The incidence and risk factors of thrombosis and the need for thromboprophylaxis in lymphoma and leukemia patients: A 9-year single-center experience.

BACKGROUND: Patients with cancer are at increased risk of thromboembolic complications. There is no evidence-based guideline on the use of routine prophylaxis in hematological malignancies except in patients with multiple myeloma. The purpose of this study was to determine the incidence and risk factors of thrombosis and suggest a rationale for primary thromboprophylaxis in acute leukemia and lymphoma patients. PATIENTS AND METHODS: A retrospective study was conducted on newly-diagnosed acute leukemia and lymphoma patients who presented at our institution from November 2009 to March 2018. The study included a total of 157 patients with acute leukemia and 238 patients with lymphoma. The groups were analyzed to determine the incidence and risk factors of thromboembolic complications. RESULTS: The incidence of all thrombotic complications was 10.12% (40/395) including 11.4% (18/157) in patients with acute leukemia and 9.2% (22/238) in patients with lymphoma. The majority of events occurred in the first 6 months. Acute leukemia patients with thrombosis had a higher number of comorbidities than those without thrombosis (p < 0.05). Lymphoma patients with thrombotic complications had significantly higher beta-2-microglobulin and lactate dehydrogenase levels compared to those without thrombosis (p < 0.05). Major bleeding events developed in five (3.1%) acute leukemia patients and two (0.8%) lymphoma patients. All the major bleeding events occurred when the patients were thrombocytopenic (platelet < 50,000/mm3). CONCLUSIONS: Acute leukemia patients with any comorbidity and lymphoma patients with higher lactate dehydrogenase and beta-2-microglobulin are at high risk of developing thromboembolic complications. The prophylactic use of anticoagulant should be considered for those patients especially in the first 6 months.

The efficacy of double filtration plasmapheresis in the treatment of homozygous familial hypercholesterolemia: A single-center experience.

INTRODUCTION: Different modalities of low-density lipoprotein (LDL) apheresis are used to treat patients with familial hypercholesterolemia (FH). The aim of this study was to describe the efficacy of the Double Filtration Plasmapheresis (DFPP) method for FH cases in our hands and to compare with other LDL apheresis techniques. MATERIALS AND METHODS: This retrospective study was conducted between January 2016 and January 2018 in the University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Adult Hematology Clinic and Therapeutic Apheresis Unit. The study included 5 patients with a diagnosis of homozygous FH. A total of 288 DFFP procedures were performed twice a month (every 15 days) for 2 years. RESULTS: The percentage reductions in Lipoprotein A, total cholesterol, Low Density Lipoprotein-C, High Density Lipoprotein-C and triglyceride levels were found to be 84%, 69.2%, 69.8%, 58.8% and 50.1% respectively (5 cases, n = 288). No cardiac event occurred after the initiation of LA with DFPP. CONCLUSION: DFPP is an effective and safe LA method that can be used in the treatment of homozygous FH patients who do not respond to diet and statin therapy.

Refractory Thrombotic Thrombocytopenic Purpura in a patient with Kaposi sarcoma.

The case is here presented of a 70-year old male patient with rare coexistence of Kaposi Sarcoma and resistant Thrombotic Thrombocytopenic Purpura (TTP). The Kaposi lesions were determined before the diagnosis of TTP and were exacerbated after receiving TTP-associated immunosuppressive therapy, in particular associated with rituximab. TTP in this case was resistant to conventional therapies such as steroid and plasma exchange and current immunosuppressive (rituximab, cyclophosphamide, vincristin) treatments. Novel treatment agents consisting of bortezomib and eculizumab given to the patient were also ineffective. To the best of our knowledge, this case presents the first case of coexistence of TTP and Kaposi sarcoma from Turkey and the challenge of refractory TTP management.

Is antimicrobial prophylaxis necessary for lymphoma patients? A single centre, real-life experience.

