Background: Although cure rates in pediatric acute lymphoblastic leukemia (ALL) are quite high with combined chemotherapy regimens, complete response (CR) and long-term survival rates in adults are 80–90 and 30–40%, respectively. Currently, combined chemotherapy regimens, such as Hyper-CVAD and PETHEMA, are used in patients with adult ALL. However, there has been no study comparing the results of Hyper-CVAD and PETHEMA ALL-93. Methods: In this retrospective single-center study, we evaluated the results of Hyper-CVAD and PETHEMA ALL-93 in 51 ALL patients treated between September 2008 and March 2017 at the Department of Hematology, Faculty of Medicine, Karadeniz Technical University. Results: Thirty-eight patients were treated with Hyper-CVAD and 13 with PETHEMA ALL-93. CR was obtained in 90 and 100% of patients, respectively. Survival estimates were comparable between Hyper-CVAD and PETHEMA ALL-93, with a median overall survival (OS) and a median disease-free survival (DFS) of 17.5 and 12.1 months, respectively, for Hyper-CVAD and of 18.6 and 12.9 months, respectively, for PETHEMA ALL-93. The 2-year OS rates for Hyper-CVAD and PETHEMA ALL-93 were 30 and 40%, respectively, and the 2-year DFS rates were 28 and 44%, respectively. PETHEMA ALL-93 resulted in more hepatotoxicity, hypofibrinogenemia, aspergillus infection, and skin rash than Hyper-CVAD. Conclusions: Although Hyper-CVAD and PETHEMA ALL-93 showed similar effects, Hyper-CVAD was tolerated better. Age and comorbidities should be taken into account before a chemotherapy regimen is determined for patients with ALL.
Objective: This study aimed to retrospectively evaluate the efficacy, safety, and survival outcome of single-agent ibrutinib therapy in chronic lymphocytic leukemia patients. Materials and Methods: A total of 136 patients (mean age ± standard deviation: 64.6±10.3 years, 66.9% males) who had received at least one dose of ibrutinib were included in this retrospective multicenter, noninterventional hospital-registry study conducted at 33 centers across Turkey. Data on patient demographics, baseline characteristics, laboratory findings, and leukemia-cell cytogenetics were retrieved. Treatment response, survival outcome including overall survival (OS) and progression-free survival (PFS), and safety data were analyzed. Results: Overall, 36.7% of patients were categorized as Eastern Cooperative Oncology Group (ECOG) class 2-3, while 44.9% were in Rai stage 4. Fluorescence in situ hybridization revealed the presence of del(17p) in 39.8% of the patients. Patients received a median of 2.0 (range: 0-7) lines of pre-ibrutinib therapy. Median duration of therapy was 8.8 months (range: 0.4-58.0 months). The 1-year PFS and OS rates were 82.2% and 84.6%, respectively, while median PFS time was 30.0 (standard error, 95% confidence interval: 5.1, 20.0-40.0) months and median OS time was 37.9 (3.2, 31.5-44.2) months. Treatment response (complete or partial response), PFS time, and OS time were better with 0-2 lines versus 3-7 lines of prior therapy (p<0.001, p=0.001, and p<0.001, respectively), with ECOG class 0-1 versus class 2-3 (p=0.006, p=0.011, and p=0.001, respectively), and with Rai stage 0-2 versus 3-4 (p=0.002, p=0.001, and p=0.002, respectively). No significant difference was noted in treatment response rates or survival outcome with respect to the presence of comorbidity, bulky disease, or del(17p). While 176 adverse events (AEs) were reported in 74 (54.4%) patients, 46 of those 176 AEs were grade 3-4, including pneumonia (n=12), neutropenia (n=11), anemia (n=5), thrombocytopenia (n=5), and fever (n=5). Conclusion: This real-life analysis confirms the favorable efficacy and safety profile of long-term ibrutinib treatment while emphasizing the potential adverse impacts of poorer ECOG performance status, heavy treatment prior to ibrutinib, and advanced Rai stage on patient compliance, treatment response, and survival outcomes.
Introduction: Chronic lymphocytic leukemia (CLL) is the most common type of leukemia seen in adults. Ibrutinib is an orally administered irreversible inhibitor of Bruton tyrosine kinase. Ibrutinib monotherapy has been found effective in many CLL studies. This study aimed at investigating the real world experiences of patients with CLL who have been treated with ibrutinib in Turkey. Materials and Methods: This retrospective multicenter study included 136 patients (91 male) from 33 sites who received at least 1 cycle of ibrutinib since February 2013. Results: The median age was 64. The median follow up time from the initial diagnosis was 69 months (range: 9-296). An average of 2 treatment protocols had been given (range: 0-7) before ibrutinib and the median time elapsed from the last treatment to the date of ibrutinib administration was 6 months (range: 0-120 months). Before ibrutinib, 51.5% of the patients had a comorbidity, 21.3% a bulky disease and 52.2% a B symptom. Of the patients, 87.9% had ECOG <3, 23.8% RAI stage <III, 38.7% 17p deletion, 7.5% 11q deletion and 1.9% p53 mutation. The median follow up time from the initiation of ibrutinib was 8.8 months (range: 0.4-58 months). The median number of ibrutinib cycles was 8 (range: 1-58). The rates of response to ibrutinib were 26% complete remission (CR), 40.7% partial remission (PR), 9.8% stable disease (SD), and 23.6% progressive disease (PD). The overall rates of response (ORR) were (79.3%-41.5%, p<0.005) in those who received <3 treatments before ibrutinib, (75%-50%, p=0.006) in those with ECOG <3 and more (88.9%-57%, p=0.002) in those with RAI stage <III. Presence of 17p deletion (p=0.409), an accompanying disease (p=0.197) or a bulky disease (p=0.751) did not affect the ORR. The dose of ibrutinib was reduced in 17% and delayed in 26.5% of the patients. The major reason for these was the side effects that developed in 55.2% of the cases. The most common adverse events were GI-related (n=37: Grade 1-2 diarrhea in 17 subjects, grade 1-2 nausea in 6 subjects, grade 1 elevated liver enzymes in 4 subjects) and hematologic-lymphatic system toxicities (n=49: Anemia in 19 patients [grade 1-2 in 14], neutropenia in 18 patients [grade 1-2 in 7], thrombocytopenia in 10 patients [grade 1-2 in 5]). Pneumonia developed in 19 subjects (grade 1-2 in 7). The proportion of the patients who survived throughout the study was 78.7%. The most common cause of death was sepsis. The median progression-free survival (PFS) was 30 months and the median survival (MS) rate could not be reached. The 12-month MS rate was 84.6% and the 36-month MS rate 51.7%. The PFS and MS times were found longer in those who had been administered <3 treatment protocols before ibrutinib (p=0.001 for PFS and p<0.005 for MS), those with ECOG <3 (p=0.011 for PFS and p=0.001 for MS), and those with RAI stage <III (p=0.001 for PFS and p=0.002 for MS). Although the PFS and MS times decreased in the presence of 17p deletion, it was not statistically significant (p=0.224 and p=0.123, respectively). Conclusion: These real world experiences have shown that the ibrutinib monotherapy with its tolerable side effects is an effective treatment option regardless of the poor prognostic gene mutations in patients with CLL Disclosures No relevant conflicts of interest to declare.
