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Apheresis in patients with sepsis: A multicenter retrospective study
(Pergamon-Elsevier Science Ltd, 2021) Aydin, Kaniye; Korkmaz, Serdal; Erkurt, Mehmet Ali; Sarici, Ahmet; Ekinci, Omer; Baysal, Nuran Ahu; Berber, Ilhami
Background and objectives: To consider the effectiveness of apheresis, which is a supportive treatment method, in sepsis. Materials and methods: A hundred and eleven adults with sepsis or septic shock were included in this retrospective study. The demographic characteristics of the patients, the focus and source of infection causing sepsis or septic shock, characteristics of the pathogen, Acute Physiological and Chronic Health Assessment (APACHE) II score, routine laboratory values, which apheresis method was used, the characteristics of the replacement fluids used during the apheresis procedure, the number of apheresis procedures, complications related to the apheresis procedure, the follow-up time after the procedure, and mortality were recorded. The primary outcome was 28day mortality. Results: Sixty-nine (62.2 %) of the patients were male. The mean age of the patients was 47.7 +/- 18.6 years. The most common source of sepsis was hospital-acquired (79.3 %), the most common pathogen causing sepsis was gram-negative bacteria (41.4 %), and the most common infection site was the respiratory tract (58.7 %). The median APACHE II score was 19 (13-24). 92 (82.9 %) of the patients had septic shock. Theropeutic plasma exchange (TPE) was performed in 11.7 % of the patients and immunoabsorbtion IA in 88.3 %. The median number of sessions was 3 (3-5). No procedure-related fatal complication was observed in the study. While 28day mortality was 61.3 % in all patients, when the mortality according to the apheresis procedures was examined, it was 11.3 % and 88.2 % in the patients who underwent TPE and IA, respectively. The most common cause of mortality was multiorgan failure. Conclusions: Apheresis in sepsis can be considered as a salvage treatment. The indication for apheresis in sepsis is still at the level of patient-based individualized decision in line with the studies done so far, including our study. However, there is a need for a multicenter randomized controlled study with a large number of patients in order to give positive or negative recommendations about its effectiveness.
Clinical characteristics and therapeutic outcomes of elderly patients with chronic myeloid leukemia: A retrospective multicenter study
(Wiley, 2015) Korkmaz, Serdal; Dal, Mehmet Sinan; Berber, Ilhami; Sahin, Deniz Goren; Dogu, Mehmet Hilmi; Ayyildiz, Orhan; Nizam, Ilknur
AimsWe aimed to investigate whether older age leads to limitations in the starting dose of imatinib in daily treatment of chronic myeloid leukemia, and to determine the compliance of elderly patients with tyrosine kinase inhibitors (TKI) therapy. MethodsData including the clinical characteristics, therapeutic outcomes and compliance with TKI therapy of elderly patients with chronic myeloid leukemia aged >65years were collected from 13 institutions in Turkey, retrospectively. ResultsA total of 69 patients (27 [39%] men, 42 [61%] women) were evaluated retrospectively. The median age of the patients was 71years (range 66-85years). Of the patients, 66 (96%) were in the chronic phase and three (4.3%) were in the accelerated phase when diagnosed. A total of 63 (91.3%) patients were receiving imatinib as the first-line therapy. The initial dose of imatinib was 400mg/day in 59 patients (93.6%). Imatinib treatment induced 57 (90.5%) complete hematological responses at 3months, 29 (46%) complete cytogenetic responses at 6months and 49 (77.7%) major molecular responses at 12months. As a result, nilotinib and dasatinib were used in 14 patients as second-line therapy. Second-line TKI induced nine complete hematological responses (64.3%) at 3months, four complete cytogenetic responses (28.6%) at 12months and seven major molecular responses (50%) at 18months. A total of 56 of the patients (81.2%) are still alive. The median overall survival and progression-free survival rates were 35months (range 1-95months) and 17months (range 0.8-95months), respectively. ConclusionElderly patients should receive TKI according to the same guidelines that apply to younger patients. Geriatr Gerontol Int 2015; 15: 729-735.
