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Öğe Cholesterol Levels in Patients with Chronic Lymphocytic Leukemia(Natl Med Assoc, 2017) Yavasoglu, Irfan; Sargin, Gokhan; Yilmaz, Fergun; Altindag, Sermin; Akgun, Gulsum; Tombak, Anil; Toka, Bila; Dal, Sinan; Ozbas, Hasan; Cetin, Guven; Donmez, Ayhan; Yegin, Zeynep Arzu; Bilgir, Oktay; Tiftik, Naci; Ertop, Sehmus; Ayyildiz, Orhan; Sonmez, Mehmet; Pektas, Gokhan; Kadikoylu, Gurhan; Tombuloglu, Murat; Bolaman, ZahitLow cholesterol levels may be accompanied by solid tumors or hematological malignancies such as multiple myeloma. Decreased cholesterol levels have been reported in some experimental studies about chronic lymphocytic leukemia (CLL). It may be associated with tumoral cell metabolism. Herein, we examine blood lipid profiles of patients with newly diagnosed CLL (284 male, 276 female, mean age 64 +/- 11 years) as defined by National Cancer Institute criteria. The control group consisted of 71 healthy subjects with mean age 55 +/- 9 years (28 male, 43 females). 60% of patients with Binet A, while 25% were Binet C. Decreased levels of total cholesterol, high density lipoprotein (HDL) and low density lipoprotein (LDL) were observed in patients with CLL than control group (p < 0,001). There was no statistical significance between CLL and control group for triglycerides (TG) and very low density lipoprotein (VLDL), also between HDL-C, VLDL, TG and grades. Cholesterol may metabolized by abnormal lymphocytes in CLL patients.Öğe Comparison of Splenectomy and Eltrombopag Treatment in the Second-Line Treatment of Immune Thrombocytopenic Purpura(2021) Uğur, Mehmet Can; Bilgir, Oktay; Namdaroğlu, Sinem; Eren, Rafet; Doğan, Esma Evrim; Erkek, Esra Turan; Nizam, NihanObjective: Primary immune thrombocytopenia (ITP) is an acquired autoimmune disease characterized by isolated thrombocytopenia. While first-line treatments focus on inhibiting autoantibodies and platelet destruction, second- and third-line treatments include splenectomy and thrombopoietin receptor agonists. In this study, we aimed to compare the efficiency and toxicities of splenectomy and eltrombopag as second-line treatments in ITP. Materials and Methods: We retrospectively analyzed patients who were diagnosed with ITP and followed between 2015 and 2020. Patients who underwent splenectomy or received eltrombopag treatment as second-line or further therapy were included. For subgroup analyses, patients were further stratified according to whether they received eltrombopag in the second or third line of treatment. Results: There were 38 patients in the splenectomy group and 47 patients in the eltrombopag group. The mean age of patients in the splenectomy and eltrombopag groups was 43.2 and 50.5 years, respectively. Time to response was significantly shorter in the splenectomy arm (p=0.001). However, response rates at the 3 rd, 6 th, 12 th, and 24 th months did not exhibit a statistically significant difference between groups; nor did total duration of response and adverse events. Response rates at the 1st, 3rd, 6th, 12th, and 24th months and the total duration of response did not exhibit a statistically significant difference between eltrombopag subgroups. Eltrombopag treatment was ceased for 20 patients after a median of 54.1 months (range: 1-151). Among them, 12 patients (60%) did not experience a loss of response. Conclusion: Comparing the splenectomy and eltrombopag arms, even though time to achieve response was in favor of the splenectomy group, this advantage disappeared when overall response rates and response rate at the 2 nd year were considered. Using eltrombopag in the second or third line of therapy does not yield any difference in terms of time to achieving response.Öğe Eltrombopag for the Treatment of Immune Thrombocytopenia: The Aegean Region of Turkey Experience(Galenos Yayincilik, 2015) Ozdemirkiran, Fusun; Payzin, Bahriye; Kiper, H. Demet; Kabukcu, Sibel; Cagliyan, Gulsum Akgun; Kahraman, Selda; Sevindik, Omur Gokmen; Ceylan, Cengiz; Kadikoylu, Gurhan; Sahin, Fahri; Keskin, Ali; Arslan, Oyku; Ozcan, Mehmet Ali; Gorgun, Gulnur; Bolaman, Zahit; Buyukkececi, Filiz; Bilgir, Oktay; Alacactoglu, Inci; Vura, Filiz; Tombuloglu, Murat; Gokgoz, Zafer; Saydam, GürayObjective: Immune thrombocytopenia (ITP) is an immune-mediated disease characterized by transient or persistent decrease of the platelet count to less than 100x109/L. Although it is included in a benign disease group, bleeding complications may be mortal. With a better understanding of the pathophysiology of the disease, thrombopoietin receptor agonists, which came into use in recent years, seem to be an effective option in the treatment of resistant cases. This study aimed to retrospectively assess the efficacy, long-term safety, and tolerability of eltrombopag in Turkish patients with chronic ITP in the Aegean