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"ABSTRAK Latar belakang: Minimal residual disease MRD adalah faktor prediktor yang sensitif pada leukemia limfoblastik akut LLA dengan menggunakan flowsitometri. Minimal residual disease dapat mendeteksi 1 sel blas diantara 10.000 sel normal 0,01 . Pemerikasaan MRD dapat digunakan untuk menyempurnakan status remisi induksi pada LLA. Metode: Penelitian uji potong lintang selama 4 bulan dilakukan di bagian Onkologi Anak RSKD, Departemen Ilmu Kesehatan Anak RSAB Harapan Kita; divisi Hematologi-Onkologi RS Kramat 128 pada Febuari ndash; Juni 2017. Subjek adalah pasien yang terdiagnosis LLA yang menyelesaikan kemoterapi pasca fase induksi. Pemeriksaan morfologi sumsum tulang, imunofenotiping leukemia dan MRD untuk evaluasi pasca fase induksi dilakukan dilakukukan di bagian Patologi Klinik RSKD.Hasil penelitian: Pada penelitian ini diikutsertakan 52 subjek dengan usia rerata 6.4 tahun. Subjek lelski 62 lebih banyak dibanding perempuan 38 . Semua pasien dengan leukemia sel B. Stratifikasi Risiko Biasa RB 46 adalah lebih sedikit dibandingkan Risiko Tinggi RT 54 . Minimal residual disease 0,01 42,3 dengan morfologi yang juga remisi. Stratifikasi RB dengan pemeriksaan MRD kuantitatif ABSTRACT Introduction Minimal residual disease MRD is the most powerful predictor of outcome in acute leukemia and is useful in therapeutic stratification for acute lymphoblastic leukemia ALL protocols. Nowadays, the most reliable methods for studying MRD in ALL are multiparametric flow cytometry. It provides a MRD level of 0,01 of normal cells, that is, detection of one leukemic cell in up to 10.000 normal nucleated cells. Evaluation after induction phase, is the most informative time to predict danger of relapse.Methods A cross sectional study was conducted at Pediatric Hematology Oncology Division, Department of Child Health, Pediatric Oncology Division of ldquo Dharmais rdquo Cancer Hospital Women and Children Harapan Kita Hospital Pediatric Hematology Oncology Division Kramat 128 Hospital on February June 2017. Morphology, immunophenotyping, MRD assessment was performed. Bone marrow aspiration and MRD detection performed after induction phase to evaluate remission.Results A total of 52 diagnosed ALL patients enrolled in this study. The mean age was 6.4 years. Incidence in male 62 is higher than female 38 . All patients are B lineage. Standard risk SR patients 46 is less than high risk HR patients 54 . Minimal residual disease 0,01 1 42,3 and morphological remission. Standard risk stratification with quantitative minimal residual disease "

"[ABSTRAKLatar Belakang: Angka kesintasan LLA pada anak di negara berkembang masih tertinggal dibanding negara maju. Ketepatan diagnosis dan stratifikasi risiko pasien LLA merupakan hal penting yang perlu dievaluasi sebagai langkah awal untuk meningkatkan kesintasan. Di negara maju ketepatan diagnosis dan stratifikasi risiko didasarkan atas hasil pemeriksaan morfologi, imunofenotiping, sitogenetik, dan molekular. Di Indonesia, hal tersebut belum dapat dilakukan sepenuhnya karena keterbatasan biaya dan fasilitas. Untuk itu, perlu kriteria stratifikasi berdasarkan klinis dan laboratorium sederhana tetapi mampu mendekati stratifikasi molekular. Respons steroid merupakan faktor prognostik kuat dalam memprediksi kejadian relaps dan memengaruhi angka kesintasan. Penambahan variabel respons steroid pada stratifikasi RSCM (stratifikasi modifikasi) diharapkan dapat mendekati kemampuan stratifikasi molekular sebagai baku emas.Metode: Penelitian kohort prospektif selama 6 bulan dilakukan di Departemen Ilmu Kesehatan Anak FKUI-RSCM pada Januari 2013 - September 2014. Subjek adalah pasienbaruterdiagnosis LLAkemudiandikelompokkanmenjadirisikobiasa(RB)danrisiko tinggi (RT) berdasarkan kriteria stratifikasi RSCM (usia, jumlah leukosit, massa mediastinum dan infiltrasi SSP). Subjek dengan RB mendapat prednison (60 mg/kgBB/hari) dan RT mendapat deksametason (6 mg/kgBB/hari) selama 7 hari. Respons steroid dievaluasi pada hari ke-8, dengan menghitung blas di darah tepi. Respons baik bila jumlah blas < 1.000/μL dan respons buruk bila jumlah blas > 1.000/μL. Subjek dengan respons buruk dikelompokkan RT sesuai stratifikasi risiko yang baru (stratifikasi modifikasi). Evaluasi remisi fase induksi dilakukan setelah 6 minggu pemberian kemoterapi berdasarkan persentase blas dan minimal residual disease (MRD) sumsum tulang. Kriteria risiko tinggi pada stratifikasi molekular bila terdapat fusi gen E2A-PBX1, MLL-AF4, dan BCR-ABL, sedangkan risiko biasa bila terdapat fusi gen TEL-AML1.Hasil Penelitian: Pada penelitian ini diikutsertakan 73 subjek dengan rerata usia subjek 5,5 (SB ± 3,8) tahun. Subjek lelaki (65,8%) lebih banyak dibanding perempuan (34,2%). Gejala klinis yang sering ditemukan adalah pucat sebanyak 65 (89%), demam 53 (72,6%), nyeri tulang 51 (70%), dan hepatomegali 51 (70%) subjek. Hasil pemeriksaan imunofenotiping mendapatkan 77,1% sel B, 17,1% sel T, dan 5,7% sel campuran. Ketidaksesuaian remisi fase induksi berdasarkan morfologi dan MRD sebesar 15,2%. Stratifikasi RSCM maupun modifikasi tidak berkorelasi dengan stratifikasi molekular (r = 1,1; p = 0,6). Angka kesintasan berdasarkan stratifikasi molekular (79%) lebih tinggi dibandingkan stratifikasi RSCM (68,5%) maupun modifikasi (69,6%).Simpulan: Stratifikasi modifikasi menunjukkan kemampuan yang sama dengan stratifikasi RSCM dibandingkan stratifikasi molekular. Angka kesintasan berdasarkan stratifikasi molekular lebih tinggi dibandingkan stratifikasi RSCM dan modifikasi.;

