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Total parenteral nutrition delays platelet engraftment in patients who undergo autologous hematopoietic stem cell transplantation

OBJECTIVES One of the major challenges in the post-transplant period is nutrition. In this prospective, non-randomized study, total parenteral nutrition (TPN) was given to 31 patients and partial parenteral nutrition (PPN) was given to 30 patients undergoing autologous hematopoietic stem cell transplantation for solid tumors or hematologic malignancies to compare the effects of these parenteral nutrition modalities on post-transplant hematological engraftment, blood chemistry, and supportive therapy requirements. METHODS All patients in the TPN group and 17 patients in the PPN group received growth factor in the post-transplant period. Both groups did not differ with respect to sex, age, and reinfused CD34(+) cell numbers. RESULTS After transplantation body mass index and body weight decreased significantly in both groups (P < 0.001). Whereas serum albumin concentrations did not decrease significantly in the TPN group, it fell markedly in the PPN group at the end of parenteral nutrition (P = 0.019). After parenteral nutrition, blood chemistry was also remarkable for serum urea and glucose levels, which were elevated significantly in the TPN group (P < 0.001 and P = 0.03, respectively). Patients receiving TPN had a higher incidence of positive microbial cultures and clinical infection than did patients receiving PPN (64.5% versus 40%, P = 0.05). The most striking result was a delay in platelet engraftment for the TPN group compared with the PPN group (15.54 and 12.93 d, respectively; P = 0.014). This difference was also noted in patients using growth factor in the PPN group (P = 0.017). Parallel to these results, platelet transfusion requirement increased in the TPN group compared with the PPN group (1.93 versus 1.16 U, P = 0.004). Both groups were unremarkable for leukocyte recovery and red blood cell transfusion requirement. CONCLUSIONS Consequently, TPN has some pitfalls of hyperglycemia, infection tendency, delayed platelet engraftment, and increased platelet transfusion requirement. Therefore, it should not be used as a standard nutrition support for patients undergoing autotransplantation.

Prostat kanserinden uzun süre sonra gelişen kompleks karyotipik anormali ile seyreden akut myeloblastik lösemi olgusu

Ozet Loseminin bir turu olan akut myeloblastik losemi (AML) myeloid seriye ait olgunlasmamis hucrelerin kemik iliginde, kanda, bazen diger dokularda asiri birikimi ile karakterize hematolojik kanserdir. Losemik hucre farklanmasinda kemik iligi ve periferik kan hucrelerinde klonal kromozomal anomaliler ortaya cikmaktadir. Bu anomaliler olgu tanisi ve prognozunu gostermesi acisindan onemlidir. Yazimizda prostat kanseri nedeni ile 12 yil once cerrahi ve hormon tedavisi alan ilk tani evresinde kompleks karyotip anomaliler tesbit edilen bir AML olgusu sunulmaktadir. Tanimlanan kompleks karyotipik anomalilerin prognoz uzerindeki etkisi tartisilmaktadir. Periferik kan ve kemik iligi incelemesinde AML tanisi konan 70 yasindaki erkek olgunun kemik iliginden yapilan sitogenetik incelemede 49, XY, -1, -2, +4, +6, +8, +8, -12, -13, der (1), +2 mar [3], 50, XY, -2, +4, +6, +8, +8, -13, +2mar [2], 50, XY, -2, +4, +6, +8, +11?, -13, +2 mar [1] saptandi. Kompleks karyotipler genelde olgularda kotu prognoz belirtecidir. AML tanisi konulan olgu her turlu destek tedavisine ragmen tanidan iki gun sonra kaybedildi. Sonuc olarak, ozellikle yasli AML’li hastalarda gerek tani, gerekse prognozun belirlenebilmesi icin genetik incelemelerin mutlaka yapilmasi gerekliligi goz onunde bulundurulmalidir. Anahtar sozcukler: Akut myeloid losemi, karyotipleme, kromozom anormallikleri, sitogenetik Abstract Acute myeloid leukemia (AML) is a type of leukemia which is characterized by the excessive accumulation of immature myeloid bone marrow precursor cells in the marrow itself, in peripheral blood and sometimes also in other tissues. During differentiation of leukemia cells, clonal chromosomal abnormalities emerge in bone marrow and in peripheral blood cells. These anomalies are important for the disease diagnosis and prognosis. Here, an AML case who underwent surgery for prostate cancer 12 years ago and received hormonal therapy is presented. Complex karyotypic abnormalities were present in the initial diagnosis phase The correlation between complex karyotypes and the prognosis in this case was discussed. Our 70 year-old patient was diagnosed as AML after peripheral blood and bone marrow analyses. His bone marrow cytogenetic analyses revealed 49, XY, -1, -2, +4, +6, +8, +8, -12, -13, der (1), +2 mar [3], 50, XY, -2, +4, +6, +8, +8, -13, +2mar [2], 50, XY, -2, +4, +6, +8, +11?, -13, +2 mar [1]. Complex karyotypes generally represents poor prognosis in AML cases. The patient died in two days after the initial diagnosis, although AML treatment was applied. As a result genetic examination should always be performed in elderly AML patients for both diagnosis and prediction of prognosis. Keywords: Acute myeloid leukemia, karyotyping, chromosome aberrations, cytogenetics