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Öğe CD5 as a prognostic marker in patients with diffuse large B-cell lymphoma: a multicenter study(Springer Heidelberg, 2022) Demirci, Ufuk; Kirkizlar, Hakki Onur; Umit, Elif G.; Gursoy, Vildan; Pinar, Ibrahim Ethem; Ozkalemkas, Fahir; Guven, Zeynep TugbaDiffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma (NHL) and comprises a heterogeneous group of disease. While classification of B-cell lymphomas has been evolving to include clonality in a specific manner, morphology, and immunohistochemistry remain the backbone. We aimed to evaluate the value of CD5 expression on disease characteristics as well as prognosis in patients with DLBCL. Data of 131 patients with DLBCL with CD5 positivity and as a comparison arm, data of 129 patients with DLBCL without CD5 positivity were evaluated. Mean age was 59 and 55.7% of the patients were male. Overall survival was 29.8 months. Poor prognostic factors including (high-LDH levels, B symptoms, low ECOG score, high R-IPI and NCCN-IPI score) were observed to be significantly related with CD5 positivity. Mean survival in CD5 positive patients were 29.8 months, which is significantly shorter than the general DLBCL survival worldwide. CD5 expression shall be evaluated in all samples of DLBCL patients due to its possible effects on outcomes.Öğe A comment on a prospective, multicenter study of low dose decitabine in adult patients with refractory immune thrombocytopenia by Zhou et al(Wiley, 2020) Demirci, Ufuk; Umit, Elif G.; Demir, Ahmet Muzaffer[Abstract Not Available]Öğe Concepts of Double Hit and Triple Hit Disease in Multiple Myeloma, Entity and Prognostic Significance(Nature Portfolio, 2020) Baysal, Mehmet; Demirci, Ufuk; Umit, Elif; Kirkizlar, Hakki Onur; Atli, Emine Ikbal; Gurkan, Hakan; Gulsaran, Sedanur KaramanRisk assessment in newly diagnosed multiple myeloma patients (NDMM) is the first and the most crucial determinant of treatment. With the utilization of FISH analysis as a part of routine practice, high risk Multiple Myeloma (MM) is defined as having at least one of the mutations related with poor prognosis including; t(4;14) t(14;16), t(14;20), del 17p, p53 mutation, gain 1q and del 1p. M-Smart MM risk stratification guideline by Mayo Clinic has proposed a concept similar to high grade lymphomas. Having two of the high risk genetic abnormalities were defined as double hit MM and having any three as triple hit MM. Based on these definitions which may bring a much more clinically relatable understanding in MM prognosis, we aimed to assess our database regarding these two concepts and their probable significance in terms of outcome and prognosis. We retrospectively evaluated 159 newly diagnosed multiple myeloma patients and their clinical course. Among these patients; twenty-four patients have one high risk determinant and also seven and two patients were classified as double hit MM and triple hit MM respectively. Overall survival (OS) of the patients with double hit MM was 6 months, 32.0 months for patients with single high risk abnormality and 57.0 months for patients with no high risk abnormality. Univariate analysis showed that Double Hit and Triple Hit MM is a predictive of low OS. Hazard Ratio of patients with one high risk abnormality was 1.42, double-hit MM patients was 5.55, and triple-hit MM patients was 7.3. Despite the development of novel drugs and their effects of prolonging survival, the treatment has not been individualized. Understanding the biology of each patient as a unique process will be the success of the treatment. As it is known that some MM patients harbor high risk genetic abnormalities according to FISH analysis, we can continue the argument that some patients bring an even higher risk and that can be defined as double or triple hit MM.