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ABSTRACTIntroduction: Survival rate of children with ALL in developing countries remains lower compared to developed countries. Diagnosis and risk stratification are important to determine survival rates. Diagnosis and risk stratification in developed countries are based on morphology, immunophenotyping, cytogenetic, and molecular examination of bone marrow while in Indonesia most of those examinations are not available due to financial and facilities limitation. Therefore, we need to develop stratification criteria based on clinical and laboratory assessment which is comparable to molecular stratification. Response to steroid is a strong predictor of relapse and survival rates in ALL. The aim of the study is to develop new stratification to improve accuracy in predicting relapse rate and increase survival rate, by adding steroid response variable to current CMH stratification, in comparison with molecular stratification as gold standard.Methods: A prospective study was conducted at Pediatric Hematology-Oncology Division, Department of Child Health, FMUI-CMH on January 2013 ? September 2014. Morphology, immunophenotyping, cytogenetic and molecular assessment were performed. Patient was stratified into standard risk (SR) and high risk (HR) based on CMH stratification criteria (based on age, WBC, mediastinal mass and CNS infiltration) and given steroid (prednisone or dexamethasone) for 7 days. Steroid response was evaluated at day 8, good response if peripheral blast count < 1,000/μL and poor response if > 1,000/μL. Poor responders were moved to HR group in new stratification (modified stratification). Bone marrow aspiration and minimal residual disease (MRD) detection were perfomed after induction phase to evaluate remission and patient was observed for 6 months. High risk criteria based on molecular stratification are E2A-PBX1, MLL-AF4 and BCR-ABL fusion genes, while standard risk is TEL-AML1.Results: A total of 73 newly diagnosed ALL patients were enrolled in this study. The mean age was 5.5 (SD ± 3.8) years. Incidence in male (65.8%) is higher than female (34.2%). Clinical characteristics are pale (89%), fever (72.6%), bone pain (70%), hepatomegaly (70%), bleeding (42.5%), lymphadenopathy (49.0%), and splenomegaly (46.6%). Immunophenotyping result was 77.1% for B-lineage; 17.1% T-lineage; and 5.7% mixed lineage. Minimal residual disease detection from 33 patients showed no difference in remission between CMH and modified stratification. Four patients were moved to HR after evaluation of steroid response. We found discrepancy of remission induction results based on morphology and MRD in 15.2% subjects. Survival rate for CMH, modified, and molecular stratification were 68.5%, 69.6%, and 75.5%, respectively. Cipto Mangunkusumo Hospital and modified stratification were not correlated with molecular stratification as the gold standard (r = 1.1 ; p = 0.6).Conclusions: Modified stratification had similar accuracy with CMH stratification compare to molecular stratification in predicting survival rate of ALL children. Remission based on MRD detection between the two stratification was also similar. Survival rate by molecular stratification was higher compared to CMH or modified stratification.;Introduction: Survival rate of children with ALL in developing countries remains lower compared to developed countries. Diagnosis and risk stratification are important to determine survival rates. Diagnosis and risk stratification in developed countries are based on morphology, immunophenotyping, cytogenetic, and molecular examination of bone marrow while in Indonesia most of those examinations are not available due to financial and facilities limitation. Therefore, we need to develop stratification criteria based on clinical and laboratory assessment which is comparable to molecular stratification. Response to steroid is a strong predictor of relapse and survival rates in ALL. The aim of the study is to develop new stratification to improve accuracy in predicting relapse rate and increase survival rate, by adding steroid response variable to current CMH stratification, in comparison with molecular stratification as gold standard.Methods: A prospective study was conducted at Pediatric Hematology-Oncology Division, Department of Child Health, FMUI-CMH on January 2013 ? September 2014. Morphology, immunophenotyping, cytogenetic and molecular assessment were performed. Patient was stratified into standard risk (SR) and high risk (HR) based on CMH stratification criteria (based on age, WBC, mediastinal mass and CNS infiltration) and given steroid (prednisone or dexamethasone) for 7 days. Steroid response was evaluated at day 8, good response if peripheral blast count < 1,000/μL and poor response if > 1,000/μL. Poor responders were moved to HR group in new stratification (modified stratification). Bone marrow aspiration and minimal residual disease (MRD) detection were perfomed after induction phase to evaluate remission and patient was observed for 6 months. High risk criteria based on molecular stratification are E2A-PBX1, MLL-AF4 and BCR-ABL fusion genes, while standard risk is TEL-AML1.Results: A total of 73 newly diagnosed ALL patients were enrolled in this study. The mean age was 5.5 (SD ± 3.8) years. Incidence in male (65.8%) is higher than female (34.2%). Clinical characteristics are pale (89%), fever (72.6%), bone pain (70%), hepatomegaly (70%), bleeding (42.5%), lymphadenopathy (49.0%), and splenomegaly (46.6%). Immunophenotyping result was 77.1% for B-lineage; 17.1% T-lineage; and 5.7% mixed lineage. Minimal residual disease detection from 33 patients showed no difference in remission between CMH and modified stratification. Four patients were moved to HR after evaluation of steroid response. We found discrepancy of remission induction results based on morphology and MRD in 15.2% subjects. Survival rate for CMH, modified, and molecular stratification were 68.5%, 69.6%, and 75.5%, respectively. Cipto Mangunkusumo Hospital and modified stratification were not correlated with molecular stratification as the gold standard (r = 1.1 ; p = 0.6).Conclusions: Modified stratification had similar accuracy with CMH stratification compare to molecular stratification in predicting survival rate of ALL children. Remission based on MRD detection between the two stratification was also similar. Survival rate by molecular stratification was higher compared to CMH