The clinical characteristics and therapeutic outcomes of elderly patients with chronic myeloid leukemia: A retrospective multicenter study.
(Lippincott Williams & Wilkins, 2014) Korkmaz, Serdal; Dal, Mehmet Sinan; Berber, Ilhami; Sahin, Deniz Goren; Dogu, Mehmet Hilmi; Ayyildiz, Orhan; Nizam, Ilknur
[Abstract Not Available]
Clinical characteristics and treatments outcomes in elderly patients with multiple myeloma: A multicenter retrospective study
(2017) Terzi, Hatice; Korkmaz, Serdal; Berber, İlhami; Keklik, Muzaffer; Doğu, Mehmet Hilmi; Şencan, Mehmet; Kaya, Emin; Eser, Bülent; Sarı, İsmail; İlhan, Osman
Abstract: Amaç: Mutipl Myeloma, tüm kanser tiplerinin %1' ini, hematolojik malignitelerin ise %10' unu oluşturan tamamen kürün sağlanamadığı fatal bir hastalıktır. Genellikle yaşlı populasyonda izlenir. Bu çalışmanın amacı, son 5 yılda farklı rejimlerle tedavi edilen 65 yaş ve üzerindeki 105 Mutipl Myeloma' lı hastadaki klinik deneyimimizi sunmaktır. Yöntem: 65 yaş üzerindeki Mutipl Myeloma'lı hastaların klinik karakterleri ve terapötik sonuçlarını analize etmek için, Türkiye'deki 5 farklı merkezden retrospektif olarak veriler toplandı.Bulgular: 51 erkek ve 54 kadından oluşan toplam 105 yaşlı Multipl Myeloma hastası (65 yaş ve üzeri) retrospektif olarak değerlendirildi. Hastalara ilk basamak olarak, VAD( vinkrsitin, adriamisin, deksametazon), VCD ( Bortezomib, siklofosfamid, deksametazon), MP( melphalan, prednizolon), MPT (Melphalan, prednizolon, thalidomid) rejimleri verildi. 29 hastada tam yanıt elde edildi ve bu hastaların 18 'ine otolog kök hücre nakli yapıldı. Tam yanıt elde edilemeyen 46 hastaya, ikinci basamak tedavi olarak bortezomib, lenalidomid ve talidomid bazlı rejimler verildi. İkinci basamak tedavi ile tedavi edilenlerin 29'unda tam yanıt elde edildi ve bu hastalardan 20'sine otolog kök hücre nakli yapıldı. 16 hastaya ise birinci ve ikinci basamak rejimlere yanıt vermediğinden lenalidomid bazlı rejimler (n: 10), talidomid bazlı rejimler (n: 6) verildi. Bu tedavilerle remisyona giren 5 hastaya Otolog kök hücre nakli yapıldı. Sonuç: Optimal tedavi yaklaşımı, verimli, güvenli, kaliteli yaşam sağlamalı ve amaç tam yanıtın yanı sıra hastalıksız sağ kalımı ve genel sağ kalımı uzatmak olmalıdır
Convalescent plasma therapy in patients with COVID-19
(Pergamon-Elsevier Science Ltd, 2021) Altuntas, Fevzi; Ata, Naim; Yigenoglu, Tugce Nur; Basci, Semih; Dal, Mehmet Sinan; Korkmaz, Serdal; Namdaroglu, Sinem
Introduction: Passive antibody therapy has been used to immunize vulnerable people against infectious agents. In this study, we aim to investigate the efficacy of convalescent plasma (CP) in the treatment of severe and critically ill patients diagnosed with COVID-19. Method: The data of severe or critically ill COVID-19 patients who received anti-SARS-CoV-2 antibody-containing CP along with the antiviral treatment (n = 888) and an age-gender, comorbidity, and other COVID-19 treatments matched severe or critically ill COVID-19 patients at 1:1 ratio (n = 888) were analyzed retrospectively. Results: Duration in the intensive care unit (ICU), the rate of mechanical ventilation (MV) support and vasopressor support were lower in CP group compared with the control group (p = 0.001, p = 0.02, p = 0.001, respectively). The case fatality rate (CFR) was 24.7 % in the CP group, and it was 27.7 % in the control group. Administration of CP 20 days after the COVID-19 diagnosis or COVID-19 related symptoms were associated with a higher rate of MV support compared with the first 3 interval groups (?5 days, 6-10 days, 11-15 days) (p=0.001). Conclusion: CP therapy seems to be effective for a better course of COVID-19 in severe and critically ill patients.