Öğe Ekstranodal Baş Boyun Diffüz Büyük B Hücreli Lenfomalarının Geriye Yönelik Olarak Değerlendirilmesi ve Nodal Hastalık ile Karşılaştırılması(2021) Kırkızlar, Hakkı; Kırkızlar, Tuğcan Alp; Demirci, Ufuk; Gülsaran, Sedanur Karaman; Baş, Volkan; Ümit, Elif; Demir, AhmetAmaç: Baş boyun bölgesinden nodal veya ekstranodal tutulumlu diffüz büyük B hücreli lenfoma (DBBHL) tanısı alan hastaların klinikopatolojik özellikleri ve toplam sağkalım oranlarını incelemeyi ve karşılaştırmayı amaçladık. Hastalar ve Yöntem: Çalışmaya primer baş boyun bölgesi ekstranodal veya nodal tutulum ile başvuran DBBHL tanılı 52 erişkin hasta alındı. Hastaların demografik, klinik, patoloji, görüntüleme, tedavi, tedavi cevabı ve prognostik indeksleri değerlendirildi. İzlem ve sağkalım sonuçları gözden geçirildi. Bulgular: Hastaların 24’ü ekstranodal, 28’i ise nodal gruba dahil edildi. Nodal ve ekstranodal gruplar karşılaştırıldığında cinsiyet, yaş, Ki67 proliferasyon indeksi, BCL-2 pozitifliği, B semptom varlığı, performans durumu, LDH, prognostik indeksler, 1. basamak tedaviye yanıt açısından fark yoktu. Ekstranodal grupta germinal merkez benzeri B hücre kökeni, BCL-6 pozitifliği, erken evre hastalık nodal gruba göre daha yüksek oranda bulundu ve bu yükseklik istatistiksel olarak anlamlı saptandı (p değerleri sırasıyla 0.010, 0.016, 0.001). Ekstranodal tutulumların dağılımı tonsil (n: 10), tiroid (n: 5), nazofarenks (n: 2), maksiller sinüs (n: 2), parotis bezi (n: 2), nazal (n: 1), dil (n:1) ve bukkal mukoza (n: 1) şeklindeydi. Ortanca sağkalım nodal grupta 37 ay, ekstranodal grupta 43 ay idi. Bu farklılık istatistiksel olarak anlamlıydı (p= 0.022). Sonuç: Ekstranodal tutulum yeri ve sayısı DBBHL’de prognozu belirlemektedir. Çalışmamızda, baş boyun bölgesi primer ekstranodal DBBHL’lerin kökeninin germinal merkez B benzeri hücre yönünde olmasının, semptomların ve görünürlüğünün nodal olanlara göre daha erken olmasının ve dolayısıyla erken tanı ve tedavi şansının olmasının daha iyi sağkalıma neden olduğu sonucuna vardık. Bu nedenle santral sinir sistemi hariç baş boyun bölgesine sınırlı ekstranodal tutulumlar daha iyi bir prognostik belirteç olarak kabul edilebilir.Öğe The evaluation of risk factors leading to early deaths in patients with acute promyelocytic leukemia: a retrospective study(Springer, 2022) Baysal, Mehmet; Gursoy, Vildan; Hunutlu, Fazil Cagri; Erkan, Buket; Demirci, Ufuk; Bas, Volkan; Gulsaran, Sedanur KaramanAcute promyelocytic leukemia (APL) differs from other forms of acute myeloid leukemia (AML), including coagulopathy, hemorrhage, disseminated intravascular coagulation (DIC), and treatment success with all-trans retinoic acid (ATRA). Despite ATRA, early deaths (ED) are still common in APL. Here, we evaluated factors associated with ED and applicability of scoring systems used to diagnose DIC. Ninety-one APL patients (55 females, 36 males, and median age 40 years) were included. ED was defined as deaths attributable to any cause between day of diagnosis and following 30th day. DIC was assessed based on DIC scoring system released by the International Society of Thrombosis and Hemostasis (ISTH) and Chinese Diagnostic Scoring System (CDSS). Patients' median follow-up time was 49.2 months, and ED developed in 14 (15.4% of) cases. Patients succumbing to ED had higher levels of the Eastern Cooperative Oncology Group Performance Status (ECOG PS), lactate dehydrogenase (LDH), and ISTH DIC, and lower fibrinogen levels (p <0.05). In multivariate Cox regression analysis, age >55 and ECOG PS >= 2 rates were revealed to be associated with ED. Based on ISTH and CDSS scores, DIC was reported in 47.3 and 58.2% of the patients, respectively. Despite advances in APL, ED is still a major obstacle. Besides the prompt recognition and correction of coagulopathy, those at high ED risk are recommended to be detected rapidly. Implementation of local treatment plans and creating awareness should be achieved in hematological centers. Common utilization of ATRA and arsenic trioxide (ATO) may be beneficial to overcome ED and coagulopathy in APL patients.Öğe Evaluation of Sarcopenia with F-18 FDG PET/CT and relation with disease outcomes in patients with multiple myeloma(Wiley, 2020) Umit, Elif G.; Korkmaz, Ulku; Baysal, Mehmet; Karaman Gulsaran, Sedanur; Bas, Volkan; Demirci, Ufuk; Onur Kirkizlar, HakkiIntroduction Multiple myeloma (MM) is a potentially incurable haematological malignancy with devastating manifestations including lytic bone lesions leading to fractures and renal insufficiency. As a disease of patients with a mean age of 66 years, both the disease and the continuous efforts of treatments lead to frailty and devastation. From this stand point, we aimed to evaluate the development of muscle