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Öğe Dynamic Thiol/Disulfide Balance and Ischemia Modified Albumin Levels in Patients with Polycythemia Vera(2021) Uçar, Mehmet Ali; Koyuncu, Mahmut Bakır; Basir, Hakan; Ilgan, Mustafa; Akdeniz, Aydan; Erel, Özcan; Neselioglu, SalimAim: Polycythemia vera is a chronic myeloproliferative disease characterized by increased red cell mass and JAK2 mutation positivity. Transformation to myelofibrosis and acute leukemia is possible in patients with polycythemia vera. Oxidative stress causes DNA damage and might be a reason for malignant transformation. Thiol molecules can prevent the harmful effects of oxidative stress. Therefore, in this study, we aimed to analyze the state of thiol homeostasis in patients with polycythemia vera. Material and Methods: Thirty-one patients with polycythemia vera and 80 healthy volunteers were included in this study. Serum samples of the cases were stored until the end of the study. Native thiol, total thiol, disulfide, and ischemia modified albumin levels were determined. Results: The mean ischemia modified albumin (1.09±0.21 vs 0.67±0.08; p<0.001, mean disulfide (23.5±6.1 vs 10.7±2.6; p<0.001), the mean disulfide/native thiol ratio (5.6±1.1 vs 3.1±1.2; p<0.001), the mean disulfide/total thiol ratio (5.0±0.9 vs 2.9±1.0; p<0.001), the mean native thiol (418.9±80.6 vs 371.4±103.7; p=0.024), the mean total thiol (466.0±89.8 vs 393.0±105.5; p=0.001) and the mean disulfide/total thiol ratio (89.8±1.8 vs 94.1±2.0; p<0.001) were found higher in polycythemia vera patients. Ischemia modified albumin levels were also higher in high-risk polycythemia vera patients. Patients on ruxolitinib therapy had higher native thiol, total thiol and disulfide levels, and higher disulfide/native thiol and disulfide/total thiol ratios. Conclusion: Oxidative stress markers are still high in patients with polycythemia vera who were under treatment. Besides, ruxolitinib may be helpful to decrease oxidative stress in these patients.Öğe Is L-glutamine really effective in reducing painful crisis and hospitalization for sickle cell anemia patients in real life?(Pergamon-Elsevier Science Ltd, 2018) Tombak, Anıl; Tas, E.; Koyuncu, Mahmut Bakır; Akdeniz, Aydan; Tiftik, Naci; Sungur, Mehmet Ali…Öğe The Role of Azacitidine in the Treatment of Elderly Patients with Acute Myeloid Leukemia: Results of a Retrospective Multicenter Study(Galenos Yayincilik, 2016) Tombak, Anıl; Uçar, Mehmet Ali; Akdeniz, Aydan; Tiftik, Eyüp Naci; Şahin, Deniz Gören; Akay, Olga Meltem; Sungur, Mehmet AliObjective: In this study, we aimed to investigate the efficacy and safety of azacitidine (AZA) in elderly patients with acute myeloid leukemia (AML), including patients with >30% bone marrow (BM) blasts. Materials and Methods: In this retrospective multicenter study, 130 patients of >= 60 years old who were ineligible for intensive chemotherapy or had progressed despite conventional treatment were included. Results: The median age was 73 years and 61.5% of patients had >30% BM blasts. Patients received AZA for a median of four cycles (range: 1-21). Initial overall response [including complete remission (CR)/CR with incomplete recovery/partial remission] was 36.2%. Hematologic improvement (HI) of any kind was documented in 37.7% of all patients. HI was also documented in 27.1% of patients who were unresponsive to treatment. Median overall survival (OS) was 18 months for responders and 12 months for nonresponders (p=0.005). In the unresponsive patient group, any HI improved OS compared to patients without any HI (median OS was 14 months versus 10 months, p=0.068). Eastern Cooperative Oncology Group performance status of <2, increasing number of AZA cycles (>= 5 courses), and any HI predicted better OS. Age, AML type, and BM blast percentage had no impact. Conclusion: We conclude that AZA is effective and well tolerated in elderly comorbid AML patients, irrespective of BM blast count, and HI should be considered a sufficient response to continue treatment with AZA.Öğe Therapeutic Plasma Exchange in Patients with Neurologic Disorders: Review of 63 Cases(Springer India, 2017) Tombak, Anıl; Uçar, Mehmet Ali; Akdeniz, Aydan; Yılmaz, Arda; Kaleağası, Hakan; Sungur, Mehmet Ali; Tiftik, Eyüp NaciTherapeutic plasma exchange (TPE) is a procedure that reduces circulating autoantibodies of the patients. TPE is commonly used in neurological disorders where autoimmunity plays a major role. We report our experience with regard to the indications, adverse events and outcomes of plasma exchange in neurological disorders. Sixty-three patients were included to this retrospective study. Median age was 48 years (range 1-85), there was a predominance of males. Neurological indications included Guillain-Barre syndrome (n = 22), myasthenia gravis (n = 21), chronic inflammatory demyelinating polyneuropathy (n = 7), polymyositis (n = 3), multifocal motor neuropathy (n = 2), acute disseminated encephalomyelitis (n = 2), neuromyelitis optica (n = 2), multiple sclerosis (n = 2), limbic encephalitis (n = 1) and transverse myelitis (n = 1). TPE was frontline therapy in 57 % of the patients (n = 36). Total number of TPE sessions was 517; median number of sessions per patient was 8 (range 1-66). TPE was done through a central venous access in 97 % and through a peripheral venous access in 3 % of the patients. Human albumin was used as replacement fluid in 49 %, hydroxyethyl starch (HES) in 49 % and fresh frozen plasma in 2 % of the cases. Adverse reactions were recorded in 60 % of the patients. Total ratio of complications in 517 TPE procedures was 10.8 % and these were mild and manageable such as allergic reactions and hypotension. Overall response rate was 81 %. Interestingly, complication and response rates were similar in both HES and human albumin groups. We conclude that TPE is an effective treatment in neurologic diseases in which autoimmunity plays an important role in the pathogenesis and HES can be used instead of albumin as replacement fluid in these disorders, since it is cost-effective, has similar efficacy and complication rates.
