Merih Kızıl Çakar

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).

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.

Does microbial contamination influence the success of the hematopoietic cell transplantation outcomes

INTRODUCTION Microbial contamination can be a marker for faulty process and is assumed to play an important role in the collection of hematopoietic progenitor cell (HPC) and infusion procedure. We aimed to determine the microbial contamination rates and evaluate the success of hematopoietic cell transplantation (HCT) in patients who received contaminated products. PATIENTS-METHODS We analyzed microbial contamination records of HPC grafts between 2012 and 2015, retrospectively. Contamination rates of autologous donors were evaluated for at three steps: at the end of mobilization, following processing with dimethyl sulfoxide, and just before stem cell infusion. Grafts of allogeneic donors were assessed only before HCT. RESULT A total of 445 mobilization procedures were carried out on 333 (167 autologous and 166 allogeneic) donors. The microbiological contamination of peripheral blood (323/333 donations) and bone marrow (10/333 donations) products were analyzed. Bacterial contamination was detected in 18 of 1552 (1.15 %) culture bottles of 333 donors. During the study period 248 patients underwent HCT and among these patients microbial contamination rate on sample basis was 1.3 % (16/1212). Microbial contamination detected in nine patients (7 autologous; 2 allogeneic). In 8 of 9 patients, a febrile neutropenic attack was observed. The median day for the neutropenic fever was 4 days (0-9). None of the patients died within the post-transplant 30 days who received contaminated products. CONCLUSION The use of contaminated products with antibiotic prophylaxis may be safe in terms of the first day of fever, duration of fever, neutrophil, platelet engraftment and duration of hospitalization.

Outcome of autologous stem-cell transplantation in relapsed or refractory Hodgkin lymphoma patients in a centre from Turkey

Abstract Purpose The aim of this study is to assess the predictors of outcome in patients with relapsed or refractory Hodgkins lymphoma (HL) receiving autologous stem-cell transplantation (ASCT) Materials and methods Fifty-two consecutive patients who received ASCT at the Stem Cell Transplantation Unit of Gazi University Hospital from February 2005 through June 2011 for relapsed or refractory HL were analysed retrospectively Results Fifty-one patients could be evaluated after transplantation, as one of the patients died in the early post-transplantation period. Complete remission was obtained in 36 (71%), partial remission in 9 (18%), stable disease in 4 (8%), and progressive disease in 2 (3%) patients. After a median follow-up of 22 (range, 0.5–75) months, 46 (88%) patients were alive. The probability of overall survival (OS), progression free survival (PFS) and transplantation related mortality at 5 years were 87, 53, and 2%, respectively. Chemosensitive relapse had a positive impact on both OS and PFS Conclusion ASCT remains to be the standard treatment of relapsed or refractory HL patients. Chemosensitive relapse is the most important prognostic factor determining the outcome of the ASCT.

Adverse impact of hyperferritinemia and transfusion dependency on treatment success in myelodysplastic syndrome

BACKGROUND Myelodysplastic syndrome (MDS) is characterized by peripheral cytopenias and dysplasia in one or more cell lines in the bone marrow. A significant proportion of patients require blood product support due to symptomatic anemia and/or thrombocytopenia during the course of their disease. This retrospective study was planned to evaluate the transfusion requirement of MDS patients and the role of ferritin in predicting transfusion requirement and response to treatment. METHODS We retrospectively reviewed the records of 35 MDS patients [median age: 66 (22-84); male/female: 21/14]. The World Health Organization (WHO) criteria was used for disease classification and International Prognostic Scoring System (IPSS) for risk stratification. RESULTS A total of 22 patients (62.8%) required transfusions during follow-up. While all the 22 patients received packed red blood cells (PRBCs), only 8 patients (22.9%) required platelet transfusion(s). Although no significant relationship was demonstrated between transfusion dependency and disease progression, patients who responded to disease-specific treatment were exposed to less PRBC transfusions compared to non-responders (p=0.04). Treatment response was found to be better in patients who had lower serum ferritin levels at diagnosis (p=0.004). A total of 11 patients were followed for a minimum of 24months. Transfusion load was not different among these patients with respect to disease subtype, IPSS risk score and treatment protocol in the first and second 12-month interval. Median overall survival of the cohort was 26.3 (0.4-160.3) months and median progression free survival was 24.9 (0.4-160.3) months. CONCLUSION The present report underlines the association of baseline hyperferritinemia and transfusion dependency with treatment success in MDS. Even in patients treated with new generation agents, the vicious impact of transfusion load seems to be the tender spot of the MDS puzzle. The prognostic impact of baseline hyperferritinemia should be validated with further studies.