BACKGROUND: Prophylaxis is strongly recommended in patients with hematological malignancy who are usually at higher risk for infection and neutropenic fever. It is still unclear whether or not there is a definite need for antimicrobial prophylaxis in intermediate-risk hematology patients such as those with lymphoma. METHODS: A retrospective analysis was made of patients admitted from January 2009 to December 2017 to the Hematology Department of Diskapi Yildirim Beyazit Training and Research Hospital, a tertiary referral hospital in Ankara, Turkey. The study included patients who were diagnosed with any type of lymphoma and given chemotherapy. Routine antimicrobial prophylaxis was administered to 127 lymphoma patients, and not to 65 lymphoma patients. These two groups were compared in respect of the incidence of total infection episodes (IE), febrile neutropenia episodes, and nonneutropenic clinically documented infection episodes. RESULTS: For all patients with lymphoma and subtypes of non-Hodgkin lymphoma or Hodgkin lymphoma, no significant difference was determined between the groups in respect of the total incidence of IE, febrile neutropenia and nonneutropenic clinically documented infection both during the first-line chemotherapy and throughout the total follow-up period (p > 0.05). Patients with prophylaxis had a higher incidence of IE, which was treated with parenteral antibiotics both during the first-line chemotherapy and throughout the total follow-up period (p < 0.05). CONCLUSION: Antimicrobial prophylaxis was seen to have no effect on the total incidence of infection episode and febrile neutropenia. Therefore, the routine use of antimicrobial prophylaxis should not be recommended for patients with lymphoma.

Dimethyl Sulfoxide-Induced Tonic-Clonic Seizure and Cardiac Arrest During Infusion of Autologous Peripheral Blood Stem Cells.

Various side effects associated with dimethyl sulfoxide (DMSO) which is used for cryopreservation of bone marrow or peripheral blood progenitor cells (PBPCs) have been reported. Among the central nervous system side effects the epileptic seizures, stroke, transient and temporary leucoencephalopathy, and global amnesia are well known. Herein we report a 52-year-old man who experienced tonic-clonic seizure within minutes after the initiation of DMSO cryopreserved autologous PBPC infusion. Unfortunately, he also developed cardiac arrest and required intubation for ventilation after the seizure. Pathophysiology of acute neurological and cardiac toxicity is unclear, but may also be idiosyncratic. Clinicians should be aware of the toxicity of cryoprotectant agents during PBSC infusion. Determining the risk factors associated with increased DMSO toxicity and taking preventive actions is utmost important.

[Fungemia and septic arthritis caused by Saprochaete capitata in a patient with fanconi aplastic anemia: a case report]. / Fanconi aplastik anemili bir hastada Saprochaete capitata'nin neden oldugu fungemi ve septik artrit: bir olgu sunumu.

Saprochaete capitata (formerly known as Blastoschizomyces capitatus, Trichosporon capitatum, Geotrichum capitatum) is a rare but emerging yeast-like fungus. It is commonly found in environmental sources and can be isolated from skin, gastrointestinal system and respiratory tract of healthy individuals as well. It mainly infects patients with hematological malignancies such as acute myeloid leukemia (AML), especially in the presence of neutropenia; and mortality rates are high in those patients. Although the data about the in vitro antifungal susceptibility are limited, it is being reported that amphotericin B and voriconazole are more effective on S.capitata isolates whereas caspofungin had no activity. Here, we report a case of fungemia and septic arthritis due to S.capitata in a patient with Fanconi aplastic anemia. A 22-year-old male patient with Fanconi aplastic anemia was hospitalized in our hematology department for bone marrow transplantation. Two days after the hospitalization, neutropenic fever developed and multiple nodules similar to candidiasis were detected in his liver with the whole abdomen magnetic resonance imaging (MRI). Caspofungin treatment (single 70 mg/kg loading dose, followed by 1 x 50 mg/kg/day) was started. The patient remained febrile, and his blood culture yielded S.capitata. The treatment regimen was changed to a combination of liposomal amphotericin B (3 mg/kg/day) and voriconazole (2 x 4 mg/kg/day). A few days later, pain and swelling came out on patient's left knee and he underwent a surgical process with the prediagnosis of septic arthritis. Culture of synovial fluid was also positive for S.capitata. On the 26th day of the hospitalization, the patient died due to sepsis and multiple organ failure. Patient's blood and synovial fluid samples were incubated in BacT/Alert automated blood culture system (bioMérieux, France). After receiving the growth signal, yeast cells were seen in Gram staining and cream-coloured, wrinkled, yeast-like colonies that were able to grow at 45oC and resistant to cycloheximide were detected on Sabouraud dextrose agar (SDA). Urease test was negative, and according to API 20C AUX (bioMérieux, France) system, none of the carbonhydrates were utilized except glucose. The isolates that were able to produce annelloconidia in corn meal-Tween 80 agar slide culture were identified as S.capitata. The identification was further confirmed by DNA sequence analysis. Minimal inhibitory concentrations (MICs) of amphotericin B, fluconazole, voriconazole, and caspofungin were found to be 0.5 µg/ml, 1.5 µg/ml, 0.032 µg/ml, and > 16 µg/ml respectively. Repetitive sequence based PCR (rep-PCR) (DiversiLab system, bioMérieux, France) was used to determine clonal relatedness of the isolates from blood and synovial fluid samples. The isolates were indistinguishable (similarity coefficient > 97%) according to rep-PCR. In conclusion, S.capitata infections should be taken into consideration in the presence of fungemia and septic arthritis in hematological patients who receive caspofungin therapy.

