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    ACUTE MYELOBLASTIC LEUKEMIA AND SQUAMOUS CELL LUNG CANCER: TWO SYNCRONE MALIGN TUMOR PRESENTATION
    (Pergamon-Elsevier Science Ltd, 2015) Karakus, Abdullah; Ekmen, Mehmet Onder; Ayyildiz, Mehmet Orhan
    [Abstract Not Available]
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    Assessment of the underlying causes of the immune thrombocytopenia: Ten years experience
    (Pakistan Medical Assoc, 2017) Dal, Mehmet Sinan; Karakus, Abdullah; Dal, Tuba; Aydin, Berrin Balik; Hattapoglu, Elif; Ekmen, Mehmet Onder; Ulas, Turgay
    Objective: Immune thrombocytopenia (ITP) is an immune haematologic disorder causing platelet destruction mediated by anti-platelet antibodies. In this study we aimed to evaluate the clinical and laboratory variables of ITP patients in southeast of Turkey. Methods: In this retrospective study 167 ITP patients between 2005 and 2015 were evaluated. All patients were screened for immunological parameters including ANA (antinuclear antibodies), anti dsDNA (anti-double-strandedDNA), ACA(anti-cardiolipin) IgM and IgG, LA (lupus anticoagulants). All patients were screened for Helicobacter pylori, HBsAg (Hepatitis B surface antigen), anti-HCV (hepatitis C virus antibody), and anti-HIV 1/2 (HIV antibody) and brucellosis. Results: Among the patients, 50 (29.9%) patients were male, 117 (70.1%) were female. The age range of patients was 18-86 (mean 38.16+/-14). In 56 patients (33.5%) splenectomy was performed. 36 patients (21.6%) were positive for ANA, 5 (3%) were positive for anti dsDNA, 14 (8.4%) for ACA Ig G, and 14 (8.4%) patients for ACA IgM. LA was tested in 165 patients and 30 (18%) patients were positive for LA. Microbiologic evaluation was as follows: 16 patients (9.6%) were positive for HbsAg, 109 (65.3%) positive for Anti-HBs, 5 positive for anti-HCV (3%), 56 (33.5%) patients were positive for Helicobacter pylori antigen, 5 (2.9%) for Brucella and one patient was positive for anti-HIV 1/2. Conclusion: Immune thrombocytopenia patients have to be evaluated according to their demographic characteristics and laboratory results. Secondary causes of ITP were HIV, HCV, Helicobacter pylori, brucellosis, tuberculosis, and autoimmune diseases in our region. Management of ITP patients can change in different regions.
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    Cisplatin-Based Therapy for the Treatment of Elderly Patients with Non-Small-Cell Lung Cancer: a Retrospective Analysis of a Single Institution
    (Asian Pacific Organization Cancer Prevention, 2012) Inal, Ali; Kaplan, M. Ali; Kucukoner, Mehmet; Urakci, Zuhat; Karakus, Abdullah; Isikdogan, Abdurrahman
    Background: In spite of the fact that platinum-based doublets are considered the standard therapy for patients with advanced non-small-cell lung cancer (NSCLC), no elderly-specific platinum based prospective phase III regimen has been explored. The aim of this retrospective singlecenter study was to evaluate the efficacy and side effects of cisplatin-based therapy specifically for the elderly. Methods: Patients receiving platinum-based treatment were divided into three groups. In the first group (GC), Gemcitabine was administrated at 1000 mg/m(2) on days 1, 8 and cisplatin was added at 75 mg/m(2) on day 1. In the second group (DC), 75 mg/m(2) docetaxel and cisplatin were administered on day 1. The third group (PC) received 175 mg of paclitaxel and 75 mg of cisplatin on day 1. These treatments were repeated every three weeks. Result: GC arm had 36, the DC arm 42 and the PC arm 29 patients. Grade III-IV thrombocytopenia was higher in the GC arm (21.2% received GC, 2.8% received DC, and 3.8% received PC), while sensory neuropathy was lower in patients with GC arm (3.0%, 22.2%, and 23.1% received GC, DC and PC, respectively). There were no statistically significant difference in the response rates among the three groups (p>0.05). The median Progression-free survival (PFS) was 5.0 months and the median Overall survival (OS) in each group was 7.1, 7.4 and 7.1 months, respectively (p>0.05). Conclusion: The response rate, median PFS and OS were similar among the three treatment arms. Grade III-IV thrombocytopenia was higher in the GC arm, while the GC regimen was more favorable than the other cisplatin-based treatmetns with regard to sensory neuropathy.
