{"id":25255,"date":"2022-08-22T14:43:00","date_gmt":"2022-08-22T11:43:00","guid":{"rendered":"https:\/\/www.klimikdergisi.org\/?p=25255"},"modified":"2022-10-13T15:11:38","modified_gmt":"2022-10-13T12:11:38","slug":"covid-19-ve-maligniteler","status":"publish","type":"post","link":"https:\/\/www.klimikdergisi.org\/tr\/2022\/08\/22\/covid-19-ve-maligniteler\/","title":{"rendered":"COVID-19 Pandemisinde Hematolojik Malignitelerin Uzun D\u00f6nem Analizi: COVID-19 (+) ve COVID-19 (-) Hastalar"},"content":{"rendered":"

G\u0130R\u0130\u015e<\/h2>\n

\u0130lk kez 2019 y\u0131l\u0131 sonlar\u0131nda \u00c7in\u2019in Hubei eyaletinde tan\u0131mlanan, 11 Mart 2020\u2019de de D\u00fcnya Sa\u011fl\u0131k \u00d6rg\u00fct\u00fc (DS\u00d6) taraf\u0131ndan pandemi olarak ilan edilen COVID-19 hastal\u0131\u011f\u0131n\u0131n etkeni SARS-CoV-2 virusudur. Hastal\u0131k halen pek \u00e7ok \u00fclkede \u00f6nemli bir sa\u011fl\u0131k sorunudur. Ba\u015fta ate\u015f ve solunum yolu semptomlar\u0131 olmak \u00fczere multisistemik semptomlarla seyretmektedir. Zaman i\u00e7inde virusun imm\u00fcn yan\u0131tta bozulmaya neden oldu\u011fu g\u00f6sterilmi\u015ftir (1). \u0130leri ya\u015f, diyabet ve kardiyak hastal\u0131klar gibi ko-morbiditeler, hastal\u0131\u011f\u0131n daha \u015fiddetli seyretmesine yol a\u00e7maktad\u0131r (2). Hematolojik kanserlerin yan\u0131 s\u0131ra solid organ kanserlerinde de primer malign hastal\u0131\u011f\u0131n etkisi, imm\u00fcns\u00fcpresif ajanlar\u0131n kullan\u0131m\u0131, kemoterapi ve radyoterapiye ba\u011fl\u0131 geli\u015fen myelos\u00fcpresyon gibi fakt\u00f6rlerin etkisiyle konak SARS-CoV-2\u2019ye kar\u015f\u0131 savunmas\u0131z hale gelmektedir (3). Bu nedenle, s\u00f6z konusu hasta gruplar\u0131nda COVID-19\u2019un daha agresif ve daha \u00f6l\u00fcmc\u00fcl seyretmesi ka\u00e7\u0131n\u0131lmaz olup \u00f6l\u00fcm oran\u0131 genel pop\u00fclasyonda %2.3 iken malign hastalarda %5.6 bulunmu\u015ftur (4). Ayr\u0131ca malign hastalarda, sa\u011fl\u0131kl\u0131 pop\u00fclasyona g\u00f6re hastanede yat\u0131\u015f s\u00fcresinin daha uzun, mekanik ventilasyon (MV) ve yo\u011fun bak\u0131m (YB) ihtiyac\u0131n\u0131n da daha y\u00fcksek oldu\u011fu g\u00f6r\u00fclm\u00fc\u015ft\u00fcr (5). Hematolojik maligniteleri ve solid organ kanserlerini kar\u015f\u0131la\u015ft\u0131ran k\u0131s\u0131tl\u0131 say\u0131da veri mevcuttur. Bir \u00e7al\u0131\u015fmaya g\u00f6re \u015fiddetli ve kritik hastal\u0131k s\u0131kl\u0131\u011f\u0131 hematolojik kanserlerde daha y\u00fcksek saptanm\u0131\u015ft\u0131r. Yine bu \u00e7al\u0131\u015fmada hematolojik kanserlerde \u00f6l\u00fcm oran\u0131 %14.9 iken solid organ kanserlerinde %4.8 bulunmu\u015ftur (6).<\/p>\n