loss in MM patients and also with a new method of sarcopenia evaluation, F-18 FDG PET/CT. While used for bone disease routinely, this method brings a fresh perspective of metabolic quantitation of alteration of muscles which may be regarded as muscle quality. Materials and Methods Data and images of 105 patients with MM both before and after treatment were evaluated in a retrospective manner. Results Both female and male patients were observed to be effected after MM treatment in terms of lumbar and femoral muscle evaluations with CT. Metabolic evaluations confirmed a loss of quality in muscles in terms of metabolic volume and total lesion glycolysis. Conclusion Sarcopenia should be evaluated in every patient and regarded as a treatment target. FDG PET/CT is an easy and handy tool to assess muscle mass and quality as well as MM disease status.Öğe The Importance of Targeted Next-Generation Sequencing Usage in Cytogenetically Normal Myeloid Malignancies(Mattioli 1885, 2021) Atli, Emine Ikbal; Gurkan, Hakan; Atli, Engin; Kirkizlar, Hakki Onur; Yalcintepe, Sinem; Demir, Selma; Demirci, UfukAdvanced diagnostic methods give an advantage for the identification of abnormalities in myeloid malignancies. Various researchers have shown the potential importance of genetic tests before the disease's onset and in remission. Large testing panels prevent false-negative results in myeloid malignancies. However, the critical question is how the results of conventional cytogenetic and molecular cytogenetic techniques can be merged with NGS technologies. In this paper, we drew an algorithm for the evaluation of myeloid malignancies. To evaluate genetic abnormalities, we performed cytogenetics, molecular cytogenetics, and NGS testing in myeloid malignancies. In this study, we analyzed 100 patients admitted to the Medical Genetics Laboratory with different myeloid malignancies. We highlighted the possible diagnostic algorithm for cytogenetically normal cases. We applied NGS 141 gene panel for cytogenetically normal patients, and we detected two or more pathogenic variations in 61 out of 100 patients (61%). NGS's pathogenic variation detection rate varies in disease groups: they were present in 85% of A.M.L. and 23% of M. D.S. Here, we identified 24 novel variations out of total pathogenic variations in myeloid malignancies. A total of 18 novel variations were identified in A.M.L., and 6 novel variations were identified in M.D.S. Despite long turnaround times, conventional techniques are still a golden standard for myeloid malignancies but sometimes cryptic gene fusions or complex abnormalities cannot be easily identified by conventional techniques. In these conditions, advanced technologies like NGS are highly recommended.Öğe Improving Care of Older Patients with Hemophilia During COVID-19 Pandemic, Reducing the Risk of Venous Thrombosis with Home Exercises(Sage Publications Inc, 2022) Demirci, Ufuk; Umit, Elif G.; Ozdemir, Hande; Demirbag Kabayel, Derya; Demir, Ahmet Muzaffer[Abstract Not Available]Öğe Incidence and predisposing factors of infection in patients treated with hypomethylating agents(Pergamon-Elsevier Science Ltd, 2023) Kirkizlar, Tugcan Alp; Kirkizlar, Onur; Demirci, Ufuk; Umut, Aytug; Iflazoglu, Huseyin; Umit, Elif Gulsum; Demir, Ahmet MuzafferObjective: Hypomethylating agents may have adverse effects such as cytopenias, cytopenia associated infections and fatality due to infections despite their favorable effects in the treatment of acute myeloid leukemia (AML), myelodysplastic syndromes (MDS) and chronic myelomonocytic leukemia (CMML). The infection prophylaxis approach is based on expert opinions and real-life experiences. Hence, we aimed to reveal the frequence of infections, predisposing factors of infection and to analyse infection attributable mortality in patients with high -risk MDS, CMML and AML who received hypomethylating agents in our center where routine infection pro-phylaxis is not applied. Material-method: 43 adult patients with AML or high-risk MDS or CMML who received HMA >= 2 consecutive cycles from January 2014 to December 2020 were enrolled in the study. Results: 43 patients and 173 treatment cycles were analyzed. The median age was 72 years and 61.3 % of patients were males. The distribution of the patients' diagnoses was; AML in 15 patients (34.9 %), high risk MDS in 20 patients (46.5 %), AML with myelodysplasia-related changes in 5 patients (11.6 %) and CMML in 3 patients (7 %). 