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    Does the eltrompobag treatment safe or effective for refractory chronic immune thrombocytopenia patients?
    (E-Century Publishing Corp, 2016) Dal, Mehmet Sinan; Karakus, Abdullah; Cakar, Merih Kizil; Ulu, Bahar Uncu; Hattapoglu, Elif; Ekmen, Mehmet Onder; Ulas, Turgay
    Background: Immune thrombocytopenia (ITP) is a heterogeneous autoimmune disorder characterized by immune-mediated platelet destruction and reduced platelet production. As the pathophysiology of the disease got clear, thrombopoietin receptor (TPO-R) agonists have been preferred in recent years, which seems to be an effective option in the treatment of resistant cases. Eltrombopag, a TPO-R agonist, is a second or third line medical treatment option for adults with chronic ITP. Objective: To determine the efficacy and safety of long-term eltrombopag treatment in treatment-refractory patients with primary ITP was the aim of this study. Materials and Methods: Retrospective data of 34 patients with refractory ITP who were treated with eltrombopag were examined. Efficacy and safety of the eltrombopag treatment was evaluated. Results: The total rate of response was 82%, and the median duration of response defined as the number of the platelets being over 50x10(9)/L was 14 (interquartile range: 7-28) days. In two patients, thrombosis was observed with no other additional risk factors due to or related to thrombosis. Conclusion: In spite of the fact that the responses to eltrombopag were satisfactory, patients need to be monitored closely for increasing platelet counts as well as thromboembolic events.
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    Efficacy of CLARA in recurrent/refractory acute myeloid leukaemia patients unresponsive to FLAG chemotherapy
    (Taylor & Francis Ltd, 2018) Kaya, Ali Hakan; Tekgunduz, Emre; Ilkkilic, Kadir; Dal, Mehmet Sinan; Merdin, Alparslan; Karakus, Abdullah; Hacioglu, Sibel Kabukcu
    We hereby report our multicentre, retrospective experience with CLARA in patients with fludarabine/cytarabine/GCSF (FLAG) refractory AML. The study included all consecutive R/R AML patients, who received CLARA salvage during October 2010-October 2015 period. All patients were unresponsive to FLAG salvage chemotherapy regimen and did not undergo previous allo-HCT. A total of 40 patients were included. Following CLARA 5 (12.5%) patients experienced induction mortality and 10 (25%) patients achieved CR. 25 (62.5%) patients were unresponsive to CLARA. 7 (17.5%) out of 10 patients in CR received allo-HCT. Median overall survival of patients who achieved CR after CLARA was 24.5 months (8.5-54.5) and 3 months (2.5-5), in patients who underwent and didn't allo-HCT, respectively. Our results indicate that CLARA may be good alternative even in FLAG refractory AML patients and can be used as a bridge to allo-HCT, who have a suitable donor and able to tolerate the procedure.
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    Is Diabetes Mellitus a Prognostic Factor for Survival in Patients with Small Cell Lung Cancer?
