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    AAT: does it have a place in acute leukemia?
    (Future Medicine Ltd, 2024) Dogu, Mehmet H.; Ozcelik, Berfin; Akbulut, Yusuf E.; Kantarci, Mert; Bektas, Ezgi; Serin, Istemi
    Aim: In this study, the authors aimed to investigate the change of AAT, its effect on the response to induction and its effects on the treatment process in acute myeloid leukemia and acute lymphoblastic leukemia patients. Materials & methods: This study included 94 patients who were hospitalized and followed up in Istanbul Training and Research Hospital, Hematology Clinic, between October 2019 and December 2021. Results: Patients with a complete response had higher serum AAT levels than those with a non-complete response (p < 0.05). The mean serum AAT level was found to be significantly higher in patients without Gram-positive growth than in patients with Gram-positive growth. Conclusion: It can be thought that AAT can play a role during the course of acute leukemia management. [GRAPHICS]
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    Hemolytic anemia and plasma exchange
    (Elsevier Ltd, 2021) Serin, Istemi; Doğu, Mehmet Hilmi
    Hemolytic anemia is a disease caused by autoantibodies and resulting in various complaints and clinical symptoms. In about half of cases, the cause of autoimmune hemolytic anemia can not be determined. Corticosteroids are the first-line treatment option for warm autoantibody-related hemolytic anemia. In patients who develop steroid side effects or do not respond adequately, other immunosuppressives may be preferred. In case a rapid response is required or fulminant hemolysis occur, human immunoglobulins (IVIGs) may be added to treatment. Finally, plasma exchange (PE) may additionally be utilised. The essence of PE is based on the removal of immune complexes, protein-bound toxins, autoantibodies and high molecular weight solutes and protein-bound solutes. The main clinical aim of the removal of solutes is usually to gain a faster response than immunosuppressive therapy. Studies related to hemolytic anemia and PE are usually based on case reports. Our case report is about a patient with severe IgG subtype hemolytic anemia. The treatment was started with 1 mg/kg methylprednisolone; to which there was no response with weekly rituximab 375 mg/m2 and IVIG administered. Because of unresponsiveness to all of the immunosuppresives, a total of 5 sessions of PE were added to the treatment procedure every other day. After these sessions, the requirement for transfusions has decreased and the patient underwent splenectomy. The patient is currently being followed up only on oral cyclosporine and the last hemoglobin level was 14.7 g /dl. In severe and refractory anemia, especially in the case of cardiovascular imbalance in fulminant hemolysis, PE may be preferred as a third series option after immunosuppressive treatments and play a role as a bridge to splenectomy.
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    Mucormycosis in hematologic malignancies: clinical follow-up and treatment results
    (ISTANBUL TRAINING & RESEARCH HOSPITAL, 2021) Sari, Nagehan Didem; Serin, Istemi; Kirgezen, Tolga; Doğu, Mehmet Hilmi
    Introduction: Mucormycosis is an aggressive-progressive invasive fungal infection caused by mold fungi in the division of mucorales of the zygomycetes class with high mortality, and is the most common fungal infection in patients with hematologic malignancies. Methods: This study retrospectively evaluated patients with mucormycosis diagnosis between January 2015 and December 2019, including demographic features, hematologic diseases and comorbidities, radiological evaluations, symptoms and signs, treatments, and outcomes. Results: Maxillofacial 9/19 (47.37%) of patients and 10/19 (59.9%) rhinoorbital mucor. Hematologic malignancy was observed in 15 (78.95%) patients, whereas others had additional pre-disposing factors, such as diabetes mellitus and chronic renal failure. The most common find-ings were persistent fever, mucopurulent nasal flux, and periorbital edema. Endoscopic sinus surgery + medication was administered in 12/19 (62.2%) patients and antifungal therapy in 7/19 (37.8%). In addition, 15/19 (79.95%) patients died and 4/19 recovered with sequela. Conclusion: The first large-scale mucormycosis study from our country will guide in determining the treatment algorithm. Effective and early surgery and antifungal application reduce mortality in mucormycosis by early diagnosis and multidisciplinary approach, without bone destruction in the paranasal sinus computed tomography with recurrent fever and earlystage sinusitis finding by performing a biopsy.
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    A new FLT3 inhibitor with two cases: the gilteritinib experience
    (E-CENTURY PUBLISHING CORP, 2021) Serin, Istemi; Doğu, Mehmet Hilmi; Huq, Gulben Erdem; Yokus, Osman
    Introduction: In acute myeloid leukemia (AML), a heterogeneous group of leukemias, there are various factors to determine prognosis. Among these prognostic factors, cytogenetic results are increasing in importance day by day. FLT3 mutations are among the most common molecular abnormalities in AML, patients with recurrent or refractory (R/R) AML with this mutation have a low response rate to salvage therapy. Gilteritinib has activity against FLT3, ALK and AXL. This article shall present two cases, for which Gilteritinib was used, a new FLT3 inhibitor, and the results of the treatment. Case 1: A 52-year-old female patient presented to the emergency clinic with weakness and fever. In initial biochemical analysis, leukocyte was 104000/mm(3). Peripheral smear contained diffuse myeloid blastoid cells, peripheral blood flow cytometry also supported the AML M0-1 phenotype. The bone marrow biopsy aspiration performed on the 14th day of induction "3+7" treatment, contained diffuse blastic infiltrate and supported refractory disease. In addition to the FLAG-IDA salvage regimen, 120 mg/day Gilteritinib was also started. Bone marrow aspiration performed on the 28th day of salvage therapy was compatible with remission. Case 2: 53 years old male patient with also no comorbidity other than known hypertension. In the initial biochemical analysis of the patient, leukocyte was 156000/mm(3), platelet 58000/mm(3) and hemoglobin 7.6 g/dl. Peripheral blood flow cytometry supported the AML M5 phenotype, whose peripheral smear showed diffuse monoblastoid cells. On the 14th day of the patient's 3+7 induction treatment, the control bone marrow aspiration showed diffuse blast infiltration and was considered refractory, FLAG-IDA salvage therapy with again 120 mg/day Gilteritinib per oral were started. On the 28th day, control bone marrow aspiration was evaluated as remission. Discussion and conclusion: Unlike other FLT 3 inhibitors, Gilteritinib has been shown to be a highly effective agent in R/R AML with FLT3 mutations. Being the first data to be reported from Turkey, we think it would be quite guiding the titular.
