Analysis of thrombosis and bleeding complications in patients with polycythemia vera: a Turkish retrospective study.

The aims of this study are to determine the incidence and risk factors of thrombosis and bleeding in polycythemia vera (PV) patients and to research the effects of these risk factors on survival. The medical records of 155 PV patients were analyzed retrospectively. Patients were divided into groups according to whether or not thrombosis had developed in follow-up, and according to whether or not bleeding had occurred during follow-up. The mean age at diagnosis was 53 years, and the mean follow-up period was 66 months. The percentage of cases in which thrombosis events had occurred before diagnosis and during follow-up were 26 and 28 %, respectively. Comparisons of disease duration and average thrombosis risk score between groups with or without thrombosis drew statistically significant results. A patient's history of thrombosis and thrombocytosis at first visit was found to have a significant effect on thrombosis recurrence. The major bleeding rate was 8 %. Post-PV myelofibrosis was an independent risk factor for bleeding. The major cause of death among the patients in this study was primary thrombosis. The most important causes of mortality among PV patients are thrombosis, and the most prominent risk factors for thrombosis development are disease duration and high thrombosis risk scores. Thrombocytosis in patients with a history of thrombosis may cause thrombosis recurrence during the follow-up period.

Brentuximab vedotin for relapsed or refractory Hodgkin lymphoma: experience in Turkey.

Current treatment modalities can cure up to 70-80 % of patients with classical Hodgkin lymphoma. Approximately, 20-30 % of patients require further treatment options. Brentuximab vedotin has been approved for the treatment of relapsed and refractory Hodgkin lymphoma. In the present study, we report the experience with brentuximab vedotin as single agent in 58 patients with relapsed or refractory Hodgkin lymphoma. The objective response rate was 63.5 % with 13 complete responders (26.5 %) among 49 patients evaluated at the early phase of treatment (2-5 cycles). Upon treatment prolongation (≥6 cycles), 37 patients achieved a final objective response rate of 32.4 % with 21.6 % of complete and 10.8 % of partial response. Overall survival at 12 months was 70.6 %, and progression-free survival at 12 months was 32.8 %. Median overall survival could not be reached and median progression-free survival was 7 months. While the median duration of response was 9 months in the whole cohort, it was 11.5 months in the complete responders. Complete response rates in patients treated with >3 chemotherapy regimens before brentuximab vedotin were significantly lower (p = 0.016). Fourteen patients were subsequently transplanted. In conclusion, brentuximab vedotin provided a bridge to transplantation in approximately one quarter of the patients. The declining response rates during the course of treatment suggest that transplantation should be implemented early during brentuximab vedotin treatment.

Comparison of the effect of Healon, Healon GV, Healon 5, Viscoat, and Ocucoat on platelet aggregation under in vitro conditions.

PURPOSE: To study the effect of Healon, Healon GV, Healon 5, Viscoat, and OcuCoat on platelet aggregation under in vitro conditions. METHODS: Ocular viscoelastic devices including Healon, Healon GV, Healon 5, Viscoat, and OcuCoat were studied to investigate the effect of these agents on platelet aggregation under in vitro conditions. The experiments were performed by using platelet-rich plasma with an aggregometer. Aggregation was induced with three different agonists including 5''-adeno-sinediphosphate (ADP), epinephrine (EPI), and collagen (Col ). The results were obtained as a percentage of maximal aggregation and compared with controls using one-way analysis of variance (ANOVA) test. RESULTS: The tests with ADP as aggregating agent revealed that the percentages of maximal aggregation were a mean of 75 +/- 4.35% for ADP only, 67 +/- 4.35% for Healon, 59.33 +/- 3.51% for Healon GV, 70 +/- 3% for Healon 5, 58 +/- 3.46% for Viscoat, and 64 +/- 2% for OcuCoat. Kruskal-Wallis one-way ANOVA test revealed no significant decrease in the percentage of maximal aggregation for all tested substances. With EPI, aggregation was induced in all control samples with a mean of 80.66 +/- 2.08%. The mean percentage of maximal aggregation was 67 +/- 3% for Healon, 77.66 +/- 4.04% for Healon GV, 77 +/- 4% for Healon 5, 80.6 +/- 4.04% for Viscoat, and 65 +/- 5% for OcuCoat. Statistical analysis showed no significant difference. With collagen, maximum aggregation was 74 +/- 5.29% for controls, 65 +/- 4.35% for Healon, 54 +/- 2% for Healon GV, 51 +/- 2.64% for Healon 5, 59 +/- 2% for Viscoat, and 72.66 +/- 1.52% for OcuCoat. Kruskal -Wallis one-way ANOVA test revealed no significant change in the percentage of maximal aggregation for all tested substances in the experiments. CONCLUSIONS: Ophthalmic viscosurgical devices like Healon, Healon GV, Healon 5, and Viscoat that contain glycosaminoglycans and OcuCoat that contains hydroxypropyl methylcellulose have inhibitory effects on platelet aggregation but the effect is not statistically significant and there is no difference among the ocular viscoelastic devices in regard to inhibitory effect on platelet aggregation.

