Person: CANDAR, ÖMER
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Publication The role of white blood cell count in perianal pathologies: A retrospective analysis of hematologic malignancies(Mattioli 1885, 2022-07-01) Orhan, Bedrettin; Özkalemkaş, Fahir; Özkocaman, Vildan; Gürbüz, Büsra; Ersal, Tuba; Pınar, İbrahim Ethem; Yalçın, Cumali; Candar, Ömer; Çubukcu, Sinem; Koca, Tuba Güllü; Ali, Rıdvan; ORHAN, BEDRETTİN; ÖZKALEMKAŞ, FAHİR; ÖZKOCAMAN, VİLDAN; GÜRBÜZ, BÜŞRA; ERSAL, TUBA; PINAR, İBRAHİM ETHEM; YALÇIN, CUMALİ; CANDAR, ÖMER; ÇUBUKÇU, SİNEM; GÜLLÜ KOCA, TÛBA; ALİ, RIDVAN; Bursa Uludağ Üniversitesi/Tıp Fakültesi/İç Hastalıkları Anabilim Dalı/Hematoloji Bilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/İç Hastalıkları Anabilim Dalı.; 0000-0001-9907-1498; 0000-0003-4168-2821; 0000-0002-5129-2977; 0000-0002-5564-8862; 0000-0001-7602-6926; JWP-2738-2024; ACW-2157-2022; GWQ-5007-2022; KIE-5102-2024; JGM-6601-2023; GMY-8535-2022; FQG-8981-2022; JJB-0254-2023; GWQ-5007-2022; GXD-8209-2022; AAJ-4354-2021Background and Objective: Infections are the most common cause of anal and perianal pathologies in patients with hematological malignancies. Perianal infection diagnosis in this group of patients is difficult; thus, a careful anorectal examination is necessary with imaging modalities. In addition, the literature reveals a knowledge gap in the approach to anal pathologies in patients with neutropenia during diagnosis or chemotherapy. This study aimed to examine our institutional data on perianal complications and investigate the relationship between the white blood cell-neutrophil count, perianal lesion, and the type of treatment in patients with hematologic malignancies during the neutropenic period.Methods: Patients with a hematologic malignancy, hospitalized for cytotoxic chemotherapy, complicated by perianal pathology, documented by at least one imaging method, were included in the study.Results: A total of 42 patients were included in the study. Most of them had acute leukemia, 31 were affected by acute myeloid leukemia (AML), and 7 by Acute lymphoid leukemia (ALL). There was no statistically significant relationship between the anal abscess formation, the neutrophil count, and a previous perianal pathology. Anal abscess development was significantly more frequent in acute myeloid leukemia. An inverse relationship was found between the total white blood cell number at onset and having a surgical intervention for anal pathology.In conclusion, this article has shown that white blood cell count at the time of hospitalization can affect the surgical intervention in patients with hematological malignancy (in the majority with acute leukemia) affected by anal pathologies occurring in the neutropenic period.Publication Systemic inflammatory indices for predicting prognosis of myelofibrosis(Nature Portfolio, 2023-08-02) Ersal, Tuba; Özkocaman, Vildan; Pınar, İbrahim Ethem; Yalçın, Cumali; Orhan, Bedrettin; Candar, Ömer; Çubukcu, Sinem; Koca, Tuba Güllü; Hunutlu, Fazıl Çağrı; Yavuz, Şeyma; Ali, Ridvan; Özkalemkaş, Fahir; ERSAL, TUBA; ÖZKOCAMAN, VİLDAN; PINAR, İBRAHİM ETHEM; YALÇIN, CUMALİ; ORHAN, BEDRETTİN; CANDAR, ÖMER; ÇUBUKÇU, SİNEM; GÜLLÜ KOCA, TÛBA; HUNUTLU, FAZIL ÇAĞRI; YAVUZ, ŞEYMA; ALİ, RIDVAN; ÖZKALEMKAŞ, FAHİR; Bursa Uludağ Üniversitesi/Tıp Fakültesi/İç Hastalıkları Anabilim Dalı/Hematoloji Bilim Dalı.; 0000-0001-9907-1498; 0000-0003-4168-2821; 0000-0003-3970-2344; 0000-0002-4991-9830; AAJ-4354-2021; FQG-8981-2022; JGM-6601-2023; KIE-5102-2024; ACW-2157-2022; EOZ-1609-2022; JJB-0254-2023; GWQ-5007-2022; KCK-7512-2024; GXS-5860-2022; GXD-8209-2022; JIW-1248-2023The impact of inflammatory markers such as systemic