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"We report three rare cases of mucosal-associated lymphoid tissue (MALT) lymphoma. Two cases are of gastric MALT lymphoma and one is a case of transverse colon MALT lymphoma. The two cases of gastric MALT lymphoma were diagnosed by endoscopy which demonstrated an ulcer in the cardia and another in the corpus. The first case is in a 62-year-old male. The patients medical history revealed upper GI tract bleeding with melaena in 1993. At the time no diagnosis was made on endoscopy In August 2000, melaena recurred and endoscopy showed an ulcer in the cardio. Histology showed high-grade gastric MALT lymphoma. Based on Ann Arbor classification, the patient was classified as stage IE gastrointestinal lymphoma. H. pylori was negative. The patient received chemotherapy The second case is in a 53-year-old male. He suffered from gastric lymphoma for 3 years. He complained of annually recurring haematemesis before a definitive diagnosis was finally established. He suffered jiom stage IE low-grade well-differentiated lymphocytic MALT lymphoma. H. pylori was negative. Endoscopic procedure after H. pylori eradication showed ulcer regression though histology still showed low-grade MALT lymphoma and H. pylori as positive. The third case is in a 46-year-old male with a complaint of haematochezia. Colonoscopy showed intususception due to tumor in the transverse colon. Histologic examination showed chronic colitis and granulomatosa. lnvagination due to colon tumor was reported. Histologic examination of the biopsy specimen showed low-grade small cell lymphocyte-plasmocytoid lymphoma. "

"Latar belakang: Primary mediastinal large B cell lymphoma (PMBCL) adalah limfoma sel B berasal dari sel B medulla timus yang memiliki sifat unik dan agresif. Jaringan tumor PMBCL paling sering didapat berupa jaringan core biopsy. Gambaran histopatologik PMBCL berupa spektrum dengan fenotip dan genetik mirip dengan limfoma Hodgkin klasik terutama subtipe nodular sklerosis. Hal-hal tersebut dapat menimbulkan kesulitan diagnosis sehingga diperlukan pemeriksaan imunohistokimia untuk penegakan diagnosis dan penentuan pengobatan. Beberapa penelitian menemukan MAL merupakan salah satu penanda PMBCL. Tujuan penelitian ini adalah mengetahui perbedaan ekspresi MAL pada PMBCL dan limfoma Hodgkin klasik mediastinum.Bahan dan cara: Penelitian ini menggunakan desain potong lintang. Sampel terdiri atas 15 kasus PMBCL dan 15 kasus limfoma Hodgkin klasik mediastinum yang sudah dilakukan pulasan imunohistokimia dari Januari 2011 sampai Mei 2018. Dilakukan pulasan MAL dan penilaian menggunakan perhitungan persentase >10% sel tumor. Hasil: Ekspresi MAL positif pada  2(13,3%) dari 15 kasus PMBCL dan limfoma Hodgkin klasik mediastinum sebanyak 8(53,3%) kasus dari 15 kasus dengan sensitivitas 20% dan spesifisitas 35%. Pada uji statistik chi-square didapatkan ekspresi MAL antara PMBCL dan limfoma Hodgkin klasik berbeda bermakna dengan nilai  p=0,020.Kesimpulan: Ditemukan ekspresi MAL antara PMBCL dengan limfoma Hodgkin klasik mediastinum berbeda bermakna.

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Background: Primary mediastinal large B-cell lymphoma (PMBCL) is an aggressive and unique large B-cell lymphoma arising in mediastinum of putative thymic B-cell origin. Core biopsy is most commonly diagnostic procedure in PMBCL mass. Morphology of PMBCL has spectrum and similarities in phenotype and genetic with classical Hodgkin lymphoma especially nodular sclerosis variant. Hence specific immunohistochemistry is needed to diagnose PMBCL. Several studies found MAL is one of some markers for PMBCL. The aim of this study is to determine the differences of MAL expression in PMBCL and thymic classical Hodgkin lymphoma.Material and method: This was a cross-sectional study with 15 cases of PMBCL and 15 cases thymic classical Hodgkin lymphoma that had been performed immunohistochemistry at RSCM from January 2011 to May 2018. All cases stained by MAL antibody and evaluated using percentage > 10% cell tumors.Result: MAL positive expression can be found in  2 (13,3%) of 15 cases PMBCL and  8 (53,3%) of 15 cases classical Hodgkin lymphoma with 20% sensitivity dan 35% specificity. The chi-square test showed  significant difference between MAL expression in PMBCL and thymic classical Hodgkin lymphoma. (p=0,020). Conclusion: There was signification difference between MAL expression in PMBCL and thymic classical Hodgkin lymphoma."

