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"ABSTRAKLatar belakang : Prevalens terjadinya malnutrisi bervariasi pada berbagai siklus kemoterapi LLA. Penelitian di Malaysia mendapatkan anak LLA pasca-kemoterapi fase induksi cenderung mengalami obesitas atau status gizi lebih. Penyebab malnutrisi pada anak LLA dapat dipengaruhi oleh berbagai faktor. Perubahan status gizi selama kemoterapi dapat memengaruhi luaran kemoterapi.Tujuan: mengetahui faktor-faktor yang memengaruhi perbaikan status gizi anak LLA setelah kemoterapi fase konsolidasi, serta pengaruhnya terhadap luaran kemoterapi, sehingga dapat dipakai sebagai masukan untuk upaya mengatasi malnutrisi pada anak LLA.Metode : Penelitian ini dengan uji retrospektif, di Rumah sakit Cipto Mangunkusumo, selama tahun 2016-2018. Total sampling pada pasien leukemia limfoblastik akut yang terdiagnosis, dan menjalani kemoterapi di RSCM hingga fase konsolidasi.Hasil : Seratus empat puluh satu subyek pasien anak LLA diikutsertakan dalam penelitian ini. Terdapat 69,5% subyek mengalami perbaikan status gizi, dan 30,5% mengalami perburukan status gizi, dengan 60% perburukan ke arah overnutrition pasca-kemoterapi fase konsolidasi. Faktor risiko independen terhadap terjadinya perbaikan status gizi pasca-kemoterapi fase konsolidasi ialah tidak timbulnya efek samping kemoterapi (RR 1,36, 95% IK 1,02 - 1,81). Jenis makanan dan cara pemberian makan tidak memengaruhi perubahan status gizi anak LLA pasca-fase konsolidasi. Terdapat hubungan antara perbaikan status gizi anak LLA pasca-fase konsolidasi dengan kejadian remisi (RR 1,24, 95% IK 1,03 - 1,5).Simpulan : Status gizi pasca-kemoterapi fase konsolidasi mengalami perbaikan dibandingkan sebelum kemoterapi, sedangkan yang mengalami perburukan status gizi cenderung mengalami overnutrition. Perbaikan status gizi anak LLA pasca-kemoterapi fase konsolidasi dipengaruhi oleh tidak timbulnya efek samping kemoterapi. Terdapat hubungan antara perbaikan status gizi anak LLA pasca-kemoterapi fase konsolidasi dengan kejadian remisi.

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ABSTRACTBackground: Acute lymphoblastic leukemia (ALL) is the most common malignancy in childhood. The prevalence of malnutrition varies in phase of ALL chemotherapy. Study in Malaysia showed ALL children after induction phase of chemotherapy tended to be obese or overweight. The causes of malnutrition in ALL children can be influenced by various factors. Changes in nutritional status during chemotherapy can affect the outcome of chemotherapy.Aim: To investigate factors that influence nutritional status improvement of ALL children after consolidation phase, as well as the effect on the outcomes of chemotherapy, so it can be used as an input to overcome malnutrition in ALL children.Method: A retrospective design was performed in Cipto Mangunkusumo Hospital from 2016 until 2018. Total sampling in patients with acute lymphoblastic leukemia who was diagnosed and started chemotherapy at Cipto Mangunkusumo Hospital until the consolidation phase.Result: A total of 141 subjects were included in this study. After consolidation phase, 69.5% of subjects experienced nutritional status improvements, and 30.5% worsened, of which 60% become over nutrition post-consolidation phase. Independent risk factor for the improvement of nutritional status after consolidation phase was the absence of chemotherapy side effects (RR 1.36, 95% CI 1.02 - 1.81). There were no association between type of food and route of feeding with nutritional status improvement of ALL children after consolidation phase. There was association between improvement in nutritional status of ALL children after consolidation phase with the incidence of remission (RR 1.24, 95% CI 1.03 - 1.5).Conclusion: Nutritional status at post-consolidation phase has improved compared to pre- chemotherapy, while those who worsening nutritional status tend to overnutrition. The absence of chemotherapy side effects affects nutritional status improvement of ALL children after consolidation phase. There is a relationship between nutritional status improvement of ALL children after consolidation phase with the incidence of remission."

