males; those whose fathers [OR = 1.72; 95% CI: (1.17-2.52)], mothers [1.49; (1.02-2.18)], close friends [2.42; (1.28-4.60)] drink alcohol and smoking [3.16; (2.09- 4.77)], use illicit substance [2.35; (1.66-3.34)], have mental health problems [1.65; (1.04-2.62)] were more likely to report HAC. Meanwhile in females, those whose fathers [OR = 1.92; 95%CI: (1.03-3.57)], close friends [5.81; (1.73-19.45)] drink alcohol and smoking [4.33; (2.31-8.15)], use illicit substance [4.34; (2.34-8.06)] have mental health problems [3.01; (1.67-5.43)] were more likely to report HAC. CONCLUSIONS: HAC prevalence is high among university students. The risk of HAC increases with the use of alcohol in family and circle of friends, smoking, illicit substance use and mental health problems. The factors associated with the risk of HAC in both genders are similar.

Is an earlier strategy for harvesting peripheral blood stem cells in healthy allogeneic donors feasible?

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.

Turkish validity and reliability of telemedicine awareness, knowledge, attitude and skills questionnaire.

OBJECTIVE: The aim of the study is to investigate the validity and reliability of the "Telemedicine Awareness, Knowledge, Attitude, and Skills (AKAS) of Telemedicine" questionnaire and to convert the questionnaire to Turkish. METHODS: The study is methodological research conducted among medical faculty students and medical residents. For the validity and reliability analysis of the "AKAS of Telemedicine" questionnaire, 425 medical faculty students and medical residents were included in the study, and the sample was 7-10 times the number of questionnaire items. Exploratory factor analysis was performed for construct validity. The test-retest method was engaged to assess reliability. Cronbach's alpha reliability coefficient and the item-total correlation coefficient were calculated for internal consistency. Descriptive statistics were given as mean, standard deviation, median, and first and third quartile values for numerical variables, and numbers and percentages for categorical variables. The Mann-Whitney U test, the Kruskal-Wallis test, and Spearman's correlation coefficient were conducted to evaluate the correlation between variables. RESULTS: The Cronbach alpha reliability coefficient of the "AKAS of Telemedicine" questionnaire was found to be 0.950, 0.851, 0.970, and 0.952 in the sub-areas, respectively. When an item was removed, the Cronbach alpha reliability coefficient values ranged between 0.826 and 0.969, and no significant difference was detected. As a result of test-retest reliability analysis, a strong positive correlation was found between the total scores (awareness r=0.848, knowledge r=0.792, attitude r=0.787, and skill r=0.816; p<0.001 for each score). CONCLUSION: The Turkish form of the "AKAS of Telemedicine" questionnaire is a valid and reliable measurement tool that can be used to evaluate the level of AKAS among physicians. It was concluded that research using the "AKAS of Telemedicine" questionnaire would be useful to determine the telemedicine AKAS levels among Turkiye, particularly in health sector workers.

Public health literacy in primary users in western Turkey.

BACKGROUND: Public health literacy (PHL) is a novel perspective on health literacy (HL). Differing from HL's individualist approach, PHL is concerned with public health events and promoting health in the whole society. OBJECTIVES: To evaluate PHL, a newly developed concept, and related factors. METHODS: In this cross-sectional study, people who visited primary healthcare centers in urban and rural settings were recruited using a questionnaire that includes Public Health Literacy Knowledge Scale (PHLKS) and Adult Health Literacy Scale (AHLS). Out of four Primary Healthcare Centers (PMCs) in western Turkey selected randomly, one PMC was located in a rural setting, while three PMCs were located in an urban setting. Multiple linear regression was used to determine the predictors for PHL. RESULTS: The study group consisted of 1672 people, of which 55.3% were male. The mean age was 40.94 ± 15.22. The median score (min-max) from PHLKS was 13.0 (0-17). Multiple linear regression showed that income level had a negative impact on PHL. Higher education, fondness for reading, hospital admission and HL, however, increased PHL levels. Additionally, living in an urban area and not having auditory problems were positively associated with PHL. CONCLUSIONS: Participants had a moderate level of PHL. Improving PHL should be a priority to tackle global and local problems that have an adverse effect on community health. To increase community engagement in public health events, people with low education and HL levels should be targeted in future training programs.

Could We Predict POAF With a Simple Ambulatory Oscillometry Evaluating Aortic Stiffness?