"Latar Belakang : Kemoterapi sitostatika dilaporkan meningkatkanaktivitas koagulasi (D-dimer meningkat) dan mengubah hypercoagulable statemenjadi hiperkoagulasi. Hypercoagulable state adalah suatu kondisi yangberpotensi untuk terjadinya trombosis (misal pada pasien kanker) yang ditandaidengan perubahan aktivitas koagulasi pra trombin (peningkatan fragmenprotrombin 1-2 atau kompleks TAT) dengan D-dimer yang normal.Hiperkoagulasi ditandai dengan PT dan aPTT memendek sementara fibrinogendan D-dimer meningkat. Insidens kemoterapi menimbulkan trombus pertahunsekitar 11 %. Insidens tromboemboli vena pada pasien yang dirawat inap yangmendapat kemoterapi pada populasi Thailand ttinggi, terutama pada pemberianterapi. Sampai saat ini belum ada laporan mengenai insidens TEV pada pasienkanker limfoma yang menjalani kemoterapi di Indonesia.Tujuan Penelitian : Menilai aktivitas koagulasi (D-dimer) dan sistemkoagulasi (PT,aPTT, fibrinogen) pada pasien limfoma non Hodgkin yangmendapatkan kemoterapi R-CHOPMetode Penelitian : Penelitian pre dan post prospektif pada pasienlimfoma non Hodgkin yang menjalani kemoterapi dengan rejimen R-CHOPsecara consecutive sampling di Ruang Rawat Inap Gedung A RSCM dan RuangRawat Inap RS Kanker Dharmais. Penelitian dilakukan pada April-Juni 2019.Pasien diambil darah dengan parameter aktivitas koagulasi (D-dimer) dan systemkoagulasi (PT, aPTT, fibrinogen). Analisis data untuk melihat perubahan reratapre dan post kemoterapi dilakukan uji t berpasangan (distribusi normal) dan ujiWilcoxon (tidak terdistribusi normal).Hasil Penelitian : Sebanyak 33 pasien dilibatkan dalam penelitian ini.Terdapat peningkatan D-dimer secara bermakna (p : 0.046), pemendekkan PT(0.048) dan aPTT ( <0.001) secara bermakna, disertai penurunan kadar fibrinogennamun tidak signifikan secara statistikaKesimpulan : Peningkatan D dimer secara bermakna, disertaipemendekkan PT dan aPTT secara bermakna, sedangkan fibrinogen mengalamipenurunan walaupun tidak signifikan secara statistik. Hal ini menunjukkankecenderungan pasien mengalami status hiperkoagulasi

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Background : Cytostatic chemotherapy is reported to increasecoagulation activity (increased D-dimer) and change the hypercoagulable stateinto hypercoagulation. Hypercoagulable state is a condition that has the potentialfor thrombosis (for example in cancer patients) characterized by changes in prethrombincoagulation activity (increase in prothrombin fragments 1-2 or TATcomplex) with normal D-dimers. Hypercoagulation is characterized by PT andaPTT shortening while fibrinogen and D-dimer are increasing. The incidence ofchemotherapy causes thrombus annually about 11%. The incidence of venousthromboembolism in hospitalized patients receiving chemotherapy in the highThai population, especially in the administration of therapy. To date there havebeen no reports of TEV incidence in lymphoma cancer patients undergoingchemotherapy in Indonesia.Objectives : Assess the activity of coagulation (D-dimers) andcoagulation systems (PT, aPTT, fibrinogen) in non-Hodgkins lymphoma patientsreceiving R-CHOP chemotherapyMethods : Pre and post prospective studies in non-Hodgkinslymphoma patients undergoing chemotherapy with the R-CHOP regimen byconsecutive sampling in the Inpatient Room of Building A RSCM and theInpatient Room of Dharmais Cancer Hospital. The study was conducted in April-June 2019. Patients were taken blood with parameters of coagulation activity (Ddimer)and coagulation system (PT, aPTT, fibrinogen). Data analysis to seechanges in mean pre and post chemotherapy was performed paired t test (normaldistribution) and Wilcoxon test (not normally distributed).Results: A total of 33 patients were included in this study. There was a significantincrease in D-dimer (p: 0.046), PT shortening (0.048) and aPTT (<0.001)significantly, accompanied by a decrease in fibrinogen levels but not statistically significantConclusion : D significantly increased dimer, accompanied bysignificant shortening of PT and aPTT, whereas fibrinogen decreased even thoughit was not statistically significant. This shows the tendency of patients toexperience hypercoagulable state"

