Objective: The aim of this study was to evaluate the clinical significance of reticulocyte hemoglobin content (CHr) in the diagnosis of iron deficiency anemia (IDA) and to compare it with other conventional iron parameters.Materials and Methods: A total of 32 female patients with IDA (serum hemoglobin <120 g/L and serum ferritin <20 ng/ mL) and 18 female patients with iron deficiency (serum hemoglobin > 120 g/L and serum ferritin <20 ng/mL) were enrolled.Results: CHr was 24.95±3.92 pg in female patients with IDA and 29.93±2.96 pg in female patients with iron deficiency. CHr showed a significant positive correlation with hemoglobin, mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, serum iron, and transferrin saturation and a significant negative correlation with transferrin and total iron-binding capacity. The cut-off value of CHr for detecting IDA was 29 pg.Conclusion: Our data demonstrate that CHr is a useful parameter that can be confidently used in the diagnosis of IDA, and a CHr cut-off value of 29 pg predicts IDA.Conflict of interest:None declared.

In this multicenter retrospective analysis, we aimed to present clinical, laboratory and treatment results of 94 patients with Hairy cell leukemia diagnosed in 13 centers between 1990 and 2014. Sixty-six of the patients were males and 28 were females, with a median age of 55. Splenomegaly was present in 93.5% of cases at diagnosis. The laboratory findings that came into prominence were pancytopenia with grade 3 bone marrow fibrosis. Most of the patients with an indication for treatment were treated with cladribine as first-line treatment. Total and complete response of cladribine was 97.3% and 80.7%. The relapse rate after cladribine was 16.6%, and treatment related mortality was 2.5%. Most preferred therapy (95%) was again cladribine at second-line, and third line with CR rate of 68.4% and 66.6%, respectively. The 28-month median OS was 91.7% in all patients and 25-month median OS 96% for patients who were given cladribine as first-line therapy. In conclusion, the first multicenter retrospective Turkish study where patients with HCL were followed up for a long period has revealed demographic characteristics of patients with HCL, and confirmed that cladribine treatment might be safe and effective in a relatively large series of the Turkish study population.

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Rheumatology 2001;40:476±478Pneumomediastinum and subcutaneous emphysema associated with dermatomyositis SIR, Dermatomyositis (DM) is a generalized disorder characterized by myositis and typical cutaneous ®nd-ings. The lung is frequently affected, usually by interstitial pneumonitis [1]. Spontaneous pneumomediastinum has also been reported as a rare complication in DM [2± 4]. Here we describe a patient with DM who developed interstitial pneumonitis complicated by pneumomediastinum and subcutaneous emphysema during steroid therapy.A 28-yr-old man was seen in another hospital in December 1999 with complaints of general fatigue, anorexia, fever, symmetrical arthritis of the hands and erythema of the ®ngers and face. Laboratory examination showed haemoglobin 9 gudl, white blood cell (WBC) count 8300umm 3 , erythrocyte sedimentation rate (ESR) 30 mmuh, aspartate transaminase (AST) 93 Uul (normally <37), alanine transaminase (ALT) 49 Uul (normally <42), lactate dehydrogenase (LDH) 1227 Uul (normal range 225± 450), creatine kinase (CK) 287 Uul (normal range 24 ±190). Tests for antinuclear antibodies (ANA), anti-Jo-1 and rheumatoid factor were negative. Electroneuromyography showed myopathic abnormalities; biopsy specimens of the right deltoid muscle revealed degeneration of muscle ®bres and a mild degree of mononuclear cell in®ltration. Chest radiography showed a mild alveolar and interstitial

The renin-angiotensin system (RAS) is involved in cell growth, proliferation and differentiation in bone marrow in an autocrine-paracrine manner, and it modulates normal and neoplastic haematopoietic cell proliferation. This study aimed to assess expressions of the RAS components, renin, angiotensinogen and angiotensin-converting enzyme (ACE), during imatinib mesylate treatment of patients with chronic myeloid leukaemia (CML). Expressions of RAS components were studied in patients with CML at the time of diagnosis (n = 83) and at 3, 6 and 12 months after diagnosis (n = 35) by quantitative real-time polymerase chain reaction. De novo CML patients had increased ACE, angiotensinogen and renin mRNA levels and these expression levels decreased following administration of imatinib. The RAS activities were significantly different among Sokal risk groups of CML, highlighting the altered biological activity of RAS in neoplastic disorders. The results of this study confirm that haematopoietic RAS affects neoplastic cell production, which may be altered via administration of tyrosine kinase inhibitors such as imatinib mesylate.