Coexistence of chronic lymphocytic leukemia and multiple myeloma, do the roots of these entities originate from the same place?

Multiple myeloma is a plasma cell disease, whereas CLL (Chronic Lymphocytic Leukemia) affects mature B‐cell lymphocytes. Even though the coexistence of those two conditions is extremely rare, as both cell types differentiate from the same multipotent stem cells, the clinician should evaluate patients carefully not to misdiagnose such a concomitancy.

The Impact of Chemotherapy on Hepatitis B Antibody Titer in Patients with Hematological Malignancies

Objective: To investigate the influence of chemotherapy (CT) on HBsAb titer in patients receiving CT due to hematological malignancy. Materials and Methods: The data of 75 patients who received CT with the diagnosis of various hematological malignancies and who had serum HBsAb levels measured prior to and after the cessation of CT were evaluated retrospectively. Results: The median age of the patients was 52 years (range: 16-78) with 49 (65%) males and 26 (35%) females. Median HBsAb titer decreased significantly after CT compared to the pre-CT median HBsAb titer [68 (range: 0-1000) vs. 100 (range: 6.2-1000)] (p=0.001). In subgroup analysis, median HBsAb titer decreased significantly after CT in acute leukemia patients [110 (range: 6.2-1000) vs. 67.8 (range: 0-1000)] (p=0.003) and in patients receiving intensive CT [97.2 (range: 6.2-1000) vs. 71 (range: 0-1000)] (p=0.036). The decrease in median HBsAb titer was significant in male patients (p<0.001). HBsAb became negative after CT in 9 patients who were HBcAb-negative and had lower pre-CT HBsAb levels. Conclusion: HBsAb decreased after CT, especially in acute leukemia and male patients, and in patients receiving intensive CT.

A 80-year-old woman with B-cell prolymphocytic leukemia

Prolymhocytic leukemia (PLL) is a rare subtype of lymphocytic leukemias and its cells are immature lymphocytes. It is divided into 2 subgroups: T-PLL and B-PLL according to the lymphocytic origin of the cells. Discriminating B-PLL from other diseases with clinically-similar features is important because of the different treatment approaches and follow-up programs. Hereby, we report a 80-year-old woman presenting with fatigue, leucocytosis and mild anemia. Her peripheral blood smear evaluation revealed 85% prolymphocytes with moderately condensed nuclear chromatin, prominent nucleoli, and a faintly basophilic cytoplasm. Positron emission tomography-computed tomography showed mediastinal lymph nodes with cervical lymph nodes. There was no pathological FDG involvement in the spleen. Bone marrow aspiration smear exhibit atypical wide lymphocytes with prominent nucleoli and abundant agranular cytoplasm. Flow cytometry analysis revealed positive CD5+, CD19+, CD20+, CD22+, CD11c+, CD25+, CD79a+ and CD79b+. Fluorescence in situ hybridization technique analysis reveals no t(11;14). Bone marrow biopsy revealed interstitially distributed atypical cells with wide nucleus and prominent nucleolus.