Hematolojik malignitelerde COVID-19 klinik seyrini inceleyen \u00e7al\u0131\u015fmalar \u00e7o\u011funlukla pandeminin ilk aylar\u0131na ili\u015fkin verileri i\u00e7ermektedir. \u00c7al\u0131\u015fmam\u0131z, merkezimizde takip ve tedavi edilen hematolojik malign hastalarda, pandeminin ba\u015f\u0131ndan itibaren uzun bir s\u00fcre\u00e7 i\u00e7erisindeki COVID-19 s\u0131kl\u0131\u011f\u0131n\u0131 ve klinik sonu\u00e7lar\u0131n\u0131 incelemeyi ama\u00e7lad\u0131.<\/p>\n

<\/b>Y\u00d6NTEMLER<\/h2>\n

\u00c7al\u0131\u015fmaya 1 Nisan 2020 \u2013 1 Temmuz 2021 tarihleri aras\u0131nda merkezimizde hematolojik malignite tan\u0131s\u0131 ile takip edilen hastalar dahil edildi. Hastalar\u0131n ya\u015f\u0131, cinsiyeti, malignite tan\u0131s\u0131, bu tarihler aras\u0131nda COVID-19 ge\u00e7irme \u00f6yk\u00fcs\u00fc, \u00f6l\u00fcm ya da sa\u011fl\u0131k durumlar\u0131 retrospektif olarak de\u011ferlendirildi. COVID-19 infeksiyonu ge\u00e7iren hastalar COVID (+), ge\u00e7irmeyen hastalar COVID (-) olarak adland\u0131r\u0131ld\u0131 ve bu iki grup malignite tan\u0131s\u0131, epidemiyolojik \u00f6zellikler ve sa\u011fkal\u0131m a\u00e7\u0131s\u0131ndan kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131. COVID (+) hastalar da kendi i\u00e7inde bu \u00f6zelliklere ek olarak \u00f6l\u00fcm nedenleri, hastanede yat\u0131\u015f ve MV ihtiyac\u0131 y\u00f6n\u00fcnden incelendi.<\/p>\n

\u0130statistiksel Analiz<\/h3>\n

Verilerin istatistiksel analizinde SPSS (\u201cStatistical Package for the Social Sciences\u201d) versiyon 25.0 program\u0131 (IBM Corp., Armonk, NY, ABD) kullan\u0131ld\u0131. S\u00fcrekli say\u0131sal de\u011fi\u015fkenlerin da\u011f\u0131l\u0131m analizi Kolmogorov-Simirnov testi ile yap\u0131ld\u0131. S\u00fcrekli say\u0131sal de\u011fi\u015fkenler aras\u0131nda iki grup kar\u015f\u0131la\u015ft\u0131rmas\u0131 i\u00e7in ba\u011f\u0131ms\u0131z \u00f6rneklem T testi ve Mann-Whitney U testi kullan\u0131ld\u0131. Kategorik de\u011fi\u015fkenler y\u00fczde (%) olarak ifade edildi ve Pearson ki-kare testi ile analiz edildi; p<\/i><0.05 sonu\u00e7lar istatistiksel olarak anlaml\u0131 kabul edildi.<\/p>\n

BULGULAR<\/h2>\n

\u00c7al\u0131\u015fmam\u0131zda toplam 1258 hasta de\u011ferlendirildi. \u0130ki y\u00fcz seksen sekiz (%22.8) hastan\u0131n COVID (+) oldu\u011fu tespit edildi. Bunlar i\u00e7inde en s\u0131k g\u00f6r\u00fclen tan\u0131 non-Hodgkin lenfoma<\/span> (NHL) (%21.7), en az g\u00f6r\u00fclen ise Hodgkin lenfoma<\/span> (HL) (%6.9) idi. Kendi i\u00e7lerinde incelendi\u011finde ise COVID (+) hasta oran\u0131 en y\u00fcksek malignite multiple miyelom<\/span> (MM) (%35.6), en d\u00fc\u015f\u00fck ise kronik miyeloid l\u00f6semi<\/span> (KML) (%17.8)\u2019ydi.<\/p>\n