"Limfoma merupakan jenis keganasan jaringan limfoid sebagai bentuk tumor padat pada jaringan limfoid yang dapat menyebar secara metastasis ke organ lain dan menyebabkan sebuah lesi yang menempati ruang (Space Occupying Lesion/SOL). Lesi yang timbul pada tulang belakang dapat menimbulkan masalah nyeri dan neurologis akibat kompresi saraf tulang belakang. Manifestasi yang timbul tergantung pada tempat kompresi tumor di saraf tulang belakang. Hasil penelitian menunjukan bahwa asal tumor tulang belakang yang paling umum adalah limfoma sebanyak 7,4% dari keseluruhan kasus tumor metastasis ke tulang belakang. Tujuan penulisan karya ilmiah akhir ners ini adalah untuk menganalisis pemberian asuhan keperawatan kolaborasi pemberian terapi Obat Anti Inflamasi Non Steroid (OAINS) dengan kombinasi teknik relaksasi napas dalam untuk mengatasi nyeri, masase abdomen dan pemberian minum air putih hangat sebagai manajemen konstipasi, dan latihan rentang gerak aktif-pasif pada pasien tirah baring. Hasil dari karya ilmiah ini menunjukan keefektifan pemberian OAINS dengan kombinasi teknik relaksasi napas dalam dalam penurunan skala nyeri menggunakan Numeric Rating Scale (NRS). Pemberian masase abdomen dan minum air hangat sebagai manajemen konstipasi dapat merangsang peristaltik usus. Latihan rentang gerak aktif-pasif pada pasien dengan tirah baring dapat memelihara tonus otot dan dapat dilakukan secara mandiri oleh pasien serta caregiver. Kata kunci: Lesi, Limfoma, Metastasis, Sumsum Tulang Belakang

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Lymphoma is a type of lymphoid tissue malignancy as a form of solid tumor in lymphoid tissue that can spread metastases to other organs and cause a space-occupying lesion (SOL). Lesions that arise in the spine can cause pain and neurological problems due to spinal nerve compression. Manifestations that arise depending on the site of compression of the tumor in the spinal cord. The results showed that the most common origin of spinal tumors was lymphoma as much as 7.4% of all cases of tumor metastases to the spine. The purpose of writing this final scientific paper for nurses is to analyze the provision of collaborative nursing care in the provision of Non-Steroid Anti-Inflammatory Drugs (NSAID) therapy with a combination of deep breathing relaxation techniques to treat pain, abdominal massage, and drinking warm water as management of constipation, and range of motion exercises. active-passive in bed rest patients. The results of this scientific work show the effectiveness of administering NSAIDs with a combination of deep breathing relaxation techniques in reducing pain scale using the Numeric Rating Scale (NRS). Giving abdominal massage and drinking warm water as management of constipation can stimulate intestinal peristalsis. Active-passive range of motion exercises in patients on bed rest can maintain muscle tone and can be done independently by the patient and the caregiver."

"ABSTRAKLatar Belakang: Kanker dan perawatannya memiliki dampak luas pada kualitas hidup pasien Dengan demikian, mengukur kualitas hidup pada pasien dengan kanker memberikan informasi penting tentang status kesehatan dan efek pengobatan. Penelitian sebelumnya menunjukkan bahwa banyak faktor dalam Comprehensive Geriatric Assessment (CGA) mempengaruhi kualitas hidup. CGA harus dilakukan pada pasien kanker, karena dapat memprediksi toksisitas, tingkat kelangsungan hidup secara keseluruhan dan dapat membantu menyesuaikan pilihan dan intensitas pengobatan pada setiap pasien. Namun, belum ada penelitian yang secara detail mengeksplorasi faktor-faktor yang berhubungan dengan kualitas hidup pada pasien yang lebih tua dengan Limfoma Non-Hodgkin (NHL). Penelitian ini bertujuan untuk mengeksplorasi seberapa besar masing-masing faktor dalam CGA terkait dengan kualitas hidup pada pasien NHL usia lanjut.Tujuan: Mengetahui gambaran kualitas hidup dan faktor-faktor yang berhubungan dengan kualitas hidup pasien lanjut usia dengan Limfoma Non Hodgkin yang mendapat kemoterapi.Metode: Desain penelitian adalah cross-sectional yang dilakukan pada pasien NHL berusia ≥60 tahun, penelitian dilakukan di Poliklinik Geriatri Terpadu dan Poliklinik Hemato Onkologi dari tiga rumah sakit umum di Jakarta (RSUPN Dr. Cipto Mangunkusumo, RS Kanker Dharmais dan Rumah Sakit Umum Fatmawati) selama Maret-Agustus 2019.Hasil: Ada 62 subjek, dengan usia rata-rata 66 tahun, 56,5% laki-laki. Hasil penelitian menunjukkan bahwa sebagian besar pasien memiliki kualitas hidup yang baik, berdasarkan pada setiap domain SF-36 dan EORTC QLQ-C30. Dalam analisis multivariat, ditemukan bahwa depresi dan status kelemahan berhubungan dengan domain PCS SF-36 dengan PR 12.086 (CI 95% 1.596-92.124) dan PR 5.622 (CI 95% 1.060-29.807), masing-masing. Analisis multivariat dengan Mental Component Summary (MCS) SF-36 menunjukkan hubungan yang signifikan dengan status depresi dengan PR 24.400 (CI 95% 2,961-140,539). Sedangkan hasil analisis multivariat dengan skala fungsional EORTC QLQ-C30 menunjukkan hubungan yang signifikan dengan skor kinerja ECOG dengan PR 171 (CI95% 8,470-3452,28).Simpulan: Setelah analisis multivariat, hanya status kelemahan, status depresi dan skor kinerja ECOG yang memiliki hubungan yang signifikan secara statistik.