"Perawatan lanjutan pada anak penderita Leukemia Limfoblastik Akut (LLA) sangat penting. Penelitian ini bertujuan untuk mengidentifikasi gambaran pengalaman orang tua melakukan perawatan lanjutan di rumah pada anak LLA. Wawancara mendalam digunakan sebagai metode dalam pengumpulan data. Enam orang partisipan yang terlibat di dalam penelitian ini dipilih secara purposif. Tema yang muncul meliputi pemahaman ibu tentang cara perawatan pada anak, ibu bekerja keras dalam merawat anak, membutuhkan dukungan, timbul respon psikologis terhadap kondisi anak, memiliki beban dalam perawatan anak, manajemen penyelesaian masalah dan harapan ibu untuk masa depan anak. Hasil penelitian ini diharapkan dapat menjadi sumber informasi bagi pengembangan perencanaan asuhan keperawatan.

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Continuity of care in children with Acute Lymphoblastic Leukemia (ALL) is very important. This study aims to identify parental experience in providing care for children with ALL at home. Indepth interview was used as a method of data collection. There were 6 participants purposively involved in this study. Themes emerged including understanding about caring, mother work hard in caring for children, need support, psychologicaly response about children condition, burden of care children, problem solving management and mother’s expectation about children future. Results of this study can be used as a basic information for nursing care plans development."

"Leukemia Limfoblastik Akut merupakan penyakit keganasan dan sering mengenai anak-anak, infeksi dapat diakibatkan oleh aktifitas bakteri S mutans yang merupakan fokus infeksi. Pada anak Leukemia Limfoblastik Akut terjadi penurunan imunitas tubuh, oleh karena itu terjadi perubahan mikroflora oral. Tujuan penelitian ini untuk menganalisis perbedaan aktifitas bakteri S mutans. anak Leukemia Limfoblastik Akut pada fase Kemoterapi induksi, intensifikasi/konsolidasi, pemeliharaan. Bahan dan cara penelitian yaitu plak bakteri S mutans anak Leukemia Limfoblastik Akut, dimasukkan kedalam media Cariostat, diinkubasi selama 48 jam 37°C. Dari hasil penelitian yang telah dilakukan terdapat perbedaan aktifitas bakteri S mutans pada fase kemoterapi induksi, intensifikasi/konsolidasi, pemeliharaan. Aktifitas bakteri S mutans tertinggi ditemukan pada fase induksi. Kesimpulan yang didapat ditemukan adanya perbedaan aktifitas bakteri S mutans antara fase induksi, intensifikasi/konsolidasi, pemeliharaan.

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Background: ALL is a malignant disease and often happen in children, the infection can be caused by bacterial activity of S mutans which is the focus of infection. Children with ALL body immunity's are decreasing which leads to changes in oral microbacteria. Objective: To analyze the differences activity of S mutans bacteria in children with ALL in phase of chemotherapy, induction, intensification /consolidation and maintenance. Methods: collecting S mutans bacteria Plaque from Children with ALL through Cariostat and incubated for 48 h at 37 ° C. Results: There are differences in the activity of S mutans bacteria in the phase of induction chemotherapy, intensification / consolidation and maintenance. The highest activity of S mutants bacteria was found in the induction phase. Conclusion: There are differences in the activity of S mutans bacteria between the induction phase, intensification / consolidation and maintenance."