region of Turkey. Materials and Methods: Retrospective data of 40 patients with refractory ITP who were treated with eltrombopag in the Aegean region were examined and evaluated. Results: The total rate of response was 87%, and the median duration of response defined as the number of the platelets being over 50x10(9)/L was 19.5 (interquartile range: 5-60) days. In one patient, venous sinus thrombosis was observed with no other additional risk factors due to or related to thrombosis. Another patient with complete response and irregular follow-up for 12 months was lost due to sudden death as the result of probable acute myocardial infarction. Conclusion: Although the responses to eltrombopag were satisfactory, patients need to be monitored closely for overshooting platelet counts as well as thromboembolic events.Öğe Increased adipsin is associated with carotid intima media thickness and metabolic disturbances in polycystic ovary syndrome(Wiley, 2016) Calan, Ozlem Gursoy; Calan, Mehmet; Senses, Pinar Yesil; Kocabas, Gokcen Unal; Ozden, Ebru; Sari, Kerime R.; Kocar, Merve; Imamoglu, Cetin; Senses, Yasar M.; Bozkaya, Giray; Bilgir, OktayContextAdipsin, a protein secreted mainly from the adipose tissue, is a structural homologous of complement factor D, a rate-limiting enzyme of the alternative complement system. Growing evidence suggests that the alternative complement system plays a role both in the regulation of energy homoeostasis and in the atherosclerosis. Polycystic ovary syndrome (PCOS) is a reproductive and metabolic disease. ObjectiveTo ascertain whether circulating adipsin levels are altered in women with PCOS, and whether there is an association between adipsin and metabolic parameters or carotid intima media thickness (CIMT). ParticipantsA total of 144 women with PCOS and 144 age- and BMI-matched controls without PCOS were recruited for this cross-sectional study. Main Outcome MeasuresCirculating adipsin levels were measured using ELISA. Metabolic, hormonal parameters and CIMT were also determined. ResultsAdipsin levels were significantly elevated in women with PCOS compared with controls (9152 1411 vs 6031 +/- 971 ng/ml, P < 0001). Adipsin positively correlated with BMI, homoeostasis model assessment of insulin resistance (HOMA-IR), free testosterone, high-sensitivity C-reactive protein (hs-CRP) and CIMT in both groups. Multivariate logistic regression analyses revealed that the odds ratio for PCOS was 325 for patients in the highest quartile of adipsin compared with those in the lowest quartile (OR=325, 95% CI=264-400, P = 0016). Our findings further indicate that BMI, HOMA-IR, hs-CRP and free testosterone are independent factors influencing serum adipsin levels and that adipsin is an independent predictor for CIMT. ConclusionCirculating adipsin levels are significantly higher in women with PCOS, and the peptide is closely related to increased cardiovascular risk and metabolic disturbances.Öğe Multicenter Retrospective Analysis of Turkish Patients with Chronic Myeloproliferative Neoplasms(Galenos Yayincilik, 2017) Soyer, Nur; Haznedaroglu, Ibrahim C.; Comert, Melda; Cekdemir, Demet; Yilmaz, Mehmet; Unal, Ali; Cagliyan, Gulsum; Bilgir, Oktay; Ilhan, Osman; Ozdemirkiran, Fusun; Kaya, Emin; Sahin, Fahri; Vural, Filiz; Saydam, GürayObjective: Chronic myeloproliferative neoplasms (CMPNs) that include polycythemia vera (PV), essential thrombocythemia (ET), and primary myelofibrosis (PMF) are Philadelphia-negative malignancies characterized by a clonal proliferation of one or several lineages. The aim of this report was to determine the demographic features, disease characteristics, treatment strategies, and survival rates of patients with CMPNs in Turkey. Materials and Methods: Across all of Turkey, 9 centers were enrolled in the study. We retrospectively evaluated 708 CMPN patients' results including 390 with ET, 213 with PV, and 105 with PMF. Results: The JAK2V617F mutation was found positive in 86% of patients with PV, in 51.5% of patients with ET, and in 50.4% of patients with PMF. Thrombosis and bleeding at diagnosis occurred in 20.6% and 7.5% of PV patients, 15.1% and 9% of ET patients, and 9.5% and 10.4% of PMF patients, respectively. Six hundred and eight patients (85.9%) received cytoreductive therapy. The most commonly used drug was hydroxyurea (89.6%). Leukemic and fibrotic transformations occurred at rates of 0.6% and 13.2%. The estimated overall survival in PV, ET, and PMF patients was 89.7%, 85%, and 82.5% at 10 years, respectively. There were no significant differences between survival in ET, PV, and PMF patients at 10 years. Conclusion: Our patients' results are generally compatible with the literature findings, except for the relatively high survival rate in PMF patients. Hydroxyurea was the most commonly used cytoreductive therapy. Our study reflects the demographic features, patient characteristics, treatments, and survival rates of Turkish CMPN patients.