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ABSTRACTBackground: Cancer and its treatment have a broad impact on patients' Quality of Life (QoL). Thus, measuring the QoL in patients with cancer provides essential information about health status and treatment effects. Previous researches showed that many factors in Comprehensive Geriatric Assessment (CGA) affect QoL. CGA should be done in cancer patients, because it could predict toxicity, overall survival rate and can help adjust the choice and intensity of treatment in each patient. However, there has been no research explicitly exploring factors related to the QoL in older patients with Non-Hodgkin's Lymphoma (NHL). This research aims to explore the how great each factors in CGA relate to the QoL in older patients in NHL.Objective: To determine quality of life and related factors in elderly patients with Non-Hodgkin's lymphoma in the hospital.Methods: The study design was cross-sectional in NHL patients aged ≥6 years, research was conducted in the Integrated Geriatric Polyclinic and Hemato-Oncology Polyclinic of three public hospital in Jakarta (RSUPN Dr. Cipto Mangunkusumo, Fatmawati Hospital, and Dharmais Cancer Hospital) during March-August 2019.Results: There were 62 subjects, with a median age of 66 years, 56.5% male. The result showed that most of the patients have a good QoL, based on each domain of SF-36 and EORTC QLQ-C30. In multivariate analysis, it was found that depression and frailty status were related to PCS SF-36 domain with PR 12.086 (CI 95% 1.596-92.124) and PR 5.622 (CI 95% 1.060-29.807), respectively. Multivariate analysis with SF-36's Mental Component Summary (MCS) showed a significant relationship with depression status with PR 24,400 (CI 95% 2.961-140,539). While the results of multivariate analysis with the EORTC QLQ-C30 functional scale showed a significant relationship with the ECOG performance score with PR 171 (CI 95% 8.470-3452.28).Conclusions: After multivariate analysis, only frailty status, depression status and ECOG performance score have a statistically significant relationship."

"Latar Belakang: Limfoma Hodgkin merupakan keganasan yang mencakup 1% kasus kanker keseluruhan. Adapun overall survival (OS) pasien limfoma Hodgkin dalam lima tahun mencapai 90%. Namun, progression-free survival (PFS) limfoma Hodgkin hanya mencapai 70-90% dalam kurun waktu 25 bulan. Setelah mengalami progresivitas, pasien mengalami penurunan PFS setelah mendapat terapi lini kedua. Sehingga, perlu diketahui faktor-faktor prediktor yang mempengaruhi PFS pasien limfoma Hodgkin.Tujuan: Mengetahui faktor-faktor prognostik PFS dua tahun pasien limfoma Hodgkin. Metode: Penelitian ini menggunakan desain kohort retrospektif yang melibatkan pasien limfoma Hodgkin yang teregistrasi dari tahun 2011-2021 di Rumah Sakit Umum Pusat Nasional Dokter Cipto Mangunkusumo. Faktor-faktor prognostik yang diteliti adalah stratifikasi risiko, skor prognosis internasional, kadar trombosit, laktat dehidrogenase, indeks komorbiditas Charlson, dan waktu sejak diagnosis hingga terapi. Analisis multivariat terhadap PFS dua tahun dilakukan menggunakan model regresi Cox.Hasil: Terdapat 115 subjek yang disertakan dalam penelitian dengan median usia 29 tahun, kadar trombosit 393.000 sel/L, LDH 340 IU/L, dan waktu sejak diagnosis hingga terapi enam minggu. Sebagian besar subjek penelitian adalah kelompok stadium lanjut (53,91%), total skor prognosis internasional 0-3 (69,57%), dan total skor indeks komorbiditas Charlson 0-1 (75,65%). Angka PFS dua tahun pasien limfoma Hodgkin di RSCM sebesar 59,13%. Hasil analisis bivariat menunjukkan waktu sejak diagnosis hingga terapi yang tidak memiliki kemaknaan secara statistik dengan HR 0,83 (IK 95% 0,42-1,59, p=0,57). Analisis multivariat menghasilkan tiga faktor prognostik independen, yakni stadium lanjut (HR 7,85 IK 95% 3,01-20,47, p<0,01), trombosit >450.000 sel/L (HR 2,77 IK 95% 1,49-5,16, p<0,01), dan LDH baik 250-500 IU/L (HR 2,57 IK 95% 1,01-3,63, p=0,04) maupun >500 IU/L (HR 3,06 IK 95% 1,20-7,82, p=0,02). Sistem skor berdasarkan ketiga variabel tersebut memiliki diskriminasi yang baik (AUROC 0,879, IK 95% 0,816-0,942, p <0,01).Kesimpulan: Stadium lanjut, trombosit >450.000 sel/L, dan LDH 250 IU/L merupakan faktor-faktor prognostik PFS dua tahun pada pasien limfoma Hodgkin.