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.

Factors affecting survival in acute leukemia with donor lymphocyte infusion in the first relapse after allogeneic stem cell transplantation.

PURPOSE: Relapse of leukemia relapsing after allogeneic (allo) stem cell transplantation (SCT) remains an important problem. Cytoreductive chemotherapy followed by donor leukocyte infusion (DLI) is one of the treatment modalities in relapsed patients. The current study evaluated the factors affecting overall survival (OS) in allo-SCT patients who received DLI after the first relapse. METHODS: In this retrospective study 54 patients (26 with acute myeloid leukemia [AML] and 28 with acute lymphoblastic leukemia [ALL]) in their first relapse after allo-SCT who received fludarabine-based chemotherapy followed by DLI were evaluated. RESULTS: The relative risk for mortality was significantly higher in patients with acute leukemia (AL) within the high-risk group who went through transplantation (risk ratio: 4.866; 95% CI: 2.029-11.670;p<0.001) and in transplants performed in the remission phases following the first complete remission (risk ratio: 2.371; 95% CI: 1.154 - 4.872; p=0.019). Additionally, the relative mortality risk of transplantation in patients with acute leukemia (AL) with a number of DLIs applied (risk ratio: 0.456; 95% CI: 0.29 - 0.717; p=0.001) nd non-myeloablative regimen (risk ratio: 0.229; 95% CI: 0.053-0.992; p=0.049) was significantly lower. CONCLUSION: Efforts to enhance the number of DLIs, thus the number of infused cells, may result in better OS in cases with AL with relapse.

A rare but severe complication of filgrastim in a healthy donor: splenic rupture.

BACKGROUND: Granulocyte-colony stimulating factor (G-CSF) is widely administered to donors who provide peripheral blood stem cells (PBSCs) for individuals who undergo hematopoietic stem cell transplants. G-CSF administration is associated with a small but definite risks of serious adverse events like splenic rupture. CASE STUDY: In this case, we report a 40 year old women, a healthy donor for her sister who has aplastic anemia, who had sharp left upper abdominal pain on the forth mobilization day. The diagnosis at CT scan was splenic rupture; irregular intrasplenic low-attenuation areas consistent with ruptured spleen and perisplenic high density fluid. Her bidimensional spleen size was 16×6 cm. RESULTS: She was followed conservatively. One month later the CT scan signs of rupture disappeared. CONCLUSION: We must pay attention to this rare but serious adverse event during filgrastim use.

The impact of ozone and equilibrium-modified atmosphere packaging on storage stability and health-promoting indicators of fresh "Angelino" plums.