\"\"<\/a>

Tablo 1.<\/strong> T\u00fcm Hastalar\u0131n COVID-19 \u0130nfeksiyonu Ge\u00e7irme \u00d6zelliklerine G\u00f6re Kar\u015f\u0131la\u015ft\u0131rmas\u0131<\/p><\/div>\n

Medyan ya\u015f, COVID (+) grupta 64 (18-93), COVID (-) grupta ise 61 (18-92) bulundu. COVID (+) kronik lenfositer l\u00f6semi<\/span> (KLL) hastalar\u0131nda medyan ya\u015f, COVID (-) gruba g\u00f6re anlaml\u0131 d\u00fczeyde y\u00fcksekti (73\u2019e kar\u015f\u0131n 66; p<\/i>=0.001). HL hastalar\u0131nda ise istatistiksel olarak anlaml\u0131 d\u00fczeyde olmamakla birlikte daha d\u00fc\u015f\u00fckt\u00fc (39.5\u2019a kar\u015f\u0131n 43.5; p<\/i>=0.371). Di\u011fer hastal\u0131klarda medyan ya\u015f iki grup aras\u0131nda benzerdi. T\u00fcm hastalar ve tan\u0131lar ayr\u0131 ayr\u0131 de\u011ferlendirildi\u011finde, erkeklerde COVID ge\u00e7irme s\u0131kl\u0131\u011f\u0131 kad\u0131nlara g\u00f6re daha y\u00fcksek olmakla birlikte istatistiksel olarak anlaml\u0131 bir fark saptanmad\u0131. Tablo1\u2019de tan\u0131lara g\u00f6re epidemiyolojik \u00f6zellikler ve COVID-19 \u00f6yk\u00fcleri yer almaktad\u0131r.\u00a0<\/span><\/p>\n

\"\"<\/a>

Tablo 2.<\/strong> \u00d6l\u00fcm S\u0131kl\u0131\u011f\u0131n\u0131n Hastal\u0131k ve COVID-19 ile \u0130li\u015fkisi<\/p><\/div>\n

\u00d6l\u00fcm oran\u0131 COVID (-) hastalarda %11.1 (n=108), COVID (+) hastalarda ise %22.9 (n=66) olup anlaml\u0131 d\u00fczeyde y\u00fcksek saptand\u0131 (\u201codds ratio\u201d [OR]: 2.3; %95 g\u00fcven aral\u0131\u011f\u0131 [GA]: 1.67-3.33; p<\/i><0.001). Tan\u0131lara g\u00f6re incelendi\u011finde KLL, akut l\u00f6semi (AL) ve MM tan\u0131l\u0131 COVID (+) hastalarda \u00f6l\u00fcm s\u0131kl\u0131\u011f\u0131, COVID (-) hastalara g\u00f6re anlaml\u0131 d\u00fczeyde y\u00fcksek bulundu. KLL\u2019de %26\u2019ya kar\u015f\u0131n %7 (OR: 4.6; %95 GA: 2.089-10.572; p<\/i><0.001); AL\u2019de %35.7\u2019ye kar\u015f\u0131n %17.7 (OR: 2.5; %95 GA: 1.167-5.720; p<\/i>=0.017); MM\u2019da %28.6\u2019ya kar\u015f\u0131n %9.2 (OR: 3.9; %95 GA: 1.413-11.0; p<\/i>=0.006) idi. Tan\u0131 ve COVID \u00f6yk\u00fcs\u00fcne g\u00f6re \u00f6l\u00fcm s\u0131kl\u0131\u011f\u0131 Tablo 2\u2019de verilmi\u015ftir. COVID (+) hastalarda \u00f6l\u00fcmlerin tamam\u0131n\u0131n COVID-19 ili\u015fkili oldu\u011fu tespit edildi. KML hastalar\u0131nda \u00f6len olmazken, HL tan\u0131l\u0131 bir hastan\u0131n \u00f6ld\u00fc\u011f\u00fc saptand\u0131. En y\u00fcksek \u00f6l\u00fcm oran\u0131, %39.5\u2019le miyelodisplastik\u00a0sendrom<\/span> (MDS) ve %35.7\u2019yle AL hastalar\u0131nda g\u00f6r\u00fcld\u00fc (Tablo 2).\u00a0<\/span><\/p>\n