OBJECTIVE: To investigate the relationship between aortic stiffness and postoperative atrial fibrillation (POAF) in patients undergoing coronary artery bypass grafting (CABG). METHODS: This study included 110 patients undergoing elective isolated CABG. Aortic stiffness was measured using a noninvasive oscillometric sphygmomanometer before surgery. Characteristics of patients with and without POAF were compared. RESULTS: POAF developed in 32 (29.1%) patients. Patients with POAF were older (63.7±8.6 vs. 58.3±8.4; P=0.014). Chronic obstructive pulmonary disease (COPD) was more common in patients with POAF (11.5% vs. 37.5%; P=0.024), whereas the frequency of hypertension, diabetes mellitus, smoking, and previous coronary artery disease did not differ. C-reactive protein and cholesterol levels were similar between patients with and without POAF. Left atrial diameter was greater in patients with POAF (35.9±1.6 vs. 36.7±1.7; P<0.039). Peripheral (p) and central (c) systolic and diastolic blood pressures were also similar between the groups, whereas both p and c pulse pressures (PP) were greater in patients with POAF (pPP: 44.3±11.9 vs. 50.3±11.6; P=0.018, cPP: 31.4±8.1 vs. 36.2±8.9; P=0.008). Pulse wave velocity (PWV) was significantly higher in POAF (8.6+1.3 vs. 9.4+1.3; P=0.006). PWV, pPR and COPD were independent predictors of POAF in multivariate regression analysis. In receiver operating characteristic analysis, PWV and pPP have similar accuracy for predicting POAF (PWV, area under the curve [AUC]: 0.661, 95% confidence interval [CI] [0.547-0.775], P=0.009) (pPP, AUC: 0.656, 95% CI [0.542-0.769], P=0.012). CONCLUSION: COPD, PWV, and PP are predictors of POAF. PP and PWV, easily measured in office conditions, might be useful for detecting patients with a higher risk of POAF.

Analysis of Coronary Angiography and Revascularization Rates Made Over 5 Years in Public Institutions in Türkiye.

BACKGROUND: Coronary angiography is currently the gold standard anatomic imaging method used to diagnose obstructive epicardial coronary artery disease. In patients with critical coronary stenosis, surgical or percutaneous revascularization is provided. Normal coronary artery ratio in coronary angiography is an indirect indicator of patient selection quality. The aim of our study is to evaluate the efficiency of coronary angiography by examining the revascularization rates according to years in patients who underwent coronary angiography. METHODS: Revascularization rates will be determined by analyzing retrospectively the number of patients who underwent coronary angiography in our country between 2016 and 2021 and were revascularized interventionally or surgically. The number of patients who underwent percutaneous, surgical, and total revascularization were proportioned to the number of coronary angiography, and their percentages were determined. RESULTS: From 2016 to 2019, there was a continuous increase in the number of coronary angiography. In 2020, the lowest coronary angiography numbers (n = 222.159) of the last 6 years were seen with the effect of the COVID-19 pandemic. In 2021, it was observed that the number of coronary angiography increased again with the relaxation of pandemic measures and the approaching of hospital admissions to old levels. It is seen that revascularization is performed in up to one-third of the patients who underwent coronary angiography. CONCLUSION: Similar to the rest of the world, revascularization rates as a result of coronary angiography procedures performed in our country are low. With this result, it should not be concluded that coronary angiography is not used effectively; on the contrary, the efficiency of coronary angiography can be increased by more effective use of noninvasive tests.

Could We Predict POAF With a Simple Ambulatory Oscillometry Evaluating Aortic Stiffness?