or modified stratification.;Introduction: Survival rate of children with ALL in developing countries remains lower compared to developed countries. Diagnosis and risk stratification are important to determine survival rates. Diagnosis and risk stratification in developed countries are based on morphology, immunophenotyping, cytogenetic, and molecular examination of bone marrow while in Indonesia most of those examinations are not available due to financial and facilities limitation. Therefore, we need to develop stratification criteria based on clinical and laboratory assessment which is comparable to molecular stratification. Response to steroid is a strong predictor of relapse and survival rates in ALL. The aim of the study is to develop new stratification to improve accuracy in predicting relapse rate and increase survival rate, by adding steroid response variable to current CMH stratification, in comparison with molecular stratification as gold standard.Methods: A prospective study was conducted at Pediatric Hematology-Oncology Division, Department of Child Health, FMUI-CMH on January 2013 ? September 2014. Morphology, immunophenotyping, cytogenetic and molecular assessment were performed. Patient was stratified into standard risk (SR) and high risk (HR) based on CMH stratification criteria (based on age, WBC, mediastinal mass and CNS infiltration) and given steroid (prednisone or dexamethasone) for 7 days. Steroid response was evaluated at day 8, good response if peripheral blast count < 1,000/μL and poor response if > 1,000/μL. Poor responders were moved to HR group in new stratification (modified stratification). Bone marrow aspiration and minimal residual disease (MRD) detection were perfomed after induction phase to evaluate remission and patient was observed for 6 months. High risk criteria based on molecular stratification are E2A-PBX1, MLL-AF4 and BCR-ABL fusion genes, while standard risk is TEL-AML1.Results: A total of 73 newly diagnosed ALL patients were enrolled in this study. The mean age was 5.5 (SD ± 3.8) years. Incidence in male (65.8%) is higher than female (34.2%). Clinical characteristics are pale (89%), fever (72.6%), bone pain (70%), hepatomegaly (70%), bleeding (42.5%), lymphadenopathy (49.0%), and splenomegaly (46.6%). Immunophenotyping result was 77.1% for B-lineage; 17.1% T-lineage; and 5.7% mixed lineage. Minimal residual disease detection from 33 patients showed no difference in remission between CMH and modified stratification. Four patients were moved to HR after evaluation of steroid response. We found discrepancy of remission induction results based on morphology and MRD in 15.2% subjects. Survival rate for CMH, modified, and molecular stratification were 68.5%, 69.6%, and 75.5%, respectively. Cipto Mangunkusumo Hospital and modified stratification were not correlated with molecular stratification as the gold standard (r = 1.1 ; p = 0.6).Conclusions: Modified stratification had similar accuracy with CMH stratification compare to molecular stratification in predicting survival rate of ALL children. Remission based on MRD detection between the two stratification was also similar. Survival rate by molecular stratification was higher compared to CMH or modified stratification., Introduction: Survival rate of children with ALL in developing countries remains lower compared to developed countries. Diagnosis and risk stratification are important to determine survival rates. Diagnosis and risk stratification in developed countries are based on morphology, immunophenotyping, cytogenetic, and molecular examination of bone marrow while in Indonesia most of those examinations are not available due to financial and facilities limitation. Therefore, we need to develop stratification criteria based on clinical and laboratory assessment which is comparable to molecular stratification. Response to steroid is a strong predictor of relapse and survival rates in ALL. The aim of the study is to develop new stratification to improve accuracy in predicting relapse rate and increase survival rate, by adding steroid response variable to current CMH stratification, in comparison with molecular stratification as gold standard.Methods: A prospective study was conducted at Pediatric Hematology-Oncology Division, Department of Child Health, FMUI-CMH on January 2013 – September 2014. Morphology, immunophenotyping, cytogenetic and molecular assessment were performed. Patient was stratified into standard risk (SR) and high risk (HR) based on CMH stratification criteria (based on age, WBC, mediastinal mass and CNS infiltration) and given steroid (prednisone or dexamethasone) for 7 days. Steroid response was evaluated at day 8, good response if peripheral blast count < 1,000/μL and poor response if > 1,000/μL. Poor responders were moved to HR group in new stratification (modified stratification). Bone marrow aspiration and minimal residual disease (MRD) detection were perfomed after induction phase to evaluate remission and patient was observed for 6 months. High risk criteria based on molecular stratification are E2A-PBX1, MLL-AF4 and BCR-ABL fusion genes, while standard risk is TEL-AML1.Results: A total of 73 newly diagnosed ALL patients were enrolled in this study. The mean age was 5.5 (SD ± 3.8) years. Incidence in male (65.8%) is higher than female (34.2%). Clinical characteristics are pale (89%), fever (72.6%), bone pain (70%), hepatomegaly (70%), bleeding (42.5%), lymphadenopathy (49.0%), and splenomegaly (46.6%). Immunophenotyping result was 77.1% for B-lineage; 17.1% T-lineage; and 5.7% mixed lineage. Minimal residual disease detection from 33 patients showed no difference in remission between CMH and modified stratification. Four patients were moved to HR after evaluation of steroid response. We found discrepancy of remission induction results based on morphology and MRD in 15.2% subjects. Survival rate for CMH, modified, and molecular stratification were 68.5%, 69.6%, and 75.5%, respectively. Cipto Mangunkusumo Hospital and modified stratification were not correlated with molecular stratification as the gold standard (r = 1.1 ; p = 0.6).Conclusions: Modified stratification had similar accuracy with CMH stratification compare to molecular stratification in predicting survival rate of ALL children. Remission based on MRD detection between the two stratification was also similar. Survival rate by molecular stratification was higher compared to CMH or modified stratification.]"

