Elif Suyanı

Factors affecting stem cell mobilization for autologous hematopoietic stem cell transplantation.

High‐dose chemotherapy with autologous stem cell transplantation (ASCT) is curative treatment in various hematologic malignancies. Mobilization and collection of peripheral blood stem cell is the essential part of ASCT. The aim of this study was to evaluate the effectiveness of various mobilization regimens, determine the risk factors associated with mobilization failure (MF). We also investigated whether iron overload, which has an adverse impact on various aspects of HSCT including overall survival had any impact on mobilization kinetics. A total of 118 consecutive patients were included in this study. The rate of MF was 11.8 % with the first mobilization regimen. Frequency of MF was higher in lymphoma (P < 0.001) patients and in those receiving G‐CSF alone (P= 0.01). Peripheral CD34+ cell count (P < 0.001), bone marrow cellularity (P < 0.001), reticulin fibrosis (P < 0.05) were significantly lower whereas serum ferritin levels (P = 0.06) tended to be higher in patients with MF. CD34+ cell count of the first apheresis product was positively correlated with the white blood cell count (P < 0.05; r = 0.232), platelet count (P = 0.01; r = 0.233), peripheral CD34+ cell count (P < 0.001; r = 0.704) and the grade of bone marrow reticulin fibrosis (P < 0.001; r = 0.366). Serum ferritin levels were negatively correlated with maximum peripheral CD34+ cell count (P = 0.02; r = −0.216) and the CD34+ cell count in the first product (P = 0.05; r = −0.183). Platelet count (P = 0.03; β = 0.262), peripheral CD34+ cell count (P = 0.02; β=0.279) were the two variables which remained to be significant in multivariate analysis. Predicting the poor mobilizers with the platelet count for instance may reduce the risk of MF by using more effective regimens in advance. J. Clin. Apheresis, 2010.

The role of body mass index and other body composition parameters in early post-transplant complications in patients undergoing allogeneic stem cell transplantation with busulfan-cyclophosphamide conditioning

Patients with impaired nutritional status may show increased risk of hematopoietic stem cell transplantation (HSCT)-related complications. This study was conducted to determine whether body mass index (BMI) and other body composition parameters, such as lean body mass index (LBMI) and body fat mass (BFM), are associated with early post-transplantation toxicity and mortality in allogeneic HSCT recipients. The records of 71 patients diagnosed with acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), chronic myeloid leukemia (CML), or myelodysplastic leukemia (MDS) who had undergone allogeneic HSCT with a conditioning regimen of busulfan–cyclophosphamide (Bu–Cy), between September 2003 and January 2009 at the Stem Cell Transplantation Unit of Gazi University Hospital were retrospectively evaluated. BMI was found to be negatively correlated with the NCI grade of mucositis, cardiotoxicity, emesis, and hyperglycemia, and with the number of erythrocyte transfusions. LBMI was also negatively correlated with the number of erythrocyte transfusions, cardiotoxicity, emesis, and hyperglycemia. BFM was negatively correlated with the day of neutrophil engraftment, and NCI grade of mucositis. Nutritional status did not have an impact on overall survival (OS), progression-free survival (PFS), or 100-day transplant related mortality (TRM).

Peritonitis due to Lactococcus lactis in a CAPD patient

Lactococcus lactis is a Gram-positive bacterium, commonly used in the dairy industry. Although Lactococcus lactis is known to be non-pathogenic for humans, it can cause infection in immunocompromized patients. We report a case of peritonitis due to L. lactis in a continuous ambulatory peritoneal dialysis patient, which is the second reported case in the literature.

Acute respiratory distress syndrome in patients with hematological malignancies

Abstract Background We investigated the clinical course and mortality of acute respiratory distress syndrome (ARDS) in patients with hematological malignancies. Methods Sixty-eight patients with hematological malignancies and ARDS admitted to medical intensive care unit (ICU) of a university hospital were analyzed semi-prospectively in the study. Results The most common etiology of ARDS was pneumonia. The ratio of partial pressure of oxygen in arterial blood to fractional concentration of inspired oxygen (PO2/FiO2) was 104 (74–165). Ten patients (15%) received non-invasive mechanical ventilation (NIV), 21 (31%) received invasive mechanical ventilation (MV), and 36 (53%) received both NIV and invasive MV. ICU mortality was 77% in the cohort. None of the variables with relevance to the underlying hematological disease was associated with mortality. The presence of two or more organ failures was the only independent risk factor for mortality (P = 0.045), whereas NIV was associated with low mortality (P = 0.001). The Kaplan–Meier curve of mortality, with respect to the type of MV support, demonstrated that NIV was associated with the lowest mortality (P < 0.001). Conclusion The mortality of ARDS in critically ill patients with hematological malignancies is quite high. The presence of multi-organ failure is independently associated with high mortality whereas the use of NIV is independently associated with low mortality.