ABSTRACT Objective: To investigate the relationship between aortic stiffness and postoperative atrial fibrillation (POAF) in patients undergoing coronary artery bypass grafting (CABG). Methods: This study included 110 patients undergoing elective isolated CABG. Aortic stiffness was measured using a noninvasive oscillometric sphygmomanometer before surgery. Characteristics of patients with and without POAF were compared. Results: POAF developed in 32 (29.1%) patients. Patients with POAF were older (63.7±8.6 vs. 58.3±8.4; P=0.014). Chronic obstructive pulmonary disease (COPD) was more common in patients with POAF (11.5% vs. 37.5%; P=0.024), whereas the frequency of hypertension, diabetes mellitus, smoking, and previous coronary artery disease did not differ. C-reactive protein and cholesterol levels were similar between patients with and without POAF. Left atrial diameter was greater in patients with POAF (35.9±1.6 vs. 36.7±1.7; P<0.039). Peripheral (p) and central (c) systolic and diastolic blood pressures were also similar between the groups, whereas both p and c pulse pressures (PP) were greater in patients with POAF (pPP: 44.3±11.9 vs. 50.3±11.6; P=0.018, cPP: 31.4±8.1 vs. 36.2±8.9; P=0.008). Pulse wave velocity (PWV) was significantly higher in POAF (8.6+1.3 vs. 9.4+1.3; P=0.006). PWV, pPR and COPD were independent predictors of POAF in multivariate regression analysis. In receiver operating characteristic analysis, PWV and pPP have similar accuracy for predicting POAF (PWV, area under the curve [AUC]: 0.661, 95% confidence interval [CI] [0.547-0.775], P=0.009) (pPP, AUC: 0.656, 95% CI [0.542-0.769], P=0.012). Conclusion: COPD, PWV, and PP are predictors of POAF. PP and PWV, easily measured in office conditions, might be useful for detecting patients with a higher risk of POAF.

Evaluation of the Relationship between Occupational Accidents and Obstructive Sleep Apnea Risk among Employees of a University Hospital.

Context: Occupational accidents are still one of the important causes of morbidity and mortality. Sleep apnea is a significant risk factor for occupational accidents in hospitals. Aims: To determine the frequency of occupational accidents and their relationship with the risk of obstructive sleep apnea (OSAS). Settings and Design: Cross-sectional study in a hospital setting. Methods and Material: This study was conducted on 331 hospital workers between 2019-2020. Accidents from the Social Security Institution records were used. The risk of OSAS was evaluated with Berlin Survey, daytime sleepiness with Epworth Sleepiness Scale, sleep quality with Pittsburg Sleep Quality Scale. Statistical Analysis: The Chi-square test was used for analysis; P < 0.05 was accepted as a statistical significance value. Results: Of the participants, 231 (69.8%) were female. Their ages ranged between 19 and 55; the mean age was 33.8 ± 8.0 years. The frequency of occupational accidents was 8.8%, 51.4% had a high risk of OSAS, 80.4% had high daytime sleepiness, and 53.5% had poor sleep quality. Conclusion: The study group had a high risk of sleep disorders. No relationship was found between sleep disorders and occupational accidents. More comprehensive studies are needed to clarify this relationship.

Coronary sinus collapsibility index and inferior vena cava collapsibility index can predict right atrial pressure in patients undergoing right heart catheterization.

BACKGROUND: The aim of the study is to investigate the relationship between the diameters and collapsibility indices of coronary sinus (CS) and inferior vena cava (IVC) and invasively measured right atrial pressure (RAP), and to determine whether these parameters have predictive value on RAP. METHODS: A total of 136 patients undergoing right heart catheterization due to pulmonary arterial hypertension were included in the study prospectively. CS diameters, IVC diameters, CS collapsibility index (CSCI), and IVC collapsibility index (IVCCI) were measured by echocardiography before catheterization. Pearson correlation analysis was used to compare the parameters. Receiver operating characteristics (ROC) curve analysis was used to determine the predictive value of the CS and IVC collapsibility indices in predicting RAP. RESULTS: Patients were divided into two groups as invasively measured RAP≥10 mm Hg (n:57) and RAP < 10 mm Hg (n:79). In the group with RAP≥10 mm Hg, IVC and CS diameters were higher than in the group with RAP < 10 mm Hg, while the IVCCI and CSCI were lower (p < 0.001). A negative correlation was observed between CSCI and IVCCI and RAP. Also, a positive correlation was observed between CSCI and IVCCI. Optimal cut-off value for IVCCI was 46.1 with a sensitivity of 75%, and specificity of 79.7%. Optimal cut-off value for CSCI was 39.2 with a sensitivity of 75.4%, and specificity of 88.6%. CONCLUSION: CS and IVC diameters and collapsibility indices measured by echocardiography were found to be associated with invasively measured RAP, and may be used together for estimating RAP.

Myocardial fibrosis assessed by magnetic resonance imaging in asymptomatic heterozygous familial hypercholesterolemia: the cholcoeur study.