\"\"<\/a>

Tablo 3.<\/strong> COVID (+) Hastalar\u0131n Sa\u011fkal\u0131m Durumlar\u0131na G\u00f6re \u00d6zellikleri<\/p><\/div>\n

Hayat\u0131n\u0131 kaybeden hastalarda medyan ya\u015f anlaml\u0131 olarak y\u00fcksek bulundu (68\u2019e kar\u015f\u0131n 61; p<\/i><0.001). Hastal\u0131k alt gruplar\u0131nda ise medyan ya\u015f, \u00f6len KLL (76\u2019ya kar\u015f\u0131n 71.5; p<\/i>=0.004) ve AL (64\u2019e kar\u015f\u0131n 35; p<\/i>=0.001) hastalar\u0131nda iyile\u015fenlere g\u00f6re anlaml\u0131 d\u00fczeyde y\u00fcksekti. \u0130statistiksel d\u00fczeyde anlaml\u0131 olmamakla beraber MM d\u0131\u015f\u0131ndaki di\u011fer hastal\u0131klarda da medyan ya\u015f \u00f6len hastalarda daha y\u00fcksek bulundu (Tablo 3).<\/p>\n

COVID-19 nedeniyle yat\u0131\u015f ihtiyac\u0131 olan hasta say\u0131s\u0131 182 (%79.8) olup bu hastalardaki \u00f6l\u00fcm oran\u0131 ayaktan tedavi g\u00f6renlere g\u00f6re anlaml\u0131 d\u00fczeyde y\u00fcksek bulundu (%34.6\u2019ya %2.8; OR:18.7; %95 GA: 5.541-59.620; p<\/i><0.001). Hastal\u0131k alt gruplar\u0131nda de\u011ferlendirme yap\u0131ld\u0131\u011f\u0131nda ise yatan MDS (%51.7\u2019ye %0; OR: 2.0; %95 GA: 1.421-3.019; p<\/i>=0.006), AL (%56\u2019ya %5.9; OR: 20.3; %95 GA: 2.302-178.1; p<\/i>=0.001) ve NHL (%23\u2019e %0; OR: 1.3; %95 GA: 1.105-1.536; p<\/i>=0.010) hastalar\u0131ndaki \u00f6l\u00fcm s\u0131kl\u0131\u011f\u0131 ayaktan tedavi g\u00f6renlere g\u00f6re y\u00fcksekti (Tablo 3).\u00a0<\/span><\/p>\n

\"\"<\/a>

Tablo 4.<\/strong> COVID (+) Hastalarda Hastaneye Yat\u0131\u015f ve MV \u0130htiyac\u0131 Da\u011f\u0131l\u0131m\u0131<\/p><\/div>\n

Yatarak tedavi g\u00f6ren hastalarda MV ihtiyac\u0131 olan hasta say\u0131s\u0131 49 (%26.9)\u2019du. Bu hastalardan 41 (%83.7)\u2019i, MV ihtiyac\u0131 olmayanlar\u0131n ise 22 (%16.8)\u2019si hayat\u0131n\u0131 kaybetmi\u015f olup MV ihtiyac\u0131 olanlarda \u00f6l\u00fcm oran\u0131 anlaml\u0131 d\u00fczeyde y\u00fcksek bulundu (OR: 25.9; %95 GA: 10.477-61.542; p<\/i><0.001). MV ihtiyac\u0131 en y\u00fcksek olan hastalar MDS (%44.8) ve AL (%36) hastalar\u0131 idi. Tablo 4\u2019te COVID (+) hastalarda hastaneye yat\u0131\u015f s\u0131kl\u0131\u011f\u0131 ve yatan hastalardaki MV ihtiyac\u0131 da\u011f\u0131l\u0131m\u0131 g\u00f6r\u00fclmektedir.<\/p>\n

