Impact of COVID-19 on Outcomes of Patients with Hematologic Malignancies: A Multicenter, Retrospective Study.

Objectives: Patients with hematological malignancies have a high risk of mortality from coronavirus disease 2019 (COVID-19). This study aimed to investigate the impact of COVID-19 on mortality rates in patients with various hematological malignancies and to determine risk factors associated with all-cause mortality. Methods: A multicenter, observational retrospective analysis of patients with hematological malignancies infected with COVID-19 between July 2020 and December 2021 was performed. Demographic data, clinical characteristics, and laboratory parameters were recorded. Patients were grouped as non-survivors and survivors. All-cause mortality was the primary outcome of the study. Results: There were 569 patients with a median age of 59 years. Non-Hodgkin lymphoma (22.0%) and multiple myelomas (18.1%) were the two most frequent hematological malignancies. The all-cause mortality rate was 29.3%. The highest mortality rates were seen in patients with acute myeloid leukemia (44.3%), acute lymphoid leukemia (40.5%), and non-Hodgkin lymphoma (36.8%). The non-survivors were significantly older (p<0.001) and had more comorbidities (p<0.05). In addition, there were significantly more patients with low lymphocyte percentage (p<0.001), thrombocytopenia (p<0.001), and high CRP (p<0.001) in the non-survived patients. Age ≥ 65years (p=0.017), cardiac comorbidities (p=0.041), and continuation of ongoing active therapy for hematological cancer (p<0.001) were the independent risk factors for the prediction of mortality. Conclusions: In patients with hematological malignancies, coexistent COVID-19 leads to a higher mortality rate in elderly patients with more comorbidities. Acute myeloid and lymphoid leukemia and non-Hodgkin lymphoma have the highest mortality rates. Older age, cardiac diseases, and continuation of ongoing active therapy for hematological cancer are the independent risk factors for mortality in hematological malignancy patients with COVID-19.

Chemotherapy and Radiation Induced Pulmonary Dysfunction in Hodgkin Lymphoma Patients.

Although the deterioration in pulmonary functions is a well-known important problem due to the treatment of the Hodgkin's lymphoma patients, the immediate and long term effects of the therapy and its distinctive components were not shown clearly yet. We planned to investigate effects of multiple agent chemotherapy and/or radiotherapy to pulmonary functions immediately and thereafter and the possible effects of the managing this situation. 34 patients were included the study. The patients were evaluated for peak expiratory flow (PEF), forced expiratory volume in 1 s (FEV1), forced expiratory vital capacity (FVC), mean total lung capacity (TLC) values, FEV1/FVC ratio, diffusing capacity for carbonmonoxide (DLco), diffusing capacity for carbonmonoxide corrected for hemoglobin concentration (DLCO) before and at 1, 6 and 12 months after the initiation of the treatment. Demographic characteristics; disease stages; chemotherapy protocols; whether radiotherapy is received; if yes, the region and the dose received were recorded. The tests were finally analysed in two separated groups; group A treated with only chemotherapy and group B; treated with combination therapy, chemotherapy and radiotherapy. In group A, FVC and FEV1 is similar before and after treatment. FEV1/FVC ratio was increased (P = 0.0001) in this group despite increasing in mean TLC values (P = 0.001). No meaningful changes were observed in PEF and DLCO values in group A. In group B, FVC, FEV1 and PEF were decreased after treatment (for FVC P = 0.028, for FEV1 P = 0.04). Despite a decrease in first month of the treatment in FEV1/FVC ratio and DLco these two parameters were recovered at the end of the first year in group B patients. TLC values were increased after treatment in group B as in group A (P = 0.035). We believe that, if these patients are managed well in 1 year; necessary precautions are provided; and patients are well-informed, then there wouldn't be too much risk and mortality rate for long-term side effects of ABVD and mediastinal RT.

The High Effect of Chemomobilization with High-Dose Etopside + Granulocyte-Colony Stimulating Factor in Autologous Hematopoietic Peripheral Blood Stem Cell Transplantation: A Single Center Experience.