immune-inflammation (SII) index and systemic inflammation response index (SIRI) on myelofibrosis (MF) prognosis was evaluated for the first time in this study. Data from 60 patients diagnosed with MF between March 2011 and September 2022 were retrospectively analyzed. In addition to disease-related markers, the impact of SII and SIRI on prognosis was evaluated. In our study, the overall median survival (OS) was 64 months. OS was significantly shorter in patients older than 65 years, with high ferritin and lymphocyte levels, transfusion dependence at diagnosis, platelet count below 100 x 10(9)/L, Hb level below 8 g/dl, and high risk according to the dynamic international prognostic scoring system (DIPSS)-Plus score. When these variables were included in the multivariate Cox regression model, it was found that being older than 65 years, having a high ferritin value, being at high risk according to the DIPSS-plus score and Hb values below 8 increased the risk of death. Platelet-to-lymphocyte ratio (PLR) and SII index were lower in patients with a fatal outcome. No statistically significant relationship was found between SIRI and mortality. The findings of this study showed that low PLR and high ferritin were associated with poor prognosis in MF. Elevated SII and SIRI, evaluated for the first time in patients with myelofibrosis, did not predict prognosis. Since non-inflammatory variables play a role in the pathogenesis of MF, bone marrow indicators and systemic inflammation indicators derived from hematologic parameters may not be accurate.Publication The effect of cryopreservation on engraftment kinetics in fully matched allogeneic stem cell transplantation: Real-life data and literature review(Pergamon-Elsevier Science Ltd, 2023-12) Ersal, Tuba; Özkocaman, Vildan; Yalçın, Cumali; Orhan, Bedrettin; Candar, Ömer; Çubukçu, Sinem; Koca, Tuba Güllü; Hunutlu, Fazıl Cağrı; Özkalemkaş, Fahir; ERSAL, TUBA; ÖZKOCAMAN, VİLDAN; YALÇIN, CUMALİ; ORHAN, BEDRETTİN; CANDAR, ÖMER; ÇUBUKÇU, SİNEM; GÜLLÜ KOCA, TÛBA; HUNUTLU, FAZIL ÇAĞRI; ÖZKALEMKAŞ, FAHİR; Bursa Uludağ Üniversitesi/Tıp Fakültesi/İç Hastalıkları/Hematoloji Bölümü; 0000-0003-3970-2344; 0000-0002-4991-9830; AAJ-4354-2021; JJP-2815-2023; KIE-5102-2024; ACW-2157-2022; JWF-3713-2024; JJB-0254-2023; GWQ-5007-2022; KCK-7512-2024; JJW-7463-2023Introduction: The standard approach for allogeneic stem cell transplantation (allo-SCT) is to administer donor cells on the same day as a fresh product to a patient who has been given a preparative regimen. The difficulty in collecting and transporting donor cells, especially during the COVID-19 pandemic, has made it essential to collect and cryopreserve the grafts before the recipient begins the transplant preparation regimen. However, the shortand long-term impacts of cryopreservation on transplant outcomes remain controversial. Materials and methods: This retrospective study included 93 patients who underwent allo-SCT between January 2012 and August 2022 at the Stem Cell Transplant Unit of Bursa Uludag University Faculty of Medicine using frozen and fresh products of peripheral blood stem cells from a fully matched sibling donor. The effect of cryopreservation of donor grafts on engraftment kinetics was investigated. Results: Frozen and fresh products were used in 37 and 56 patients, respectively. The majority of patients had acute myeloid leukemia and acute lymphoblastic leukemia. The median age at transplantation was 41 years. Neutrophil engraftment time was similar between the two groups (median: 14 vs. 16 days, p = 0.393). Platelet engraftment time was longer in the frozen product group (median: 12 vs. 15 days, p < 0.001). There was no