\u0130RDELEME<\/h2>\n

Pandeminin ba\u015flang\u0131\u00e7 d\u00f6neminde yap\u0131lan \u00e7al\u0131\u015fmalarda, hematolojik maligniteli hastalarda COVID-19 s\u0131kl\u0131\u011f\u0131 %10 civar\u0131nda bildirilmi\u015ftir (7). Bir y\u0131ldan daha uzun bir d\u00f6nemi kapsayan \u00e7al\u0131\u015fmam\u0131zda COVID (+) hasta oran\u0131 %22.8 olup daha y\u00fcksek saptanm\u0131\u015ft\u0131r. Ye\u011fino\u011flu ve arkada\u015flar\u0131n\u0131n (5), COVID (+) hematolojik maligniteli 740 hasta ile yapt\u0131klar\u0131 \u00e7al\u0131\u015fmalar\u0131nda en s\u0131k tan\u0131 %30.1 ile NHL\u2019dir. \u00c7al\u0131\u015fmam\u0131zda da COVID (+) hastalarda en s\u0131k tan\u0131 %21.7 ile NHL olarak tespit edildi.<\/p>\n

\u00c7al\u0131\u015fmam\u0131zdaki t\u00fcm hastalar de\u011ferlendirildi\u011finde; medyan ya\u015f (64\u2019e kar\u015f\u0131n 61) COVID (+) ve COVID (-) grupta benzerken KLL hastalar\u0131nda COVID (+) grupta, COVID (-) gruba g\u00f6re anlaml\u0131 d\u00fczeyde daha y\u00fcksek bulundu. Ayr\u0131ca literat\u00fcrde COVID (+) KLL hastalar\u0131nda medyan ya\u015f 63 (35-92) y\u0131l verilmi\u015ftir (8); \u00e7al\u0131\u015fmam\u0131zda ise medyan ya\u015f daha y\u00fcksek olup 73 (31-93) y\u0131ld\u0131r.\u00a0<\/span><\/p>\n

Pandeminin ilk d\u00f6nemlerinde yap\u0131lan bir analizde, hematolojik malign hastalarda COVID-19\u2019a ba\u011fl\u0131 \u00f6l\u00fcm oran\u0131 %13.8; malignitesi olmayan hastalarda ise %6.8 olarak bildirilmi\u015ftir (5). \u00c7al\u0131\u015fmam\u0131zda ise literat\u00fcr verisinden farkl\u0131 \u015fekilde COVID (+) ve COVID (-) hematolojik maligniteli hastalar kar\u015f\u0131la\u015ft\u0131r\u0131lm\u0131\u015f ve COVID (+) hastalarda \u00f6l\u00fcm oran\u0131 anlaml\u0131 d\u00fczeyde y\u00fcksek bulunmu\u015ftur. Her iki bulgu da SARS CoV-2\u2019nin hematolojik malignitelerde \u00f6l\u00fcm s\u0131kl\u0131\u011f\u0131n\u0131 art\u0131rd\u0131\u011f\u0131n\u0131 desteklemektedir.\u00a0<\/span><\/p>\n

Hastal\u0131k alt gruplar\u0131na bak\u0131ld\u0131\u011f\u0131nda ise COVID (+) hastalarda \u00f6l\u00fcm s\u0131kl\u0131\u011f\u0131ndaki art\u0131\u015f\u0131n anlaml\u0131 d\u00fczeyde oldu\u011fu hastal\u0131klar, s\u0131kl\u0131k s\u0131ras\u0131na g\u00f6re AL, MM ve KLL\u2019dir. \u00a0<\/span><\/p>\n

B\u00fcy\u00fckta\u015f ve arkada\u015flar\u0131 (9) \u00e7al\u0131\u015fmalar\u0131nda, 27 COVID (+) akut l\u00f6semi hastas\u0131n\u0131n 7 (%26)\u2019sinin hayat\u0131n\u0131 kaybetti\u011fini ve bunlar\u0131n tamam\u0131n\u0131n akut myeloid l\u00f6semi (AML) hastas\u0131 oldu\u011funu belirtmi\u015ftir. \u00c7al\u0131\u015fmam\u0131zda, 155 akut l\u00f6semi hastas\u0131n\u0131n 42 (%27)\u2019si COVID-19 ge\u00e7irmi\u015ftir; bu hastalarda \u00f6l\u00fcm oran\u0131 %35.7 olup COVID (-) gruptan istatistiksel olarak anlaml\u0131 d\u00fczeyde y\u00fcksektir. Ayn\u0131 \u00e7al\u0131\u015fmada COVID (+) ve COVID (-) hastalarda medyan ya\u015f s\u0131ras\u0131yla 44 ve 46 iken \u00e7al\u0131\u015fmam\u0131zda COVID (+) AL hastalar\u0131nda medyan ya\u015f 44.5 olup COVID (-) gruptan anlaml\u0131 d\u00fczeyde olmasa da y\u00fcksektir. \u00c7al\u0131\u015fmam\u0131z\u0131n farkl\u0131 olarak ula\u015ft\u0131\u011f\u0131 bir di\u011fer sonu\u00e7 da COVID-19 nedeniyle hayat\u0131n\u0131 kaybeden AL hastalar\u0131n\u0131n daha ileri ya\u015fta oldu\u011fudur (Tablo 3).\u00a0<\/span><\/p>\n