Effectiveness of ozone concentrations (2, 5, and 10 ppm) and exposure time (3 and 9 min) on selected physicochemical properties (pH, soluble solids, color values (L*, a*, and b*), and texture) and health-promoting indicators such as organic acids, total phenolics (TP), and anthocyanins of "Angelino" fresh plums was evaluated during storage (0, 30, 90, and 120 days) in equilibrium modified atmosphere packaging (EMAP). Total anthocyanin contents and organic acid profiles were significantly affected by storage times. Malic acid (MA) was the main organic acid in "Angelino" plums. MA content (4663 and 4764 mg/L) was the highest value in the ozonated 2-ppm/9-min and 5-ppm/3-min than other ozonated groups and also control at 120 days of the storage. The ozone treatments especially 2-ppm/9-min and 5-ppm/3 min can significantly retard the degradation of MA content (8294 to 2688-2694 mg/L) during the storage (p < .05). Total phenol content were most significantly decreased in the control during storage, with the loss at the level of 31.7% of TPs, while the lowest one 2-ppm/9-min (20.8%) and 5-ppm/-3 min (21.9%). The color and texture are maintained for the ozone applications compared to the control during storage. Ozonation with 2-ppm/9-min and 5-ppm/-3 min showed the best performance while maintaining the storage stability based on the physicochemical properties including hardness and bioactive compounds (such as anthocyanins and organic acids), visual appearance due to the more attractive color (L*, a*, b*) the plums.

Combined effect of electrolyzed water (EW) and sonication with equilibrium modified atmosphere packaging for prolonging storage stability of fresh strawberry.

This research focuses on the effectiveness of electrolyzed water (50 and 100 ppm for 3 min), ultrasonication (80 W for 3 min), and their combinations on fresh strawberries, which are then packaged using microperforated film to enhance their storage stability. The gas composition in the headspace, pH, soluble solids, color (L*, a*, b*, and ΔE* values), anthocyanins, total phenolics, and texture profile was evaluated for the 35 days of storage at +4 °C. The lowest weight loss was measured at about 100 ppm electrolyzed water (EW; 0.47%), and the highest one was in the control group (0.57%) after storage. At the end of the storage, O2 in the headspace decreased from 20.90% to 10.50-8.10% and CO2 was accumulated from 0.03% to 16.4-14.34%. The results showed that soluble solids decreased (9.95 to 8.48-7.85 °Bx) and pH values increased (3.34 to 3.79-3.91) during storage. At the end of the storage, the total phenolics in the control group decreased by the most during storage (from 1209.09 ppm to 808.00 ppm), whereas the 50 ppm EW group had the highest (931.66 ppm). Further, the significantly highest anthocyanin amount was found to be 143.86 ppm in the 100 ppm EW group at the end of 28 days of storage. The EW can significantly delay the degradation of anthocyanin over the storage period. The sonication at 100 ppm EW damages strawberry tissues, reducing their hardness. The lowest decay rate was found in fruits treated with 100 ppm EW (41.67%), followed by 50 ppm EW (58.33%), compared to the control (75.00%). This study reveals that applications of the 50 ppm EW and also 50 pm EW combined with ultrasonication have great potential in the extending storage stability of the fresh strawberries.

The effect of volume replacement during therapeutic leukapheresis on white blood cell reduction in patients with extreme leukocytosis.

BACKGROUND: Extreme leukocytosis, generally defined as a white blood cell (WBC) count of more than 100 × 10(9) /L consisting largely of blast cells, especially when accompanied by clinical signs and symptoms of leukostasis or hyperviscosity, often predicts a poor clinical outcome in patients with acute leukemia. In this study, we aimed to investigate the effect of volume replacement (VR) during therapeutic leukapheresis (TA) procedure on early mortality rate and WBC reduction. STUDY DESIGN AND METHODS: We retrospectively analyzed 29 patients who underwent TA from 2007 to 2011. Fifteen of the patients underwent TA procedure with VR and 14 of the patients underwent TA procedure without VR. RESULTS: WBC reduction was significantly higher in patients who underwent TA with VR (p < 0.001). Early mortality rate was significantly lower in leukemia patients who underwent TA with VR than in patients who underwent TA without VR (p < 0.01); early mortality rates were 6.7% for 7-day and 13.8% for 100-day survivals. The mortality rates in the TA without VR group, however, were 42.9 and 71.4% for 7- and 100-day survivals, respectively. CONCLUSION: Decreased early mortality rate in TA with VR group may be associated with prompt reduction of WBCs achieved with TA with VR and may also be associated with removal of the cytokines related to leukostasis. TA with VR would give more time for induction chemotherapy and increased overall survival rate.

The effect of diabetes mellitus and end-stage renal disease on the number of CD34+ cells in the blood.