Convalescent plasma therapy in patients with COVID-19
(Pergamon-Elsevier Science Ltd, 2021) Altuntas, Fevzi; Yigenoglu, Tugce Nur; Bascl, Semih; Dal, Mehmet Sinan; Korkmaz, Serdal; Turgut, Burhan; Erkurt, Mehmet Ali
[Abstract Not Available]
Convalescent plasma therapy in patients withCOVID-19
(Wiley, 2020) Yigenoglu, Tugce Nur; Hacibekiroglu, Tuba; Berber, Ilhami; Dal, Mehmet Sinan; Basturk, Abdulkadir; Namdaroglu, Sinem; Korkmaz, Serdal
There are currently no licensed vaccines or therapeutics for COVID-19. Anti-SARS CoV-2 antibody-containing plasmas, obtained from the recovered individuals who had confirmed COVID-19, have been started to be collected using apheresis devices and stored in blood banks in some countries in order to administer to the patients with COVID-19 for reducing the need of intensive care and the mortality rates. Therefore, in this review, we aim to point out some important issues related to convalescent plasma (CP) and its use in COVID-19. CP may be an adjunctive treatment option to the anti-viral therapy. The protective effect of CP may continue for weeks and months. After the assessment of the donor, 200-600 mL plasma can be collected with apheresis devices. The donation interval may vary between countries. Even though limited published studies are not prospective or randomized, until the development of vaccines or therapeutics, CP seems to be a safe and probably effective treatment for critically ill patients with COVID-19. It could also be used for prophylactic purposes but the safety and effectiveness of this approach should be tested in randomized prospective clinical trials.
COVID-19 clinical course and blood groups: Turkish population-based study
(Tubitak Scientific & Technological Research Council Turkey, 2021) DAL, Mehmet Sinan; Ata, Naim; Altuntas, Fevzi; Basci, Semih; Yigenoglu, Tugce Nur; Korkmaz, Serdal; Namdaroglu, Sinem
Background/aim: SARS-CoV-2 enters the cell through the binding of the S glycoprotein on the surface of the virus to the angiotensin-converting enzyme 2 (ACE-2) in the host cells and also SARS-CoV S protein binding to ACE-2 was inhibited by anti-A antibodies. The aim of the study was to investigate the relationship between blood groups and the course of COVID-19 in Turkey. Materials and methods: Laboratory confirmed COVID-19 patients aged 18 and over (n = 39.850) were randomized in age and sex -matched groups according to blood groups Results: Advanced age, male sex and blood group A were found to be related with increased rate of intensive care unit (ICU) admission (OR = 1.089, 95% CI: 1.085-1.093 for age; OR = 1.963, 95% CI: 1.737-2.218 for male sex; OR = 1.216, 95% CI: 1.023-1.446 for blood group A). When blood group O individuals were compared to non-O individuals, no significant difference was observed regarding the rate of hospital and ICU admission, mechanical ventilation (MV) support, length of hospital and ICU stay, and case fatality rate (CFR). The CFR in patients with blood group A, B, O, and AB were 2.6%, 2.2%, 3.1%, and 2.3%, respectively. There were no significant differences between Rh-negative and positive patients regarding the rate of hospital and ICU admission (p = 0.280 and p = 0.741, respectively), also the rate of MV support and CFR was similar (p = 0.933 and p = 0.417). Conclusion: Our study revealed that ABO and Rh blood groups do not have any impact on the rate of hospital admission, hospital and ICU stay, MV support, and CFR.