38 infection events (21.9 %) occurred in 173 treatment cycles. 86.9 % (33 cycles) and 2.6 % (1 cycle) of infected cycles were bacterial and viral infections, respectively and 10.5 % (4 cycles) were bacterial and fungal concurrently. The most common origin of the infection was respiratory system. Hemoglobin count was lower and CRP level was higher at the beginning of the infected cycles significantly (p values were 0.002 and 0.012, respectively). Requirement of red blood cell and platelet transfusions were found to be significantly increased in the infected cycles (p values were 0.000 and 0.001, respectively). While > 4 cycles of treatment and increased platelet count were found to be protective against infection, > 6 points of Charlson Comorbidity Index (CCI) were found to increase the risk of infection. The median survival was 7.8 months in non-infected cycles while 6.83 months in infected cycles. This difference was not statistically significant (p value was 0.077). Discussion: The prevention and management of infections and infection-related deaths in patients treated with HMAs is crucial. Therefore, patients with a lower platelet count or a CCI score of > 6 may be candidates for infection prophylaxis when exposed to HMAs.Öğe Increased Risk of e-Thrombosis in e-Life Era(Sage Publications Inc, 2021) Demirci, Ufuk; Umit, Elif Gulsum; Demir, Ahmet Muzaffer[Abstract Not Available]Öğe Late onset left ventricular dysfunction and cardiomyopathy induced with ibrutinib(Sage Publications Ltd, 2020) Gulsaran, Sedanur K.; Baysal, Mehmet; Demirci, Ufuk; Bas, Volkan; Kirkizlar, Hakki O.; Umit, Elif; Demir, Ahmet M.Introduction Ibrutinib, an oral inhibitor of Bruton's tyrosine kinase, has altered the treatment perspective of chronic lymphocytic leukemia and showed modest activity against several types of non-Hodgkin's lymphomas. According to phase studies and real-world data, reported serious adverse effects included atrial fibrillation, diarrhea, and bleeding diathesis. However, heart failure was not reported to be a probable adverse effect linked with ibrutinib. Case report In this paper, we present a 66-year-old female chronic lymphocytic leukemia patient who developed significant and symptomatic left ventricular dysfunction at the 13th month of ibrutinib treatment. Management and outcome Following cessation of ibrutinib, ejection fraction and clinical findings of the left ventricular dysfunction alleviated. Discussion Although the use of ibrutinib is generally well tolerated, cardiac functions should be monitored occasionally in all patients.Öğe Management of Patients with Factor VII Deficiency in Surgery: A Single-center Experience(Erciyes Univ Sch Medicine, 2022) Demirci, Ufuk; Gulsaran, Sedanur Karaman; Bas, Volkan; Umit, Elif G.; Kirkizlar, Hakki Onur; Demir, Ahmet MuzafferFactor VII deficiency is a rare condition characterized by a broad spectrum of clinical phenotypes, from asymptomatic status to severe, life-threatening bleeding, such as central nervous system or gastrointestinal bleeding. Factor VII deficiency is usually diagnosed after a bleeding attack or as a result of screening tests performed in cases with a family history. Importantly, bleeding may also occur in patients with a factor level of 20% to 50%. This report describes the approach to management before, during, and after surgery used in 5 patients with varying factor levels. The use of recombinant factor VIIa (15-30 mu g kg) was required in 3 of the patients. No bleeding or thromboembolism was observed in any of the 5 patients.