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Öğe Assessing Safety of Pneumatic Tube System (PTS) for Patients with Very Low Hematologic Parameters(Int Scientific Information, Inc, 2016) Koroglu, Mustafa; Erkurt, Mehmet Ali; Kuku, Irfan; Kaya, Emin; Berber, Ilhami; Nizam, Ilknur; Yagar, YavuzBackground: Preventive interventions save lives during the process of chemotherapy for hematologic malignancies, when a hematology laboratory can ensure accurate results. The use of a pneumatic tube system (PTS) is associated with measurement errors and unnecessary transfusions. The aim of this study was to evaluate pre-analytical errors associated with transportation method (PTS versus hand-delivered) and to investigate whether there are unnecessary transfusion events in pancytopenia leukemia patients with very low hematological parameters. Material/Methods: A total of 140 paired blood collections were performed for hemogram and biochemistry assays. Paired EDTA and serum gel blood samples were collected from 58 cases with acute leukemia on different days. For each pair, one sample was hand-delivered by a courier (Group 1) while the other sample was transported through a PTS (Group 2). Results: The hand-delivered method showed that some platelet transfusions were unnecessary for different thrombocyte cut-off values. Calculated unnecessary platelet (PLT) transfusion ratios when using PTS (PLT <30x10(3)/mu L, 16.3%; PLT <25x10(3)/mu L, 16.4%; PLT <20x10(3)/mu L, 80.3%; PLT <15x10(3)/mu L, 48.6%; and PLT <10x10(3)/mu L, 150.0%) were found to be statistically significant (p=0.002, p=0.046, p<0.000, p=0.028, and p<0.000, respectively). In contrast, for RBC transfusion ratios, although the ratios were high in Group 2, we found no significant difference between the two groups; (HGB <8.0 g/dL, 23.3%; HGB <9.0 g/dL, 25.0%, HGB<10.0 g/dL, 19.3%) and (p=0.002, p=0.085, p<0.160, and p=0.235, respectively). Conclusions: Although our results cannot be universally applied, physicians should be careful, skeptical, and suspicious of transfusion decisions in hematology clinics and consider potential analytical and pre-analytical errors in cases of severe cytopenia when using PTS.Öğe Can BuCyE conditioning regimen be an alternative treatment to BEAM at autologous transplantation in malignant lymphoma patients?: a single center experience(E-Century Publishing Corp, 2015) Berber, Ilhami; Erkurt, Mehmet Ali; Nizam, Ilknur; Koroglu, Mustafa; Kaya, Emin; Kuku, Irfan; Bag, Harika GozukaraHigh-dose chemotherapy (HDC) applied together with autologous stem cell transplantation (ASCT) is a commonly used treatment modality in patients with malignant lymphoma. At present, there is a limited number of studies which compare toxicity and efficacy of various high-dose regimens applied in the treatment of malignant lymphoma. For this reason, the aim of this study was to investigate the efficacy and toxicity of BuCyE (busulfan, cyclophosphamide and etoposide) and BEAM (carmustine, etoposide, cytarabine and melphalan) preparative regimens in the patients with malignant lymphoma scheduled for autologous stem cell transplantation. Between November, 2010 and April, 2015, 42 patients with relapsed or refractory malignant lymphoma who underwent autologous stem cell transplantation following BEAM (n=11) and BuCyE (n=31) preparative regimens were analyzed at Bone Marrow Transplantation Unit of TurgutOzal Medicine Center in Turkey. The groups were compared in terms of patient characteristics, hematopoietic engraftment time, toxicity profiles and survival. No significant differences were detected between the groups with regard to age, gender distribution, international prognostic index, ASCT indications, disease status at the time of ASCT and type of lymphoma (P>0.05). Median number of infused CD34+ cells/kg, neutrophil and platelet engraftment statuses of BuCyE and BEAM groups were found to be similar (P>0.05). More patients in BuCyE group developed mucositis and nausea, but this difference was not statistically significant (P>0.05). A similar statistically insignificant difference was seen in that infectious complications occurred more commonly in BEAM group (P>0.05). Overall survival and event-free survival rates were not significantly different between the groups (P>0.05). BuCyE is a conditioning regimen which can be effectively used as an alternative to BEAM in the patients with malignant lymphoma undergoing ASCT. Moreover, toxicity rates of both regimens are similar. In order to comprehend the effect of each HDC regimen, further evidence-based data obtained from the studies involving larger sample sizes are required.