COVID-19 in hematopoietic cell transplant recipients
(Springernature, 2021) Altuntas, Fevzi; Ata, Naim; Yigenoglu, Tugce Nur; Basci, Semih; Dal, Mehmet Sinan; Korkmaz, Serdal; Namdaroglu, Sinem
In this study, we aim to report the outcome of COVID-19 in hematopoietic cell transplant (HCT) recipients. HCT recipients (n = 32) with hematological disease and hospitalized for COVID-19 were included in the study. A cohort of age and comorbid disease-matched hospitalized COVID-19 patients with hematological malignancy but not underwent HCT (n = 465), and another cohort of age and comorbid disease-matched hospitalized COVID-19 patients without cancer (n = 497) were also included in the study for comparison. Case fatality rate (CFR) was 5.6% in patients without cancer, 11.8 in patients with hematological malignancy and 15.6% in HCT recipients. The CFR in HCT recipients who were not receiving immunosuppressive agents at the time of COVID-19 diagnosis was 11.5%, whereas it was 33% in HCT recipients who were receiving an immunosuppressive agent at the time of COVID-19 diagnosis. In conclusion, our study reveals that for the current pandemic, HCT recipients, especially those receiving immunosuppressive drugs, constitute a special population of cancer patients.
Diffuse Large B-Cell Lymphoma in adults aged 65 years and older: A retrospective multicenter analysis of clinical characteristics and therapeutic outcomes
(Cig Media Group, Lp, 2015) Dogu, Mehmet Hilmi; Keklik, Muzaffer; Terzi, Hatice; Korkmaz, Serdal; Erkurt, Mehmet Ali; Cagliyan, Gulsum Akgun; Kaynar, Leylagul
[Abstract Not Available]
Extracorporeal blood purification treatment options for COVID-19: The role of immunoadsorption
(Pergamon-Elsevier Science Ltd, 2020) Yigenoglu, Tugce Nur; Ulas, Turgay; Dal, Mehmet Sinan; Korkmaz, Serdal; Erkurt, Mehmet Ali; Altuntas, Fevzi
The activation of the innate and adaptive immune systems by SARS-CoV-2 causes the release of several inflammatory cytokines, including IL-6. The inflammatory hypercytokinemia causes immunopathological changes in the lungs including vascular leakage, and alveolar edema. As a result of these changes in the lungs, hypoxia and acute respiratory distress syndrome occur in patients with COVID-19. Even though there are clinical trials on the development of therapeutics and vaccines, there are currently no licensed vaccines or therapeutics for COVID-19. Pharmacological approaches have shown poor results in sepsis-like syndromes caused by the hypercytokinemia. Suppressing the cytokine storm is an important way to prevent the organ damage in patients with COVID-19. Extracorporeal blood purification could be proposed as an adjunctive therapy for sepsis, aiming to control the associated dysregulation of the immune system, which is known to protect organ functions. Several extracorporeal blood purification therapies are now available, and most of them target endotoxins and/or the cytokines and aim improving the immune response. For this purpose, plasmapheresis and immunoadsorption may be an important adjunctive treatment option to manage the complications caused by cytokine storm in critically ill patients with COVID-19.