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Background: Hodgkin's lymphoma is a malignancy that accounts for 1% of all cancer cases. The overall survival (OS) of Hodgkin's lymphoma patients in five years reaches 90%. However, progression-free survival (PFS) for Hodgkin's lymphoma only reaches 70-90% within 25 months. After experiencing progression, patients experienced a decrease in PFS after receiving second-line therapy. So, it is necessary to know the predictor factors that influence the PFS of Hodgkin's lymphoma patients.

Aim: To determine prognostic factors for two-year PFS in Hodgkin's lymphoma patients. Methods: This study used a retrospective cohort design involving Hodgkin's lymphoma patients registered from 2011-2021 at Dokter Cipto Mangunkusumo National General Hospital. The prognostic factors studied were risk stratification, international prognosis score, platelet levels, lactate dehydrogenase, Charlson comorbidity index, and time from diagnosis to therapy. Multivariate analysis of two-year PFS was performed using Cox regression models.

Results: There were 115 subjects included in the study with a median age of 29 years, platelet levels of 393,000 cells/L, LDH 340 IU/L, and time from diagnosis to therapy of six weeks. Most of the research subjects were in the advanced stage group (53.91%), the total international prognosis score was 0-3 (69.57%), and the total Charlson comorbidity index score was 0-1 (75.65%). The two-year PFS rate for Hodgkin's lymphoma patients at RSCM was 59.13%. The results of bivariate analysis showed that the time from diagnosis to therapy was not statistically significant with HR 0.83 (95% CI 0.42-1.59, p=0.57). Multivariate analysis yielded three independent prognostic factors, namely advanced stage (HR 7.85, 95% CI 3.01-20.47, p<0.01), platelets >450,000 cells/L (HR 2.77, 95% CI 1.49-5.16, p<0.01), and LDH either 250-500 IU/L (HR 2.57, 95% CI 1.01- 3.63, p=0.04) or >500 IU/L (HR 3.06 95% CI 1.20-7.82, p=0.02). The scoring system based on these three variables had good discrimination (AUROC 0.879, 95% CI 0.816- 0.942, p <0.01).

Conclusion: Advanced stage, platelets >450,000 cells/L, and LDH >250 IU/L are prognostic factors for two-year PFS in Hodgkin's lymphoma patients."

"Latar Belakang: Diffuse Large B-cell Lymphoma (DLBCL) merupakan limfoma tersering di Indonesia. Kemoterapi R-CHOP mempunyai risiko moderat untuk terjadinya neutropenia / demam neutropenia. Limfosit dapat menggambarkan imunitas pejamu, sedangkan neutrofil dan monosit dapat menggambarkan respons inflamasi. Belum ada penelitian yang menilai hitung jenis leukosit sebagai prediktor neutropenia akut awitan pertama pascakemoterapi R-CHOP pada pasien DLBCL.Tujuan: Mengetahui hubungan parameter hitung jenis leukosit sebelum kemoterapi sebagai prediktor neutropenia akut awitan pertama pascakemoterapi R-CHOP pada pasien DLBCL.Metode: Kohort retrospektif di RSUPN. Cipto Mangunkusumo. Pasien DLBCL 18-60 tahun, ECOG 0-1, tanpa komorbid yang berhubungan dengan kemoterapi, yang dilakukan kemoterapi R-CHOP 3 siklus pertama tanpa profilaksis G-CSF.Hasil: Dari 95 pasien, neutropenia akut awitan pertama pascakemoterapi terjadi pada 83 (87,4%) subjek atau 83 (55,3%) siklus dari total 150 siklus kemoterapi. Demam neutropenia terjadi pada 50,6% dari awitan neutropenia. Neutropenia berat terjadi pada 34 (41,0%) siklus dari 83 episode neutropenia. Neutropenia akut awitan pertama paling sering terjadi pada 7-15 hari pascakemoterapi.Rasio neutrofil limfosit mempunyai AUROC 0,74 (IK 95% 0,6-0,82); sedangkan limfosit absolut, neutrofil absolut, monosit absolut, dan rasio limfosit monosit mempunyai AUROC <0,70. Rasio neutrofil limfosit > 4,1 dapat memprediksi neutropenia akut awitan pertama pascakemoterapi RCHOP pada pasien DLBCL (sensitivitas 71,1%; spesivisitas 64,2%; nilai duga positif 71,1%; dan nilai duga negatif 64,2%).