MM hastalar\u0131nda ilk verilerde mortalite oran\u0131 %50\u2019nin \u00fczerindedir. Bu hastalar\u0131n da %27-57\u2019sini yatan hastalar olu\u015fturmaktad\u0131r (10). \u00c7al\u0131\u015fmam\u0131zda, COVID (+) MM hastalar\u0131nda mortalite oran\u0131 %28.6\u2019d\u0131r ve di\u011fer \u00e7al\u0131\u015fmalardan farkl\u0131 olarak COVID (-) MM hastalar\u0131 ile kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131\u011f\u0131nda mortalite oran\u0131 anlaml\u0131 d\u00fczeyde y\u00fcksek bulundu. \u0130ki grup aras\u0131nda anlaml\u0131 d\u00fczeyde ya\u015f fark\u0131 olmamakla birlikte MM hastalar\u0131, MDS\u2019den sonra en ya\u015fl\u0131 hasta pop\u00fclasyonunu olu\u015fturmaktad\u0131r. Bir kohort \u00e7al\u0131\u015fmas\u0131nda, MM hastalar\u0131n\u0131n %62\u2019sinde hastane yat\u0131\u015f ihtiyac\u0131 geli\u015fmi\u015f ve bu hastalar\u0131n da %24\u2019\u00fc hayat\u0131n\u0131 kaybetmi\u015ftir (11). \u00c7al\u0131\u015fmam\u0131zda yat\u0131\u015f ihtiyac\u0131 ve yatan hastalardaki mortalite oran\u0131 daha y\u00fcksek olup s\u0131ras\u0131yla %78.5 ve %34.4\u2019t\u00fcr. Hem hastalar\u0131n ileri ya\u015fta olmas\u0131 hem de %40\u2019\u0131ndan fazlas\u0131nda MV ihtiyac\u0131 bulunmas\u0131, hastal\u0131k \u015fiddeti ve ko-morbiditeler a\u00e7\u0131s\u0131ndan de\u011ferlendirilmese de y\u00fcksek mortaliteyi a\u00e7\u0131klayabilmektedir.\u00a0<\/span><\/p>\n