The aim of this study was to investigate the effect of end-stage renal disease (ESRD) and diabetes mellitus (DM) on the number of stem cells in the peripheral blood. Sixty-two patients diagnosed with ESRD who had not received dialysis previously, 25 patients with a diagnosis of DM without nephropathy, and 21 healthy volunteers were included in the study. The group diagnosed with ESRD was divided into two groups. The first group (DM-CRD) consisted of 28 patients with DM who had developed chronic renal disease (CRD). The second group (NON-DM-CRD) consisted of 34 patients without DM who had CRD by etiology. The routine complete blood count, renal function, and number of CD34+ cells were determined for all of those involved in the study. The microalbumin/creatinine levels were measured, and glomerular filtration rates were calculated in all patients. The number of CD34+ cells was found to be significantly lower in the DM control group and DM-CRD group compared with the healthy group. No statistically significant difference was found between the NON-DM-CRD and the healthy control group. There was a moderate negative correlation between the ratio of microalbumin/creatinine and the number of CD34+ cells. A significant reduction in the number of CD34+ cells was shown in subjects with DM and ESRD caused by diabetic nephropathy.

Treatment with plasma exchange may serve benefical effect in patients with severe hyperbilirubinemia: a single center experience.

Hyperbilirubinemia is a common clinical manifestation, and may be life threatening. Many diseases result in hyperbilirubinemias, some are refractory, and cannot be cured by medication or surgery. Plasma exchange (PE) for hyperbilirubinemia is not a pathogenesis oriented therapy but strives for the opportunity to cure. In the present study, we aimed to present the outcomes of treatment of hyperbilirubinemia with PE in patients with various disorders. Eleven patients who underwent PE due to hyperbilirubinemia between 2006 and 2012 in Apheresis Unit of Erciyes University, were retrospectively reviewed. After PE, we observed a marked decline in total and direct bilirubin levels. The decline in the biochemical values were statically significant (p<0.003). Both total and direct bilirubin levels remained above the normal limits in one of 11 patients. PE should be considered as an effective and safe option in cases with hyperbilirubinemia, and this procedure can improve survival in patients with sufficient residual capacity of liver regeneration.

Pretransplant iron overload may be associated with increased risk of invasive fungal pneumonia (IFP) in patients that underwent allogeneic hematopoietic stem cell transplantation (alloHSCT).

Invasive fungal pneumonia (IFP) has become increasingly common in patients that previously underwent alloHSCT. The aim of this study was to determine the role of hyperferritinemia, via iron overload in invasive fungal pneumonia in patients that underwent alloHSCT. Medical records of 73 patients with pneumonia that underwent alloHSCT were studied retrospectively, whereby a pre-transplantation serum ferritin level measured up to 100 days prior to transplantation of patients with invasive fungal pneumonia (IFP) and non-fungal pneumonia (non-IFP) was compared. Patient records revealed 35 and 38 cases of IFP and non-IFP, respectively. In risk evaluation for IFP, age, gender, HLA status, conditioning regimen, smoking history, and underlying disease were not significantly different among groups (p>0.05). However, performance status (Karnofsky) was significantly lower in patients with IFP (p<0.05). The median ferritin levels were 1,705 ng/ml (41-7198) in the IFP group and 845 ng/ml (18-7099) in non-IFP group and the difference was found statistically significant (p=0.001). Elevated pretransplant serum ferritin level is associated with IFP in patients that underwent alloHSCT, in particular when values exceed 1550 ng/ml.

The oral iron chelator deferasirox might improve survival in allogeneic hematopoietic cell transplant (alloHSCT) recipients with transfusional iron overload.