BACKGROUND: Familial Hypercholesterolemia (FH) is an underdiagnosed condition with an increased cardiovascular risk. It is unknown whether lipid accumulation plays a role in structural myocardial changes. Cardiovascular Magnetic Resonance (CMR) is the reference technique for the morpho-functional evaluation of heart chambers through cine sequences and for myocardial tissue characterization through late gadolinium enhancement (LGE) and T1 mapping images. We aimed to assess the prevalence of myocardial fibrosis in FH patients. METHODS: Seventy-two asymptomatic subjects with genetically confirmed FH (mean age 49·24, range 40 to 60 years) were prospectively recruited along with 31 controls without dyslipidaemia matched for age, sex, BMI, and other cardiovascular risk factors. All underwent CMR including cine, LGE, pre- and post-contrast T1 mapping. Extracellular volume (ECV) and enhancement rate of the myocardium (ERM = difference between pre- and post-contrast myocardial T1, normalized by pre-contrast myocardial T1) were calculated. FINDINGS: Five FH patients and none of the controls had intramyocardial LGE (p= 0·188). While no changes in Native T1 and ECV were found, post-contrast T1 was significantly lower (430·6 ± 55ms vs. 476·1 ± 43ms, p<0·001) and ERM was higher (57·44± 5·99 % vs 53·04±4·88, p=0·005) in HeFH patients compared to controls. Moreover, low post-contrast T1 was independently associated with the presence of xanthoma (HR 5·221 [1·04-26·28], p= 0·045). A composite score combining the presence of LGE, high native T1 and high ERM (defined as ≥ mean ± 1·5 SD) was found in 20·8% of the HeFH patients vs. 0% in controls (p<0·000, after adjustment for main confounders). INTERPRETATION: CMR revealed early changes in myocardial tissue characteristics in HeFH patients, that should foster further work to better understand and prevent the underlying pathophysiological processes.

Does myeloma genetic have an effect on stem cell mobilization?

BACKGROUND: Autologous stem cell transplantation (ASCT) after induction treatment is the standard of care. Our understanding of myeloma genetics has been very limited and its effect to stem cell mobilization is not widely investigated. We aimed to investigate the effect of genetic abnormalities on stem cell mobilization in myeloma. METHODS: The data of 150 MM patients who underwent stem cell mobilization at our center between 2009-2020 were included and analyzed retrospectively. Pre-treatment bone marrow cytogenetics and fluorescence in situ hybridization tests were performed for each patient. RESULTS: Groups were divided into two as patients with normal cytogenetic and abnormal cytogenetic. No difference observed between groups regarding age, gender and ECOG (p = 0.4; p = 0.2; p = 0.3). Groups were similar concerning myeloma characteristics, received treatment and treatment response. Median CD34+ cells/kg harvested was 444(2-11.29) in normal cytogenetic group whereas it was 4,8(2.4-8.6) in abnormal cytogenetic group(p = 0.2). Optimal CD34+ cells level achievement was 73 (67 %) in normal cytogenetic group while it was 25(71.4 %) in abnormal cytogenetic group(p = 0.6). Neutrophil and platelet engraftment durations were similar among cytogenetic groups (p = 0.7; p = 0.9). R-ISS based groups were also did not differ regarding harvested CD34+ cells and achievement optimal CD34 level (p = 0.79, p = 0.74). Engraftment durations for neutrophil and platelet were comparable between R-ISS based groups (p = 0.59, p = 0.65) CONCLUSIONS: Here we were not able to find any impact of genetic abnormalities on stem cell mobilization in myeloma patients. Expanded studies can aid to identify the effect of particular genetic anomalies on the stem cell mobilization.

Recovery of Symmetrical Peripheral Gangrene of Limbs in a Patient After Performing Hemoadsorption in Septic Shock.

We report a 42-year-old patient who had Hodgkin lymphoma and developed bilateral symmetrical peripheral gangrene (SPG) in the feet and hands, which occurred during septic shock after autologous hematopoietic stem-cell transplantation. SPG is a rare but severe complication of disseminated intravascular coagulation (DIC) and is frequently associated with sepsis. The pathophysiology of SPG includes DIC-mediated intravascular thrombosis and thrombotic occlusion of microcirculation, resulting in low blood flow. Sepsis-induced hypotension has been suspected as one of the other causes of SPG, and it is thought to be aggravated by vasopressor treatments given for hypotension. Our patient first experienced coldness, paleness, and cyanosis in his body's acral parts, and then SPG later developed in both his feet and hands. Septic shock management was performed with cytokine hemoadsorption, broad-spectrum antibiotics, and massive fluid replacement rapidly. The patient fully recovered without the need for amputation. Hemoadsorption is an extracorporeal cytokine-adsorption method for removing excess cytokines. Prompt management of septic shock and early monitoring of peripheral ischemia are essential to avoid SPG.