"Leukemia limfoblastik akut (ALL) adalah jenis kanker yang paling umum pada anak-anak. Nyeri dan kelelahan berhubungan dengan faktor-faktor kanker dan perawatannya. Tujuan dari penelitian ini adalah untuk menemukan hubungan antara kualitas nyeri dan kelelahan pada anak-anak dengan ALL 1-3 hari setelah kemoterapi. Penelitian ini menggunakan desain cross sectional dan menggunakan teknik consequtive sampling. Total sampel adalah 44 anak-anak dengan ALL (7-18 tahun) di Jakarta. Alat ukur yang digunakan dalam penelitian ini adalah kuesioner Simple Pain Inventory (BPI) untuk mengukur kualitas nyeri dan Kelelahan Onkologi Anak-Allen (FOA-A) untuk mengukur kelelahan. Nilai rata-rata kualitas nyeri adalah 1,63932 dan nilai rata-rata kelelahan adalah 9,25. Hasil penelitian ini menunjukkan bahwa ada hubungan yang signifikan antara kualitas nyeri dan kelelahan (p = 0,006), status kambuh dan kelelahan (p = 0,058), dan antara seseorang yang menemani anak-anak dan kelelahan (p = 0,016). Hasil penelitian ini merekomendasikan pentingnya penilaian nyeri lebih lanjut dan pengobatan kombinasi antara farmakologi dan nyeri non-farmakologi setelah kemoterapi untuk mengurangi kelelahan pada anak-anak dengan kanker.

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Acute lymphoblastic leukemia (ALL) is the most common type of cancer in children. Pain and fatigue are related to cancer factors and their treatments. The aim of this study was to find an association between pain quality and fatigue in children with ALL 1-3 days after chemotherapy. This research uses cross sectional design and uses consequtive sampling technique. The total sample was 44 children with ALL (7-18 years) in Jakarta. The measuring instrument used in this study was a Simple Pain Inventory (BPI) questionnaire to measure the quality of pain and Fatigue Oncology of Children-Allen (FOA-A) to measure fatigue. The average value of pain quality is 1.63932 and the average value of fatigue is 9.25.

The results of this study indicate that there is a significant relationship between quality of pain and fatigue (p = 0.006), relapse and fatigue status (p = 0.058), and between someone who accompanies children and fatigue (p = 0.016). The results of this study recommend the importance of further pain assessment and combination treatment between pharmacology and non-pharmacological pain after chemotherapy to reduce fatigue in children with cancer."

"Latar belakang: Leukemia limfoblastik akut (LLA) merupakan kanker tersering pada anak. Berbagai studi mendapatkan bahwa vitamin D berperan dalam pencegahan beberapa jenis kanker. Belum ada studi yang menilai hubungan status vitamin D dengan penyakit LLA pada anak di Indonesia.Tujuan: Untukmengetahui hubungan antara status vitamin D dengan penyakit LLA pada anak. Metode: Studi potong lintang pada 40 anak LLA yang baru terdiagnosis dan 40 anak sehat yang sesuai umur dan jenis kelamin. Pasien LLA diambil secara consecutive sampling di RSUPN Dr. Cipto Mangunkusumo Jakarta dan RSUP Dr. M. Djamil Padang. Status vitamin D diklasifikasikan berdasarkan rekomendasi Institute of Medicine yaitu defisiensi bila kadar < 12 ng/mL, insufisiensi 12 - <20 ng/mL, dan normal 20-100 ng/mL. Data dianalisa menggunakan uji Chi-Squaredan independent sample t-test, dengan kemaknaan p <0,05.Hasil: Terdapat 22 (55%) anak laki-laki pada masing-masing kelompok dan kelompok usia 1-4 tahun merupakan kelompok terbanyak (48%). Mayoritas anak LLA memiliki status vitamin D normal (78%), demikian juga kelompok kontrol (63%). Terdapat 3(7%) dan 6(15%) anak LLA serta 1(2%) dan 14(35%) anak sehat memiliki status defisiensi dan insufisiensi berturut-turut dengan p =0,14. Rerata kadar vitamin D anak LLA adalah 25,1(7,6) ng/mL dan anak sehat 21,9(5,67) ng/mL, dengan perbedaan rerata 3,14 (IK95% 0,15-6,13) dan p =0,04.Simpulan:Mayoritas anak LLA yang baru terdiagnosis memiliki status vitamin D normal. Rerata kadar vitamin D anak LLA lebih tinggi bermakna dari anak sehat, namun tidak terdapat hubungan yang bermakna antara status vitamin D dan penyakit LLA pada anak.

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Background:Acute lymphoblastic leukemia (ALL) is the most common cancer in children. Various studies have found that vitamin D plays a role in the prevention of several types of cancer. Currently, there is no study in Indonesia that assess association between vitamin D status and pediatric ALL

Objective:To determine association between vitamin D status and pediatric ALL.