Öğe Morphologic evaluation of megakaryocytes in immune thrombocytopenia patients older than 80 years(Kare Publ, 2023) Demirci, Ufuk; Umit, Elif Gulsum; Baysal, Mehmet; Demir, Ahmet MuzafferOBJECTIVE: In immune thrombocytopenia (ITP), which is a common acquired bleeding disorder, cytotoxic T-cell-mediated cellular immune response against both circulating platelets and bone marrow megakaryocytes are the most important mechanisms in the pathogenesis. METHODS: In our study, we evaluated the features of 33 patients with ITP, over 80 years of age. RESULTS: The median age of the patients was 90, 15 patients were female (45.4%). The mean platelet count of the patients was 39x109/L and the mean mean platelet volume was 10,33fL. Twelve patients had a target thrombocyte count greater than 30x109/L, while 20 patients had a target platelet count of 75x109/L or greater with an absolute indication of antiaggregation. In the environmental spread, 18 dysplasia findings were observed. CONCLUSION: Morphologic observations suggesting dysplasia including micromegakaryocytes and a non-dysplastic but dysmegakaryopoietic finding, multiple segmented nuclei may be related to the degree of thrombocytopenia and response to treatment. Likewise, nondysplastic features including immature forms, emperipolesis, bare nucleus, hypolobulation, and hypersegmented nucleus were related to the degree of thrombocytopenia.Öğe Reducing the Risk of Venous Thrombosis During Self-Isolation and COVID-19 Pandemic for Patients With Cancer: Focus on Home Exercises Prescription(Sage Publications Inc, 2020) Demirci, Ufuk; Ozdemir, Hande; Demirbag-Kabayel, Derya; Umit, Elif G.; Demir, Ahmet Muzaffer[Abstract Not Available]Öğe Retrospective Analysis of Follicular Lymphoma Patients in Trakya University School of Medicine: a Single Center Experience(Trakya Üniversitesi, 2021) Akay, Fatih Erkan; Koçyiğit, Beliz; Şişman, Fevzi Oktay; Ayrık, Mert Yücel; Savaşır, İpek; Cengiz, Elif; Demirci, UfukAims: To establish a dataset including demographic features, disease characteristics, and survival rate of follicular lymphoma patients in Trakya Universi- ty School of Medicine and contribute to the database of follicular lymphoma in Turkey. Methods: In this retrospective cross-sectional study, we analyzed data constituting of follicular lymphoma patients over 18 years of age followed during the years of 2015-2020 in Trakya University Division of Hematology. Results: Out of 43 patients, 22 (51.2%) were female and 21 (48.8%) were male. The mean age was 56.56 (standard deviation 13.24) years. There were 5 (11.6%) pa- tients with B symptoms, presence of bone marrow involvement was seen in 17 (39.5%) patients, lastly, there were 18 (41.9%) patients with splenomegaly. Twen- ty-one (48.8%) patients received rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine sulfate, and prednisone, making it the most common treatment protocol administered in our study. Conclusion: Follicular lymphoma patients usually end up getting diagnosed at an advanced stage of the disease, presenting with incidentally noticed painless lymphadenopathy. Additionally, based on evidence in the literature, a clear gap in the successful diagnosis of follic- ular lymphoma patients can be observed between developed and developing countries. To overcome this hurdle, enhanced cooperation with hematopathology may lead to an increased awareness enabling physicians to make a more accurate diagnosis. Nonetheless, further studies are still needed to fully apprehend the epidemiology of follicular lymphoma patients in Turkey.Öğe Ruksolitinib Tedavisinin Aniden Kesilmesi Sonrasında Post-ET Myelofibrozis Bulgularında Alevlenme: Akılda Kalması Gereken Bir Klinik Tablo(2021) Demirci, Ufuk; Gülsaran, Sedanur Karaman; Baş, Volkan; Ümit, Elif; Kırkızlar, Hakkı; Demir, AhmetMiyeloproliferatif neoplazmalar (MPN’ler), kök hücre kaynaklı klonal miyeloproliferasyon ile karakterizedir. Janus kinaz 2 (JAK2) genindeki mutasyonların keşfedilmesinden sonra tedaviler için önemli bir hedef haline gelmiştir. Ruksolitinib kullanımının, sağkalımı arttırması, splenomegaliyi azaltmassı, JAK2 V617F varyant alel sıklığını azaltmasının yanında ayrıca hastalarda JAK1 inhibisyonu ile konstitusyonel semptomlarda önemli iyileşme ve sitokin salınımını azalttığı görülmektedir. Anemi ve trombositopeni gibi yan etkileri nedeniyle tedaviye devam edeilemediği durumlar olabilir. Tedavinin hızla kesilmesinden sonra farklı kliniklerde ilerleyebilen “Ruksolitinib Bırakma Sendromu” adı verilen klinik bir durum ortaya çıkabilir.