Prognostic role of pre‐transplantation serum C‐reactive protein levels in patients with acute leukemia undergoing myeloablative allogeneic stem cell transplantation

The aim of this study was to identify indicators of outcome prior to transplantation in allogeneic hematopoietic stem cell transplantation (HCT). Clinical data of 106 patients with acute leukemia were retrospectively analyzed. We examined the role of pre‐conditioning serum C‐reactive protein (CRP) and ferritin levels, HCT‐CI and European Group for Blood and Marrow Transplantation (EBMT) scores on transplant toxicities, transplant‐related mortality (TRM), progression‐free survival (PFS), and overall survival (OS). High pre‐conditioning serum CRP levels showed a positive correlation with higher EBMT scores (p < 0.001), HCT‐CI (p = 0.004), and ferritin levels (p < 0.001). In univariate Cox regression analysis, serum CRP ≥10 mg/L, serum ferritin ≥1500 ng/mL, and HCT‐CI ≥3 had a significant adverse effect on OS. Serum CRP ≥10 mg/L and HCT‐CI ≥3 predicted increased risk of TRM in univariate analysis. Multivariate Cox regression analysis showed that HCT‐CI score ≥3 independently predicted increased risk of TRM and CRP ≥10 mg/L predicted increased risk of disease progression. Although CRP lost its significance on TRM in multivariate analysis, as an inexpensive and readily available serum biomarker of inflammation, the prognostic role of pre‐transplant CRP levels should be analyzed in selected diseases and increased number of patient groups.

Effects of Everolimus on Cytokines, Oxidative Stress, and Renal Histology in Ischemia-Reperfusion Injury of the Kidney

Background. To evaluate the effects of everolimus on renal ischemia-reperfusion injury (IRI). Methods. Wistar albino rats were divided into control, ischemia-reperfusion (IR), and ischemia-reperfusion/everolimus (IR/eve) groups. Everolimus was administered for seven consecutive days to the IR/eve group prior to injury. IR and IR/eve groups underwent forty-five minutes ischemia followed by the application of reperfusion at 2 and 24 hours. Blood samples and kidneys were taken from all animals. Results. Serum blood urea nitrogen and creatinine levels increased at two hours of reperfusion in the IR and IR/eve groups, and decreased at 24 hours of reperfusion in the IR group. In the IR/eve group, we detected significantly high interleukin-6 levels and low tumor necrosis factor-α and malondialdehyde levels at 24 hours. Myeloperoxidase levels increased at two hours of reperfusion in the IR/eve group, but decreased significantly at 24 hours. Everolimus did not improve renal tubular and interstitial injuries in renal IRI. Conclusions. It has been demonstrated that pretreatment with everolimus has beneficial effects on cytokines and oxidative stress in renal IRI. However, these effects are insufficient for the correction of histopathological changes and restoration of normal kidney function.

Abnormal protein bands in patients with multiple myeloma after haematopoietic stem cell transplantation: does it have a prognostic significance?

Abnormal protein bands (APB) unrelated to the original monoclonal protein occasionally appear in serum immunofixation samples from patients with multiple myeloma (MM) following haematopoietic stem cell transplantation (HCT). To investigate the significance of APB, medical records and serum immunofixation patterns of 53 MM patients, who had undergone HCT (49 autologous and 4 allogeneic) at the stem cell transplantation unit of Gazi University Faculty of Medicine, were reviewed. Patients were staged according to Durie–Salmon and International staging systems (ISS) and disease response was determined according to European Bone Marrow Transplantation (EBMT) criteria. Fourteen (26.4%) of the 53 patients developed APBs after HCT. The median time for the appearance and duration of APB was 3 (range 1–24) and 5.5 (range 1.5–14) months, respectively. Probability of overall survival (OS) at the end of the follow‐up was 77 and 61.4% in patients with and without APB, respectively (p = 0.334). The median duration of follow‐up (767 days (range, 220–2905) vs. 726 days (range, 120–1780) p = 0.545) was not different in patients with and without APB. Probability of progression free survival (PFS) at the end of follow‐up was 28.8% in patients with and 27.7% in patients without APB (p = 0.835). PFS (910 days (range 180–2905) vs. 730 days (range 90–1765) p = 0.835) was longer in patients with APB, though without statistical significance. Thus, the occurrence of APB post‐transplantation is not associated with any adverse long‐term consequences and does not require treatment modification. Copyright