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Background: Diffuse Large B-cell Lymphoma (DLBCL) is the most common lymphoma in Indonesia. R-CHOP chemotherapy has a moderate risk for neutropenia / febrile neutropenia. Lymphocytes can describe host immunity, while neutrophils and monocytes can describe the inflammatory response. No study has assessed differential count of leukocytes as a predictor of the first onset acute neutropenia after R-CHOP chemotherapy in DLBCL patients.

Objective: To determine the relationship between differential count of leukocytes before chemotherapy as a predictor of the first onset acute neutropenia after R-CHOP chemotherapy in DLBCL patients.

Methods: Retrospective cohort in RSUPN. Cipto Mangunkusumo. DLBCL patients 18-60 years old, ECOG 0-1, no comorbidity related to chemotherapy. Subjects were given with the first 3 cycles of R-CHOP chemotherapy without G-CSF prophylaxis.

Results: Of the 95 patients, first onset acute neutropenia after chemotherapy occurred in 83 (87.4%) subjects or 83 (55.3%) cycles of 150 chemotherapy cycles. Febrile neutropenia occurs in 50,6% of the onset of neutropenia. Severe neutropenia occurs in 34 (41.0%) cycles of 83 neutropenic episodes. The first onset of acute neutropenia is most common at 7-15 days after chemotherapy.

The neutrophil lymphocyte ratio has AUROC 0.74 (95% CI 0.65-0.82); while absolute lymphocytes, absolute neutrophils, absolute monocytes, and monocyte lymphocyte ratios have AUROC <0.70. The neutrophil lymphocyte ratio > 4.1 can predict the first onset of acute neutropenia after RCHOP chemotherapy in DLBCL patients (sensitivity 71.1%; specificity 64.2%; positive predictive value 71.1%; negative predictive value 64.2%).

Conclusion: The neutrophil lymphocyte ratio before chemotherapy > 4.1 has moderate performance in predicting the first onset of acute neutropenia post R-CHOP chemotherapy in DLBCL patients. Absolute lymphocytes count, monocytes count, neutrophils count, and monocyte lymphocyte ratio cannot be used as a predictor of the first onset acute neutropenia post R-CHOP chemotherapy in DLBCL patients."

"Kanker darah leukemia dan limfoma merupakan salah satu komorbid dari Coronavirus Disease 2019 (COVID-19 ) yang dapat mengurangi efektivitas vaksin. Perkembangan leukemia dan limfoma dapat dideteksi dengan menggunakan protein citrullinated histone H3 (CIT-H3) yang merupakan hasil sitrulinasi enzim peptidilarginin deiminase 4 (PAD 4) pada neutrofil. Protein CIT-H3 umumnya dapat dijadikan biomarker perkembangan kanker karena kadarnya yang mengalami kenaikan pada subjek leukemia dan limfoma. Kenaikan tersebut juga ditemukan pada subjek COVID-19. Tujuan dari penelitian ini adalah untuk mengetahui korelasi kadar CIT-H3 dengan parameter hematologi pada subjek leukemia dan limfoma berupa hemoglobin, leukosit, trombosit, limfosit, neutrofil, serta absolute neutrophil count (ANC). Penelitian dilakukan dengan menggunakan metode enzyme linked immunosorbent assay (ELISA) untuk memeriksa kadar CIT-H3 dari 40 sampel serum darah subjek leukemia dan limfoma yang telah divaksinasi COVID-19 minimal sebanyak dua kali atau telah mengalami infeksi COVID-19 sebelumnya. Hasilnya didapatkan bahwa kadar CIT-H3 berkorelasi positif dengan parameter ANC (r= 0,04, p= 0,34) pada karakteristik komorbid subkelompok subjek dengan komorbid. Dapat disimpulkan bahwa terdapat korelasi positif antara kadar CIT-H3 dan ANC.