International Forum: The Turkish perspective on apheresis activity: The Turkish apheresis registry report
(Pergamon-Elsevier Science Ltd, 2023) Ozatli, Duzgun; Giden, Asli Odabasi; Erkurt, Mehmet Ali; Korkmaz, Serdal; Basci, Semih; Ulas, Turgay; Turgut, Burhan
Therapeutic apheresis is an extracorporeal treatment that selectively removes abnormal cells or harmful sub-stances in the blood that are associated with or cause certain diseases. During the last decades the application of therapeutic apheresis has expanded to a broad spectrum of hematological and non-hematological diseases due to various studies on the clinical efficacy of this procedure. In this context there are more than 30 centers per-forming therapeutic apheresis and registered in the apheresis database in Turkey. Herein, we, The Turkish Apheresis Registry, aimed to analyze some key articles published so far from Turkey regarding the use of apheresis for various indications.
Mesenchymal stem cell transfusion: Possible beneficial effects in COVID-19 patients
(Pergamon-Elsevier Science Ltd, 2021) Yigenoglu, Tugce Nur; Basci, Semih; Sahin, Derya; Ulas, Turgay; Dal, Mehmet Sinan; Korkmaz, Serdal; Hacibekiroglu, Tuba
SARS-CoV-2 attaches to the angiotensin-converting enzyme 2 (ACE-2) receptor on human cells. The virus causes hypercytokinemia, capillary leak, pulmonary edema, acute respiratory distress syndrome, acute cardiac injury, and leads to death. Mesenchymal stem cells (MSCs) are ACE-2 negative cells; therefore, can escape from SARSCoV-2. MSCs prevent hypercytokinemia and help the resolution of the pulmonary edema and other damages occurred during the course of COVID-19. In addition, MSCs enhance the regeneration of the lung and other tissues affected by SARS-CoV-2. The case series reported beneficial effect of MSCs in COVID-19 treatment. However, there are some concerns about the safety of MSCs, particularly referring to the increased risk of disseminated intravascular coagulation, and thromboembolism due to the expression of TF/CD142. Prospective, randomized, large scale studies are needed to reveal the optimum dose, administration way, time, efficacy, and safety of MSCs in the COVID-19 treatment.
Outcome of COVID-19 in patients with chronic myeloid leukemia receiving tyrosine kinase inhibitors
(Sage Publications Ltd, 2020) Basci, Semih; Ata, Naim; Altuntas, Fevzi; Yigenoglu, Tugce Nur; Dal, Mehmet Sinan; Korkmaz, Serdal; Namdaroglu, Sinem
Introduction In this study, we aim to report the outcome of COVID-19 in chronic myeloid leukemia (CML) patients receiving tyrosine kinase inhibitor (TKI). Method The data of 16 laboratory-confirmed COVID-19 patients with CML receiving TKI and age, gender, and comorbid disease matched COVID-19 patients without cancer at a 3/1 ratio (n = 48), diagnosed between March 11, 2020 and May 22, 2020 and included in the Republic of Turkey, Ministry of Health database, were analyzed retrospectively. Results The rates of intensive care unit (ICU) admission, and mechanical ventilation (MV) support were lower in CML patients compared to the control group, however, these differences did not achieve statistical significance (p = 0.1, and p = 0.2, respectively). The length of hospital stay was shorter in CML patients compared with the control group; however, it was not statistically significant (p = 0.8). The case fatality rate (CFR) in COVID-19 patients with CML was 6.3%, and it was 12.8% in the control group. Although the CFR in CML patients with COVID-19 was lower compared to the control group, this difference did not achieve statistical significance (p = 0.5). When CML patients were divided into 3 groups according to the TKI, no significant difference was observed regarding the rate of ICU admission, MV support, CFR, the length of stay in both hospital and ICU (all p > 0.05). Conclusion This study highlights that large scale prospective and randomized studies should be conducted in order to investigate the role of TKIs in the treatment of COVID-19.