"Obesitas adalah salah satu masalah kesehatan kronik yang dialami oleh sebagian besar survivor LLA. Deksametason digunakan dalam terapi LLA dan memiliki efek samping peningkatan berat badan sehingga diduga memiliki hubungan terdahap risiko obesitas pada anak dengan ALL yang mendapatkan terapi. Data penelitian diambil dari 149 subjek, 43 kasus dan 106 kontrol. Analisis Odds Ratio menunjukkan bahwa dosis kumulatif deksametason berhubungan dengan angka kejadian obesitas pada setiap kelompok dosis dengan nilai paling besar pada dosis 100-200 mg (OR = 4,961 CI = 1,812-13,536). Analisis multivariat menujukan bahwa stratifikasi risiko merupakan faktor risiko obesitas (OR = 7,839 CI = 2,559-24,009), sedangkan usia merupakan faktor protektif (OR = 0,041 CI = 0,008 0,220).

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Obesity is one of chronic health conditions that affect a majority of ALL survivors. Corticosteroid is used in the treatment of ALL and has the side effect of weight gain. Hence, the usage of corticosteroid in the treatment of ALL is suspected to be the cause of obesity in ALL survivors. The study was done on 149 subjects, consisted of 43 cases and 106 controls. Odds ratio analysis shows correlation between high corticosteroid dose and obesity in all dose ranges with highest value at 100-200 mg range (OR = 4,961 CI = 1,812-13,536). Multivariate analysis shows that risk stratification is a risk factor for obesity (OR = 7,839 CI = 2,559-24,009) whereas age is protective for obesity (OR = 0,041 CI = 0,008-0,220).

"

"Kemoterapi memiliki dampak terjadinya kelelahan pada anak yang menderita leukemia limfoblastik akut. Kelelahan pada anak dapat diperberat oleh masalah tidur yang dialami anak. Penelitian ini bertujuan untuk menganalisis hubungan masalah tidur dengan kelelahan pada anak dengan leukemia limfoblastik akut yang menjalani satu siklus kemoterapi fase induksi. Desain penelitian ini adalah deskriptif analitik dengan pengukuran berulang masalah tidur dan kelelahan pada anak berumur 7-18 tahun (n=62). Pengambilan data dilakukan selama 7 hari yaitu, satu hari sebelum, lima hari selama, dan satu hari setelah kemoterapi. Hasil analisis data menggunakan uji korelasi Pearson dengan tingkat kemaknaan 95% menunjukkan hubungan yang signifikan (p<0,001) antara masalah tidur dengan kelelahan. Kesimpulannya masalah tidur menjadi penyebab beratnya kelelahan pada anak sehingga penting untuk dilakukan pengkajian dan memberikan intervensi mengatasi masalah tidur untuk mengurangi kelelahan pada anak. Pelatihan manajemen masalah tidur dan kelelahan menjadi penting untuk meningkatkan pengetahuan dan kemampuan perawat dalam mengatasi kelelahan pada anak leukemia limfoblastik akut yang menjalani kemoterapi fase induksi.