Autologous hematopoietic stem cell transplantation (auto-HSCT) provides hematopoietic support after high-dose chemotherapy and is the standard of care for patients with multiple myeloma (MM), chemo sensitive relapsed high or intermediate grade non-Hodgkin's lymphoma (NHL) and Hodgkin's lymphoma (HL). However, yields of hematopoietic stem cells vary greatly between patients, and the optimal strategy to mobilize hematopoietic stem cells into peripheral blood for collection has not been defined yet. We investigated the efficacy and safety of chemo mobilization with an intermediate dose etoposide (VP-16; 200 mg/m(2) on days 1-3) and granulocyte-colony stimulating factor (G-CSF)(5 µg/kg twice daily from day 4 through the final day of collection). We reviewed our institutional experience with 91 patients (71 MM, 12 HL, 8 NHL) mobilized with this regimen. VP-16 + G-CSF resulted in successful mobilization in 95.55% of the patients (on one patient stem cell collection with plerixafor was applied), including 76 patients (83.52%) whose stem cells were collected successfully in a single day. Collection was managed between min. D8 and max. D17. Patient age, gender, exposure to previous irradiation and chemotherapy, previous mobilization attempts, and disease characteristics were not considered during selection. Adverse effects of the regimen included supportive transfusions and fevers requiring hospitalization or intravenous antibiotics. VP-16 and G-CSF appears to be a safe and effective mobilization regimen for patients with multiple myeloma, non-Hodgkin's lymphoma and Hodgkin's lymphoma undergoing autologous stem cell transplantation, producing excellent stem cell yield with the majority of patients requiring 1 day of apheresis.

Epidermal growth factor receptor in CRC patients in the era of the RAS.

The aim of this study was to investigate EGFR expression patterns and the effect of EGFR expression on stage, prognosis and response to conventional chemotherapy agents other than monoclonal antibodies in CRC patients. This study included 59 metastatic CRC patients. The expression of EGFR was quantified by immunochemistry in biopsy specimens that were obtained before treatment was initiated. The cases were considered to be positive for EGFR if >1% of the tumor cells had complete circumferential membranous staining. The median age of the patients was 54.6 years, and 59% of the patients were male. Twenty-six patients presented with stage IV disease, and the remaining patients developed distant metastasis during follow-up. Fifty-one patients were treated with regimens containing irinotecan. The numbers of patients with EGFR expression in the primary tumors, the metastatic lymph nodes and the normal colonic tissue were 34 (65.4%), 10 (76.9%) and 34 (65.4%) respectively. The initial disease stage and lymph node stage were correlated with EGFR expression (p<0.05). Additionally, EGFR positivity was correlated with a statistically significant reduction in the response rate to chemotherapy, the overall survival (21 vs. 28 months) and the progression-free survival (15 vs. 22 months) in metastatic patiens treated with chemotherapy other than targeted therapies. In conclusion, EGFR expression in correlated with stage in all CRC patients and response to chemotherapy and survival in metastatic CRC patients.

Pancreatic carcinoma, thrombosis and mean platelet volume: single center experience from the southeast region of Turkey.

BACKGROUND: The aim of this study was to investigate the general characteristics of patients with deep vein thrombosis (DVT) and pancreatic cancer as well as evaluate the relationship between mean platelet volume (MPV), DVT and survival. MATERIALS AND METHODS: Seventy-seven patients with pancreatic cancer, who were admitted to Cukurova University Medical Faculty, Department of Medical Oncology, were enrolled in the study RESULTS: The mean age was 59±20. Forty-nine (63.6%) were men and 28 women (36.4%) . Sixty-eight (88.3%) patients had adenocarcinoma and 9 (11.7%) had a malignant epithelial tumor. Thirty-six (46.7%) had liver metastasis at diagnosis. Twenty-six (33.8%) patients were alive, 20 (26%) were dead and in 31 (40.2%) the status was unknown. Only 14 (18.1%) patients had DVT. In 42 (54.5%) patients MPV values were normal, in 28 (36.4%) patients they were above normal, and in 7 (9.1%) patients they were below normal. There was no statistically significant difference between gender, tumour localization, chemotherapy and survival rates (p:0.56, p:0.11, p:0.21). There was no significant difference between DVT, gender, localisation, histological subtype, the presence of metastasis, stage and if the patient had been treated with chemotherapy (p:0.5, p:0.6, p:0.2, p:0.32, p:0.1, p:0.84). There was also no significant difference between MPV and DVT (p:0.57) but there was a significant difference between liver metastasis and DVT (p:0.02). Age, stage, the presence of metastasis and DVT were prognostic in pancreatic cancer patients. CONCLUSIONS: Cases of pancreatic cancer with liver metastasis should be studied more carefully as thrombosis is more common in these patients.

