Background: The discovery of tyrosine kinase inhibitors provided a breakthrough in the treatment of chronic myeloid leukemia. Nowadays, the management of tyrosine kinase inhibitor-related side effects is one of the important problems in chronic myeloid leukemia treatment. Grades 3–4 pulmonary toxicity; especially pleural effusion is mostly seen with dasatinib treatment but rarely seen with nilotinib and bosutinib. Development of cross-intolerance due to pleural effusion is not an expected situation. Pleural effusion related to tyrosine kinase inhibitors is mostly exudative in nature with abundant lymphocytes. Case report: Massive pleural effusion developed in a 59-year-old male patient with chronic myeloid leukemia, who was being treated with bosutinib. In the past, the patient had experienced massive pleural effusion also with dasatinib and nilotinib. The evaluation for differential diagnosis of pleural effusion did not reveal any additional malignancy. Management and outcome: After discontinuation of bosutinib and initiation of prednisolone, pleural effusion was totally resolved. Prednisolone was gradually discontinued and third-generation tyrosine kinase inhibitor ponatinib was started. After 12 months of follow-up, massive pleural effusion occurred again, leading to discontinuation of ponatinib. Discussion: Cross-intolerance is an important problem in the tyrosine kinase inhibitor era. The significance of this case is the development of cross-intolerance to all second-generation tyrosine kinase inhibitors and furthermore to a third-generation tyrosine kinase inhibitor. Management strategies for pleural effusion and close follow-up are important.

Incidence of venous thromboembolism (VTE) is higher than the expected in patients with hematologic malignancies and duration of hospitalization period increases the risk of thrombosis. The objective of this study was to investigate the incidence of and risk factors for venous thrombosis in hospitalized patients with hematologic malignancies. We designed a prospective cohort study and enrolled patients with hematologic malignancies, who had been hospitalized between 2020 and 2021. Thromboprophylaxis was given to all patients, other than those under a high risk of hemorrhage. 94 patients were enrolled. The incidence of superficial vein thrombosis was 11.7% and the incidence of deep vein thrombosis (including pulmonary embolism and catheter thrombosis) was 7.4%. Patients, who developed thrombosis, had statistically significantly longer hospital stays (21 vs. 11.5 days, p=0.023) and a higher number of hospitalizations (1 vs. 3, p=0.015) compared to those, who did not develop thrombosis. Patients, who had 3 or more risk factors for thrombosis, were found to be under the highest risk. (p=0.017, OR=4.32; 95% CI: 1.3–14.35). Furthermore, patients with recurrent hospitalizations (p=0.024, OR=1.49; 95% CI: 1.05–2.11) and higher fibrinogen levels (p=0.028, OR=1; 95% CI: 1–1.006) were under an increased risk of thrombosis. Venous thrombosis is frequently seen in hospitalized patients with hematologic malignancies. A universally accepted risk scoring system is required for detection of patients, under a high risk for thrombosis.

The recent inclusion of immune‐privileged site lymphoma in the World Health Organization classification signifies a distinctive entity encompassing the central nervous system and testicles. This classification is rooted in the unique challenges posed by the blood–brain barrier and blood–testis barrier, along with the distinct cancer microenvironment compared to standard lymphomas. These intricacies contribute to the complexity of treatment strategies, and as of now, a standardized protocol remains elusive. Our presented case underscores the critical need for a comprehensive treatment plan in immune‐privileged site lymphomas, where surgery alone, in the form of indolent intervention, may fall short in addressing the underlying aggressive nature of the disease. Failure to administer systemic treatment, where indicated, heightens the risk of aggressive recurrence and substantially elevates mortality rates. Through a detailed examination of our case, we aim to contribute to the evolving body of knowledge surrounding these unique lymphomas, offering valuable insights that may guide future treatment strategies and improve patient outcomes.

Objective: Chronic antigenic stimulation is frequently blamed in the pathogenesis of extranodal marginal zone lymphomas including splenic marginal zone lymphoma (SMZL). Chronic hepatitis C is frequently observed in SMZL patients in some geographical regions. However, these reports are largely from North America and Europe, and data from other countries are insufficient. In this multicenter study we aimed to identify the clinical characteristics of SMZL patients in Turkey, including viral hepatitis status and treatment details. Materials and Methods: Data were gathered from participating centers from different regions of Turkey using IBM SPSS Statistics 23 for Windows. Hepatitis B virus surface antigen (HBsAg), anti-HBs antibody, anti-HB core antigen antibody (anti-HBcAg), HB viral load, anti-hepatitis C virus (HCV) antibody, HCV viral load results were analyzed. Results: One hundred and four patients were reported. Hepatitis C virus positivity was observed in only one patient. However, hepatitis B virus surface antigen (HBsAg) positivity was observed in 11.2% and HBsAg and/or anti-HB core antigen antibody (anti-HBcAg) positivities were seen in 34.2% of the patients. The median age was 60 years (range=35-87). Median follow-up duration was 21.2 months (range=00.2-212; 23.2 months for surviving patients). Median overall survival was not reached. Estimated 3-year and 10-year survival rates were 84.8% and 68.9%, respectively. Older age, no splenectomy during follow-up, platelet count of <90x10(3)/mu L, lower albumin, higher lactate dehydrogenase, higher beta(2)-microglobulin, and HBsAg positivity were associated with increased risk of death. Only albumin remained significant in multivariable analysis. Conclusion: These results indicate that hepatitis B virus may be a possible risk factor for SMZL in our population. It may also be an indirect prognostic factor.

Objective: Imatinib mesylate, a tyrosine kinase inhibitor (TKI), has revolutionized CML treatment, improving patient survival to levels comparable to the general population. This study evaluates treatment response, side effects, and survival rates in CML patients followed at our clinic. Materials and Methods: A retrospective analysis was conducted on 76 CML patients treated with imatinib at ………. University Hospital between August 2000 and April 2022. Treatment responses, side effects, and survival outcomes were assessed. Results: The median age of patients was 49 years, with 93.4% in the chronic phase and 6.6% in the accelerated phase. Patients achieving MMR at the 6th month had significantly longer event-free survival (EFS) (198.09 ± 12.39 months; p<0.0001). The 10-year overall survival (OS) rate was 94.2%, and the 5-year OS rate was 98.5%. A total of 46.05% of patients were switched to second-generation TKIs due to insufficient response or side effects. Cox regression analysis revealed that older age at diagnosis increased the risk of death, and failure to achieve MMR at the 12th month raised event risk by 76-fold. During treatment, 30.3% of patients experienced imatinib-related side effects, with serious side effects observed in 9.2% of patients. Conclusion: Imatinib remains a highly effective and well-tolerated treatment for CML in real-world settings. The outcomes observed in this study aligned similarly with those reported in international clinical trials. Achieving early molecular responses significantly improves long-term survival. These findings underscore the importance of adherence to treatment protocols and regular monitoring.