Introduction Nelarabine, a prodrug of arabinosylguanine has lineage-specific toxicity for T lymphoblasts and is used to treat refractory or relapsed T-cell acute lymphoblastic leukemia and T-cell lymphoblastic lymphoma patients. The most commonly observed adverse effects associated with nelarabine are mainly hematological, i.e. neutropenia, anemia, and thrombocytopenia. Additionally, neurological, and gastrointestinal toxicities have been reported. Central nervous system neurotoxicity associated with nelarabine is very rare. Case description A 37-year-old man patient diagnosed with T-cell acute lymphoblastic leukemia had experienced generalized tonic-clonic seizure which lasted for a few seconds and upper extremity weakness after three weeks of the nelarabine infusion. Computed tomography and magnetic resonance imaging have shown periventricular and nucleus caudatus abnormalities. Radiological findings suggested toxic leukoencephalopathy and acute infarct of right nucleus caudatus. Management and outcome After high-dose steroids, intravenous immunoglobulin, and support treatment, his neurologic symptoms disappeared except for mild peroral numbness. However, radiological sequelae persisted despite clinical improvement. Conclusion Physicians involved in the care of these patients who use nelarabine should be aware of the fact that cerebral toxicity of the nelarabine may occur especially in the presence of predisposing factors. It is crucial to monitor closely those patients receiving nelarabine and also those who have additional predisposing factors for neurotoxicity.

Background and Objectives: Relapsed/refractory extramedullary myeloma (RREMM) is an uncommon and aggressive subtype of multiple myeloma defined by plasma cell proliferation outside the bone marrow. Therapeutic options for RREMM are limited, and the prognosis is generally unfavorable. This research aimed to assess the effectiveness of the bendamustine, pomalidomide, and dexamethasone (BPD) regimen in patients with RREMM. Material and Methods: We carried out a retrospective investigation of 11 RREMM patients who underwent BPD treatment. The primary endpoint was progression-free survival. The secondary endpoints of the study were two-year survival and overall response rate (ORR). We analyzed the sociodemographic and clinical features of the patients. Results: The average age of the patients was 62 years. They had a median of four prior treatment lines, and eight patients had previously received autologous stem-cell transplantation. After eight BPD treatment cycles, the ORR stood at 54%, with one very good partial response (VGPR), five partial responses (PR), three progressive diseases (PD), and two stable diseases (SD). The median follow-up was 15 months, with a two-year PFS rate of 71.3% and a two-year survival rate of 81.8%. Conclusions: The BPD regimen demonstrated promising effectiveness in RREMM patients, yielding favorable ORR and survival rates. To corroborate these findings and explore additional treatment alternatives for this patient group, larger prospective studies are required.

Objectives: Patients with hematologic malignancies have a high risk of coronavirus disease 2019 (COVID-19) mortality. This study aimed to investigate the impact of COVID-19 on mortality rates in patients with various hematologic malignancies and to determine risk factors associated with all-cause mortality. Methods: A multi-center, observational retrospective analysis of patients with hematologic 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 hematologic 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). 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. Cardiac comorbidities, (p=0.016), cytotoxic chemotherapy (p=0.024), low lymphocyte percentage (p=0.025), thrombocytopenia (p<0.0001), and high CRP values (p=0.017) were the independent risk factors for the prediction of mortality. Conclusions: In patients with hematologic 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. Cardiac diseases, cytotoxic chemotherapy, lymphopenia, thrombocytopenia, and high CRP are the independent risk factors for mortality in hematologic malignancy patients with COVID-19. Keywords: Covid; Hematologic Malignancy; Cytotoxic chemotherapy.

AML is an aggressive and mortal disease. Worldwide, approximately 120.000 new AML cases and over 100.000 AML-related deaths occur each year and FLT3 mutations contribute to poor prognosis in AML. FLT3 mutations of 149 patients aged 20-95 years who were diagnosed with AML in our clinic were evaluated retrospectively. Relapse/refractory disease was found in 87.2% of these cases and FLT3 mutation in 25.5%. Of mutation-positive cases 65.8% had FLT3-ITD mutation and 34.2% had FLT3-TKD mutation. In our study, 38 patients with newly diagnosed FLT3 mutations were treated with FLT3 inhibitors such as midostaurin, sorafenib, and sunitinib in combination with chemotherapy and 76.3% (n:29) of the patients with FLT3 mutation received midostaurin. Mortality rate was higher in those with FLT3-TKD mutation compared to those with FLT3-ITD mutation. The risk of mortality in patients who received midostaurin and chemotherapy was 2.0 times higher than the control group, which consisted mostly of relapsed/refractory patients who received only chemotherapy. The cumulative mortality rate in all patients was 66.4%, with a median OS of 44.8 months. Increasing age (HR: 1.03; p<0.001), presence of FLT3 mutation (HR: 1.82; p=0.007), presence of relapse/refractory disease (HR: 23.66; p=0.002) were associated with higher mortality. Mortality risk was low in patients with allogeneic stem cell transplantation (HR: 0.19; p<0.001). When the survival rate was analyzed according to FLT3 mutation, the presence of FLT3 mutation negatively affected survival (HR: 1.82). In conclusion, our study is important as it has the highest number of patients in the efficacy analysis of FLT3 inhibitors in our region, as far as we know. The prognostic impact of FLT3-TKD mutations remains mysterious due to the low frequency. Further studies recruiting more patients may be useful to better understand the efficacy of FLT3 inhibitors in patients with FLT3-TKD mutations.

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