statistically significant difference between freezing time and viability. The acute graft-versus-host disease (GVHD) rate was 37.8 % in the frozen product group and 28.6 % in the fresh product group (p = 0.349). There was no significant difference between the two groups in terms of primary and secondary graft failure, chronic GVHD, 30-day chimerism, relapse, overall survival, progression-free survival, and nonrelapse mortality. Conclusion: Having donor cells ready before transplantation significantly prevents donor-induced adverse events and provides confidence and practicality to both the clinician and the recipient. Allo-SCT with frozen products is a successful method that can be safely applied, especially when disruptions in donor-derived cell collection or transportation are foreseen.Publication Therapeutic plasma exchange in gastric signet ring cell carcinoma presenting as microangiopathic hemolytic anemia: A rare case report(Wiley, 2022-09-20) Candar, Ömer; Ekinci, Ömer; Merter, Mustafa; Aslan, Mehmet; Aras, İbrahim; CANDAR, ÖMER; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Hematoloji Anabilim Dalı.; 0000-0001-7602-6926; EOZ-1609-2022Microangiopathic hemolytic anemia (MAHA) defines a group of disorders characterized by the formation of microthrombi in capillaries and arterioles and the fragmentation of erythrocytes that pass through. Cancer-related MAHA is a rare but serious condition that is encountered in patients diagnosed with a malignancy. This clinical picture is thought to be linked to certain tumor characteristics; particularly, adenocarcinoma histology, vascular invasion, and bone marrow infiltration. MAHA is most commonly associated with tumors of gastric, prostate, and breast origin. The optimal treatment is not clear; however, there is evidence for the importance of promptly starting an effective antineoplastic regimen and it was also reported that administering therapeutic plasma exchange (TPE) therapy for immunocomplex removal could be beneficial for patients with symptoms of bleeding and thrombosis. Here, we present a case that presented a picture of MAHA secondary to gastric signet-ring cell adenocarcinoma (SRCC). The clinical picture was initially evaluated as thrombotic thrombocytopenic purpura and the patient benefited significantly from the TPE treatment administered before the adenocarcinoma diagnosis was confirmed. In this period, epistaxis stopped, platelet count increased from 25 x 10(9)/L to 162 x 10(9)/L, fragmented erythrocyte rate in the peripheral smear decreased by more than 75% and other laboratory findings of hemolysis (LDH, bilirubin, etc.) significantly improved.Publication The effect of the time from diagnosis to induction therapy on prognosis in patients with acute leukemia undergoing leukapheresis for symptomatic hyperleukocytosis(Wiley, 2023-04-11) Pınar, İbrahim Ethem; Özkocaman, Vildan; Ersal, Tuba; Dağtekin, Mehmet Emin; Yalçın, Cumali; Orhan, Bedrettin; Candar, Ömer; Çubukcu, Sinem; Koca, Tuba Güllü; Gürsoy, Vildan; Özkalemkaş, Fahir; PINAR, İBRAHİM ETHEM; ÖZKOCAMAN, VİLDAN; ERSAL, TUBA; DAĞTEKİN, MEHMET EMİN; YALÇIN, CUMALİ; ORHAN, BEDRETTİN; CANDAR, ÖMER; ÇUBUKÇU, SİNEM; GÜLLÜ KOCA, TÛBA; ÖZKALEMKAŞ, FAHİR; Bursa Uludağ Üniversitesi/Tıp Fakültesi/İç Hastalıkları Anabilim Dalı/Hematoloji Bilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/İç Hastalıkları Anabilim Dalı.; 0000-0001-9907-1498; 0000-0003-4168-2821; ACW-2157-2022; JGM-6601-2023; KIE-5102-2024; JWP-2738-2024; FQG-8981-2022; IRQ-4413-2023; EOZ-1609-2022; JJB-0254-2023; GWQ-5007-2022; JIW-1248-2023IntroductionOur study investigated leukapheresis's effect on delayed induction therapy outcomes in patients