The outcome of COVID-19 in patients with hematological malignancy
(Wiley, 2021) Yigenoglu, Tugce N.; Ata, Naim; Altuntas, Fevzi; Basci, Semih; Dal, Mehmet Sinan; Korkmaz, Serdal; Namdaroglu, Sinem
In this study, we aim to report the outcomes for COVID-19 in patients with hematological malignancy in Turkey. Data from laboratory-confirmed 188 897 COVID-19 patients diagnosed between 11 March 2020 and 22 June 2020 included in the Republic of Turkey, Ministry of Health database were analyzed retrospectively. All COVID-19 patients with hematological malignancy (n = 740) were included in the study and an age, sex, and comorbidity-matched cohort of COVID-19 patients without cancer (n = 740) at a 1:1 ratio was used for comparison. Non-Hodgkin lymphoma (30.1%), myelodysplastic syndrome (19.7%), myeloproliferative neoplasm (15.7%) were the most common hematological malignancies. The rates of severe and critical disease were significantly higher in patients with hematological malignancy compared with patients without cancer (P = .001). The rates of hospital and intensive care unit (ICU) admission were higher in patients with hematological malignancy compared with the patients without cancer (P = .023,P = .001, respectively). The length of hospital stay and ICU stay was similar between groups (P = .7,P = .3, retrospectively). The rate of mechanical ventilation (MV) support was higher in patients with hematological malignancy compared with the control group (P = .001). The case fatality rate was 13.8% in patients with hematological malignancy, and it was 6.8% in the control group (P = .001). This study reveals that there is an increased risk of COVID-19-related serious events (ICU admission, MV support, or death) in patients with hematological malignancy compared with COVID-19 patients without cancer and confirms the high vulnerability of patients with hematological malignancy in the current pandemic.
Patients with hematologic cancers are more vulnerable to COVID-19 compared to patients with solid cancers
(Springer-Verlag Italia Srl, 2022) Basci, Semih; Ata, Naim; Altuntas, Fevzi; Yigenoglu, Tugce Nur; Dal, Mehmet Sinan; Korkmaz, Serdal; Namdaroglu, Sinem
Previous studies reported that COVID-19 patients with cancer had higher rates of severe events such as intensive care unit (ICU) admission, mechanical ventilation (MV) assistance, and death during the COVID-19 course compared to the general population. However, no randomized study compared the clinical course of COVID-19 in patients with hematologic cancers to patients with solid cancers. Thus, in this study, we intend to reveal the outcome of COVID-19 in hematologic cancer patients and compare their outcomes with COVID-19 patients with solid cancers. The data of 926 laboratory-confirmed COVID-19 patients, including 463 hematologic cancer patients and an age-gender paired cohort of 463 solid cancer patients, were investigated retrospectively. The frequencies of severe and critical disease, hospital and ICU admission, MV assistance were significantly higher in hematologic cancer patients compared with the solid cancer patients (p = 0.001, p = 0.045, p = 0.001, and p = 0.001, respectively). The hospital stay was longer in patients with hematologic cancers (p = 0.001); however, the median ICU stay was 6 days in both groups. The case fatality rate (CFR) was 14.9% in patients with hematologic cancers, and it was 4.8% in patients with solid cancers, and there was a statistically significant difference regarding CFR between groups (p = 0.001). Our study revealed that COVID-19 patients with hematologic cancers have a more aggressive course of COVID-19 and have higher CFR compared to COVID-19 patients with solid cancers and support the increased susceptibility of patients with hematologic cancers during the outbreak.
Primary central nervous system lymphoma in daily practice and the role of autologous stem cell transplantation in relapsed disease: A retrospective multicenter study
(Pergamon-Elsevier Science Ltd, 2016) Erkurt, Mehmet Ali; Berber, Ilhami; Tekgunduz, Emre; Dogu, Mehmet Hilmi; Korkmaz, Serdal; Demir, Cengiz; Yilmaz, Mehmet
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. (c) 2016 Elsevier Ltd. All rights reserved.