Bir meta-analiz \u00e7al\u0131\u015fmas\u0131nda, COVID (+) KLL hastalar\u0131nda \u00f6l\u00fcm oran\u0131 %33\u2019t\u00fcr (8). \u00c7al\u0131\u015fmam\u0131zda bu oran %26\u2019d\u0131r ve COVID (-) gruba g\u00f6re anlaml\u0131 d\u00fczeyde y\u00fcksektir. Ayn\u0131 meta-analiz \u00e7al\u0131\u015fmas\u0131nda, yatan hastalar\u0131n \u00f6l\u00fcm oran\u0131 %37, MV ihtiyac\u0131 ise %30 oran\u0131nda bildirilmi\u015ftir. S\u00f6z konusu \u00e7al\u0131\u015fmada, KLL hastalar\u0131n\u0131n %45\u2019i kemoterapi almakta ve bunun da \u00e7o\u011funlu\u011funu (%76) Bruton trozin kinaz inhibit\u00f6rleri olu\u015fturmaktad\u0131r. \u00c7al\u0131\u015fmam\u0131zda yat\u0131\u015f\u0131 yap\u0131lan KLL hastalar\u0131nda \u00f6l\u00fcm oran\u0131 %33.3 ve MV ihtiyac\u0131 ise %31.4\u2019t\u00fcr. Tedavi s\u00fcre\u00e7leri de\u011ferlendirilmemi\u015ftir. COVID-19 infeksiyonu ya\u015fl\u0131 pop\u00fclasyonda daha \u015fiddetli seyretmektedir (12). Pandeminin ilk d\u00f6nemlerinde ya\u015fl\u0131 hastalarda y\u00fcksek ko-morbiditeye ra\u011fmen \u015fifa oran\u0131 %86.7\u2019ye ula\u015fm\u0131\u015ft\u0131r (13). \u00c7al\u0131\u015fmam\u0131zda t\u00fcm hastalarda medyan ya\u015f 64 olmakla birlikte, hayat\u0131n\u0131 kaybeden COVID (+) hastalarda medyan ya\u015f anlaml\u0131 d\u00fczeyde y\u00fcksektir. Literat\u00fcre g\u00f6re daha az say\u0131da KLL hastam\u0131z olmas\u0131na kar\u015f\u0131n, farkl\u0131 olarak COVID (+) hasta grubunda medyan ya\u015f\u0131n y\u00fcksek olmas\u0131n\u0131n yan\u0131 s\u0131ra, hayat\u0131n\u0131 kaybeden KLL hastalarda da medyan ya\u015f (76\u2019ya kar\u015f\u0131n 71.5) anlaml\u0131 olarak y\u00fcksek bulundu. Bu durum ya\u015fl\u0131 hastalarda malignitenin mortalite \u00fczerine ko-morbitelerden ba\u011f\u0131ms\u0131z bir etken olabildi\u011fini d\u00fc\u015f\u00fcnd\u00fcrmektedir.<\/p>\n

Mussoti ve arkada\u015flar\u0131n\u0131n (14) pandemi s\u00fcrecinde MDS hastalar\u0131n\u0131 de\u011ferlendirdi\u011fi \u00e7al\u0131\u015fmada,\u00a0 <\/span>COVID (+) 63 MDS hastas\u0131nda toplam \u00f6l\u00fcm oran\u0131 %47.6 olup %73\u2019\u00fcn\u00fc erkek hastalar olu\u015fturmaktad\u0131r. \u00c7al\u0131\u015fmam\u0131zda da \u00f6l\u00fcm oran\u0131 (%47.9) benzerdir ancak farkl\u0131 olarak \u00f6len 23 hastan\u0131n 12\u2019si erkek, 11\u2019i kad\u0131nd\u0131r. Ayr\u0131ca kad\u0131n hastalarda \u00f6l\u00fcm oran\u0131 %84.6 olup anlaml\u0131 d\u00fczeyde y\u00fcksek bulundu. COVID (+) hematolojik malign hastal\u0131klar\u0131 inceleyen bir meta-analiz \u00e7al\u0131\u015fmas\u0131nda, yatan hastalarda \u00f6l\u00fcm oran\u0131 %34 olarak bildirilmi\u015ftir (15). \u00c7al\u0131\u015fmam\u0131zda da COVID tedavisi amac\u0131yla yat\u0131\u015f\u0131 yap\u0131lan hastalarda \u00f6l\u00fcm s\u0131kl\u0131\u011f\u0131 %34.6 bulundu; \u00e7o\u011funlu\u011fu ise %23.8 oran\u0131yla MDS hastalar\u0131 olu\u015fturdu. MDS hastalar\u0131n\u0131n hem yat\u0131\u015f ihtiyac\u0131 %72.5\u2019la olduk\u00e7a y\u00fcksekti hem de MV ihtiyac\u0131 %44.8 oran\u0131yla en y\u00fcksek hasta grubunu olu\u015fturuyordu. MDS\u2019de medyan ya\u015f 70\u2019in \u00fczerindedir (16). \u00c7al\u0131\u015fmam\u0131zda da COVID (+) hastalarda medyan ya\u015f 70.5 (65-87) y\u0131ld\u0131r. Ek hastal\u0131klar de\u011ferlendirilmemi\u015f olmakla birlikte ileri ya\u015f\u0131n getirdi\u011fi frajilite ve MDS nedeniyle uzun s\u00fcreli n\u00f6tropenik kalma olas\u0131l\u0131klar\u0131, bu hasta grubundaki daha y\u00fcksek yat\u0131\u015f ve MV ihtiyac\u0131n\u0131 a\u00e7\u0131klayabilir.<\/p>\n