INTRODUCTION: Iron overload (IO) has been shown to be an important cause of mortality and morbidity in patients who underwent allogeneic hematopoietic stem cell transplantation (alloHSCT). This study aimed to evaluate the possible effect of oral iron-chelation treatment (deferasirox) on survival in alloHSCT recipients in the posttransplant period. MATERIALS AND METHODS: A total of 80 alloHSCT recipients with IO were analyzed, retrospectively. Pretransplant and posttransplant data were obtained from the patients' files. Patients were divided into two groups. Group 1; patients who did not receive any chelator treatment due to side effects or compliance problems. These patients were treated by phlebotomy. Group 2 consisted of patients who received deferasirox treatment. RESULTS: The median treatment duration with deferasirox was 122 days (min-max:91-225). The iron chelating treatment significantly reduced serum ferritin levels administered at a dosage of 20-30 mg/kg/day (p<0.001). The median OS in Group 1 was found 16.0 (min-max:1.0-63.0) months and 25.0 (min-max:3.0-72.0) months in Group 2. In univariate and multivariate analysis, patients in Group 1 showed poorer OS compared to those in Group 2 with an increase in risk of death (HR:3.22, min-max:1.67-6.23, p=0.001 and HR:3.51,, min-max:1.75-6.99, p<0.001; respectively). The median DFS in Group 1 was found 11.0 (min-max:3.0-24.0) months and 22.0 (min-max:8.0-43.0) months in Group 2. The difference was found statistically significant (p=0.023). The other factors that we found significant difference in multivariate analysis between groups were; presence of acute GVHD (patients with aGVHD had increased risk of death compared to patients without aGVHD (HR:2.49, min-max: 1.32-4.69, p=0.005), chronic GVHD (HR:2.57, min-max:1.23-5.41, p=0.013), median interval to tx (HR: 2.23, min-max:1.17-4.26, p=0.015) and HLA match (HR:3.01, min-max:1.35-6.73, p=0.007) CONCLUSION: Oral deferasirox (Exjade) treatment may improve survival in patients with iron overload who underwent alloHSCT.

Changes in CD34+ cell count in peripheral blood after whole blood donation.

AIM: We aimed to investigate the change in the number of stem cells and white cells in the early period following blood donation. PATIENTS AND METHOD: 22 male (71%) and 9 female (29%), 31 volunteers in total were included in the study. 450 ml of whole blood were collected from each of the volunteers for the donation. Complete blood counts were performed on the volunteers before and at 6 and 24h after the donation and CD34+ cell counts per ml of peripheral blood were measured by flow cytometry technique. RESULTS: There was a statistically significant increase in the number of CD34+ cells in the peripheral blood at 6h following blood donation (p<0.001). At 24h, however, there was a statistically significant decrease in the number of CD34+ cells, compared to 6h (p<0.001). There was a statistically significant increase in the number of leukocytes in the peripheral blood at 6h following blood donation (p<0.001). At 24h, there was a decrease in the number of leukocytes, which was statistically significant compared to 6h (p<0.001). When the difference in CD34+ cell and leukocytes counts before blood donation and at 24h after blood donation were compared, the results were not statistically significant. CONCLUSION: As the result of this study, a transient increase in the number of CD34+ cells in the peripheral blood after blood donation was demonstrated, with a decline in CD34+ cell counts back to levels prior to donation at 24h.

The management of hyperleukocytosis in an adult patient with acute lymphoblastic leukemia and ataxia-telangiectasia.

Ataxia-telangiectasia (AT) is a hereditary disorder characterized by progressive neurological dysfunction, oculocutaneous telangiectasia, immunodeficiency, cancer susceptibility, and radiation sensitivity. Pediatric patients may develop acute lymphoblastic leukemia (ALL). However development of ALL in an adult patient with AT is a rare occurrence. Here we report such a patient who presented with hyperleukocytosis and were treated with leukapheresis. A 25years old male patient, who were diagnosed with AT and mental retardation, was admitted to the emergency department due to fatigue, nausea and headache. On admission he had a moderate general condition and was fully cooperated. His white blood cell (WBC) count were 466×10(9)/l. Blastic cells were observed in peripheral blood smear. Flow cytometry (FC) of peripheral blood showed T-ALL. Two sessions of large volume leukapheresis was performed. Symptoms due to hyperleukocytosis markedly improved after leukapheresis. Patients with AT should be closely monitored due to risk of malignancy. Leukapheresis may improve the prognosis of high risk ALL patients presenting with hyperleukocytosis.

The results of therapeutic plasma exchange in patients with severe hyperthyroidism: a retrospective multicenter study.