Splenic Marginal Zone Lymphoma in Turkey: Association with Hepatitis B Instead of Hepatitis C Virus as an Etiologic and Possible Prognostic Factor - A Multicenter Cohort Study
(2020) Okay, Müfide; Aslan, Tuncay; Özdemir, Evren; Üner, Ayşegül; Ayhan, Arzu; Güngör, Elif Sena; Uysal, Ayşe; Alayvaz, Nevin; Yıldızhan, Esra; Ağıt, Abdullah; Dal, Mehmet Sinan; Korkmaz, Serdal; Namdaroğlu, Sinem; Sivgin, Serdar; Akgün Çağlıyan, Gülsüm; Demircioğlu, Sinan; Barışta, İbrahim; Özhamam, Esra; Vural, Filiz; Eser, Bülent; Özet, Gülsüm; Yıldırım, Rahşan; Doğu, Mehmet; Berber, İlhami; Erkurt, Mehmet Ali; Malkan, Ümi?T Yavuz; Altuntaş, Fevzi; Büyükaşık, Yahya
Abstract: Objective: Chronic antigenic stimulation is frequently blamed in the pathogenesis of extranodal marginal zone lymphomas including splenic marginal zone lymphoma (SMZL). Chronic hepatitis C is frequently observed in SMZL patients in some geographical regions. However, these reports are largely from North America and Europe, and data from other countries are insufficient. In this multicenter study we aimed to identify the clinical characteristics of SMZL patients in Turkey, including viral hepatitis status and treatment details. Materials and Methods: Data were gathered from participating centers from different regions of Turkey using IBM SPSS Statistics 23 for Windows. Hepatitis B virus surface antigen (HBsAg), anti-HBs antibody, anti-HB core antigen antibody (anti-HBcAg), HB viral load, anti-hepatitis C virus (HCV) antibody, HCV viral load results were analyzed. Results: One hundred and four patients were reported. Hepatitis C virus positivity was observed in only one patient. However, hepatitis B virus surface antigen (HBsAg) positivity was observed in 11.2% and HBsAg and/or anti-HB core antigen antibody (anti-HBcAg) positivities were seen in 34.2% of the patients. The median age was 60 years (range=35-87). Median follow-up duration was 21.2 months (range=00.2-212; 23.2 months for surviving patients). Median overall survival was not reached. Estimated 3-year and 10-year survival rates were 84.8% and 68.9%, respectively. Older age, no splenectomy during follow-up, platelet count of <90x103/µL, lower albumin, higher lactate dehydrogenase, higher ?2-microglobulin, and HBsAg positivity were associated with increased risk of death. Only albumin remained significant in multivariable analysis. Conclusion: These results indicate that hepatitis B virus may be a possible risk factor for SMZL in our population. It may also be an indirect prognostic factor.
Therapeutic plasma exchange for envenomation: Is it reasonable?
(Pergamon-Elsevier Science Ltd, 2021) Berber, Ilhami; Korkmaz, Serdal; Sarici, Ahmet; Erkurt, Mehmet Ali; Kuku, Irfan; Kaya, Emin; Bicim, Soykan
Background and objectives: The incidence of poisoning due to snakebite and Crimean Congo Hemorrhagic Fever (CCHF), referred to as 'envenomation', varies according to the region, and many deaths occur every year. Therapeutic plasma exchange (TPE) is a method of extracorporeal blood purification that clears toxins and virus load from the circulation. Therefore, its use has been increasing recently in envenomation cases. However, there are a limited number of studies on poisoning due to snakebite and CCHF. In the present study, we share our TPE experience retrospectively in patients diagnosed with poisoning due to snakebite and CCHF between 2010 and 2019. Materials and methods: A total of 26 patiens, including 20 patients with poisoning due to snakebite and 6 CCHF patients were treated with TPE. Demographic data, clinical status, and outcomes of patients were recorded. Routine biochemical and hematologic laboratory parameters were analyzed before and after TPE. TPE was performed by using centrifugation technology via a central venous catheter. Fresh frozen plasma was used as replacement fluid. Results: An average of 3.95 (1-11) apheresis sessions were applied to patients poisoned due to snakebite, and 19 patients (95 %) were discharged in an average of 8.3 (1-17) days without any complications. None of the patients enrolled in the study lost their limbs. Only one patient died due to disseminated intravascular coagulopathy. Six patients with CCHF who received 5 sessions of TPE on average were discharged successfully after an average of 6.5 days. No adverse events or complications were observed in any patient after TPE. Conclusions: TPE is a good alternative and a reliable method in treating envenomation cases who are refractory to supportive measures. TPE should be performed without delay in cases of poisoning due to snakebite and CCHF.