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Chemotherapy had an impact of disruption in sleep patterns and fatigue in children who suffer from acute lymphoblastic leukemia. Fatigue in children can be exacerbated by sleep problems experienced by children. This study aimed to analyze the relationship of sleep problems with fatigue in children with acute lymphoblastic leukemia who underwent a cycle of induction phase chemotherapy. The design of this research used descriptive analytic with repeated measurements of sleep problems and fatigue in children aged 7-18 years (n = 62). The data were taken for 7 days, consist of one day before, five days during, and one day after chemotherapy.

The result of data analysis using Pearson correlation test with significance level 95% showed significant relationship (p <0.001) between sleep problems with fatigue. The conclusion were sleep problems cause severe fatigue in children so it is important to do the assessment and provide intervention to overcome sleep problems to reduce fatigue in children. Training on sleep problems and fatigue management becomes important to improve knowledge and abilities of nurses in overcoming fatigue in children with acute lymphoblastic leukemia undergoing chemotherapy on induction phase."

"Pengobatan pada anak Leukemia limfoblastik akut terus dikembangkan, saat ini di Indonesia ada beberapa protokol yang lazim digunakan yaitu protokol Nasional Jakarta, protokol WK-LLA 2000, protokol LLA 2006 dan protokol LLA 2013. Tujuan studi ini untuk mengetahui probabilitas kesintasan hidup 3 tahun pada anak leukemia limfoblastik akut antara protokol 2006 dan 2013. Studi ini menggunakan mix method yaitu kohort retrosfektif dan wawancara mendalam. Populasi dalam penelitian ini adalah anak LLA usia 1-15 tahun yang mendapatkan protokol 2006 dan 2013 di RSKD Jakarta dari tahun 2008 ndash; 2016 sebanyak 68 anak dengan waktu penelitian dari April 2016 sampai Juni 2016. Data dianalisis dengan menggunakan Cox Regression. Hasil studi ini didapatkan probabilitas kesintasan 3 tahun anak LLA berdasarkan protokol pengobatan 2006 dan 2013 HR 1,57 CI 90 0,577 ndash; 4,299, namun perbedaan antara kedua protokol ini tidak bermakna secara statistik dengan p-value 0,456. Hasil wawancara mendalam juga didapat pada protokol 2006 dan 2013 secara prinsip sama namun tetap ada beberapa perbedaan diantara keduanya seperti jadwal pengobatan dan dosis secara kumulatif meningkat. Kesimpulan yang didapat ada interaksi waktu pada variabel trombosit, kedua protokol ini secara prinsip sama dan tidak terdapat banyak perbedaan dalam hal input dan proses.

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Treatment of children with Acute lymphoblastic leukemia was developing, currently in Indonesia there are several commonly used protocols such as National protocol Jakarta, WK LLA 2000 protocol, LLA protocol 2006 and protocol LLA 2013. The purpose of this study to determine the probability of survival 3 years In children with acute lymphoblastic leukemia between protocols 2006 and 2013. This study used a mix method of retrospective cohorts and in depth interviews. The population in this study were LLA children aged 1 15 years who received protocol 2006 and 2013 in RSKD Jakarta from 2008 2016 is 68 children with research time from April 2016 until June 2016. Data were analyzed using Cox Regression.

The result of this study shows the probability of 3 year survival of LLA children based on treatment protocol 2006 and 2013 HR 1,57 CI 90 0,577 ndash 4,299, but the difference between these two protocols was not statistically significant with p value 0.456. The results of in depth interviews were also obtained in protocols 2006 and 2013 in the same principle but there remain some differences between the both of the treatment schedule and doses are cumulatively increased. The conclusion is that there is time interaction on platelet variable, these two protocols are in principle the same and there is not much difference in input and process."

"Penderita LLA yang berusia tiga hingga sembilan tahun memiliki risiko standar mengalami resistensi terhadap kemoterapi dan risiko rendah mengalami kekambuhan penyakit. Salah satu penyebab resistensi terhadap kemoterapi ini adalah ekspresi gen MDR1 C3435T. Penderita LLA anak di RSCM memiliki frekuensi alel T yang lebih banyak dibandingkan alel C. Penelitian ini ingin mengetahui tinggi rendahnya ekspresi gen MDR, dihubungkan dengan faktor risiko usia dan frekuensi tiap alel polimorfisme gen MDR1 C3435T. Analisis ekspresi gen dilakukan pada 30 pasien penderita LLA anak yang berusia tiga hingga sembilan tahun di Departemen Ilmu Kesehatan Anak RSCM dan 1 non penderita sebagai pembanding. Tinggi rendahnya ekspresi gen MDR1 dianalisis menggunakan metode 5? nuclease assay dengan alat RT-PCR pada cDNA penderita. Optimasi metode analisis yang dilakukan memberikan hasil bahwa jumlah cDNA yang optimal adalah 4.800 ? 9.600 ng per 20 µl reaksi. Analisis ekspresi gen yang dilakukan menggunakan metode komparatif memperlihatkan bahwa sebanyak 21,875% penderita memiliki ekspresi gen MDR1 relatif lebih tinggi serta 78,125% penderita memiki ekspresi gen MDR1 relatif lebih rendah dibandingkan dengan non penderita. Hal ini sesuai dengan tingginya jumlah alel T dan faktor risiko berupa usia penderita.