    (Asian Pacific Organization Cancer Prevention, 2012) Inal, Ali; Kaplan, M. Ali; Kucukoner, Mehmet; Urakci, Zuhat; Karakus, Abdullah; Nas, Necip; Guven, Mehmet
    Background: Previous studies have pointed to many different prognostic factors for small cell lung cancer (SCLC) but diabetes mellitus (DM) has not been clearly or consistently identified as of prognostic value. The aim of this study was to investigate the prognostic significance of the characteristics of patients and clinical laboratory tests in SCLC. Specifically, we investigated that the impact of DM for survival in the patients receiving first-line etoposide plus cisplatin (EP) chemotherapy. Methods: We retrospectively reviewed 161 patients with SCLC with a focus on DM and other potential prognostic variables were chosen for univariate and multivariate analyses with respect to survival. Result: Among the sixteen variables of univariate analysis, five were identified to have prognostic significance: performance status (PS) (p < 0.001), stage (p=0.001), DM (p=0.005), serum albumin (p < 0.001) and hemoglobin levels (p=0.03). Multivariate analysis showed PS, stage and serum albumin level to be independent prognostic factors for survival (p=0.02, p=0.02 and p=0.009 respectively), but DM was not an independnet factor. Conclusion: In conclusion, PS, stage and serum albumin level were identified as important prognostic factors, while DM at the time of diagnosis of SCLC did not have prognostic importance for survival.
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    Presentation and management of paroxysmal nocturnal hemoglobinuria: a single-center experience
    (Pagepress Publ, 2016) Dal, Mehmet Sinan; Karakus, Abdullah; Ekmen, Mehmet Onder; Ayyildiz, Orhan
    Paroxysmal nocturnal hemoglobinuria (PNH) is a rare acquired disorder characterized by intravascular hemolysis. Real-world experience of PNH management is largely unreported. A retrospective analysis was undertaken based on medical records from six patients with PNH [two with aplastic anemia (AA)] treated at our center, Dicle University, Turkey. Diagnosis was based on granulocyte PNH clones, ranging from 93% to 66%. All patients had symptoms consistent with PNH. One patient was managed adequately with supportive measures only. Five were treated with the complement inhibitor eculizumab. Follow-up data (< 1 year) were available in four cases (the fifth had received only three infusions by final follow-up). Hemoglobin level in these four patients increased from 4.1-7.2 g/dL to 8.3-13.0 g/dL. Lactate dehydrogenase, a marker for hemolysis, decreased profoundly in the two non-AA patients, with more minor improvements in the two AA patients. Weakness and fatigue improved in all eculizumab-treated patients. Four of the five treated patients became transfusion independent, including the patient given only three infusions. In the remaining case, a patient with AA, transfusion requirement decreased, and abdominal pain and dysphagia resolved. No adverse events occurred. PNH can be successfully managed in routine practice.
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    PREVALENCE OF FACTOR XIII VAL34LEU POLYMORPHISM IN THROMBOSIS CASES IN THE SOUTHEAST OF TURKEY AND ITS CORRELATION WITH THROMBOSIS
    (Carbone Editore, 2017) Yildirim, Mehmet Serdar; Dal, Mehmet Sinan; Karakus, Abdullah; Oto, Ferhat; Goruk, Mucahit; Akdogan, Mehmet Recai; Nas, Necib
    Background: Thrombosis is triggered by a shift in the balance of procoagulant and anticoagulant factors due to acquired or inherited causes. Factor XIII plays an important role in the stabilization of the linkage between fibrins. Three different genetic structure of Valine34Leucine polymorphism in FXIIIA have been described. Valine/Valine structure has been identified as the homozygous normal (wild-type), whereas Valine/Leucine and Leucine/Leucine structures have been identified as heterozygous and homozygous mutants respectively. Genetic polymorphisms in FXIII-A subunit vary substantially from society to society. The primary objective of this study was to determine the relationship between factor XIII polymorphisms and arterial/venous thromboembolism in the southeast of Turkey. Methods: A total of 127 patients with arterial and venous thrombosis were included as the study group and 102 healthy subjects with no thromboembolic disorders were included as the control group. Val34Leu polymorphism in FXIII was investigated in both groups using PCR (Polymerase chain reaction). Results: The prevalence of the polymorphism in the study and control groups were compared with chi-square test, no statistically significant differences were found (the prevalence in the study and control group are 68.5% and 66.7% for V/V allele, 29.2% and 29.4% for V/L allele, and 2.4% and 3.9% in L/L allele respectively, with p = 0.787). When deep vein thrombosis (DVT) diagnosed female patients group (n = 8) was compared to the healthy female control group, V/L allele was significantly lower, whereas L/L allele was significantly higher (p = < 0.01). Conclusions: This study indicates that there is no evidence for association between factor XIII-A Val34Leu polymorphism and arterial/venous thromboembolism. The significant result we found for the DVT patients should be strengthened by further studies with greater number of cases. In future, further studies are needed with more specific groups and with greater numbers of patients.