Öğe DHAP plus filgrastim as an effective peripheral stem cell mobilization regimen for autologous stem-cell transplantation in patients with relapsed/refractory lymphoma: A single center experience(Pergamon-Elsevier Science Ltd, 2016) Berber, Ilhami; Erkurt, Mehmet Ali; Kuku, Irfan; Maya, Emin; Bag, Harika Gozukara; Nizam, Ilknur; Koroglu, MustafaThis study aimed to evaluate the efficiency of DHAP regimen plus filgrastim for mobilization of stem cells in patients with recurrent and/or refractory lymphoma. Thirty-four patients who took DHAP as salvage therapy prior to autologous stem cell transplantation were included. After chemotherapies, 2 cycles of DHAP plus filgrastim were administered to the patients. Stem cells from 32 patients (94%) were collected on median 11th day (8-12), and the median collected CD34(+) cell dose was 9.7 x 10(6)/kg (range 3.8-41.6). DHAP plus filgrastim was found to be an effective chemotherapy regimen in mobilizing CD34(+) stem cells into the peripheral. (c) 2016 Elsevier Ltd. All rights reserved.Öğe Haploidentical Transplantation Experience in Turgut Ozal Medical Center: Case Report and a Review of Literature(İnönü Üniversitesi Tıp Fakültesi Dergisi, 2014) Berber, Ilhami; Erkurt, Mehmet Ali; Kaya, Emin; Koroglu, Mustafa; Nizam, Ilknur; Bentli, Recep; Kuku, IrfanHaploidentical hematopoietic stem-cell transplantation is an optional transplant modality for patients without a Human Leukocyte Antigensmatched donor. Still, one-third of patients who might benefit from allogeneic transplantation are able to find a Human Leukocyte Antigensmatched related donor. In need of immediate stem-cell transplantation, haploidentical donor is an important solution for many patients. Previously, haploidentical hematopoietic stem-cell transplantation was characterised by a high rejection rate, graft-versus-host disease, graft failure, and transplant-related mortality, but there have since been significant improvements in some areas. Development of new extensive T-cell depletion methods with megadose stem cell administration have overcome problems of haploidentical hematopoietic stem-cell transplantation. We presented an applied case haploidentical hematopoietic stem-cell transplantation as an experience in Turgut Ozal Medical Center.Öğe Hermansky-Pudlak Syndrome: A Case Report(Hindawi Ltd, 2014) Berber, Ilhami; Erkurt, Mehmet Ali; Kuku, Irfan; Kaya, Emin; Koroglu, Mustafa; Nizam, Ilknur; Gul, MehmetObjective. The aim of this paper is to report the case of a patient diagnosed with Hermansky-Pudlak syndrome, as a result of bleeding diathesis. Clinical Presentation and Intervention. A 23-year-old male presented with recurrent epistaxis and, upon physical examination, was found to be remarkable for albinism and suborbital ecchymosis. The absence of dense bodies in the platelets was demonstrated using electron microscopy. This patient was (slowly) administered one unit of a platelet suspension, and his bleeding decreased considerably. Conclusion. This case shows that Hermansky-Pudlak syndrome should be considered in the differential diagnosis of a patient presenting with bleeding diathesis, when the clinical presentation also includes oculocutaneous albinism and visual problems.Öğe Leukapheresis in acute myeloid leukemia patients with hyperleukocytosis: A single center experience(Pergamon-Elsevier Science Ltd, 2015) Berber, Ilhami; Kuku, Irfan; Erkurt, Mehmet Ali; Kaya, Emin; Bag, Harika Gozukara; Nizam, Ilknur; Koroglu, MustafaHyperleukocytosis is defined as WBC count above 100,000/mm(3) in peripheral blood. Increased WBC count leads to leukocyte aggregation, increased blood viscosity, and consequently results in stasis in small blood vessels. Ultimate neurological, pulmonary, gastrointestinal complications, coagulopathy, and tumor lysis syndrome cause increase in morbidity and mortality. Leukapheresis is a treatment modality used for hyperleukocytosis. In patients presenting with hyperleukocytosis the indications for leukapheresis were accepted as having symptoms of leukostasis and prophylactic. Indications for leukapheresis in prophylactic group evaluated according to WBC count. We report a single center experience about leukapheresis in managing 31 AML patients with hyperleukocytosis. In addition to demographic characteristics, disease-related clinical and laboratory findings of the patients were recorded. Survival rates were also calculated. Ten patients were female. The most common of AML subtype was AML-M2. The median number of leukapheresis per patient was 2 and totally 60 leukapheresis cycles were performed in all patients. There was a significant decrease in WBC count and LDH level after leukapheresis as compared with the baseline values (p<0.05). Early and total mortality were 16.1% and 58.0%, respectively. Alive and died patients were evaluated according to baseline WBC, LDH; increased WBC count and LDH level were found in died patients (p<0.05). According to leukapheresis indications, patients were divided into two groups: 14 patients in symptomatic leukostasis, 17 patients in prophylaxis. No statistically significant differences were noted between both groups in leukapheresis effectiveness, mean survival time, early and total mortality rate (p>0.05). None of our patients suffered serious side effects and tumor lysis syndrome during or after apheresis. Leukapheresis is an effective and safe approach to reduce WBC counts in patients with AML with hyperleukocytosis. Further evidence-based data obtained from larger sample sizes are required to better understand the impact of prophylaxis leukapheresis on early and total mortality of AML patients with hyperleukocytosis. (C) 2015 Elsevier Ltd. All rights reserved.Öğe Leukapheresis Treatment in Elderly Acute Leukemia Patients with Hyperleukocytosis: A Single Center Experience(Wiley, 2016) Berber, Ilhami; Erkurt, Mehmet Ali; Kuku, Irfan; Kaya, Emin; Bag, Harika Gozukara; Nizam, Ilknur; Koroglu, MustafaAim: Leukapheresis is an invasive treatment modality used for hyperleukocytosis. Various drugs and fluids are used during the leukapheresis. Aging itself and associated factors such as increased comorbidity, decreased tolerance to drugs, increased drug toxicity give rise to the application of other treatment modalities in elderly patients. Treatment of acute leukemia in the elderly differs from young patients. Consequently, we assumed that outcome, effectiveness, and side effects of leukapheresis treatment used for acute leukemia patients with hyperleukocytosis may be different in elderly compared to younger patients. Methods: We retrospectively evaluated a total of 39 patients. Eighteen patients were 65 years and older. Indications for leukapheresis were determined as symptoms of leukostasis and prophylaxis. Acid citrate dextrose-A, calcium gluconate, and plasma were used during the leukapheresis. Age, sex, diagnosis, count, and indications of leukapheresis procedures, leukocyte count, and lactate dehydrogenase level were analyzed at the onset of and after leukapheresis; side effects, causes of death, early and total mortality rates were also analyzed. We compared the two groups with regard to effectiveness, clinical outcomes, and side effects. Results: There were no statistically significant differences between the two groups with respect to sex, diagnosis, initial leukocyte count, lactate dehydrogenase level, number of leukapheresis procedures, rates of side effects, or early and total mortality (P > 0.05). Leukapheresis treatment was effective in both groups (P < 0.05) and no significant difference was found in its effectiveness between two groups ( P> 0.05). Conclusion: Leukapheresis is an effective and safe treatment modality in elderly acute leukemia patients with hyperleukocytosis. (C) 2015 Wiley Periodicals, Inc.Öğe A life-saving therapy in Class I HELLP syndrome: Therapeutic plasma exchange(Pergamon-Elsevier Science Ltd, 2015) Erkurt, Mehmet Ali; Berber, Ilhami; Berktas, Haci Bayram; Kuku, Irfan; Kaya, Emin; Koroglu, Mustafa; Nizam, IlknurHELLP syndrome, which can affect multiple organ systems and cause maternal and fetal mortality, is a serious complication of pregnancy characterized by microangiopathic hemolytic anemia, elevation of liver enzymes, and thrombocytopenia. Delivering the infant usually suffices for the treatment of this syndrome. In cases with Class I HELLP syndrome, however, the clinical picture may rapidly deteriorate despite delivery. In this paper we presented the outcomes with the use of therapeutic plasma exchange in cases with class I HELLP syndrome. This study included 21 patients diagnosed with the Class I HELLP syndrome at Inonu University Faculty of Medicine, Department of Hematology between 2011 and 2014. A central venous catheter was placed and plasma exchange therapy was begun in patients unresponsive to delivery, steroid, and supportive therapy (blood and blood products, antihypertensive therapy, intravenous fluid administration, and antibiotics) within 24 hours after the diagnosis of Class I HELLP syndrome according to the Mississippi Criteria. All patients underwent therapeutic plasma exchange for three sessions each with a 1:1 volume. Hemogram and biochemical parameters of the patients were evaluated before and after the procedure. According to results, there was a statistically significant decrease in total bilirubin, LDH, AST, and ALT levels whereas a significant increase in platelet count was observed. Hemoglobin levels were increased, although this increase was not statistically significant. HELLP syndrome is primarily treated with the delivery of infant; however, some cases may show disease progression despite completion of delivery. As a potential cause of both maternal and fetal mortality, HELLP syndrome condition should be aggressively treated. Therapeutic plasma exchange is one of the available treatment options. Our study has found that postpartum use of plasma exchange therapy within 24 hours is an efficient and lifesaving treatment choice in Class I HELLP syndrome. (C) 2014 Elsevier Ltd. All rights reserved.