Acute myeloid leukemia (AML) is an aggressive clonal myeloid neoplasia that causes accumulation of myeloblast in the blood or bone marrow. For diagnosing AML, at least 20% of nucleated cells in the blood or bone marrow are required to include myeloblasts according to the current classification of the World Health Organization (WHO). This threshold value is 30% according to the French-American-British (FAB) classification system (1).Flow cytometry with multiple parameters is used for determining the relationship of the origin in newly diagnosed acute leukemia (2-4). For diagnosing AML, particularly CD3, CD7, CD13, CD14, CD33, CD34, CD64, and CD117, cytoplasmic myeloperoxidase (MPO) and human leukocyte antigen D-related (HLA-DR) should definitely be evaluated while performing immunophenotypic studies. In lymphoid cells such as cCD3 and cCD79a, the absence of specific surface markers should be demonstrated. In order to determine the rate of blasts in immunophenotypic studies, CD45, CD34, or CD117 should be used (5).Variables used to aid the prediction of the course of disease and response to treatment beforehand are called prognostic factors. These prognostic factors can be divided into two groups as those related to the general health state of the patient and those related to the biological features of leukemia. Patients with advanced age (>60 years), poor performance, comorbid diseases, secondary AML, presence of dysplasia, absence of Auer rods, sub-types of M0, M5, M6, and M7, CD34 expression, CD56 expression, presence of extramedullary disease, presence of fibrosis in the bone marrow, slow response to cytoreduction, more than one chemotherapy applied for obtaining full response, presence of Philadelphia chromosome, monosomies in the 5th and 7th chromosomes, complex karyotypes, and presence of FMS-like tyrosine kinase 3 (FLT3) are associated with poor prognosis. On the other hand, the presence of Auer rods, M3 and M4Eo sub-types according to the FAB classification, presence of t(8;21), t(15;17), inversion (inv) 16, and t(16;16), and presence of nucleophosmin-1 (NPM1) and CCAAT/enhancer binding protein alpha are associated with good prognosis (6, 7). Is Flow Cytometric Immunophenotyping Useful for Predicting Acute Myeloid Leukemia Prognosis?Introduction: Acute myeloid leukemia (AML) is an aggressive clonal myeloid neoplasm that causes the accumulation of myeloblasts in blood and bone marrow. This study aimed to determine immunophenotypic characteristics and their prognostic value in patients with AML, to compare the results of patients with the literature and to reveal regional differences. Results: Fifty-two patients (52%) were males and 48 (48%) were females; the mean age at diagnosis was 49±11.4 (18-62) years. The overall survival was 203.0±74.6 (0-1666) days, and the disease-free survival time was 137.0±46.7 (0-1588) days. Considering the response to induction therapy, complete response was 53% (n=53), non-response was 16% (n=16), and death during the induction was 31% (n=31). At the time of statistical analy...

Multiple myeloma (MM) is an atypical plasma cell dyscrasia in the bone marrow (BM) which accounts for about 10% of all hematological malignancies. While extramedullary disease (EMD) is reported at a ratio of 6-20% in MM, cardiac and pericardial involvement is rare. In the event of cardiac or pericardiac involvement, on the other hand, progression into cardiac tamponade takes place in 60% of the patients. We will present a very rare case of recurrence with pericardial involvement after autologous stem cell transplantation

Mantle cell lymphoma (MCL) comprises less than 10% of non-Hodgkin's lymphoma cases. Major independent risk factors are identified as the MCL International Prognostic Index (MIPI) and Ki-67 proliferation index of tumor. The aim of this study is retrospectively evaluate MCL patients treated and followed-up in our department. Materials and Methods: This study included 27 MCL patients medical records of whom could be reached. The data was reviewed to figure out MIPI score, bone marrow involvement, extranodal involvement, treatment protocols, treatment response, relapse status, and transplant history. Patients were followed-up for a mean duration of 64.4 (1-246) months. Subsequent to the first-line treatment, complete response was achieved in 17 (63%) and partial response was achieved in 3 (11%) patients, whereas 7 (26%) patients experienced disease progression. Median PFS following first-line treatment was 29 (3-120) months. Based on the classification by MIPI scoring, low-risk patients had significantly longer median survival than that of high-risk patients (194 months vs 126 months, p=0.04), and the patients at moderate-risk had significantly longer PFS compared to high-risk patients (41month vs 3 months, p=0.025). Median age, stage III-IV, and short duration of PFS in patients with high MIPI score were our findings in parallel with available literature. R-hyper-CVAD/MTX-AraC was mostly preferred first-line treatment at our center with a shorter median PFS compared to literature. Given the expanding use of target-driven therapies for MCL, we believe our results are noteworthy in comparing such therapies with pre-existing therapies.

As a result of the population aging, the incidence of both hematologic and non-hematologic diseases of elderly gets higher, requiring bone marrow (BM) aspirations and biopsies be implemented also in the geriatric patients. Our aim in this study is to address BM examination in the geriatric patients aged 85 and over, describing its indications and morbidity and discussing the established diagnoses and outcomes of applied therapies based on BM examinations in comparison to the available literature which is actually limited in number particularly in this patient group. We have retrospectively reviewed the BM aspiration/biopsy results of 114 patients aged ≥ 85 years who were followed-up by hematology department of a university hospital from 2010 to 2020. The patients were selected through the internal data handling system of the hospital using the entry codes corresponding to BM aspiration and biopsy and those at the age of 85 or older were identified. Demographic features, primary diagnosis, any comorbidities, complete blood count (CBC) details, erythrocyte sedimentation rate (ESR), red blood cell indices, C-reactive protein (CRP), serum ferritin, vitamin B12, and folic acid levels, any abnormal results in serum biochemistry testing, the indication(s) for and the result(s) from BM aspiration/biopsy, and the treatments applied based on those result(s) were recorded for each patient as well as the rates of and reasons for mortality. In our cohort of 114 patients with a mean age of 86.3±1.7 (85-93) years, 64.9% (n=74) were males. None of the patients experienced any serious complication during BM aspiration and biopsy. First three indications in our cohort for BM aspiration/biopsy in decreasing order of frequency were cytopenia in 48.2% (n=55), anemia + elevated ESR in 18.4% (n=21), and leukocytosis + anemia + thrombocytopenia in 15.8% (n=18). BM aspiration/biopsy results gave rise to a pathologic or hematologic diagnosis in 85.9% (n=98) and 78.9% (n=90) of patients, respectively. Most frequent hematologic malignancies were myelodysplastic syndrome (MDS), acute myeloid leukemia (AML), and multiple myeloma (MM). Kaplan-Meier analysis revealed hemoglobin (Hb) and LDH levels as prognostic factors with an impact on mortality. Prognostic factors with an impact on mortality based on multivariate stepwise Cox regression analysis, on the other hand, were uric (p= 0.018, hazard ratio (HR)= 1.134, 95% confidence interval (CI) = 1.022-1.258), LDH (p=0.092, HR=1.001, 95% CI= 1.000-1.002), and platelet levels (p=0.007, HR=1.000, 95% CI=1.000-1.000). BM examination should definitely be performed in patients aged ≥ 85 years, particularly in the event of cytopenia, unexplained anemia, and elevated ESR both for diagnostic purposes and to prolong life expectancy through administration of modified therapies depending on the performance status. In such patients uric acid, LDH and platelet levels should be closely followed-up as independent prognostic variables which effect mortality.

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