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Leukemia and lymphoma blood cancer are comorbidities of Coronavirus Disease 2019 (COVID-19) which can reduce the effectiveness of vaccines. Metastases of leukemia and lymphoma can be detected using citrullinated histone H3 (CIT-H3) protein which is the result of citrullination of the peptidylarginine deiminase 4 (PAD 4) enzyme present in neutrophils. The CIT-H3 protein can generally be used as a biomarker for cancer metastases because of the increase in its levels in leukemia and lymphoma subjects. This increase was also found in the subject of COVID-19. This study aimed to determine the correlation of CIT-H3 levels with hematological parameters in leukemia and lymphoma subjects such as hemoglobin, leukocytes, platelets, lymphocytes, neutrophils, and absolute neutrophil count (ANC). The research was carried out using the enzyme-linked immunosorbent assay (ELISA) method to examine CIT-H3 levels from 40 blood serum samples from leukemia and lymphoma subjects who had been vaccinated against COVID-19 at least twice or had experienced previous COVID-19 infection. The results showed that CIT-H3 levels were positively correlated with ANC parameters in the comorbid characteristics of the subgroup of subjects with comorbidities (r= 0,04, p= 0,34). It can be concluded that there is a positive correlation between CIT-H3 levels and ANC."

"Latar belakang: Respon terapi diffuse large B-cell lymphoma (DLBCL) sangat heterogen. Skor IPI dan subtype DLBCL berdasarkan algoritma Hans masih banyak dipakai untuk menentukan prognosis. Jumlah monosit absolut (AMC) dan Tumor microenviroment (TME)  memiliki peranan penting dalam memprediksi  terjadinya event pada DLBCL. Beberapa TME yang telah dikaji adalah tumor associated macrophage (TAM), dan tumor infiltrating lymphocytes (TIL), namun masih terdapat hasil yang kontradiktif terhadap tingkat survival pasien DLBCL yang mendapatkan regimen terapi RCHOP dalam dua tahun.Tujuan penelitian: Mengetahui hubungan antara AMC,  TAM dan TIL terhadap event free survival 2 Tahun  pada  DLBCL yang mendapatkan terapi RCHOP.Metode penelitian: Penelitian ini adalah studi kohort retrospektif dengan mengambil data rekam medis pasien dari Rumah Sakit dr. Cipto Mangunkusumo (RSCM) yang terdaftar sejak Januari 2014-Maret 2021. Kami mengumpulkan data demografis, hasil pemeriksaan klinis,  laboratorium, termasuk AMC, pemeriksaan radiologi dan event selama 2 tahun. Pemeriksaan CD163 dan CD8 menggunakan pewarnaan imunohistokimia antibodi dari parafin blok biopsi jaringan. Kami menganalisis nilai cut off terbaik dari AMC, CD163, dan CD8 dalam menentukan survival dua tahun dan korelasi AMC terhadap CD163 dan CD8.Hasil: Kami menganalisis sebanyak 108 pasien (52% laki-laki, 33,3% usia lebih dari enam puluh tahun). Ditemukan nilai cut off terbaik AMC, CD163, dan CD8 berturut-turut adalah 631, 23, dan 27,5%. Terdapat hubungan yang bermakna berturut-turut antara AMC dan CD163 serta CD8 (r=0,577, p<0,001; r=-0,599, p<0,001). Kesimpulan dari penelitian ini ditemukan AMC, TAM M2 (CD163) dan TIL CD8 secara kuantitatif berhubungan dengan event free survival 2 tahun pada pasien DLBCL yang mendapatkan terapi RCHOP. Terdapat hubungan korelasi positif sedang antara AMC dengan TAM M2 (CD163),  dan hubungan korelasi negatif sedang antara AMC dengan  TIL CD8.

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Background: Response to therapy of diffuse large B-cell lymphoma (DLBCL) is very heterogeneous. IPI scores and DLBCL subtypes based on Hans' algorithm are still widely used to determine prognosis. Absolute monocyte count (AMC) and tumor microenvironment (TME) are important in predicting events in DLBCL. Several TMEs studied are tumor-associated macrophages (TAM) and tumor-infiltrating lymphocytes (TIL). However, there are still contradictory results regarding the survival rate of DLBCL patients who receive RCHOP therapy regimens within two years.

Objective: This study aimed to determine the correlation between AMC, TAM, and TIL on 2-year event-free survival in DLBCL receiving RCHOP therapy.

Methods: This research is a retrospective cohort study by taking patient medical record data from Dr. Cipto Mangunkusumo Hospital (RSCM) registered from January 2014-March 2021. We collected demographic data, clinical and laboratory examinations, including AMC, radiological examinations, and events for 2 years. Examine CD163 and CD8 using antibody immunohistochemical staining of paraffin tissue biopsy blocks. We analyzed the best cut-off values ​​of AMC, CD163, and CD8 in determining two-year survival and the correlation of AMC to CD163 and CD8.

Results: We analyzed 108 patients (52% male, 33.3% over sixty). It was found that the best cut-off values ​​for AMC, CD163, and CD8 were 631, 23, and 27.5%, respectively. There was a significant relationship between AMC and CD163 and CD8, respectively (r=0.577, p<0.001; r=-0.599, p<0.001). This study concluded that AMC, TAM M2 (CD163), and TIL CD8 were quantitatively associated with 2-year event-free survival in DLBCL patients receiving RCHOP therapy. A moderate positive correlation exists between AMC and TAM M2 (CD163) and a moderate negative correlation between AMC and TIL CD8."