Prevalence of onychophagia and its relation to stress and quality of life.

INTRODUCTION: Onychophagia is defined as putting one's fingers into the mouth and biting the nails. We sought to evaluate the prevalence of onychophagia in university and high school students and its relation to sociodemographic factors, perceived stress, and quality of life. METHODS: A total of 3,475 students were included in the study. A questionnaire including sociodemographic characteristics, items about onychophagia, the Perceived Stress Scale (PSS), and the European Health Impact Scale were used. RESULTS: The prevalence of onychophagia among university students was 17.6%, and among high school students it was 29.2%. In university students with onychophagia, the median score on the PSS was higher than the median score of students without onychophagia. In high school students, the median score on the PSS was 28.2 for students without onychophagia and 28.0 for students with onychophagia; the difference was not significant. The median scores on the quality of life scale for both university and high school students with onychophagia were lower than the mean score of students without onychophagia. CONCLUSIONS: Onychophagia is a common problem in the general population with a multidimensional etiology. It has dermatological, dental, and psychiatric consequences and comorbidities, and so a multidisciplinary approach is necessary for the prevention and treatment of onychophagia.

Gemcitabine, dexamethasone and cisplatin (GDP) is an effective and well-tolerated mobilization regimen for relapsed and refractory lymphoma: a single center experience

Background/aim: Gemcitabine, dexamethasone and cisplatin (GDP) is a well-established salvage regimen for relapsed and refractory lymphomas. In this study, we aimed to share our experience with the patients who received GDP/R-GDP (rituximab-gemcitabine, dexamethasone and cisplatin) for stem cell mobilization. Materials and methods: Data of 69 relapsed and refractory Hodgkin lymphoma (HL) and Non-Hodgkin lymphoma (NHL) patients who received GDP/R-GDP as salvage chemotherapy in our center between July 2014 and January 2020 were retrospectively evaluated. After the evaluation of response, 52 patients had a chemosensitive disease and underwent mobilization with GDP/R-GDP plus G­CSF (granulocyte colony-stimulating factor). Collected CD34+ stem cells and related parameters were compared in terms of diagnosis of HL and NHL, early and late stage, patients who did not receive RT and those who received RT, and patients aged under 60 and over 60. Results: On the 15th day on average (range 11­20), a median number of 8.7 × 106 /kg (4.1­41.5) CD34+ stem cells were collected in 51 (98%) of our 52 chemosensitive patients and 1 (2%) patients failed to mobilize. We observed acceptable hematological and nonhematological toxicity. The targeted amount of 2 × 106 /kg CD34+ stem cells was attained by 98% (n: 51) patients, and all of them underwent autologous stem cell transplantation. Moreover, low toxicity profiles provide outpatient utilization option clinics with close follow-up and adequate supportive care. Conclusion: We suggest that GDP/R-GDP plus G-CSF can be used as an effective chemotherapy regimen for mobilizing CD34+ stem cells from peripheral blood in relapsed and refractory lymphoma patients due to low toxicity, effective tumor reduction, and successful stem cell mobilization. It can also be assumed that the GDP mobilization regimen may be more effective, especially in patients with early-stage disease and in HL patients.

Old is bad? The effect of age on peripheral stem cell mobilization and transplantation outcomes.

INTRODUCTION: Allogeneic stem cell transplantation (Allo-SCT) is a well-established treatment option for hematological malignancies. With the introduction of reduced-intensity conditioning regimens (RIC) and better supportive measures the elderly are able to receive Allo-SCT. A considerable number of patients are elderly, and often their HLA matched sibling donor is elderly, moreover. Here, we aim to explore the effect of donors' age on stem cell harvesting, engraftment duration after Allo-SCT, and product quality. METHOD: Sixty-one healthy allogeneic stem cell donors aged 50 years and older who underwent stem cell mobilization at our center between 2009-2019 were enrolled for the study. All donors received 4-5 days of G-CSF, mostly filgrastim or lenograstim and their biosimilar equivalents were given subcutaneously as a total dose of 10 mcg/kg/day. Groups were separated into three groups as aged 50-54 group A, 55-59 group B, aged 60 and older group C. RESULTS: Pre-apheresis peripheral blood CD34+ count was similar all groups (p = 0.2). One day apheresis was sufficient for 72.7 % of group A, 27.3 % for group B and 47.1 % for group C (p = 0.02). Total harvested CD34+ cells were comparable among groups (p = 0.5). CONCLUSION: Adequate stem cell harvest in older donors is feasible. Older donors may require more than one apheresis procedure and generally procedure was well tolerated. When assessing donors, age should represent less significance.