with acute leukemia presenting with symptomatic hyperleukocytosis.MethodsThis retrospective cohort study included 30 adult patients diagnosed with acute leukemia who underwent leukapheresis for leukostasis. The patients were divided into the first 24 h and >24 h groups, according to the time from diagnosis to induction therapy (TDT).ResultsThere was no significant difference between the TDT groups regarding complete remission (CR), 4-week mortality, and overall survival (OS) at a median follow-up of 409 days. Tumor lysis syndrome, disseminated intravascular coagulation, and hemoglobin levels were significant in early mortality. In univariate analysis, age, hemoglobin levels, patients' eligibility for intensive chemotherapy, and achieving CR were critical factors for OS.ConclusionThe study findings suggest that waiting for the clinical and laboratory results may be a safe and reasonable approach before assigning patients the best treatment option with leukapheresis.Publication Results of allogeneic stem cell transplantation in bone marrow failures: A single-center experience(Springernature, 2022-11-01) ERSAL, TUBA; ÖZKOCAMAN, VİLDAN; ÖZKALEMKAŞ, FAHİR; PINAR, İBRAHİM ETHEM; ORHAN, BEDRETTİN; CANDAR, ÖMER; ALİ, RIDVAN; Yalçın, Cihan; Bursa Uludağ Üniversitesi/Tıp Fakültesi/İç Hastalıkları Anabilim Dalı.; 0000-0001-9907-1498; 0000-0002-0510-2992; ACW-2157-2022; JGM-6601-2023; JWP-2738-2024Publication Evaluation of using empiric glycopeptides in accordance with the idsa guidelines in hematologic malignancy patients with febrile neutropenia(Mattioli 1885, 2022-05-01) Yalçın, Cumali; Özkalemkaş, Fahir; Özkocaman, Vildan; Ersal, Tuba; Pınar, İbrahim Ethem; Orhan, Bedrettin; Candar, Ömer; Çubukcu, Sinem; Koca, Tuba Güllü; Akyol, Merve Nur; Ada, Nevriye Gül; Özakın, Cüneyt; Kazak, Esra; Akalın, Halis; Ali, Rıdvan; YALÇIN, CUMALİ; ÖZKALEMKAŞ, FAHİR; ÖZKOCAMAN, VİLDAN; ERSAL, TUBA; PINAR, İBRAHİM ETHEM; ORHAN, BEDRETTİN; CANDAR, ÖMER; ÇUBUKÇU, SİNEM; GÜLLÜ KOCA, TÛBA; AKYOL, MERVE NUR; ADA, NEVRİYE GÜL; ÖZAKIN, CÜNEYT; KAZAK, ESRA; AKALIN, EMİN HALİS; ALİ, RIDVAN; Bursa Uludağ Üniversitesi/Tıp Fakültesi/İç Hastalıkları Anabilim Dalı/Hematoloji Bilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/İç Hastalıkları Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Mikrobiyoloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Mikrobiyoloji ve Enfeksiyon Hastalıkları Anabilim Dalı.; 0000-0001-9907-1498; 0000-0003-4168-2821; 0000-0001-7530-1279; 0000-0003-3970-2344; 0000-0001-5428-3630; KIE-5102-2024; JIW-1248-2023; FQG-8981-2022; AAJ-4354-2021; JGM-6601-2023; ACW-2157-2022; EOZ-1609-2022; JJB-0254-2023; GWQ-5007-2022; JYC-2094-2024; GNJ-2469-2022; AAG-8392-2021; AAG-8459-2021; AAU-8952-2020; GXD-8209-2022Background: This study aimed to evaluate the effects of the appropriate use of empiric glycopeptide therapy in hematologic malignancy patients with febrile neutropenia (FN).Materials and Methods: Patients with FN who were hospitalized in our clinic and started empiric glycopeptide therapy were retrospectively analyzed. Empiric glycopeptide treatment initial indications were determined according to 7 specific criteria in the IDSA guidelines. In addition, the duration of glycopeptide use according to initial indications, causative pathogens in culture positivity, frequency of VRE infection, and the mortality rate was identified.Results: 87 patients were included. Of these, 102 episodes of FN were analyzed. Appropriate use of glycopeptides was observed in 98% of patients. The most common initial indication for glycopeptide was skin or soft-tissue infection, with 52% (n = 53). The mean duration of glycopeptide use was 11 (2-22) days. The