Öğe Sarcopenia in Hodgkin's lymphoma evaluated with 18-FDG PET/CT, focus on age, performance, and treatment(Springer, 2021) Bas, Volkan; Umit, Elif Gulsum; Korkmaz, Ulku; Baysal, Mehmet; Karaman Gulsaran, Sedanur; Demirci, Ufuk; Kirkizlar, Hakki OnurSarcopenia is defined as a progressive and generalized muscle disorder associated with certain physiological and pathological conditions. We aimed to evaluate the prevalence of sarcopenia in patients with HL using 18-fluoro deoxyglucose (FDG) PET/CT, which would provide a data of muscle mass with the CT compartment and also data of muscle metabolism with the 18-FDG compartment of the imaging modality. Fifty-nine patients diagnosed with HL were included in the study. PET/CT images before and after treatment were evaluated with regard to lumbar muscle mass and metabolism. Mean lumbar muscle evaluation with CT before treatment was 92, 40 HU, and after treatment was 89, 41 HU. Mean metabolic tumor volume (MTV) evaluated with FDG PET before treatment was 4, 13 mm(3)while after treatment was 4, 10 mm(3). The lumbar muscle mass in terms of HU which was evaluated with CT was observed to be decreased after treatment. Likewise, the metabolic evaluation was observed to be also decreased after treatment. Despite the decline in muscle mass after treatment in the whole group, this decline was particularly observed in the better initial performance group. In patients with BMI > 32, there was a significant decline in muscle mass. Abdominal nodal involvement was related with poorer muscle mass and quality. In HL care, particular attention should be given to patients who are younger and with better physical condition in terms of preserving the muscle reserves and preventing sarcopenia.Öğe Successful pregnancy and delivery management in a patient with Bernard Soulier Syndrome(Sage Publications Ltd, 2023) Demirci, Ufuk; Erbilen, Esra Altan; Umit, Elif Gulsum; Inan, Cihan; Sayin, N. Cenk; Demir, Ahmet MuzafferBernard Soulier Syndrome (BSS) is an inherited bleeding disorder characterized by macrothrombocytopenia and absence of ristocetin-induced platelet aggregation. Clinical findings vary from person to person. Most of the patients are diagnosed with muco-cutaneous bleeding such as purpura, epistaxis and gingival bleeding in early childhood. Few pregnant women with BSS are described in the literature. Management of thrombocytopenia during pregnancy and delivery requires a multidisciplinary approach. The family should be warned about the potentially life-threatening bleeding during pregnancy and the delivery and the decision about mode of delivery should be individualised, involving discussion with patient and multidisciplinary team.Öğe A survey evaluating hematology physiciansE perspectives on central nervous system prophylaxis(Korean Soc Hematology, 2023) Demirci, Ufuk; Yuksel, Meltem Kurt; Izlar, Hakki Onur Kirk; Atesolu, Elif Birtas; Mehtap, Ozgur; Salim, Ozan; Demir, Ahmet MuzafferBackground Central nervous system (CNS) prophylactic options for diffuse large B-cell lymphoma (DLBCL) are administered differently in most centers. Unfortunately, there is still not a consensus on which patients, which regimen, for how many cycles, and when prophy-laxis should be administered. Thus, this remains an unmet clinical need. Methods We administered a survey study under the Lymphoma Scientific Subcommittee of the Turkish Society of Haematology. The questions were directed to hematologists through the monkey survey system. Results The CNS International Prognostic Index score is a factor that clinicians frequently use when deciding on prophylaxis and is considered reliable. Although the perspective on anatomical risk factors is similar to that reported in the literature, breast involvement is still considered a critical risk factor in Turkey. Participants considered double or triple hit and double/triple expressor lymphoma as significant risk factors. Various methods have been used to demonstrate CNS relapses. Intrathecal prophylaxis is the preferred method. Conclusion There are diverse methodological and technical ideas. The controversial results reported in the literature on the effectiveness of CNS prophylaxis may explain this finding. Although CNS prophylactic methods for patients with DLBCL are still controversial, the effect of secondary CNS involvement on survival is inevitable. Standard practices followed by na-tional guidelines may be effective in reducing the variety of application methods and creat-ing homogeneous results for efficacy and survival follow-up studies.