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Three to nine years old ALL patients associated by having standard risk to get chemoteraphy resistance and low risk to relapse. The main cause of the chemoteraphy resistance is the presence of MDR1 gene?s polymorphism, C3435T. Previous research showed that T allel?s frequency was greater than C allel?s in children with ALL in Cipto Mangunkusumo hospital. This research purpose is to link the MDR1 gene?s expression, it?s polymorphic allel frequency and age risk factor. MDR1 gene expression was assessed in 30 ALL patients whose age between 3 and 9 years old in Pedriatric Department Cipto Mangunkusumo Hospital and 1 healthy subject for reference. The gene expression analysis was done with 5? nuclease assay method using RT-PCR in patient?s cDNA. The optimized method used 4.800 ? 9.600 ng cDNA in 20 µl reaction. A relatively high gene expression was possessed by 21,875% patients while the other 78,125% patients own a relatively low gene expression compared to the reference sample. For conclusion, the high T allel frequency and the age of the patients predispose their lower gene expression."

"Leukemia limfoblastik akut (LLA) adalah keganasan yang paling sering terjadi pada anak-anak. Angka kesembuhan yang besar terjadi akibat terapi kanker saat ini, namun respon toksik yang terkait dan pembentukan radikal bebas meningkatkan angka kematian akibat pengobatan daripada kematian akibat penyakitnya itu sendiri. Komplikasi kemoterapi meningkatkan rasa ingin tahu dokter untuk mempelajari penggunaan antioksidan sebagai pengobatan tambahan pada kanker. Penelitian ini bertujuan untuk mengevaluasi peran N-asetilsistein ​​(NAS) sebagai terapi antioksidan pada anak-anak dengan LLA SR (standard risk) selama fase induksi kemoterapi, dan kemungkinan peran mereka dalam pencegahan dan pengendalian komplikasi hati terkait dengan penggunaan agen kemoterapi. Sebuah uji klinis acak tersamar tunggal NAS dibandingkan dengan plasebo yang dilakukan pada pasien anak Departemen Ilmu Kesehatan Anak Divisi Hematologi dan Onkologi di Rumah Sakit Cipto Mangunkusumo, Jakarta. Penelitian ini dilakukan pada 11 pasien anak-anak usia mereka berkisar antara 2 dan 10 tahun dengan LLA SR yang menjalani kemoterapi fase induksi dan memenuhi kriteria inklusi. Pasien secara acak dialokasikan ke dalam dua kelompok, NAS atau kelompok plasebo. Mereka dievaluasi secara klinis untuk terjadinya komplikasi dan sampel darah dikumpulkan sebagai parameter laboratorium (plasma malondialdehid (MDA), enzim transaminase, dan bilirubin). Sebanyak 11 subjek dilakukan analisis yang terdiri dari 6 pada kelompok n-asetilsistein dan 5 pada kelompok plasebo. Karakteristik subjek didominasi oleh anak laki-laki dengan status gizi kurang. Kadar rerata MDA cenderung mengalami penurunan, sebanyak tiga subjek dari enam subjek pada kelompok perlakuan dan tiga subjek dari lima subjek pada kelompok plasebo. Insidens peningkatan kadar enzim transaminase sebesar 25%. Tidak terjadi kejadian kolestasis pada subjek penelitian. Pengobatan NAS ​​berdasarkan dosis antioksidan cenderung menurunkan kadar MDA, dan mencegah peningkatan enzim transaminase, dan bilirubin.

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Acute lymphoblastic leukemia (ALL) is the most commonly malignancy in children. Cancer therapies have experienced great success nowadays, yet the associated toxic response and free radicals formation have resulted in significant number of treatment-induced deaths rather than disease-induced fatalities. Complications of chemotherapy increases physicians curiosity to study antioxidant use as adjunctive treatment in cancer. This study aims to evaluate the role of N-acetylcysteine (NAC) as antioxidant therapy in children with ALL during the induction phases of chemotherapy, and their possible role in prevention and control of hepatic complications associated with the use of chemotherapic agents. A randomized single-blind clinical trial of NAC in comparison with placebo conducted in hematology and oncology pediatric patient of Cipto Mangunkusumo Hospital, Jakarta. The study was performed in 11 pediatric patients with ALL with their ages ranging between 2 and 10 years, undergoing induction phase chemotherapy that fulfilled the inclusion criteria consecutively. Patient were randomly allocated into of two groups, NAC or placebo group. They were evaluated clinically for the occurance of complications and blood samples were collected as the laboratory parameters (plasma malondyaldehide (MDA), transaminase enzyme, and bilirubin). A total 11 participants were included in analysis consisted of 6 in n-acetylcysteine group and 5 in placebo group. Characteristics of subject were predominated by boys and moderate malnourished. Mean MDA levels tended to decrease, as many as three subjects from six subjects in the NAC group and three subjects from five subjects in the placebo group. Incidence of increased levels of the transaminase enzyme by 25%. There was no cholestasis events in the study subjects. NAS treatment based on antioxidant doses tends to reduce MDA levels, and prevent the increase in the transaminase enzyme and bilirubin."