Öğe Primarily unknown origin adenocarcinoma metastasis in bone marrow presenting with thrombotic thrombocytopenic purpura: A case report(Pergamon-Elsevier Science Ltd, 2013) Koroglu, Mustafa; Erkurt, Mehmet Ali; Berber, Ilhami; Kuku, Irfan; Kaya, Emin; Ozkahraman, Adnan; Aydin, Nasuhi EnginWe report a case of thrombotic thrombocytopenic purpura refractory to plasma exchange treatment. In bone marrow examination non hematopoetic cell groups have seen. But the primary tumor could neither be located endoscopically nor in imaging examinations. Upon the bone marrow biopsy confirm the adenocarcinoma metastasis an objective improvement have achived in the blood picture after polychemotherapy. (C) 2013 Elsevier Ltd. All rights reserved.Öğe Therapeutic plasma-exchange in hematologic disease: Results from a single center in Eastern Anatolia(Pergamon-Elsevier Science Ltd, 2013) Erkurt, Mehmet Ali; Kuku, Lrfan; Kaya, Emin; Ozgen, Unsal; Berber, Ilhami; Koroglu, Mustafa; Ozgul, MustafaTherapeutic plasma-exchange (TPE) is used as primary and adjunctive therapy in treatment of several hematologic diseases. We retrospectively evaluated the results of TPE in hematologic diseases during 2008-2012. A total of 301 TPE procedures were performed in 44 patients (19 male and 25 female, with mean age of 50.6 +/- 15 years). Fifteen of 44 patients had thrombotic thrombocytopenic purpura (TTP), 14 patients had HELLP syndrome (Hemolysis Elevated Liver enzymes, Low Platelet count), 10 patients had multiple myeloma-hyperviscosity and the rest five patients had snake bite. Fresh frozen plasma (FFP) was used as replacement fluid. Complete response (CR) was achieved on 13 patients (87%) in primarily TTP. CR was achieved in all other three diseases. Total complications were detected in 8.1% of the TPE procedures. Adverse events (AEs), were seen in 5.4% of all procedures. None of the patients died from any complication. AE occurred in 4% (Grade-I), 1% (Grade-II), and 0.3% (Grade-III) of the procedures. The most common AE were nausea/vomiting, hypotension, pruritus and abdominal pain. TPE is effectively and safely carried out in our center in hematologic diseases. (C) 2013 Elsevier Ltd. All rights reserved.Öğe An Unexpected Complication of Bone Marrow Aspiration and Trephine Biopsy: Arteriovenous Fistula(Karger, 2014) Berber, Ilhami; Erkurt, Mehmet Ali; Kuku, Irfan; Kaya, Emin; Kutlu, Ramazan; Koroglu, Mustafa; Yigit, AliObjective: To report a case of arteriovenous fistula (AVF) following bone marrow aspiration and trephine biopsy. Clinical Presentation and Intervention: A 76-year-old man was diagnosed with acute myeloblastic leukemia. Pain and hematoma were detected in his left leg and hip 4 days after bone marrow aspiration and trephine biopsy. A pelvic arteriography was performed, and a diagnosis of AVF was made. Conclusion: This case shows that clinicians should be aware of AVF, especially in cases with refractory bleeding after bone marrow aspiration and trephine biopsy despite normal blood coagulation parameters. (C) 2014 S. Karger AG, BaselÖğe Yaygın Cilt Tululumu Olan Extranasal NK Hücreli Lenfomalı Olgu Sunumu(İnönü Üniversitesi Tıp Fakültesi Dergisi, 2013) Erkurt, Mehmet Ali; Berber, Ilhami; Karadag, Nese; Bentli, Recep; Kaya, Emin; Koroglu, Mustafa; Kuku, IrfanDoğal katil hücreli tümörler nadir ve heterojen bir grubu oluşturmaktadır. Bu kanserler yüksek derecede agresif ve kötü prognoza sahiptirler ve değişik derecelerde cilt tutulumu yapabilirler. Extranazal lenfomalar klinik olarak daha az agresif, daha localize ve diğer tiplere göre daha iyi sonuçlara sahiptir. Biz nadir olarak görülen yaygın cilt tutulumu ile giden bir extranazal doğal katil hücreli lenfoma olgusu sunduk. Atmış iki yaşında erkek hastaya testiste şişlik şikayetinden sonra yapılan orşektomi ve kemik iliği incelemesi sonrası kemik iliği tutulumu ile birlikte ekstranazal doğal katil hücreli lenfoma tanısı konuldu. Üç kür CHOP tedavisi sonrasında ciltte yaygın tutulum gelişti ve tanıdan dört ay sonra kaybedildi.
