Objective:The increased risk of infection for patients caused by construction and renovation near hematology inpatient clinics is a major concern. The use of high-efficiency particulate absorption (HEPA) filters can reduce the risk of infection. However, there is no standard protocol indicating the use of HEPA filters for patients with hematological malignancies, except for those who have undergone allogeneic hematopoietic stem cell transplantation. This quasi-experimental study was designed to measure the efficacy of HEPA filters in preventing infections during construction.Materials and Methods:Portable HEPA filters were placed in the rooms of patients undergoing treatment for hematological malignancies because of large-scale construction taking place near the hematology clinic. The rates of infection during the 6 months before and after the installation of the portable HEPA filters were compared. A total of 413 patients were treated during this 1-year period.Results:There were no significant differences in the antifungal prophylaxis and treatment regimens between the groups. The rates of infections, clinically documented infections, and invasive fungal infections decreased in all of the patients following the installation of the HEPA filters. When analyzed separately, the rates of invasive fungal infections were similar before and after the installation of HEPA filters in patients who had no neutropenia or long neutropenia duration. HEPA filters were significantly protective against infection when installed in the rooms of patients with acute lymphocytic leukemia, patients who were undergoing consolidation treatment, and patients who were neutropenic for 1-14 days.Conclusion:Despite the advent of construction and the summer season, during which environmental Aspergillus contamination is more prevalent, no patient or patient subgroup experienced an increase in fungal infections following the installation of HEPA filters. The protective effect of HEPA filters against infection was more pronounced in patients with acute lymphocytic leukemia, patients undergoing consolidation therapy, and patients with moderate neutropenia.

No abstract

Evidence based medicine is a medical decision making approach using the best available medical evidence. For this, the research question should be clearly defined, the evidence should be investigated, the evidences should be assessed, the medical decisions must be made and implemented and the results of the implementation should be observed. Meta-analysis and systematic review are at the top of the evidence based-pyramid at evidence based medicine. Meta-analysis is an original article that it is the synthesis of a large number of researches to reach a large number of data, provides more reliable information about the subject being searched. When the meta-analysis is prepared; the research question is determined, the literature is searched and appropriate studies are selected, the selected researches are coded, the effect size is calculated, the data are analyzed again according to the effect sizes and meta-analysis is written respectively. The PRISMA Protocol is often used in conducting meta-analysis. This review summarizes steps for evidence based medicine, steps for conducting meta-analysis, the PRISMA Checklist and the PRISMA Flow Diagram which are translated into Turkish. This review is belived to be a valuable contribution to Turkish scientist, especially in planning to conduct a meta-analysis.Kanıta dayalı tıp, elde bulunan en iyi tıbbi kanıtları kullanarak tıbbi karar verme yaklaşımıdır. Bu amaçla araştırma sorusu net olarak belirlenmeli, kanıtlar araştırılmalı, belirlenen kanıtlar değerlendirilmeli, tıbbi karar verilmeli ve uygulanmalı, uygulamanın sonuçları gözlenmelidir. Kanıta dayalı tıpta, kanıt piramidinin en üst basamağında meta-analiz ve sistematik derlemeler yer almaktadır. Meta-analiz, çok sayıda araştırmayı sentezleyerek geniş veri sayısına ulaşmayı ve araştırılan konu hakkında daha objektif bilgiler edinilmesini sağlayan bir orijinal araştırma türüdür. Meta-analiz hazırlanırken, sırasıyla araştırma sorusu belirlenir; literatür taraması yapılarak uygun araştırmalar seçilir, seçilen araştırmalar kodlanır; etki büyüklüğü hesaplanır, etki büyüklüklerine göre veriler tekrar analiz edilir ve meta-analiz yazılır. Meta-analiz yazım aşamasında sıklıkla PRISMA Protokolü’nden yararlanılmaktadır. Bu derlemede, kanıta dayalı tıp basamakları, meta-analiz yazım basamakları özetlenmiş; PRISMA Kontrol Listesi ve PRISMA Akış Şemasının Türkçe çevirilerine yer verilmiştir. Bu araştırmanın özellikle meta-analiz yapma hazırlığında olan araştırmacılara katkısı olabileceği düşünülmektedir.