time of glycopeptide use was longer in patients with catheter-related infections than in those with severe mucositis and hemodynamic instability (p = 0,041/p = 0,016). The duration of glycopeptide use was shorter in patients with consolidation therapy than in those without consolidation therapy. The mortality rate in culture-positive patients was significantly higher than in culture-negative patients (p = 0.041). At 72 h, glycopeptide therapy was discontinued in 8 of 79 FN episodes within culture-negative patients.Conclusion: This study showed that the mortality rate was higher in culture-positive patients. Additionally, glycopeptides should be discontinued early with no evidence of gram-positive infection.Publication Potential modifications of the plasmic scoring system for predicting thrombotic thrombocytopenic purpura: Sometimes, less is more(Wiley, 2023-05-27) Orhan, Bedrettin; Özkocaman, Vildan; Akdemir, Çiğdem; Ersal, Tuba; Pınar, İbrahim Ethem; Yalçın, Cumali; Çandar, Ömer; Çubukcu, Sinem; Koca, Tuba Güllü; Ambarcıoğlu, Pınar; Ali, Rıdvan; Özkalemkaş, Fahir; ORHAN, BEDRETTİN; ÖZKOCAMAN, VİLDAN; AKDEMİR, ÇİĞDEM; PINAR, İBRAHİM ETHEM; YALÇIN, CUMALİ; CANDAR, ÖMER; ÇUBUKÇU, SİNEM; GÜLLÜ KOCA, TÛBA; ALİ, RIDVAN; ÖZKALEMKAŞ, FAHİR; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Hematoloji Anabilim Dalı/Dahiliye Bilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/İç Hastalıkları Anabilim Dalı.; 0000-0003-4168-2821; 0000-0003-3970-2344; 0000-0001-9907-1498; 0000-0001-7602-6926; ACW-2157-2022; JWP-2738-2024; KHE-5423-2024; KIE-5102-2024; JGM-6601-2023; JJP-2815-2023; EJN-7496-2022; AAJ-4354-2021; EOZ-1609-2022; JJB-0254-2023; GWQ-5007-2022; GXD-8209-2022; JJW-7463-2023IntroductionThrombotic thrombocytopenic purpura (TTP) is a life-threatening occlusive disease of the microcirculation characterized by systemic platelet plugs, organ ischemia, deep thrombocytopenia, and fragmentation of erythrocytes. One of the widely used scoring system to determine the clinical probability of TTP is the PLASMIC scoring system. This study aimed to evaluate the contribution of PLASMIC score modifications to sensitivity and specificity in patients with microangiopathic hemolytic anemia (MAHA) undergoing plasma exchange with a prediagnosis of TTP at our center.Materials and MethodsThe data of patients who were hospitalized with a previous diagnosis of MAHA and TTP and underwent plasma exchange at Bursa Uludag University, Faculty of Medicine, Department of Hematology between January 2000 and January 2022 were retrospectively analyzed.ResultsOverall, 33 patients (including 15 and 18 with and without TTP, respectively) were included in this study. Receiver operating characteristic (ROC) analysis revealed that the area under the curve (AUC) for the original PLASMIC score was 0.985 (95% confidence interval [95% CI]: 0.955-1.000), and AUC for the PLASMIC score without mean corpuscular volume (MCV) was 0.967 (95% CI: 0.910-1.000), which is close to the original AUC. With the removal of MCV from the scoring system, the sensitivity decreased from 100% to 93%, whereas the specificity increased from 33% to 78%.ConclusionsBased on the results of this validation study, removing MCV from the PLASMIC score led to the categorization of eight non-TTP cases in the low-risk category, and this could avoid unnecessary plasma exchange. However, in our study increasing the specificity was at the expense of the sensitivity by missing one patient with this new scoring system without MCV. Further multicenter studies with large sample sizes are required owing to the fact that different parameters may be effective in TTP prediction among different populations.