In vitro effect of silicone oil and liquid perfluorocarbons on platelet aggregation.

PURPOSE: To study the in vitro effect of silicone oil of different viscosities and liquid perfluorocarbons on platelet aggregation. METHODS: Silicone oil with a viscosity of 5700 cs and 1000 cs and liquid perfluorocarbons of perfluoroperhydrophenantren and perfluorodecaline were studied to investigate the effect of these agents on platelet aggregation under in vitro conditions. The experiments were performed by using platelet rich plasma with an aggregometer. Aggregation was induced with three different agonists, including 5"-adenosine diphosphate (ADP), epinephrine (EPI), and collagen (Col). The results were obtained as a percentage of maximal aggregation and compared with controls using Kruskal-Wallis one way analysis of variance test. RESULTS: The tests with ADP as aggregating agent revealed that the percentage of maximal aggregation was a mean of 72.66+/-3.51% for ADP only, 58.66+/-3.05% for silicone oil of 1000 cs, 62.66+/-2.08% for silicone oil of 5700 cs, 56.00+/-7.00% for perfluoroperhydrophenantren, and 52.3+/-3.1 % for perfluorodecaline. With EPI, aggregation was induced in all control samples with a mean of 76+/-9.54%. The mean percentage of maximal aggregation was 66.7+/-3.06 for silicone oil of 1000 cs, 72.33+/-5.5% for silicone oil of 5700 cs, 71.67+/-3.79% for perfluoroperhydrophenantren, and 70.33+/-2.52% for perfluorodecaline. With collagen, it was 86.67+/-1.53% for controls, 83.67+/-3.51% for silicone oil of 1000 cs, 85.33+/-4.51% for silicone oil of 5700 cs, 83.33+/-4.93% for perfluoroperhydrophenantren, and 81.33+/-4.16% for perfluorodecaline. Statistical analysis revealed no significant change in the percentage of maximal aggregation for all tested substances in the experiments. CONCLUSIONS: Silicone oil of different viscosities and perfluoroperhydrophenantren and perfluorodecaline have minimal antiaggregating effect on platelets. The level of effect is not statistically significant.

Overview of 321 patients with idiopathic thrombocytopenic purpura. Retrospective analysis of the clinical features and response to therapy.

In this retrospective study, we evaluated the clinical features and the effects of various treatment modalities on the clinical course in patients diagnosed with idiopathic thrombocytopenic purpura (ITP) at our center between 1984-2000. We retrospectively examined the medical records of 321 (229 females, 92 males) ITP patients. One hundred and seventy-one (53.3%) patients were lost to follow-up. When evaluating the clinical features, all 321 patients were included; however, when the response to treatment modalities was evaluated only 150 patients followed up regularly were considered. The median age of the patients on initial diagnosis was 34 years (range: 14-78). At initial diagnosis, 235 (73.2%) patients had signs of bleeding. Of patients diagnosed with ITP initially, six later turned out to have systemic lupus erythematosus (SLE) and two myelodysplastic syndrome (MDS). The median follow-up of 150 patients followed up regularly was 30 months (range: 4-396). One hundred and thirty-seven of these subjects had an indication for treatment and 94.2% of them were administered either standard or high-dose steroids as the first-line therapy. Complete remission (CR) was defined as any platelet count >100,000/mm(3) lasting for 3 months or longer without treatment. CR was achieved in 51.9% of the patients given steroids as the initial therapy. During a median follow-up of 33 months, relapse occurred in 58.2% of these patients, and after a median follow-up of 11 months the rest of them were still in remission. Ninety-eight patients followed up regularly were administered second-line therapies. CR was obtained in 44.4% of the patients who used steroids as second-line therapy. Within a median follow-up of 15 months, 20.8% of these patients relapsed. Splenectomy was performed in 76 patients and CR was obtained in 68.4% of the regularly followed up patients. Relapse occurred within a median of 96 months in 15.4% of the patients who had CR. Kaplan-Meier curves showed that the duration of CR obtained by splenectomy was significantly higher than that obtained by steroids (p<0.001). The 10-year disease-free survivals in patients who used steroids and who underwent splenectomy were, respectively, 13% and 58%. In our adult ITP patients, steroids induced nearly similar rates of CR both as first-and second-line therapies. Splenectomy seems to be effective in patients unresponsive to steroids. The duration of CR obtained by splenectomy is significantly longer when compared with the duration of CR obtained by steroid therapy.