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    A Real-Life Turkish Experience of Ruxolitinib in Polycythemia Vera
    (Galenos Publ House, 2023) Serin, Istemi; Dogu, Mehmet Hilmi; Ekinci, Omer; Cagliyan, Gulsum Akgun; Basturk, Abdulkadir; Aras, Merih Reis; Demircioglu, Sinan
    Introduction: Ruxolitinib is a small -molecule inhibitor of the JAK1/2 pathway. This study aimed to reveal the results and side-effect profile of the use of ruxolitinib as a treatment option in polycythemia vera (PV). Methods: A total of 34 patients with PV from 18 different centers were included in the study. The evaluation of the response under treatment with ruxolitinib was determined as a reduction in spleen volume (splenomegaly size: >= 35%) by imaging and control of hematocrit levels (<= 45%) compared to baseline. Results: While the number of patients in which a reduction in spleen volume and hematocrit control was achieved was 19 (55.9%) at 3 months of treatment, it was 21 (61.8%) at 6 months. Additionally, while the number of side effects was negatively correlated with the reduction in spleen volume (Spearman's rho: -0.365, p=0.034), a decrease in the hematocrit level was positively correlated (Spearman's rho: 0.75, p=0.029). Those without a reduction in spleen volume experienced more constipation (chi-square: 5.988, Fisher's exact test: p=0.033). Conclusion: This study shed light on the use of ruxolitinib in PV and the importance of splenomegaly on studies planned with larger patient groups.
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    Real-world data on the effectiveness and safety of Ixazomib-Lenalidomide-Dexamethasone therapy in relapsed/refractory multiple myeloma patients: a multicenter experience in Turkey
    (Taylor & Francis Ltd, 2023) Bakirtas, Mehmet; Dal, Mehmet Sinan; Yigenoglu, Tugce Nur; Giden, Asli Odabasi; Serin, Istemi; Basci, Semih; Kalpakci, Yasin
    A multicenter, retrospective, observational study was conducted to explore effectiveness and safety of ixazomib plus lenalidomide with dexamethasone (IRd) in relapsed/refractory multiple myeloma (RRMM) patients following at least >= two lines of therapy. Patients' treatment responses, overall response rate, progression-free survival rate, and adverse events were recorded. Mean age of 54 patients was 66.5 +/- 9.1 years. There were 20 patients (37.0%) with progression. Median progression-free survival was 13 months in patients who received a median of three therapy lines in a 7.5-month follow-up period. Overall response rate was 38.5%. Of 54 patients, 19 (40.4%) had at least one adverse event, and nine (19.1%) had an adverse event of at least grade 3 or more. Of 72 adverse events observed in 47 patients, 68% were grade 1 or 2. Treatment was not stopped in any patient due to adverse events. IRd combination therapy was effective and safe in heavily treated RRMM patients.
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    Serum Aspergillus galactomannan lateral flow assay for the diagnosis of invasive aspergillosis: a single center study
    (WILEY, 2021) Serin, Istemi; Doğu, Mehmet Hilmi
    Background: Aspergillus species meet the most important group of invasive fungal diseases (IFD) in immunosuppressed patients. Galactomannan is a polysaccharide antigen located in the wall structure of Aspergillus. The most commonly used method for antigen detection is enzymelinked immunoassay (ELISA). Aspergillus galactomannan Lateral Flow Assay (LFA) constitutes one of the new methods in the diagnosis of invasive aspergillosis (IA). The goal of this study is to demonstrate efficacy of LFA in our patients and to compare it to synchronous ELISA results. Methods: Galactomannan antigen was examined using both LFA and ELISA in serum samples taken from patients who were followed up in our hematology clinic. All patients are classified in subgroups as "proven", "probable", and “possible" patients according to the last EORTC / MSG guideline. Patients who met the “proven" IA criteria were included in the study as the gold standard. Results: A total of 87 patients were included in the study. Majority of patients had acute myeloid leukemia (AML) (56.3%). Eleven (12.6%) were in "proven" IA group. LFA test showed a superior diagnostic performance compared to ELISA (LFAAUC = 0.934 vs ELISAAUC = 0.545; p <0.001). The LFA had a sensitivity of 90.9%, and a specificity of 90.8% for "0.5 ODI" in predicting IA (PPV = 55.8%; NPV = 98.6%; p <0.001). Conclusion: The most important finding of this study is that the specificity of LFA was found to be higher for cut-off value of 0.5. It is recommended to combine the methods in many studies to provide a better early diagnosis for IA.