Öğe Multidisciplinary clinical management of paroxysmal nocturnal hemoglobinuria(E-Century Publishing Corp, 2015) Sahin, Fahri; Ozkan, Melda Comert; Mete, Nihal Gokmen; Yilmaz, Mumtaz; Oruc, Nevin; Gurgun, Alev; Kayikcioglu, Meral; Guler, Ayse; Gokcay, Figen; Bilgir, Ferda; Ceylan, Cengiz; Bilgir, Oktay; Sari, Ismail Hakan; Saydam, GürayParoxysmal nocturnal hemoglobinuria (PNH) is a rare, acquired disease caused by clonal expansion of one or more hematopoietic stem cell (HSC) lines due to a somatic mutation of the phosphatidylinositol glycan anchor (PIG-A) gene located on Xp22.1. PNH incidence is 1.5-2 cases per million of the population per year. PNH can affect multiple systems in the body and requires multidisciplinary clinical management. Patients can manifest with severe pancytopenia, life-threatening thrombosis affecting the hepatic, abdominal, cerebral, and subdermal veins, and high requirements for blood transfusion due to haemolytic anemia. PNH can also be associated with bone marrow failure. Advances in diagnostic techniques and a targeted therapeutic approach for PNH have emerged in the last two decades. Eculizumab, a promising humanized monoclonal antibody against C5, is the first approved therapy for PNH.Öğe Relationship Between Serum Macrophage Migration Inhibitory Factor Level and Insulin Resistance, High-Sensitivity C-Reactive Protein and Visceral Fat Mass in Prediabetes(Elsevier Science Inc, 2018) Bilgir, Oktay; Gokcen, Belma; Bilgir, Ferda; Guler, Asli; Calan, Mehmet; Yuksel, Arif; Aslanipour, Behnaz; Aksit, Murat; Bozkaya, GirayBackground: Growing evidence suggest that macrophage migration inhibitory factor (MIF) plays a vital role in glucose metabolism. We aimed to ascertain whether MIF levels are altered in subjects with prediabetes and also to determine the relationship between MIF and metabolic parameters as well as visceral fat mass. Material and Methods: This cross-sectional study included 40 subjects with prediabetes and 40 age-, body mass index (BMI)- and sex-matched subjects with normal glucose tolerance. Circulating MIF levels were measured using enzyme-linked immunosorbent assay. Metabolic parameters of recruited subjects were evaluated. Visceral fat mass was measured using bioelectrical impedance method. Results: Circulating MIF levels were found to be elevated in subjects with prediabetes compared to controls (26.46 +/- 16.98 versus 17.44 +/- 11.80 ng/mL, P = 0.007). MIF positively correlated with BMI, visceral fat mass and indirect indices of homeostasis model assessment of insulin resistance. In linear regression model, an independent association was found between MIF levels and metabolic parameters, including BMI, visceral fat mass and homeostasis model assessment of insulin resistance. Multivariate logistic regression analyses revealed that the odds ratio for prediabetes was higher in subjects in the highest quartile of MIF compared to those in the lowest quartile, after adjusting for potential confounders. Conclusions: Increased MIF levels are associated with the elevation of prediabetic risk.Öğe Soluble CD40 ligand, high sensitive C-reactive protein and fetuin-A levels in patients with essential thrombocythemia(Pergamon-Elsevier Science Ltd, 2012) Bilgir, Ferda; Bilgir, Oktay; Kebapcilar, Levent; Calan, Mehmet; Ozdemirkiran, Fusun; Cinali, Turker; Bozkaya, GirayBackground: CD40 ligand (CD40L) is expressed on the surface of activated platelets and activated T lymphocytes. Circulating soluble CD40 ligand (sCD40L) is formed from these molecules proteolytically. Fetuin-A is a potent antiinflammatory cytokine. Aim of the study: In this study, we aim to investigate sCD40L levels to determine whether there is platelet activation and to measure high sensitive C-reactive protein (hs-CRP) levels to demonstrate if this leads to an inflammatory process and also to study fetuin-A levels to see if there is any concomitant antiinflammatory event in patients with essential thrombocythemia (ET). Methods: We compared 30 patients with essential thrombocythemia with 30 control subjects and in these patients we measured levels of sCD40L, hs-CRP and fetuin-A. Results: sCD40L levels were significantly higher in the Er group compared to the control group (30.6 +/- 14.4 vs. 18.5 +/- 8.9, p = 0.001). Although fetuin-A levels showed a slight trend to be increased in ET patients, the difference did not reach significance (4.5 +/- 4.2 vs. 3.2 +/- 2.1, p = 0.158). There were no statistically significant differences in hs-CRP levels (24.6 +/- 4.9 vs. 25.0 +/- 5.2, p = 0.750). Conclusion: sCD40L was significantly higher in patients with an ET without any association with an inflammatory process and we believe this may be a marker of platelet regeneration. (C) 2011 Elsevier Ltd. All rights reserved.