Ö ÖZ ZE ET T A Am ma aç ç: : Tüylü hücreli lösemi (THL) kemik iliği, periferik kan, dalak, karaciğer ve lenf nodlarının çevresel sitoplazmik uzantılı malign B hücrelerin infiltrasyonu ile karakterize klonal B hücre hastalığıdır. Kladribin ve pentostatin gibi pürin analogları öncesinde ortalama yaşam süresi 4 yıl iken, sonrasında bu süre 15 yıla kadar yükselmiştir. Bu makalede kliniğimizde takip edilen THL'li hastaların klinik özellikleri ve tedavi sonuçlarını değerlendirmeyi amaçladık. G Ge er re eç ç v ve e Y Yö ön n-t te em ml le er r: : Karadeniz Teknik Üniversitesi Tıp Fakültesi Hematoloji Bilim Dalında Ekim 2007 ile Haziran 2015 yılları arasında THL tanısı konulan ve kladribin alan hastaların klinik özellikleri ve tedavi sonuçları retrospektif olarak değerlendirildi. B Bu ul lg gu ul la ar r: : 16 hastanın 15'i erkek ve 1'i kadın olup ortanca tanı yaşı 54 (35-75) yıl idi. Kladribin ile 15 hastada (%94) tam hematolojik yanıt (THY), 1 hastada (%6) parsiyel yanıt (PY) gözlendi. Sekiz hastada (%50) relaps gelişti ve ortalama progresyonsuz yaşam süresi 78 ay idi. Hastaların relaps anındaki yaş ve komorbid durumları değerlendirildiğinde 4 hastaya tek ajan rituksimab, 2 hastaya kladribin uygulandı ve 5 hastada (%83) THY, 1 hastada (%17) PY izlendi. Ardından 3 hastada (%50) 2. relaps izlenmiş olup ortalama progresyonsuz yaşam süresi 54.7 ay idi. Tüm hastaların ortalama yaşam süresi 105 ay, 8 yıllık ortalama yaşam oranı %66 idi. S So on nu uç ç: : Kladribinin THL'de etkin ve güvenli bir tedavi seçeneği olduğu, relaps gelişiminde kladribin için uygun olmayan hastalarda rituksimab kullanılabileceği ve uygun vakalarda birlikte kullanımının tedavi etkinliğini artırabileceği kanaatine varıldı. A An na ah ht ta ar r K Ke el li im me el le er r: : Tüylü hücreli lösemi; kladribin; rituksimab; mortalite A AB BS ST TR RA AC CT T O Ob bj je ec ct ti iv ve e: : Hairy cell leukemia (HCL) is a clonal B-cell disorder characterized by infiltration of the bone marrow, peripheral blood, spleen, liver and lymph nodes by malignant B-cell with circumferential cytoplasmic projections. Median survival before purine analogues such as cladribine and pentostatin was only 4 years, but this subsequently increased to 15 years. The aim of this article was to evaluate the clinical characteristics and treatment outcome of patients with HCL. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : The clinical characteristics and treatment outcome of patients diagnosed with HCL and treated with cladribine at the Karadeniz Technical University, Faculty of Medicine, Department of Hematology between October 2007 to June 2015 were evaluated retrospectively. R Re es su ul lt ts s: : Fifteen out of 16 patients were males and 1 females and the median age was 54 (range 35-75) years.Fifteen patients (94%) achieved a complete hematologic response (CHR), 1 (6%) a partial response (PR) with cladribine. Eight patients (50%) relapsed and median progression-free survival was 78 months. When patients' age and comorbid conditions at time of relapse were analyzed,...
Akut promiyelositik lösemi (APL), farklı klinik ve biyolojik özelliğe sahip akut miyeloid lösemi (AML)'nin bir alt tipidir. Günümüzde all-trans retinoik asit (ATRA) ve antrasiklin bazlı kemoterapi APL tedavisinde standart tedavi yaklaşımıdır. Bu çalışmanın amacı APL'li hastaların klinik özelliklerini ve tedavi sonuçlarını değerlendirmektir.
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