Hyperthyroidism characterized by elevated serum levels of circulating thyroid hormones. The aim of hyperthyroidism treatment is to achieve a euthyroid state as soon as possible and to maintain euthyroid status. However, drug withdrawal and utilization of alternative therapies are needed in cases in which leucopenia or impairment in liver functions is observed during medical therapy. In the present study, we aimed to present our cases which underwent therapeutic plasma exchange (TPE) due to severe hyperthyroidism. The results of 22 patients who underwent therapeutic plasma exchange due to hyperthyroidism in Apheresis Units of Erciyes University and Gaziantep University, between 2006 and 2012, were retrospectively reviewed. These cases had severe thyrotoxic values despite anti-thyroid drug use. After TPE, we observed a significant decrease in free thyroxin (FT4) (p<0.001) and free triiodotyhronin (FT3) (p<0.004) levels. There was statistically significant increase in the mean values of TSH levels after TPE (p<0.001). Clinical improvement was achieved in hyperthyroidism by TPE in 20 cases (91%). Both FT3 and FT4 levels remained above the normal limits in two of 22 patients. TPE should be considered as an effective and safe therapeutic option to achieve euthyroid state before surgery or radioactive iodine treatment. TPE is a useful option in cases with severe hyperthyroidism unresponsive to anti-thyroid agents and in those with clinical manifestations of cardiac failure and in patients with severe adverse events during anti-thyroid therapy.

The comparison of Filgrastim (Neupogen®), biosimilar filgrastim (Leucostim®) and Lenograstim (Granocyte®) as a first line peripheral blood stem cell mobilization strategy in autologous hematopoieitic stem cell transplantation: a single center experience from Turkey.

OBJECTIVES AND AIM: Patients affected by hematological malignancies can often benefit from high dose chemotherapy followed by peripheral blood stem cells (PBSCs) transplantation. Different strategies have been used to mobilize an adequate number of PBSC, including granulocyte colony-stimulating factor (G-CSF) alone or chemotherapy plus G-CSF. In this study, we aimed to compare the efficacy profile of different G-CSF agents including filgrastim (Neupogen®), biosimilar filgrastim (Leucostim®) and Lenograstim (Granocyte®) on CD34(+) mobilization in patients who underwent autologous hematopoietic stem cell transplantation (autoHSCT). MATERIALS AND METHODS: We retrospectively analysed data of patients who underwent autoHSCT diagnosed with multiple myeloma (MM), Hodgkin Lymphoma (HL), non-Hodgkin Lymphoma (NHL) and others. Data for stem cell mobilization has been obtained from patients' files. Patients who received Filgrastim (Neupogen®), biosimilar Filgrastim (Leucostim®, Group) and Lenograstim (Granocyte®) were evaluated mainly for total CD34(+) cell count at the end of mobilization procedure. RESULTS: A total of 96 patients who underwent autoHSCT were retrospectively analyzed. 27 (28.2%) of the patients were female, and 69 (71.8%) were male. The diagnosis of the patients were; multiple myeloma (39 patients, 40.6%), Hodgkin Lyphoma (23 patients, 23.9%), non-Hodgkin lymphoma (16 patients, 16.6%), and others (18 patients, 18.9%). The median number of leukapheresis cycle necessary to harvest a minimal count of 3×10(6) CD34(+)/kg was 2 in Neupogen® (min-max: 1-4) and Granocyte® (min-max: 1-3) groups and 1 (min-max: 1-2) in Leucostim® group. The median doses of G-CSF agents (µg/kg/day) in PBSC collection procedure were; 10.00 (min-max: 7.00-12.00) in the Neupogen® group, 8.00 (min-max: 7.25-9.00) in the Leucostim® group and 8.50 (6.00-9.50) in the Granocyte® group. There was no statistical significance among groups (p=0.067). The number of total collected PB CD34(+) cells (×10(6)/kg) was 7.64 (min-max: 4.09-13.86) in the Neupogen® group, 13.43 (min-max: 8.15-23.38) in the Leucostim® group and 5.45 (min-max: 4.28-9.40) in the Granocyte® group. The data showed that patients in the leucostim group had significantly higher PB CD34(+) cells compared to patients in the Granocyte® group (p=0.013). CONCLUSION: Leucostim® was comparable to Neupogen® for PBSC mobilization in patients who underwent autoHSCT.