The frequency of tuberculosis in adult allogeneic stem cell transplant recipients in Turkey.

In general, tuberculosis (Tb) is rarely seen in allogeneic stem cell transplant (alloSCT) recipients, but this observation has been challenged in developing countries such as Turkey, where Tb infection is more prevalent than in Europe and the US. In this retrospective study, we report on the incidence of Tb infections in 351 alloSCT recipients at 4 bone marrow transplantation units in Turkey over the last 10 years. The frequency of Tb in alloSCT recipients after allografting (5 of 351) was far greater than that in the general population (35.4 per 100,000). Of the 351 patients who underwent alloSCT, 77 who received isoniazid (INH) chemoprophylaxis for 6 months did not develop posttransplantation Tb. However, 5 of the remaining 274 patients who received no chemoprophylaxis developed Tb a median of 12 months (range, 10-47 months) after allografting. Antituberculosis therapy resulted in complete recovery in all cases. In 2 additional patients who were found to have active pulmonary Tb at the time of transplantation, alloSCT was delayed until the infections were treated. Infections of mycobacteria other than Mycobacterium tuberculosis were not observed. The number of patients who received and tolerated INH may not be sufficient for firm conclusions, but the data suggest that, in countries where Tb is prevalent, pre- and posttransplantation follow-up for Tb and the use of INH prophylaxis should be considered.

Secondary amyloidosis in the course of idiopathic myelofibrosis.

Secondary amyloidosis without a known cause, diagnosed antemortem in a patient with idiopathic myelofibrosis, is reported here. This is the first such case, to our knowledge. Amyloid deposits were seen in the bone marrow, renal glomeruli and jejunum. Reasons for investigating for amyloidosis were hypogammaglobulinemia, proteinuria and recurrent diarrhea.

Successful outcome of aspergillus brain abscess in a patient who underwent bone marrow transplantation for aplastic anemia.

We report the course of an aspergillus brain abscess in an 18-year-old female patient who underwent bone marrow transplantation for aplastic anemia. The abscess was discovered on day 35 post-transplant, in a cranial computerized tomography (CT) scan performed for the evaluation of an unexplained headache. Meanwhile, she was receiving broad-spectrum antibacterials and liposomal amphotericin B for a right upper pulmonary lobe infiltrate. A percutaneous puncture of the cerebral lesion was performed; fungal elements were seen in the pus obtained and its culture yielded A. fumigatus. The dose of amphotericin B was increased, intraconazole was added and two more punctures were done. With these antifungals, the abscess regressed significantly; so, amphotericin B was discontinued after a cumulative dose of 6775 mg but intraconazole was maintained at 400 mg/day. At the last follow-up, seventeen months after detection of the abscess, the patient was well, without symptoms and the cerebral lesion diminished to a very small, thick-walled CT image.

Incidence of aplastic anemia in Turkey: a hospital-based prospective multicentre study.

The incidence of aplastic anemia among hospitalized adult patients was prospectively determined in this first study in Turkey. New cases of aplastic anemia among patients 14 years and older who were admitted to the study centers were included in a 3 year survey. Seventy-three patients fulfilled the diagnostic criteria, yielding a mean annual incidence rate of 1.14 cases in 10(3) admissions. The male-to-female ratio of the cases (1.6:1) differed from the almost equal ratio of the larger population of Turkey. The median age was 30 years and females were younger at diagnosis. The age distribution of the cases was different from that of the population; showing two incidence peaks in both sexes. The majority of the patients (89%) had severe disease.