Thirty-minutes infusion rate is safe enough for bevacizumab; no need for initial prolong infusion.

Bevacizumab (Bev) is a vascular endothelial growth factor-A monoclonal antibody that targets tumor angiogenesis. The transfusion rate of Bev is 90 min in the first dose, 60 min in the second and than from the third dose it is 30 min if no hypersensitivity reaction occurs in the first two doses. The purpose of this study determines whether these initial prolonged infusions are really necessary or not. Between 2007 and 2009, we were using the standard schedule for Bev infusions. In July 2009, we reviewed our medical reports, nursing orders and adverse drug reaction forms to identify the Bev used patients and possible hypersensitivity reactions (HSRs). Depending on that information between August 2009 and July 2014, we started to make Bev infusions in 30 min from the first dose of the therapy. In this study, we documented the findings of these 30-min infusion used patients. From August 2009 to July 2014, we treated 145 patients with 1,145 Bev infusions each one in 30 min. Out of 145 patients, 12 of them received only single dosage of Bev infusion treatment. Bev doses were 5 mg/kg for 87 patients, 7.5 mg/kg for 64 patients, 10 mg/kg for four patients and 15 mg/kg for only one patient. No HSRs were reported during these transfusions. Initial prolonged infusion times are unnecessary for Bev. Thirty-minute infusion rates can be used safely for all courses.

Bilateral breast involvement of Hodgkin lymphoma revealed by FDG PET/CT.

The involvement of breast tissue with Hodgkin's lymphoma (HL) has been reported in very few cases up to date. We report a 33-year-old woman who had been treated and followed up with nodular sclerosing HL for 7 years, and admitted with recurrent disease. The fluorine-18 fluorodeoxyglucose positron emission tomography (FDG PET) images revealed disseminated disease with the involvement of bilateral breast tissues showing FDG uptake. In this case, the breast involvement of HL was confirmed by histopathological results.

The value of FDG PET/CT in the initial staging and bone marrow involvement of patients with multiple myeloma.

OBJECTIVE: The aim of this study was to describe the role of positron emission tomography/computed tomography (PET/CT) with fluorine-18 fluorodeoxyglucose (FDG) in the detection of skeletal and visceral involvement in patients with MM (multiple myeloma) at the initial diagnosis and to evaluate the relation between maximum standardized uptake values (SUVmax) of FDG with bone marrow cellularity and plasma cell ratios. MATERIALS AND METHODS: The study population consisted of 42 patients (15 F, 28 M; mean ± SD age; 47 ± 12 years). Thirty-two patients were referred for initial diagnosis and ten patients were referred for assessment of therapy response. PET/CT scan was obtained 60 min after the administration of 5.4 MBq/kg FDG. The SUVmax of FDG uptake was measured from the region of interest, which was placed at the site of most prominent lesion in bone marrow in PET/CT images. RESULTS: Thirty patients were positive (29 of 32 initially diagnosed, one of ten previously treated) and 12 patients were negative on PET/CT scan. Conventional radiological methods were negative in three of 30 FDG PET/CT-positive patients and these methods did not show any pathological finding in 12 FDG PET/CT-negative patients. The sensitivity of FDG PET in detecting bone marrow involvement at initial diagnosis was 90%. There was a significant correlation between SUVmax values and bone marrow biopsy cellularity and plasma cell ratios, (r = 0.54 and r = 0.74, p < 0.01). CONCLUSIONS: The results of this study demonstrated that FDG-PET is a useful technique for the assessment of MM and the correlation between SUVmax and plasma cell ratios in bone marrow biopsy may avoid repeated bone marrow biopsies in the follow-up period.

Alemtuzumab in Sézary syndrome: efficient but not innocent.

Mycosis fungoides is the most common form of cutaneous T-cell lymphomas. The related Sézary syndrome is a more aggressive form in which the skin is diffusely affected and the peripheral blood is involved. Although easily managed during its early phases, late-stage mycosis fungoides/Sézary syndrome is usually difficult to treat and becomes refractory to chemotherapy. Recently, promising case-based results have been obtained with alemtuzumab, a humanized immunoglobulin G1 monoclonal antibody that binds to CD52 cell surface antigens, in the treatment of advanced stage mycosis fungoides/Sézary syndrome. We report a case of Sézary syndrome treated successfully with alemtuzumab but who died of treatment-related infection.