Faculty of Medicine
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Item type:Publication, RITUXIMAB MAINTENANCE THERAPY IN DIFFUSE LARGE B-CELL LYMPHOMA - SINGLE CENTAR EXPERIENCE(2013); ; ; Dusko Dukovski - Some of the metrics are blocked by yourconsent settings
Item type:Publication, A rare and misdiagnosed bleeding disorder-hereditary Bernard-Soulier syndrome, found in a family in Macedonia(Turkish Society of Hematology, 2005); ; - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Mutual and diverse prognostic features of Hodgkin`s disease in extremely unfavourable stage(Turkish Society of Hematology, 2005); ; ; ; - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Multiple myeloma related anemia treated with erythropetin(Turkish Society of Hematology, 2005); ; Liljana Hadzi-Pecova - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Report of a Severe case of TTP in Coma - Is Plasma Exchange Essential for Restoration?(International Society of Thrombosis and Hemoastasis, 2006); ; Aleksandar Stojanovic - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Cardiac and pulmonary late effects in Hodgkin’s lymphoma survivors in The Republic of North Macedonia(2020-07-13); ; ; Aleksandar StojanovicBackground: Survivors with HL express higher morbidity and mortality rates than the general population of comparable age, mainly because of the late cardiological and pulmonary complications associated with the duration and character of previously administered therapy. The objectives of this study are to determine changes in cardiac and pulmonary functions in patients with Hodgkin’s lymphoma treated with chemotherapy with or without mediastinal radiation therapy. Patients and Methods: The study includes 287 patients with Hodgkin's lymphoma. An analysis of the ECG, echocardiography and spirometric examinations were utilized for the detection of potential cardiac and pulmonary late complications, resulting from the treatment of patients, following long-term remissions. Results: Late adverse effects are a factor that further increases morbidity and mortality in our surviving HL patients. In 20.8% of the patients, heart disease was detected. It is confirmed that the total dose of doxorubicin influences the onset of late cardiac complications with statistical significance. Late cardiac adverse events occurred in 17.3% of our patients, who received a cumulative dose of doxorubicin greater than 200 mg/sq.m. Patients who received additional mediastinal radiotherapy, had an incidence of heart disease twice higher than patients who received chemotherapy only. In our analyzed series of patients, 24.7% manifested pulmonary toxicity and in 12.7%, a severe degree of pulmonary ventilatory failure was detected. With regard to the latter findings, we also confirm that patients who are receiving bleomycin develop significantly more pulmonary disorders, compared with patients who are receiving chemotherapy regimens without bleomycin. Conclusion: Improvements have been introduced in formulating certain drugs, so that cardiotoxic effects are reduced or with diminished intensity, or even completely omitting them and replacing them with a less or non-toxic drug. With regard to radiotherapy, size and shape of radiation fields can be precisely customized and dose reduction became acceptable. Despite the progress achieved regarding treatment outcomes in HL patients, due to the optimization of therapeutic protocols, the issue of potential side effects, arising as a treatment consequence, remains a concern. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, CIRS-G score as a rapid way to determine the overall multimorbidity burden and to select optimal and individualized therapy in newly diagnosed eldery CLL patients(Македонско лекарско друштво = Macedonian Medical Association, 2020); ; ; ; Slobodanka Trpkovska TerzievaIntroduction. Chronic lymphocytic leukemia (CLL) is the most common lymphoproliferative disorder in the elderly population. Many of these patients have multiple comorbidities, which might influence the choice of an adequate upfront chemoimmunotherapy option. The Cumulative Illness Rating Scale for Geriatrics (CIRS-G) score seems to be a reliable tool for assessment of the burden of comorbidity in elderly cancer patients. Objectives. The primary objective of our study was to assess the distribution of CIRS score status in CLL patients in real clinical practice. The secondary objective was to analyze which treatment option was used, and the effects it produced in each patients’ group, classified according to the CIRS score. Methods. In our prospective, single-center study, we focused on CLL patients that were referred to the University Clinic for Hematology in Skopje between 2017 and 2019. Comorbidity was assessed by the CIRS-G score in all patients included in our study (n=56) prior to the process of deciding on the most adequate treatment option. Results. The median age was 69 (±9.4) years. Comorbidities were identified in 80.4% of the study population, with an average CIRS score of 3.9. The three most common comorbidities were related to involvement of the vascular system (41.1%), endocrine-metabolic disorders (32.1%), and respiratory system disorders (17.9%). Only 16.1% of the patients had only 1 affected organ or system, other than hematological issues, while 64% of the patients had ≥2 affected systems. In 33.9% of the study patient cohort, the watch and wait initial approach was the standard of care. We considered 66.1% of patients to be requiring treatment, as follows: chemotherapy (chlorambucil, fludarabine+cyclophosphamide, bendamustine) only (30.4%), rituximab-based therapy (33.9%), and 1.8% of patients, due to the high comorbidity burden, were eligible only for supportive care. There was a stable trend of correlation between the CIRS score assessment and the treatment option prescribed (rs=0.7188, p<0.000001). Conclusions. The comorbidity status is a major consideration when treating elderly patients with CLL. Our study shows that comorbidity is quite a common feature in CLL patients and that it is increasing with age. CIRS is helpful in identifying the best treatment combination for the patients, that will enhance achieving long-term control of CLL, maintaining an optimal quality of life level. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Chronic lymphocytic leukemia following successfull treatment of Hodgkin’s lymphoma: report of two patients(Македонско лекарско друштво = Macedonian Medical Association, 2017); ; ; ; Arif LatifiOver the past few decades, introducing effective therapy, improved staging procedures, and significant improvement of supportive measures, significantly improved the prospects for patients with Hodgkin's lymphoma, leading to a 75-90% cure rate. Hodgkin's lymphoma survivors are at high risk of developing a large variety of second malignant neoplasms. It is crucial to maintain awareness regarding this issue. The subsequent development of Chronic Lymphocytic Leukemia (CLL) in patients after successful treatment of Hodgkin's lymphoma (HL) is an extremely rare possibility. The relationship between these two lymphoproliferative disorders is unclear. Herein we describe two cases of CLL, developed in previously treated patients with HL, with characterization of two distinct lymphoproliferative disease in these two patients. We also systematically reviewed the existing literature on this very rare occurrence of treatment-induced second hematological malignancies. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Current status in management of patients with chronic lymphocytic leukemia (CLL) in Republic of Macedonia(Macedonian Medical Association/ Walter de Gruyter GmbH, 2016-01); ; ; ; Lidija CevreskaChronic lymphocytic leukemia (CLL) is the most commonly diagnosed type of leukemia in Western Europe and North America, and represents about 30% of all leukemias in adults. CLL is a disease of elderly, who often have multiple comorbidities. These factors affect further treatment decisions, despite the great progress in the therapy of CLL in the last two decades. The aim of this study was to evaluate the current status in the management of patients with CLL in the Republic of Macedonia and to compare it with CLL patients in other western countries. We analyzed 102 patients with CLL referred to our Institution for control and/or treatment in the period from January 2015 to October 2015. Median age of our group of patients at the time of diagnosis was 62.7 years with almost 40% of patients older than 64 years. Male to female ratio was 1.3:1 and 54% of patients were diagnosed in stage "0" according to Rai staging system. Watch and wait was the most common treatment approach (58.8%) at the time of diagnosis, but at the moment of analysis only 33% of patients were still without treatment. The most common treatment in this group of CLL patients was FCR protocol with 39.5% of patients treated with an average of 5 cycles of this immunochemotherapeutic regimen. The average time of progression free survival (PFS) in all treated patients was 32.8 months with range between 2-72 months. In summary, clinical characteristics of CLL patient in our clinical settings and the most common therapeutic approach at our Institution do not differ significantly from the characteristics of the average CLL patient in other studies. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Preservation of Fertility and of Reproduction Ability in Lymphoma Patients(ID-Design, 2013-05-09); Aleksandar StojanovicAim: The aim of this article is to provide the health professionals with clear, novel and practical guidelines regarding management of fertility in patients with malignant hematological disorders, with special accent on lymphoma. Also, it aims at raising consciousness of all physicians administering chemotherapy, about the undesired effects of many chemotherapy regimens, on the reproductive ability, about available methods for preserving fertility and regarding many other issues in connection with fertility in patients treated for lymphoma. Materials and methods: Online internet databases and publications have been searched, and a systematic literature review has been performed, using the following keywords: fertility, chemotherapy as well as relevant keywords in connection to the subject. Results: Within the search, reports regarding smaller-sized groups, as well as in series of patients and case reports have been found, but relatively few large randomized studies or actual reports regarding the success rate and the influence of methods for fertility preservation in patients treated for Hodgkin's and Non-Hodgkin's lymphoma. We have managed in summarizing a large proportion of the research studies and transferring it into an integral multidisciplinary text, offering valid and applicable options for fertility preservation in patients treated for lymphoma. We use the term lymphoma in general, since the chemotherapy and radiotherapy approaches for Hodgkin's and for Non-Hodgkin's lymphomas are similar, rendering a major part of the fertility preservation guidelines appropriate for both entities. Recommendations: Hematologists should possess fundamental knowledge regarding the late complications of lymphoma treatment. Besides acknowledging the risk of secondary cancer development as well as of non-neoplastic cardiac and pulmonary complications, they should be prepared to raise the issue of infertility as an integral part of the treatment plan, since that is a complication of significant importance for patients treated with chemotherapy within their reproductive life period. Possible methods for preserving fertility should be presented and discussed, and patients should be referred promptly to a reproductive medicine specialist. Cryopreservation of both sperm and embryos are considered standard practice and are generally available, while other methods are still in investigational phase and performed in specialized centers under mandatory professional surveillance and expertise. Conclusion: It is recommended to utilize treatments that are with as little as possible gonadal toxicity, to consider a wide array of options for fertility preservation as soon as possible, and to practice a decision-making process most beneficial for the patient, based on the latest medical accomplishments and most novel prospects.