Therapeutic plasma exchange in patients with thrombotic thrombocytopenic purpura: A retrospective multicenter study
(Pergamon-Elsevier Science Ltd, 2013) Korkmaz, Serdal; Keklik, Muzaffer; Sivgin, Serdar; Yildirim, Rahsan; Tombak, Anil; Kaya, Mehmet Emin; Acik, Didar Yanardag
Thrombotic thrombocytopenic purpura (TIT) is a particular form of thrombotic microangiopathy typically characterized by thrombocytopenia, microangiopathic hemolytic anemia, fever, neurological abnormalities, and renal dysfunction. UP requires a rapid diagnosis and an adapted management in emergency. Daily sessions of therapeutic plasma exchange (TPE) remain the basis of management of UP. Also, UP is a rare disease that is fatal if it is not treated. TPE has resulted in excellent remission and survival rates in UP patients. Aim: We aimed to present our experience in 163 patients with UP treated with TPE during the past 5 years from 10 centers of Turkey. Patients and methods: One hundered and sixty-three patients with UP treated with TPE during the past 5 years from 10 centers of Turkey were retrospectively evaluated. TPE was carried out 1-1.5 times plasma volume. Fresh frozen plasma (FFP) was used as the replacement fluid. TPE was performed daily until normalization of serum lactate dehydrogenase (LDH) and recovery of the platelet count to >150 x 10(9)/dL. TPE was then slowly tapered. Clinical data, the number of TPE, other given therapy modalities, treatment outcomes, and TPE complications were recorded. Results: Fifty-eight percent (95/163) of the patients were females. The median age of the patients was 42 years (range; 16-82). The median age of male patients was significantly higher than female (53 vs. 34 years; p < 0.001). All patients had thrombocytopenia and microangiopathic hemolytic anemia. At the same time, 82.8% (135/163) of patients had neurological abnormalities, 78.5% (128/163) of patients had renal dysfunction, and 89% (145/163) of patients had fever. Also, 10.4% (17/163) of patients had three of the five criteria, 10.4% (17/163) of patients had four of the five criteria, and 6.1% (10/163) of patients had all of the five criteria. Primary UP comprised of 85.9% (140/163) of the patients and secondary UP comprised of 14.1% (23/163) of the patients. Malignancy was the most common cause in secondary UP. The median number of TPE was 13 (range; 1-80). The number of TPE was significantly higher in complete response (CR) patients (median 15.0 vs. 3.5; p < 0.001). CR was achieved in 85.3% (139/163) of the patients. Similar results were achieved with TPE in both primary and secondary UP (85% vs. 87%, respectively; p = 0.806). There was no advantage of TPE + prednisolone compared to TPE alone in terms of CR rates (82.1% vs. 76.7%; p = 0.746). CR was not achieved in 14.7% (24/163) of the patients and these patients died of TTP related causes. There were no statistical differences in terms of mortality rate between patients with secondary and primary TIT [15% (21/140) vs. 13% (3/23); p = 0.8061. But, we obtained significant statistical differences in terms of mortality rate between patients on TPE alone and TPE + prednisolone [14% (12/86) vs. 3% (2/67), p < 0.001]. Conclusions: TPE is an effective treatment for UP and is associated with high CR rate in both primary and secondary UP. Thrombocytopenia together with microangiopathic hemolytic anemia is mandatory for the diagnosis of UP and if these two criteria met in a patient, TPE should be performed immediately. (C) 2013 Elsevier Ltd. All rights reserved.

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