"Background: Diffuse large B-cell lymphoma (DLBCL) merupakan keganasan limfoid yang paling sering terjadi di dunia. DLBCL memiliki 2 subtipe yaitu germinal center B- cell-like (GCB) dan non-GCB. Programmed cell death-1 (PD-1) merupakan protein transmembran tipe 1 dari anggota imunoglobulin B7/CD28 sebagai reseptor imunomodulator yang memiliki peranan penting mencegah terjadinya kelainan autoimun. PD-1 di ekspresikan pada sel T, sel B dan sel natural killer. PD-1 memiliki ligan yaitu programmed cell death ligand-1 (PD-L1). PD-L1 banyak diekspresikan di beberapa jenis sel tumor dan di lingkungan mikro tumor. Salah satu karakteristik dari sel kanker adalah mampu menghindari destruksi dari sistem imun dengan cara mengaktivasi jalur PD-1/PD-L1. Peningkatan ekspresi PD-L1 memiliki asosiasi dengan prognosis yang buruk sedangkan peningkatan ekspresi PD-1 memiliki asosiasi dengan prognosis yang baik. Ekspresi PD-1 dan PD-L1 sudah diteliti pada kanker paru, namun jarang diteliti pada pasien DLBCL. Pada penelitian ini akan dievaluasi perbedaan antara ekspresi PD-1 dan PD-L1 pada pasien DLBCL subtipe GCB dan non-GCB. Metode: 20 kasus DLBCL subtipe GCB dan 20 kasus DLBCL subtipe non-GCB dalam sedian blok parafin (formalin-fixed paraffin-embedded tissue) dari Departemen Patologi Anatomik RSCM-FKUI pada periode tahun 2014 hingga 2017. Ekspresi PD-L1 dan PD-1 dievaluasi dengan teknik imunohistokimia. Ekspresi PD-L1 dievaluasi pada sel tumor, sedangkan ekspresi PD-1 dievaluasi di limfosit. Hasil: Terdapat perbedaan bermakna ekspresi PD-L1 pada sel tumor pasien DLBCL subtipe GCB dan non-GCB (P < 0,05), sedangkan ekspresi PD-1 tidak di diekspresikan pada limfosit pasien DLBCL subtipe GCB dan non-GCB. Kesimpulan: Terdapat peningkatan bermakna ekspresi protein PD-L1 yang diekspresikan pada sel tumor pasien DLBCL subtipe non-GCB dibandingkan subtipe GCB. Tidak terdapat ekspresi PD-1 pada limfosit pasien DLBCL subtipe GCB dan non-GCB.

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Background: Diffuse large B-cell lymphoma (DLBCL) is one of the most common lymphoid malignancies in the world and has two major molecular subtypes, germinal center B-cell-like (GCB) and non-GCB. Program cell death-1 (PD-1) is a type 1 transmembrane protein from members of immunoglobulin B7/CD28 as immunomodulator receptor that has an important role in preventing autoimmune disorder. PD-1 is expressed in T cells, B cells and natural killer cells. Program cell death ligand-1(PD-L1) is ligand of PD-1. PD-L1 is expressed in several types of tumor cells and in tumor microenvironment. One of cancer cells characteristic is the ability to avoid destruction of the immune system by activating PD-1 /PD-L1 pathway. Increased of PD-L1 expression is associated with poor prognosis while increased of PD-1 expression is associated with good prognosis. Expressions of PD-1 and PD-L1 have been studied in lung cancer, but study in DLBCL patients is limited. In this research, we evaluated the difference between PD-1 and PD-L1 expression in GCB and non-GCB subtypes of DLBCL. Methods: 20 cases of GCB subtype of DLBCL and 20 cases of non-GCB subtype of DLBCL in formalin-fixed paraffin-embedded tissue (FFPE) were taken from the archive of the Anatomical Pathology Department of RSCM-FKUI during 2014 to 2017. The expression of PD-L1 and PD-1 were evaluated by immunohistochemical technique. Expression of PD-L1 was evaluated in tumor cells, whereas PD-1 expression was evaluated in lymphocyte. Result: There was significant differences between PD-L1 expression in tumor cells of GCB subtype of DLBCL as compared to non-GCB subtype (P <0.05). The expression of PD-1 was not found in lymphocytes of GCB and non-GCB subtypes of DLBCL. Conclusion: The expression of PD-L1 in tumor cells of non-GCB subtype of DLBCL increased significantly as compared to GCB subtype. The expression of PD-1 protein was not found in lymphocyte cell of GCB as well as non-GCB subtypes of DLBCL."