"Latar Belakang : Pasien anak dengan keganasan yang mendapatkan pengobatan kemoterapi sering mengalami episode demam neutropenia. Kondisi ini akan meningkatkan risiko infeksi yang berat akibat penurunan fungsi utama neutrofil sebagai pertahanan terhadap mikroorganisme asing. Rondinelli, dkk telah mengusulkan suatu sistem skoring untuk memprediksikan terjadinya komplikasi infeksi berat pada pasien keganasan dengan demam neutropenia selama pemberian kemoterapi sehingga diperoleh tata laksana yang sesuai. Faktor risiko prediktif terjadinya infeksi berat tersebut meliputi usia < 5 tahun, penggunaan kateter vena sentral, suhu tubuh > 38,50 C, kadar hemoglobin < 7 g/dL, adanya fokus infeksi, dan terdapatnya infeksi saluran nafas akut bagian atas. Tujuan : Mengetahui apakah sistem skoring Rondinelli dapat membantu mendeteksi risiko terjadinya komplikasi infeksi berat pada anak dengan LLA-L1 yang mengalami demam neutropenia selama pemberian kemoterapi fase induksi di Divisi Hematologi-Onkologi IKA FKUI/RSCM. Metode : Penelitian ini adalah uji diagnostik dengan metode potong lintang retrospektif dengan membandingkan sistem skoring Rondinelli terhadap baku emas terjadinya komplikasi infeksi berat berupa kondisi septikemia disertai terdapatnya bakteremia pada kultur darah. Sampel diambil dari data sekunder berupa rekam medis pasien-pasien LLA-L1 yang menjalani rawat inap di bangsal Departemen IKA FKUI/RSCM mulai bulan Januari 2010 hingga bulan Agustus 2012. Subyek penelitian adalah pasien anak berusia 0 hingga 18 tahun dengan Leukemia limfoblastik akut L1 (LLA-L1) yang mengalami episode demam neutropenia yang pertama kali selama pemberian kemoterapi fase induksi. Hasil : Penelitian dilakukan pada 30 subyek yang memenuhi kriteria inklusi. Insidens komplikasi infeksi berat saat episode demam neutropenia yang pertama kali pada pasien LLA-L1 selama pemberian kemoterapi fase induksi sebesar 30%. Sensitivitas, spesifisitas, nilai duga positif, nilai duga negatif, rasio kemungkinan positif, dan rasio kemungkinan negatif skoring Rondinelli untuk mendeteksi komplikasi infeksi berat pada pasien LLA-L1 dengani demam neutropenia selama pemberian kemoterapi fase induksi berturut-turut adalah 66,7%; 90,5%; 75%; 86,3%; 6,94; dan 0,36. Area di bawah kurva ROC pada penelitian ini 0,759. Simpulan : Sistem skoring Rondinelli merupakan instrumen yang cukup baik untuk mendeteksi komplikasi infeksi berat pada anak dengan LLA-L1 yang mengalami demam neutropenia selama pemberian kemoterapi fase induksi.

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Background: Pediatric patients with malignancy who are receiving chemotherapy often experience febrile neutropenia episodes. This condition increase the risk of serious infection due to decreased of neutrophil which have primary function as a defense against foreign microorganisms. Rondinelli, et al have been proposed a scoring system for predicting the occurrence of severe infection complications in malignancy patients with febrile neutropenia after receiving chemotherapy in order to obtain appropriate treatment. Predictive risk factors for severe infection include age < 5 years, use of central venous catheter, body temperature > 38.50 C, hemoglobin level < 7 g/dL, the presence clinical focus of infection, and the absence of upper respiratory tract infection. Objective: To know whether Rondinelli scoring system can help in detecting the risk of severe infection complications in ALL-L1 with febrile neutropenia during the induction phase chemotherapy in the Pediatrics Hematology-Oncology Division, Universitas Indonesia Faculty of medicine / CMH. Method: This is a diagnostic study with a retrospective cross-sectional method by comparing the Rondinelli scoring system with the gold standard of severe infection complications such as septicemia condition and bacteremia in blood culture. Subjects were taken from the medical record of LLA-L1 patients in Pediatric Department, Universitas Indonesia Faculty of medicine / CMH starting from January 2010 until August 2012. Subjects were pediatric patients aged 0 to 18 years with ALL-L1 who experienced the first episodes of febrile neutropenia during the induction phase chemotherapy. Results: The study was conducted in 30 subjects who met the inclusion criteria. The incidence of severe infectious complications at the first episode of febrile neutropenia in patients ALL- L1 during the induction phase of chemotherapy was 30%. Sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio Rondinelli scoring for detecting severe infection complications in ALL-L1 neutropenia patients with febrile neutropenia during the induction phase of chemotherapy respectively are 66.7%; 90.5%, 75%, 86.3%, 6.94, and 0.36. In this study, area under the ROC curve was 0.75. Conclusion: Rondinelli scoring system is fairly good instrument for detecting complications of severe infections in ALL-L1 with febrile neutropenia during the induction phase chemotherapy"

