Turkish Journal of Hematology Volume: 35 - Issue: 1

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Images in Hematology71 Ascites in the Course of Plasma Cell Myeloma Complicated by AL AmyloidosisJakub Debski, Lidia Usnarska-Zubkiewicz, Katarzyna Kapelko-Słowik, Aleksander Pawlus, Urszula Zaleska-Dorobisz,Kazimierz Kuliczkowski; Wroclaw, Poland73 Pachymeningeal Involvement with Blindness as the Presenting Manifestation of Non-Hodgkin LymphomaCharanpreet Singh, Arjun Lakshman, Aditya Jandial, Sudha Sharma, Ram Nampoothiri, Gaurav Prakash, Pankaj Malhotra; Chandigarh, IndiaLetters to the Editor75 Leukoagglutination, Mycoplasma pneumoniae Pneumonia, and EDTA Acid BloodBeuy Joob, Viroj Wiwanitkit; Bangkok, Thailand, Pune, India77 Cyclic Guanosine Monophosphate-Dependent Protein Kinase I Stimulators and Activators Are Therapeutic Alternatives for Sickle Cell DiseaseMohankrishna Ghanta, Elango Panchanathan, Bhaskar VKS Lakkakula; Tamil Nadu, Chhattisgarh, India79 Three Factor 11 Mutations Associated with Factor XI Deficiency in a Turkish FamilyVeysel Sabri Hançer, Zafer Gökgöz, Murat Büyükdoğan; İstanbul, Ankara, Turkey81 Participation in Physical and Sportive Activities among Adult Turkish People with Hemophilia: A Single-Center ExperienceArni Lehmeier, Muhlis Cem Ar, Sevil Sadri, Mehmet Yürüyen, Zafer Başlar; İstanbul, Turkey83 A Lesser Known Side Effect of Tigecycline: HypofibrinogenemiaFulya Yılmaz Duran, Halil Yıldırım, Emre Mehmet Şen; İzmir, Turkey85 Effectiveness of Ankaferd BloodStopper in Prophylaxis and Treatment of Oral Mucositis in Childhood Cancers Evaluated with Plasma Citrulline LevelsTürkan Patıroğlu, Nagihan Erdoğ Şahin, Ekrem Ünal, Mustafa Kendirci, Musa Karakükcü, Mehmet Akif Özdemir; Kayseri, Turkey87 Late Side Effects of Chemotherapy and Radiotherapy in Early Childhood on the Teeth: Two Case ReportsSevcihan Günen Yılmaz, İbrahim Şevki Bayrakdar, Seval Bayrak, Yasin Yaşa; Antalya, Eskişehir, Bolu, Ordu, Turkey89 t(9;19)(q22;p13) in Acute Myelomonocytic LeukemiaMoeinadin Safavi, Akbar Safaei, Marzieh Hosseini; Tehran, Shiraz, Iran91 Invasive Aspergillosis in Refractory Angioimmunoblastic T-Cell LymphomaPrakash NP, Anoop TM, Rakul Nambiar, Jaisankar Puthusseri, Swapna B; Thiruvananthapuram, India92 Expansion of a Myeloma-associated Lesion from Orbita to the CerebrumSinan Demircioğlu, Demet Aydoğdu, Özcan Çeneli; Konya, TurkeyA-X
REVIEWDOI: 10.4274/tjh.2018.0007Turk J Hematol 2018;35:1-11Invasive Fungal Infections in Patients with HematologicalMalignancies: Emergence of Resistant Pathogens and NewAntifungal TherapiesHematolojik Kanserleri Olan İnvaziv Mantar Enfeksiyonlu Hastalar: Dirençli PatojenlerinOrtaya Çıkışı ve Yeni Antifungal TedavilerMaria N. Gamaletsou 1 , Thomas J. Walsh 2 , Nikolaos V. Sipsas 31The Leeds Teaching Hospitals NHS Trust, St James University Hospital, Department of Infection and Travel Medicine, Leeds, United Kingdom2Weill Cornell Medicine of Cornell University, Department of Medicine, Pediatrics, and Microbiology and Immunology, New York, United States ofAmerica3National and Kapodistrian University of Athens Faculty of Medicine, Department of Pathophysiology, Athens, GreeceAbstractInvasive fungal infections caused by drug-resistant organisms arean emerging threat to heavily immunosuppressed patients withhematological malignancies. Modern early antifungal treatmentstrategies, such as prophylaxis and empirical and preemptive therapy,result in long-term exposure to antifungal agents, which is a majordriving force for the development of resistance. The extendeduse of central venous catheters, the nonlinear pharmacokineticsof certain antifungal agents, neutropenia, other forms of intenseimmunosuppression, and drug toxicities are other contributing factors.The widespread use of agricultural and industrial fungicides withsimilar chemical structures and mechanisms of action has resulted inthe development of environmental reservoirs for some drug-resistantfungi, especially azole-resistant Aspergillus species, which have