H1N1 infection in a cohort of hematopoietic stem cell transplant recipients: prompt antiviral therapy might be life saving

E. Suyani, Z. Aki, Ö. Güzel, Ş. Altindal, E. Şenol, G. Sucak. H1N1 infection in a cohort of hematopoietic stem cell transplant recipients: prompt antiviral therapy might be life saving.
Transpl Infect Dis 2011: 13: 208–212. All rights reserved

Complete remission with a combination of lenalidomide, cyclophosphamide and prednisolone in a patient with incomplete POEMS syndrome.

ment had commenced. However, the symptoms of the patient had not improved and 2 months prior to her admission to our hospital, skin hyperpigmentation had started. Her physical examination upon admission revealed papilledema and hepatosplenomegaly. Blood cell counts were as follows: hemoglobin 13.7 g/dl, white blood cell count 9.98 ! 10 9 /l, and platelet count 773 ! 10 9 /l. Serum biochemistries revealed calcium 9 mg/dl, albumin 4.7 g/dl, globulin 3 g/dl, lactate dehydrogenase 103 U/l and normal liver and renal function tests. Serum immunofixation showed IgA type monoclonal gammopathy without an accompanying light chain. Her immunoglobulin levels were as follows: IgG 1,060 mg/dl, IgA 442 mg/dl, and IgM 374 mg/dl. Serum kappa and lambda light chain levels and their ratio were 48.6 mg/l, 88.8 mg/l, and 0.55, respectively. Bone marrow biopsy revealed 15% polyclonal plasma cell infiltration without amyloid deposition. The bone marrow biopsy was repeated resulting in 1–3% polyclonal plasma cells, again without amyloid deposition. There were no lytic or sclerotic bone lesions on the skeletal survey. Adrenocorticotropic hormone (ACTH), prolactin and thyroid-stimulating hormone levels were found to be raised. A Synacthen stimulation test was negative. Abdominal computed tomography showed hepatomegaly of 17 cm, splenomegaly of 17 cm POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, skin changes) syndrome, a rarely seen plasma cell disorder, is characterized by increased levels of cytokines, vascular endothelial growth factor (VEGF) in particular, which plays a role in the pathogenesis by inducing angiogenesis [1, 2] . Radiation therapy, alkylator-based chemotherapy, corticosteroids and peripheral stem cell transplantation are the mainstay of the treatment [1–3] . Anti-VEGF therapies like bevacizumab [4, 5] and proteosome inhibitors such as bortezomib [6] , thalidomide [7] and lenalidomide have been reported to be beneficial. A 40-year-old female was admitted to our hospital with bilateral dropped foot and claw hands. She had a history of progressive neuropathy starting nearly 2.5 years ago, with tingling, paresthesia and pain in the feet followed by motor dysfunction, progressing to dropped foot and later involving her hands, leading to claw hands. Magnetic resonance imaging had shown minimal annular bulging of the discs L1–5, which was not consistent with the clinical condition of the patient at the time. An electromyography of the patient had revealed bilateral diffuse demyelinating peripheral neuropathy with axonal involvement. Vitamin B 12 deficiency had also been detected. Vitamin B 12 replacement and pregabalin treatReceived: March 7, 2011 Accepted after revision: May 24, 2011 Published online: August 18, 2011

The positive impact of regular exercise program on stem cell mobilization prior to autologous stem cell transplantation

AIM The present study was planned to determine the effects of regular exercise program on hematopoietic stem cell (HSC) mobilization prior to autologous stem cell transplantation. METHOD Twenty-two consecutive patients were enrolled in the study. A regular 20 min exercise program was administered to the patients. The hematopoietic stem cell mobilization outcome, number of Granulocyte Colony-Stimulating Factor (G-CSF) and aphaeresis application days were compared with 20 case-matched controls who did not receive exercise program during HSC mobilization. RESULTS The median number of CD34(+) stem cells collected in the exercise and control groups were 8.15 × 10(6)/kg (range: 2.85-33.06 × 10(6)/kg) and 7.3 × 10(6)/kg (range: 1.78-25.9 × 10(6)/kg), respectively (p=0.696). G-CSF was administered for a median of 8 days (range, 5-10) in the exercise group and 8 days (range, 5-12) in the control group (p=0.848). The median apheresis duration was 1 day (range, 1-3) in both exercise and control groups (p=0.226). CONCLUSION Exercise seems to have a positive impact on stem cell mobilization though without statistical significance.