Granulocytic sarcoma is a tumor consisting of myeloid blasts with or without maturation that occurs at an anatomical site other than bone marrow. Most frequently affected sites are skin, lymph nodes, gastrointestinal tract, bone, soft tissue and testes. AML may manifest as granulocytic sarcoma at diagnosis or relapse. Although it has been considered to be rare relapse as granulocytic sarcoma after stem cell transplantation is being increasingly reported. However it is rare without bone marrow involvement and in AML M6 subtype. Breast is also a rare involvement. We report a 30-year-old woman with AML M6 relapsed 16 months after allogeneic stem cell transplantation as a granulocytic sarcoma in right breast without bone marrow involvement. She was treated with systemic chemotherapy but died of sepsis. 18FDG-PET/CT images were also obtained and detected lesions other than detected by breast ultrasound. The incidence of granulocytic sarcoma may increase if suspected or new diagnostic modalities are performed.

sequencing (Foundation Medicine, Inc). This post hoc analysis evaluated OS and PFS in sub-groups of pts by blood-based tumour mutational status (data cutoff: 13 Sep 2019).Results: Among 920 mutation-evaluable ITT WT pts, 24.5% had KRAS mut , 14.5% had STK11 mut and 15.5% had KEAP1 mut tumours. Within the KRAS mut population, 44.9% of pts also had co-occurring mutations in STK11 and/or KEAP1. KRAS mut , STK11 mut and KEAP1 mut tumours were generally associated with higher tumour mutation burden levels than tumours in pts WT for these mutations. PFS and OS outcomes with ABCP, ACP and BCP in pts with and without KRAS mutation and per STK11/KEAP1 status are shown in the table.Conclusions: KRAS mut pts treated with ABCP derived improvement in OS and PFS benefit compared with pts treated with BCP and showed numerical improvement vs pts treated with ACP. In KRAS mut pts, ABCP provided survival benefit regardless of STK11 and KEAP1 status. The efficacy data from this exploratory analysis suggest that ABCP could be considered a treatment option for pts with KRAS mutations, regardless of STK11 or KEAP1 status.Clinical trial identification: NCT02366143.

Nodular lymphocyte predominant Hodgkin's lymphoma (NLPHL) is a rare subtype of Hodgkin's lymphoma. In this study, we aimed to investigate the clinical features and therapeutic outcomes of patients with NLPHL who were diagnosed at different institutes in Turkey. We retrospectively reviewed the records of the patients diagnosed with NLPHL. Adult patients who were diagnosed after 2005 with histological confirmation were selected for the study. Forty-three patients were included in the study. Median age of patients was 37.5 years (18-70) at the time of diagnosis. About 60.5% patients were diagnosed as stage I and II NLPHL, and remaining 39.5% had stage III and IV disease. Median follow-up was 46 months. During follow-up, none of the patients died. Seven patients relapsed or progressed after initial therapy at a median of 12 months. Five of 7 relapsed/refractory patients (71.4%) were salvaged with chemotherapy only (DHAP, ICE), and the remaining 2 (28.6%) were salvaged with chemoimmunotherapy. All of relapsed/refractory patients were able to achieve complete remission after salvage therapy. Lactate dehydrogenase levels were significantly higher in patients with progressive disease compared with nonprogressive disease. Our study showed an excellent outcome with all patients alive at last contact with a median follow up of 46 months despite a wide range of different therapeutic approaches. All relapsed and refractory patients were successfully salvaged despite a low frequency of patients received immunotherapy in conjunction with chemotherapy. Our results suggest that immunotherapy may be reserved for further relapses.