Prognostic Value of the Residual SYNTAX Score on In-Hospital and Follow-Up Clinical Outcomes in ST Elevation Myocardial Infarction Patients Undergoing Percutaneous Coronary Interventions.

AIMS: We investigated the prognostic significance of residual SYNTAX score (RSS) in patients undergoing PCI due to STEMI and relationship between RSS and in-hospital and long-term ischemic cardiac events. METHODS: Between June 2015 and December 2018, 538 patients who underwent primary PCI were evaluated for in-hospital events and 478 patients were evaluated for clinical events during follow-up. Primary and secondary endpoints for both in-hospital and follow-up periods were cardiac death and major adverse cardiac events (MACE). RESULTS: 538 patients were included the study. RSS values of 131 patients were 0, and RSS values of 407 patients were >0. The median value of the RSS > 0 group was 7. According to this value, the RSS > 0 group was divided into 2 groups as R-ICR (RSS < 7, N = 188) and ICR (RSS ≥ 7, n = 219). In the RSS ≥ 7 group, during in-hospital and follow-up period, both mortality and MACE rates were higher than the other two groups. Area under the curve (AUC) for RSS for in-hospital death was found to be higher than SS (p=0.035) but similar to Grace Score (GS) (p=0.651). For MACE, RSS was higher than SS (p=0.025) and higher than the GS (p=0.041). For follow-up cardiac mortality, the AUC of the RSS was found to be higher than SS (0.870/0.763, p=0.02) and GS (0.870/0.733, p=0.001). For MACE, the AUC of RSS was higher than SS (p=0.03) and GS (p=0.004). CONCLUSIONS: High RSS values in STEMI patients are associated with increased risk of ischemic cardiac events. RSS may help determine revascularization and level of additional PCI to improve prognosis by reducing the risk of ischemic cardiac events after P-PCI.

Relationship between White Blood Count to Mean Platelet Volume Ratio and Clinical Outcomes and Severity of Coronary Artery Disease in Patients Undergoing Primary Percutaneous Coronary Intervention.

BACKGROUND: The white blood cell count to mean platelet volume ratio (WMR) is an indicator of inflammation in patients with atherosclerotic disease. Residual SYNTAX Score (RSS) is an objective measure of degree and complexity of residual stenosis after percutaneous coronary intervention (PCI). We investigated the relationship between WMR and clinical prognosis and RSS in patients undergoing primary percutaneous coronary intervention (P-PCI). METHOD: Between June 2015 and December 2018, 537 patients who underwent primary PCI were evaluated for in-hospital events, and 477 patients were evaluated for clinical events during follow-up after discharge. The endpoint of our study is major adverse cardiac events (MACEs) seen in the in-hospital and follow-up periods. RESULTS: In our study, 537 patients were stratified into two groups according to admission median WMR. There were 268 patients in the low WMR group (WMR < 1286) and 269 patients in the high WMR group (WMR ≥ 1286). RSS (p = 0.01) value of the high WMR group was higher than that of the low WMR group. The rates of in-hospital MACE (p = 0.001), cardiac death (p < 0.001), decompansated heart failure (0.007), and ventricular tachycardia/fibrillation (p = 0.003) were higher in the high WMR group than in the low WMR group. The follow-up MACEs (p = 0.043), cardiac death (p = 0.026), and reinfarction (p = 0.031) ratio were higher in the high WMR group. In ROC analysis, cut-off values of in-hospital and follow-up MACEs were >1064 (sensitivity: 83.12%, and specificity: 36.29%) and >1130 (sensitivity: 69.15%, and specificity: 44.91%), respectively. The Kaplan-Meier analysis showed that the high WMR group had the significantly lowest MACE-free survival rate (log-rank test, p = 0.006). A moderate correlation was observed between WMR and RSS (r: 456, p = 0.002). CONCLUSION: A higher WMR value on admission was associated with worse outcomes in patients with P-PCI and independently predicted for follow-up MACEs. The WMR provides both a rapid and an easily obtainable parameter to identify reliably high-risk patients who underwent primary percutaneous coronary intervention due to STEMI.