beenreported from four continents. The majority of resistant strains havethe mutation TR34/L98H, a finding suggesting that the source ofresistance is the environment. The global emergence of new fungalpathogens with inherent resistance, such as Candida auris, is a newpublic health threat. The most common mechanism of antifungal drugresistance is the induction of efflux pumps, which decrease intracellulardrug concentrations. Overexpression, depletion, and alteration ofthe drug target are other mechanisms of resistance. Mutationsin the ERG11 gene alter the protein structure of C-demethylase,reducing the efficacy of antifungal triazoles. Candida species becomeechinocandin-resistant by mutations in FKS genes. A shift in theepidemiology of Candida towards resistant non-albicans Candida spp.has emerged among patients with hematological malignancies. Thereis no definite association between antifungal resistance, as defined byelevated minimum inhibitory concentrations, and clinical outcomes inÖzİlaca dirençli organizmaların neden olduğu invaziv mantarenfeksiyonları, ağır immün baskılanma altındaki hematolojik kanserlihastalar için bir tehdittir. Profilaktik, Öz ampirik ve önleyici tedavilergibi güncel anti-fungal tedavi yaklaşımları, direnç gelişiminde büyükbir itici güç olan anti-fungal ajanlara uzun süreli maruz kalma ilesonuçlanmaktadır. Santral venöz kateterlerin uzun süreli kullanımı,bazı anti-fungal ajanların doğrusal olmayan farmakokinetiği,nötropeni, yoğun immün baskılamanın farklı formları ve ilaçtoksisitesi direnç gelişimine katkıda bulunan diğer faktörlerdir. Benzerkimyasal yapılara ve etki mekanizmalarına sahip, tarımsal veendüstriyel fungisitlerin yaygın kullanımı, dört kıtadan bildirilen bazıilaca dirençli mantarlar, özellikle azole dayanıklı Aspergillus türleriiçin çevresel kaynakların gelişmesine neden olmaktadır. Dirençlisuşların çoğunda bulunan TR34 / L98H mutasyonu, direncin çevreselkaynaklı olduğunu düşündürmektedir. Candida auris gibi doğaldirençli yeni fungal patojenlerin ortaya çıkması, yeni bir halk sağlığıtehdididir. Anti-fungal ilaç direncinin en yaygın mekanizması, hücreiçi ilaç konsantrasyonlarını azaltan hücre dışına atım pompalarınınuyarılmasıdır. Diğer direnç mekanizmaları arasında ilaç hedefininaşırı ekspresyonu, tükenmesi ya da değişmesi bulunmaktadır. ERG11genindeki mutasyonlar, antif-fungal triazollerin etkinliğini azaltarakC-demetilazın protein yapısını değiştirir. Candida türleri, FKSgenlerindeki mutasyonlarla ekinokandine dirençli hale gelir. Candidaepidemiyolojisinde dirençli albicans-dışı Candida spp. hematolojikkanseri olan hastalarda ön plana çıkmaktadır. Bu popülasyondaki hastagrubunda artmış minimum inhibitör konsantrasyonlarla tanımlanananti-fungal direnç ile klinik sonuçlar arasında kesin bir ilişki yoktur.Moleküler yöntemlerin kullanımı ile dirence neden olan genlerin veya©Copyright 2018 by Turkish Society of HematologyTurkish Journal of Hematology, Published by Galenos Publishing HouseAddress for Correspondence/Yazışma Adresi: Maria N. GAMALETSOU, M.D.,Received/Geliş tarihi: January 04, 2018The Leeds Teaching Hospitals NHS Trust, St James University Hospital, Department of Infection and Travel Medicine, Leeds, United Kingdom Accepted/Kabul tarihi: January 22, 2018Phone : +44 1132 066 083E-mail : magama@med.uoa.gr ORCID-ID: orcid.org/0000-0002-0530-32091
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BRIEF REPORTDOI: 10.4274/tjh.2017.0
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Annayev A, et al: Kidney Functions
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Annayev A, et al: Kidney Functions
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Debski J, et al: Plasma Cell Myelom
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Singh C, et al: Pachymeningeal Invo
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LETTERS TO THE EDITORTurk J Hematol
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Advisory Board of This Issue (March
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