Methods:A cross-sectional study of 40 newly diagnosed ALL children and 40 age-and sex-matched healthy children. ALL patients were taken by consecutive sampling at Dr. Cipto Mangunkusumo Hospital Jakarta and Dr. M. Djamil Hospital Padang. Vitamin D status is classified based on Institute of Medicine recommendations; deficiency <12 ng/mL, insufficiency 12 - <20 ng/mL, and normal 20-100 ng/mL. Data were analyzed using Chi-square test and independent sample t-test. A p-value <0.05 is considered to be statistically significant.

Results: There were 22 (55%) boys in each group and the group 1-4 years was the most age group (48%). Majority of ALL children had normal vitamin D status (78%) and also in healthy children (63%). There were 3(7%) and 6(15%) ALL children as well as 1(2%) and 14(35%) healthy children had deficiency and insufficiency status consecutively, with p value =0.14. The mean vitamin D level of ALL children and healthy children were 25.1 (7.6) ng/mL and was 21.9 (5.67) ng/mL consecutively, with mean difference of 3.14 (95% CI 0.15-6.13) and p value =0.04..

Conclusion:The majority of newly diagnosed ALL children have normal vitamin D status. The mean vitamin D levels of ALL children was significantly higher than healthy children, however there was no significant association between vitamin D status and ALL in children."

"[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.]"

"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"

"Latar Belakang & Tujuan: Leukemia limfoblastik akut (LLA) adalah jenis kanker yang sering ditemukan pada pasien anak. Selama terapi, pasien akan menerima fase maintenance untuk mencegah remisi dengan diberikan obat utama 6-merkaptopurin. Ada beberapa faktor yang dapat mempengaruhi berjalannya fase maintenance, diantaranya kejadan anemia. Studi ini bertujuan untuk memperoleh prevalensi, karakteristik, dan faktor risiko dari pasien yang mengalami anemia selama fase maintenance diperlukan untuk membantu mengantisipasi dan mencegah diberhentikannya fase maintenance yang dapat berakibat pada kejadian relaps. Metode: Penelitian ini menggunakan studi observational cross sectional. Sebanyak 101 rekam medis pasien anak di Rumah Sakit Cipto Mangunkusumo yang memenuhi kriteria inklusi digunakan sebagai sampel. Hasil: Usia (p = 0.0025) dan jenis kelamin (p=0.004) memiliki hubungan yang signifikan dengan terjadinya anemia selama fase maintenance terapi ALL dengan 6-merkaptopurin. IMT (p = 0.052), kelompok risiko (p = 0.067), dan kadar serum albumin (p = 0.21) tidak menunjukkan hubungan yang signifikan. Kesimpulan: Prevalensi kejadian anemia pada pasien LLA yang menjalankan fase maintenance terapi adalah 79.2% dengan karakteristik dimana pasien didominasi oleh pasien laki-laki, median usia 4 tahun, median BMI 16.10 kg/m², mayoritas tergolong pasien LLA risiko standard, dan median kadar albumin dalam serum 4.50 g/dL. Faktor-faktor yang mempengaruhi terjadinya anemia selama fase maintenance terapi LLA mencakup usia dan jenis kelamin.

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Background & Aim: Acute lymphoblastic leukemia (ALL) is the most common form of malignancies among children. During the therapy, ALL patients undergo maintenance phase therapy at the end of the protocol with 6-mercaptopurine as the main drug to prevent relapse. However, maintenance phase therapy may be interrupted in several conditions (i.e. anemia) increasing the risk of relapse. This study is done to obtain the prevalence, characteristics and contributing factors to anemia to prevent treatment interruptions and lower the risk of relapse.

Method: This research utilizes observational cross-sectional study. A total of 101 medical records of children patients in Rumah Sakit Cipto Mangunkusumo (RSCM) that fulfil the inclusion criteria were used as samples.

Result: Age (p = 0.0025) and gender (p = 0.004) have significant relationship with the occurrence of anemia during the maintenance phase of ALL treatment with 6-mercaptopurine. BMI (p = 0.052), risk groups (p = 0.067), and serum albumin level (p = 0.21) do not show significant relationship to anemia in this population.