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    Prognostic Factors for Second-line Treatment of Advanced Non-small-cell Lung Cancer: Retrospective Analysis at a Single Institution
    (Asian Pacific Organization Cancer Prevention, 2012) Inal, Ali; Kaplan, M. Ali; Kucukoner, Mehmet; Urakci, Zuhat; Karakus, Abdullah; Isikdogan, Abdurrahman
    Background: Platinum-based chemotherapy for advanced non-small cell lung cancer (NSCLC) is still considered the first choice, presenting a modest survival advantage. However, the patients eventually experiance disease progression and require second-line therapy. While there are reliable predictors to identify patients receiving first-line chemotherapy, very little knowledge is available about the prognostic factors in patients who receive second-line treatments. The present study was therefore performed. Methods: We retrospectively reviewed 107 patients receiving second-line treatments from August 2002 to March 2012 in the Dicle University, School of Medicine, Department of Medical Oncology. Fourteen potential prognostic variables were chosen for analysis in this study. Univariate and multivariate analyses were conducted to identify prognostic factors associated with survival. Result: The results of univariate analysis for overall survival (OS) were identified to have prognostic significance: performance status (PS), stage, response to firs-line chemotherapy, response to second-line chemotherapy and number of metastasis. PS, diabetes mellitus (DM), response to first-line chemotherapy and response to second-line chemotherapy were identified to have prognostic significance for progression-free survival (PFS). Multivariate analysis showed that PS, response to first-line chemotherapy and response to second-line chemotherapy were considered independent prognostic factors for OS. Furthermore, PS and response to second-line chemotherapy were considered independent prognositc factors for PFS. Conclusion: In conclusion, PS response to first and second-line chemotherapy were identified as important prognostic factors for OS in advanced NSCLC patients who were undergoing second-line palliative treatment. Furethermore, PS and response to second-line chemotherapy were considered independent prognostic factors for PFS. It may be concluded that these findings may facilitate pretreatment predication of survival and can be used for selecting patients for the correct choice of treatment.
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    Use of gemtuzumab ozogamicin in relapsed refractory acute myeloid leukemia: Multi-center real life data from Turkey
    (Elsevier Advanced Technology, 2021) Kucukdiler, Ayse Hilal Eroglu; Yavasoglu, Irfan; Selim, Cem; Mutlu, Cansu Atmaca; Karakus, Abdullah; Koyuncu, Mahmut Bakir; Bilgir, Oktay
    We retrospectively evaluated the use of gemtuzumab ozogamicin (GO) in relapsed refractory (R/R) acute myeloid leukemia (AML) patients. Twenty-one CD33 positive R/R AML patients who received GO as a single agent in 4 hematology centers were included in this study. The median age was 59, and the median ECOG performance score was 2. According to cytogenetic analysis, 1 patient had favorable risk, 12 patients with in-termediate, and 8 patients with adverse risk. The overall response rate was 52.3%. Partial response was achieved in 3 of 8 patients with adverse risk. 33.3% of patients developed grade 3 anemia. Grade 4 neutropenia and thrombocytopenia were observed in 80% of the patients. One of the patients died due to sinusoidal obstruction syndrome / veno-occlusive disease (SOS / VOD) due to GO side effects. GO may be considered as a good option for salvage therapy in R/R AML patients.