"Kemoterapi fase induksi merupakan fase pertama tahap pengobatan pada anak dengan LLA dan dilakukan hampir segera setelah diagnosis ditegakkan, dimulai dan berlansung selama 4-6 minggu (28-42 hari). Hasil yang dicapai pada fase ini akan menentukan prognosis dan fase kemoterapi selanjutnya. Penelitian ini bertujuan untuk mengidentifikasi faktor-faktor yang berhubungan dengan lama rawat kemoterapi fase induksi pada anak penderita LLA. Desain yang digunakan dalam penelitian ini adalah desain cross sectional, dengan jumlah sampel 94 melalui consecutive sampling. Analisis yang digunakan dengan uji Spearman. Hasil menunjukan terdapat hubungan yang signifikan antara riwayat neutropenia (p value = 0,003) dan riwayat infeksi (p value = 0,000) dengan lama rawat kemoterapi fase induksi. Perawatan atau intervensi yang tepat selama kemoterapi fase induksi perlu menjadi perhatian untuk mencegah atau menurunkan kejadian neutropenia dan infeksi pada anak dengan LLA.

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Induction chemotherapy phase is the first stage of the treatment in children with ALL and carried out immediately after been diagnosed, started and occurred at 4 to 6 weeks (28-42 days). The results achieved in this phase will determine the prognostic and the next chemotherapy phase. This study aimed to identified factors related to the length of stay of induction chemotherapy phase in children with ALL. The design used in this study is a cross-sectional design, with 94 samples got through consecutive sampling.

The Spearman test is used for analysis. Result showed a significant relationship between a history of neutropenia (p value = 0.003) and infection history (p value = 0.000) with the length of stay of induction chemotherapy phase. Appropriate treatment or intervention during the induction phase of chemotherapy needs to be concern to prevent or decrease the incidence of neutropenia and infection in children with ALL."

"ABSTRAKLeukemia Limfoblastik Akut LLA merupakan penyakit keganasan sel darah yang ditandai dengan akumulasi sellimfoblas dan sering terjadi pada anak-anak.. Pemberian cytarabine dapat secara klinis mengeradikasi sisa-sisa selkeganasan, namun memiliki efek samping salah satunya dapat merusak jaringan ginjal. Sampai saat ini, protokolbelum memiliki pedoman tentang penyesuaian dosis rejimen cytarabine kepada berbagai kelompok usia anak.Penelitian ini bertujuan untuk melihat perbedaan nilai kreatinin darah di kelompok usia yang berbeda. Desainpenelitian adalah potong lintang dengan consecutive sampling pada 50 pasien yang sesuai dengan kriteria. Datadidapatkan dari Laboratorium Departemen Patologi Klinik RSCM berdasarkan rekam medis yang didapatkan dariRS Ciptomangun Kusumo. Data nilai kreatinin pada kelompok usia yang berbeda memperlihatkan persebaranyang tidak normal dengan nilai median kreatinin darah 0.4mg/dL p=0.00 . Perbandingan median kedua kelompokdilakukan dengan uji Mann ndash; Whitney dan menunjukkan hasil signifikan dengan nilai median kelompok usia 1-12 tahun sebesar 0.3mg/dL dan kelompok usia 13-18 tahun sebesar 0.5mg/dL dengan selisih nilai median0.2mg/dL p=0.001 . Terjadi peningkatan nilai kreatinin lebih banyak pada subjek kelompok usia 13-18 tahun 23.5 dibandingkan dengan kelompok usia 1-12 tahun 6.1 . Perbedaan median nilai kreatinin darah antarakelompok usia 1-12 tahun dan 13-18 tahun tidak menunjukan peningkatan melebihi batas ambang, namunbermakna secara statistik.

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ABSTRACTAcute Lymphoblastic Leukemia ALL is a blood neoplastic disease which characterized by accumulation oflymphoblastic cells and occurs frequently in children. The medication protocol has many regiments withCytarabine among all of the drugs which being used for the reinduction phase therapy. It has some adverse effectslike damaging kidneys by certain mechanisms. This study aims to see the difference of the level of serum creatininein different pediatric age groups. This study is using cross sectional as the design of the study with 50 samplesaccording to the criteria using consecutive sampling technique. Datas gathered from Laboratory of ClinicalPathology Department according to medical record from Cipto Mangunkusumo National Hospital. The serumcreatinine level from both pediatric age groups shows an uneven distribution with 0.4mg dL p 0.00 as the medianof the serum creatinine level from both groups. The comparison of both median tested by Mann Whitney methodand shows a significant result with 0.3mg dL as the median of pediatric aged 1 12 group and 0.5mg dL as themedian of pediatric aged 13 18 group with 0.2mg dL as the difference between both median p 0.001 . Pediatricaged 13 18 group shows more subject with increased serum creatinine level 23.5 than the pediatric aged 1 12group 6.1 . The median difference of serum creatinine level between pediatric group aged 1 12 and 13 18 showsan increasing serum creatinine value below the cut off but statistically significant."