Conclusion: The prevalence of anemia in ALL patients that underwent maintenance phase therapy is 79.2%, with the several characteristics, including domination by male children patients, median age of 4 years old, median BMI of 16.10 kg/m², categorized as standard risk group, and median serum albumin level of 4.50 g/dL. The contributing factors to anemia during maintenance phase therapy include age and gender."

"Latar Belakang: leukemia limfositik akut LLA merupakan keganasan terbanyak pada anak dengan terapi utama kemoterapi, yang akan memicu respon hormonal dan inflamasi sehingga menyebabkan berbagai komplikasi, di antaranya gangguan pada saluran cerna dan penurunan status nutrisi. Diperlukan intervensi nutrisi agar status nutrisi dapat terjaga dan masa pertumbuhan serta perkembangan anak dapat berjalan optimal. Beberapa rekomendasi tata laksana nutrisi anak dengan leukemia yang menjalani kemoterapi telah dipublikasikan, namun belum semua rekomendasi tersebut dapat diterapkan karena keterbatasan sarana dan prasarana, sehingga diperlukan modifikasi agar tata laksana menjadi optimal. Metode: serial kasus ini membahas empat pasien LLA anak yang menjalani kemoterapi dengan berbagai komplikasi terkait nutrisi. Identifikasi pasien berisiko malnutrisi dilakukan dengan melaksanakan skrining nutrisi pada saat pasien masuk perawatan. Tata laksana nutrisi diberikan secara bertahap sesuai kondisi pasien, dengan target pemenuhan energi sesuai BB ideal berdasarkan tinggi badan yang dihitung dengan menggunakan persamaan Schofield. Pemenuhan protein diberikan minimal sebesar 1,5 g/kg BB/hari, dengan target maksimal 3 g/kg BB ideal, karbohidrat 40 - 60 , dan lemak 10 - 30. Mikronutrien diberikan sesuai dengan angka kecukupan gizi, berupa multivitamin dan mineral. Edukasi nutrisi diberikan terhadap pasien dan keluarga saat pasien diperbolehkan pulang. Hasil: dua orang pasien dalam serial kasus ini mengalami malnutrisi sedang saat dilakukan skrining nutrisi, dan seorang pasien yang menjalani kemoterapi fase konsolidasi mengalami penurunan BB yang diakibatkan komplikasi saat pemberian kemoterapi. Lama rawat pasien berkisar 8 - 14 hari, keempat pasien pulang dalam kondisi baik. Kesimpulan: tata laksana nutrisi yang optimal dapat menurunkan risiko komplikasi terkait nutrisi pasien LLA anak yang menjalani kemoterapi.

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Background acute lymphocytic leukemia ALL is the highest malignancy in children with primary therapy of chemotherapy, which would trigger a hormonal response and inflammation that cause a variety of complications, including disorders of the gastrointestinal tract and decreased nutritional status. Nutritional intervention is needed so that the nutritional status can be maintained and the period of growth and development of children can run optimally. Some child nutritional care recommendations with leukemia who undergo chemotherapy have been published, but not all of these recommendations can be implemented due to limited facilities and infrastructure.

Method this case series discusses four children ALL patients undergoing chemotherapy with various nutrition related complications. Identification of patients at risk of malnutrition was conducted through nutritional screening on admission. Nutritional managements given in stages according to the condition of the patient, with the fulfillment target of energy corresponding ideal body weight based on height were calculated using the equation Schofield. Fulfillment of the protein is given at least equal to 1.5 g kg BW day, with a maximum target of 3 g kg ideal body weight, 40 - 60 carbohydrate and 10 - 30 fat. Micronutrients given in accordance with the Dietary Allowances, in the form of multivitamins and minerals. Nutrition education given to patients and families when the patient is allowed to go home.

Results two malnutrition patients are being currently conducted nutritional screening, and a patient who underwent consolidation phase chemotherapy experienced a weight loss caused complications during chemotherapy. Hospitalized patients ranges from 8 - 14 days, four patients go home in good condition.

Conclusions optimal nutritional care can reduce the risk of complications related to nutrition child ALL patients undergoing chemotherapy."