No abstract

Background and Aim: PET is a useful tool that allows deeper assessment of response beyond that measured by M protein levels. It has been reported to predict outcome following both ASCT and recently non-transplant setting too. To be able to integrate PET-CT negativity to internationally accepted response criteria the cut-off level needs to be validated by independent investigators. This prospective study was initiated to elucidate the prognostic role of PET-CT in the ASCT setting testing the cut-off level 4.2 initially reported by Zamagniet al versus the cut-off (3.35) based on our results. Patients and Methods: 139 consecutive patients diagnosed and transplanted in Ankara University with pre- and post-transplant (Tx) PET-CT imaging were included. Patients were: Median age 56.5 +/- 8.7 (M/F: 79/60), ISS I/II/III: 50/55/34, renal impairment (10.8%), bone involvement (90.6%), del13q (40.9%), t(4;14) and/or p53(26.5%), LDH high(12.9%), induction with Bortezomib (73.4%). Pre-Tx clinical response ³VGPR: 52.9%, post-Tx clinical response ³VGPR: 77.5%. Overall Survival (OS): median: 33 months (4.2-141 months). PASW statistics for Windows program was used for statistical analysis. Results: ROC analysis revealed 3.35 as a significant cut-off level (p=0.005; OS). PET-CR was defined FDG uptake less than 4.2 or 3.35 depending on the analysis. Pre-Tx PET-CR:17.4%, post-Tx PET-CR: 69.6% (<4.2), 46.4% (<3.35). Cross tabulation of post-Tx clinical response versus PET response is summarized in Table 1. PET (>4.2) was predictive for PFS (p=0.05) but not OS (p=0.096). However PET (>3.35) was predictive for OS (p=0.037) but not PFS. PET (>4.2) was predictive for OS (p=0.014) and PFS (p=0.019)among only ³VGPR patients. Similarly PET (>3.35) among ³VGPR patients was also predictive for OS (p=0.05) and PFS (p=0.04). PET-CR was not predictive among ³CR patients significantly. Cox regression analysis for PFS, when PET (>4.2) is used, ISS was significant only (OR: 1.99, p=0.049) when post-Tx clinical response (OR: 0.46, p=0.022) is not included in the model. For OS, clinical response both pre-Tx (OR: 0.35, p=0.015) and post-Tx (OR: 0.18, p<0.001) is the only significant parameter. PET (>3.35) increased the predictive value of PET. In addition to clinical response, PET-CR appeared as a borderline significant factor for OS: pre-Tx (OR: 2.2, p=0.078), post-Tx (OR: 2.26, p=0.067). In conclusion both PET (<4.2) and PET (<3.35) recognizes deeper responses as manifested by extension of PFS (PET<4.2) and OS (PET<3.35). Both assessments were able to define patients with separate survival outcomes within the ³VGPR group. This effect could not be confirmed within the ³CR group due to the relatively smaller sample size. After multivariate analysis only PET (>3.35) approached significance. To be able to integrate PET-CR to response criteria definition of PET-CR needs to be confirmed. Table 1PET cut-off 4.2PET cut-off 3.35Number of patientsnegativepositivenegativepositive<PR2020PR155911VGPR39143122CR22141521< VGPR17511113 VGPR61284643< CR561942333 CR221415213 year PFS45.8%25.6%48.9%28.9%3 year OS91.6%76.1%94.9%79.5% Figure-1: PET(<3.35) and OS Figure-1:. PET(<3.35) and OS Figure-2. PET(<3.35) and OS within the ³VGPR patients Figure-2. PET(<3.35) and OS within the ³VGPR patients Disclosures No relevant conflicts of interest to declare.

Inappropriate hemogram results may be a sign of underlying cold agglutinin disease. Hemolytic anemia not always accompanies the disease; however, cold exposure may trigger erythrocyte agglutination in vitro and may cause erratic laboratory results.

No abstract

Objective:Tyrosine kinase inhibitors (TKIs) have changed the indications for allogeneic hematopoietic stem cell transplantation (allo-HSCT) in chronic myeloid leukemia (CML). Therefore, we aimed to evaluate the effect of TKIs on allo-HSCT in CML.Materials and Methods:In this quasi-experimental study, we compared patient, disease, and transplantation characteristics as well as allo-HSCT outcomes between the pre-TKI era (before 2002) and the post-TKI era (2002 and later) in patients with CML. A total of 193 allo-HSCTs were performed between 1989 and 2012.Results:Patients in the post-TKI era had more advanced disease (>chronic phase 1) at the time of transplant and more frequently received reduced-intensity conditioning compared to patients in the pre-TKI era. Relapse/progression occurred more frequently in the year ≥2002 group than in the year <2002 group (48% vs. 32% at 5 years, p=0.01); however, overall survival (OS) was similar in these two groups (5-year survival was 50.8% vs. 59.5%, respectively; p=0.3). TKIs (with donor lymphocyte infusions or alone) for treatment of relapse after allo-HSCT were available in the post-TKI era and were associated with improved OS. While the rates of hematologic remission at 3 months after allo-HSCT were similar between TKI eras, patients having remission had better disease-free survival (DFS) [relative risk (RR): 0.15, confidence interval (CI) 95%: 0.09-0.24, p<0.001] and OS (RR: 0.14, CI 95%: 0.09-0.23, p<0.001). Male allo-HSCT recipients had worse DFS (RR: 1.7, CI 95%: 1.2-2.5, p=0.007) and OS (RR: 1.7, CI 95%: 1.1-2.6, p=0.02) than females.Conclusion:TKIs are an effective option for the treatment of relapse after allo-HSCT in CML. Hematologic remission after allo-HSCT is also an important factor for survival in CML patients.