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    A Multi-Center Study on the Efficacy of Eltrombopag in Management of Refractory Chronic Immune Thrombocytopenia: A Real-Life Experience
    (2019) Çekdemir, Demet; Güvenç, Serkan; Özdemirkıran, Füsun; Eser, Ali; Şahin Haydaroğlu, Handan; Turak Ermiş, Esra; Esen, Ramazan; Cömert, Melda; Sadri, Sevil; Aslaner, Müzeyyen; Uncu Ulu, Bahar; Karakuş, Abdullah; Bapur Selim, Derya; Alacacıoğlu, İnci; Aydın, Demet; Tekinalp, Atakan; Namdaroğlu, Sinem; Ceran, Funda; Tarkun, Pınar; Kiper, Demet; Çetiner, Mustafa; Yenerel, Mustafa; Demir, Muzaffer Ahmet; Yılmaz, Güven; Terzi, Hatice; Atilla, Erden; Malkan, Yavuz Ümit; Acar, Kadir; Öztürk, Erman; Tombak, Anıl; Sunu, Cenk; Salim, Ozan; Alayvaz, Nevin; Sayan, Özkan; Ozan, Ülkü; Ozan, Mesut; Gökgöz, Zafer; Andıç, Neslihan; Kızılkılıç, Ebru; Noyan, Figen; Özen, Mehmet; Tanrıkulu Pepedil, Funda; Alanoğlu, Güçhan; Özkan, Hasan Atilla; Aslan, Vahap; Çetin, Güven; Akyol Erikçi, Alev; Deveci, Burak; Ersoy Dursun, Fadime; Dermenci, Hasan; Aytan, Pelin; Gündüz, Mehmet; Karakuş, Volkan; Özlü, Can; Demircioğlu, Sinan; Akay Yanar, Olga Meltem; Özatlı, Düzgün
    Abstract: Objective: The aim of the present study was to evaluate the efficacyand safety of eltrombopag, an oral thrombopoietin receptor agonist,in patients with chronic immune thrombocytopenia (ITP).Materials and Methods: A total of 285 chronic ITP patients (187women, 65.6%; 98 men, 34.4%) followed in 55 centers were enrolledin this retrospective cohort. Response to treatment was assessedaccording to platelet count (/mm3) and defined as complete (plateletcount of >100,000/mm3), partial (30,000-100,000/mm3 or doublingof platelet count after treatment), or unresponsive (<30,000/mm3).Clinical findings, descriptive features, response to treatment, and sideeffects were recorded. Correlations between descriptive, clinical, andhematological parameters were analyzed.Results: The median age at diagnosis was 43.9±20.6 (range: 3-95)years and the duration of follow-up was 18.0±6.4 (range: 6-28.2)months. Overall response rate was 86.7% (n=247). Complete andpartial responses were observed in 182 (63.8%) and 65 (22.8%)patients, respectively. Thirty-eight patients (13.4%) did not respondto eltrombopag treatment. For patients above 60 years old (n=68),overall response rate was 89.7% (n=61), and for those above 80 years old (n=12), overall response rate was 83% (n=10). Consideringthrombocyte count before treatment, eltrombopag significantlyincreased platelet count at the 1st, 2nd, 3rd, 4th, and 8th weeks oftreatment. As the time required for partial or complete responseincreased, response to treatment was significantly reduced. The timeto reach the maximum platelet levels after treatment was quitevariable (1-202 weeks). Notably, the higher the maximum plateletcount after eltrombopag treatment, the more likely that side effectswould occur. The most common side effects were headache (21.6%),weakness (13.7%), hepatotoxicity (11.8%), and thrombosis (5.9%).Conclusion: Results of the current study imply that eltrombopag isan effective therapeutic option even in elderly patients with chronicITP. However, patients must be closely monitored for response andside effects during treatment. Since both response and side effectsmay be variable throughout the follow-up period, patients should beevaluated dynamically, especially in terms of thrombotic risk factors.
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    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.