Hematolojik maligniteler i\u00e7inde COVID-19 g\u00f6r\u00fclme s\u0131kl\u0131\u011f\u0131 en az olan hastal\u0131k KML gibi g\u00f6r\u00fcnmektedir. \u00c7ok uluslu bir analizde s\u0131kl\u0131\u011f\u0131 %1\u2019in alt\u0131nda bildirilmi\u015ftir (17). Verilerimizde hasta say\u0131s\u0131n\u0131n az olmas\u0131 nedeniyle %17.8\u2019le bu oran daha y\u00fcksek g\u00f6r\u00fcnse de, en d\u00fc\u015f\u00fck oran\u0131n KML hastalar\u0131nda olmas\u0131 literat\u00fcrle uyumludur. Ayr\u0131ca \u00e7al\u0131\u015fmam\u0131zda COVID-19 nedeniyle \u00f6len KML hastas\u0131 yoktur. Literat\u00fcrde de bu oran %13.7 olup di\u011fer malignitelerden d\u00fc\u015f\u00fckt\u00fcr (17). Bunun tirozin kinaz inhibit\u00f6rlerinin koruyucu etkisinden kaynakland\u0131\u011f\u0131 d\u00fc\u015f\u00fcn\u00fclmektedir. Bu konuda, molek\u00fcler ve klinik ara\u015ft\u0131rmalar yap\u0131labilir.<\/p>\n

\u00c7al\u0131\u015fmam\u0131z\u0131n temel s\u0131n\u0131rland\u0131r\u0131c\u0131 noktalar\u0131 hastalar\u0131n hem maligniteye hem de COVID-19\u2019a y\u00f6nelik tedavi modalitelerinin incelenmemi\u015f olmas\u0131n\u0131n yan\u0131 s\u0131ra tek merkezli olmas\u0131d\u0131r. Buna kar\u015f\u0131n \u00e7al\u0131\u015fmam\u0131z, t\u00fcm hematolojik malignitelerin literat\u00fcrdeki genel yakla\u015f\u0131m olan malign ve benign hasta gruplar\u0131nda kar\u015f\u0131la\u015ft\u0131r\u0131lmas\u0131 yerine malign hasta pop\u00fclasyonunda COVID (+) ve COVID (-) hastalar\u0131 kar\u015f\u0131la\u015ft\u0131rmas\u0131yla literat\u00fcre \u00f6nemli veriler sunmaktad\u0131r.<\/p>\n","protected":false},"excerpt":{"rendered":"

G\u0130R\u0130\u015e \u0130lk kez 2019 y\u0131l\u0131 sonlar\u0131nda \u00c7in\u2019in Hubei eyaletinde tan\u0131mlanan, 11 Mart 2020\u2019de de D\u00fcnya Sa\u011fl\u0131k \u00d6rg\u00fct\u00fc (DS\u00d6) taraf\u0131ndan pandemi olarak ilan edilen COVID-19 hastal\u0131\u011f\u0131n\u0131n etkeni SARS-CoV-2 virusudur. Hastal\u0131k halen pek \u00e7ok \u00fclkede \u00f6nemli bir sa\u011fl\u0131k sorunudur. Ba\u015fta ate\u015f ve solunum yolu semptomlar\u0131 olmak \u00fczere multisistemik semptomlarla seyretmektedir. Zaman i\u00e7inde virusun imm\u00fcn yan\u0131tta bozulmaya neden […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[5129],"tags":[5174,5482,4229,5189],"class_list":["post-25255","post","type-post","status-publish","format-standard","hentry","category-ozgun-arastirma","tag-covid-19","tag-hematolojik-maligniteler","tag-pandemi","tag-sars-cov-2"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/25255","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/comments?post=25255"}],"version-history":[{"count":3,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/25255\/revisions"}],"predecessor-version":[{"id":25783,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/25255\/revisions\/25783"}],"wp:attachment":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media?parent=25255"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/categories?post=25255"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/tags?post=25255"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}