P-03 THE PATTERN OF TRANSFUSION REQUIREMENT IN A GROUP OF PATIENTS WITH MYELODYSPLASTIC SYNDROME IN THE ERA OF NEW GENERATION AGENTS

The Myelodysplastic syndrome (MDS) is characterized by peripheral blood cytopenia and dysplastic changes of one or more cell lines in the bone marrow. There is an increased risk of transformation to acute myelogenous leukemia in time. A significant proportion of the patients require blood product due to severe anemia and/or thrombocytopenia. Our objective in this retrospective study was, to determine the characteristics of patients with respect to blood product requirement and to determine whether there was a change in transfusion practice with time in patients who require blood product transfusion. We analyzed a total 35 (14 Female/21 Male) patients who were diagnosed with MDS from 2002 through 2012 whose data were also available in the blood bank of Gazi University Hospital. We used WHO classification for determination MDS subtype and International Prognostic Scoring System (IPSS) for risk-stratification. The median age was 66.0 (range: 22–88). The most common subtypes were refractory cytopenia with unilineage dysplasia (RCUD) (48.6%), Refractory anemia with excess blasts (RAEB-1) (14.3%) RAEB-2 (14.3%) and chronic myelomonocytic leukemia (CMML-1) (14.3%). The riskstratification for 33 patients was low-risk in30.3%, intermediate-1 in 60.6% and intermediate-2 in9.1%. Among the 25 patients whose molecular studies (FISH) was available, 1 patient had 5q deletion, 1 patient had 7q deletion whereas the others were normal Fifteen patients required treatment and received one of the drugs 5-azacytidine, thalidomide or lenalidomide). Sixty three percent of the patients required transfusion among which 86.4% received packed red blood cells. 45.5% received platelets. Eleven patients were followed a minimum of 24 months. The transfusion requirement of the patients in the first and second 12 month interval were similar. The transfusion requirement was also similar in the first and second year with respect to the MDS subtype, IPSS and treatment status. Median overall survival was 40.5 months (range: 23–79) and median progression free survival was 33.2 months (range 21–65). It might be expected that transfusion requirement to increase with time due to disease progression. Whereas our data show that the transfusion requirement of the patients remained stable in 2 years follow-up. The new generation agents might have delayed the disease progression and increase in transfusion requirement might have been observed with a longer follow up. P-04 ABO MAJOR INCOMPATIBILITY IN ALLOGENEIC BONE MARROW TRANSPLANTATION: RBC REMOVAL WITH COMTEC CELL SEPARATOR P. Accorsi, R. Giancola, C. Passeri, A. Iacone. Dept. of Transfusion Medicine, Pescara Civil Hospital, Dept. of Transfusion Medicine, Pescara Civil Hospital, Italy

Evaluation of Multiple Myeloma Patients Presenting with Renal Failure in a University Hospital in the Year 2010

Background: The aim of this cross-sectional study was to evaluate multiple myeloma patients presenting with renal failure in a University hospital. Methods: The records of all the patients diagnosed with multiple myeloma in the departments of hematology and nephrology at Gazi University Hospital between January 2010 and January 2011 were reviewed retrospectively. Renal failure was defined as a serum creatinine level of ≥2 mg/dL. Median age was 63 (range 37–80) years, with 13 male and 17 female patients. Results: Eight (26.7%) of the 30 patients had renal failure and 4 (50%) patients with renal failure required renal replacement therapy with hemodialysis after admission. Renal functions recovered in four (50%) of the eight patients after treatment. In one of the eight patients (12.5%) creatinine levels improved, but did not reach the level defined as reversal of renal failure. The renal functions of the three (37.5%) patients did not improve and they remained on chronic hemodialysis program during which one of them died due to a cerebrovascular accident and one other patient was lost due to follow-up. Conclusion: A substantial proportion of myeloma patients referred with renal failure might enjoy a disease-free survival and could be saved from chronic renal replacement therapy with prompt diagnosis and treatment in the era of new-generation anti-myeloma agents which provide fast and effective responses. Multiple myeloma should be considered in the differential diagnosis of acute renal failure even in the absence of hyperglobulinemia and hypercalcemia.