Until currently, HD-MTX therapy with repeated intrathecal injections has been generally accepted as an elective regimen for preventing central nervous system involvement and acts as a cornerstone of treatment in children with ALL (Mantadakis et al., 2005). However, high-dose methotrexate (HD-MTX), defined as a dose

Latar belakang. Angka remisi pascakemoterapi LLA masih belum memuaskan, banyak faktor yang memengaruhi belum optimalnya luaran terapi LLA, salah satunya adalah faktor subtipe sel limfosit LLA. Tujuan. Melihat hubungan subtipe sel limfosit dengan tingkat remisi pascakemoterapi fase induksi LLA. Metode. Penelitian kohort prospektif dilakukan di RS dr. Hasan Sadikin Bandung dari bulan Februari-September 2016. Subyek adalah anak <14 tahun yang baru didiagnosis LLA berdasarkan hasil aspirasi sumsum tulang. Diambil sampel darah perifer untuk dilakukan pemeriksaan immunophenotyping agar dapat diketahui subtipe sel limfositnya, dilakukan kemoterapi fase induksi selama 6 minggu berdasarkan protokol terapi. Dilakukan aspirasi sumsum tulang evaluasi untuk melihat tingkat remisinya. Analisis statistik dilakukan dengan uji Fisher-exact. Hasil. Terdapat 40 subjek yang memenuhi kriteria inklusi dan menjalani kemoterapi fase induksi. Dari 40 subjek, 26 menyelesaikan kemoterapi fase induksi, dan dari 26 subjek yang dilakukan evaluasi aspirasi sumsum tulang, 20/26 mengalami remisi lengkap dan 6/26 tidak remisi. Terdapat 18/24 subjek sel B-LLA yang mengalami remisi lengkap dan 6/24 tidak remisi, sedangkan penderita sel T-LLA yang mengalami remisi lengkap 2/2 subjek. Tidak terdapat perbedaan yang bermakna antara subtipe sel limfosit dengan tingkat remisi pascakemoterapi fase induksi (p=0,585). Kesimpulan. Subtipe sel limfosit tidak berpengaruh terhadap tingkat remisi pascakemoterapi fase induksi. Sari Pediatri 2017;18(6):448-52Kata kunci: LLA, remisi lengkap fase induksi, subtipe sel limfosit Correlation of Lymphocyte Cell Subtype with Remission after Induction Phase Chemotherapy in Acute Lymphoblastic LeukemiaNur Suryawan, Ponpon Idjradinata, Lelani Reniarti Background. The remission rate after chemotherapy is still unsatisfactory. Many factors cause the outcome of the therapy not optimally, one of which is the lymphocyte cell subtype of the patient. Objective. To find out the correlation of lymphocyte cell subtype with remission after induction phase chemotherapy in ALL. Methods. This prospective cohort study was done in the in-patient ward of Child Heakth Department, Hasan Sadikin Hospital during February-September 2016. The subject were <14 years old children, newly diagnosed as ALL children according to the bone marrow aspiration. Peripheral blood sample were taken for immunophenotyping examination for lymphocyte cell subtype. Based on the therapy protocol, induction phase chemotherapy was done for 6 weeks, and afterwards bone marrow aspiration was done again to find out the remission grade. Statistical analysis using Fisher-exact test.Results. There were 40 subjects who fulfilled the inclusion criteria and had the induction phase chemotherapy. Only 26 of 40 subjects completed the induction phase chemotherapy, and of the 26 subjects who had bone marrow aspiration, 20/26 got complete remission; 6/26 got no remission. Of 24 subjects in this study, 18/24 with B-ALL cell had completed remission, and 6/24 got no remission, while 2/...

Introduction Most pediatric cancer patients in developing countries present at an advanced stage due to delayed diagnosis, being an important barrier to effective care. The objective of this study was to evaluate the associated factor of patient delay and explore significant parental practice‐associated risk factor to patient delay. Methods This was a sequential mixed methodology, utilizing data from the Indonesian Pediatric Cancer Registry for clinical variables and completed interviews with parents using structured questionnaires to obtain their sociodemographic data. A binary logistic regression analysis model was fitted to identify factors associated with patient delay. Additional semi‐structured interviews related to parental practice of using complementary and alternative medicine (CAM) were administered to 30 parents. Thematic framework analysis was performed on qualitative data to explore determinant factors of parental practice of using CAM. Results We interviewed 356 parents with children with cancer. The median patient delay was 14 days (interquartile range [IQR]: 6–46.5 days). The most extended delay was in patients with malignant bone tumors (median 66, IQR: 14–126). In multivariable logistic regression analysis, solid cancer (odds ratio [OR] = 5.22, 95% confidence interval [CI]: 2.79–9.77, p < .001) and use of CAM (OR = 1.86, 95% CI: 1.13–3.08, p = .015) were associated with patient delay. Qualitative interviews highlighted key issues relative to determinant parental factors using CAM, including vague initial childhood cancer symptoms, parental health‐seeking behavior, CAM availability and accessibility, also barriers of healthcare facilities. Conclusion Type of cancer and use of CAM are essential factors that cause patient delay. It should be addressed in the future childhood cancer awareness and childhood cancer diagnosis pathway.

Program untuk pendidikan, penyaringan, dan konseling siswa sekolah menengah pertama pada populasi berisiko tinggi penyakit thalassemia belum termasuk ke dalam program nasional. Minimnya informasi tentang penyakit thalassemia terutama pada populasi usia reproduktif menjadi kajian penting pada penelitian ini. Penelitian ini bertujuan untuk mengetahui adanya peningkatan pengetahuan mengenai thalassemia setelah diberikan edukasi kepada siswa Sekolah Menengah Pertama (SMP). Penelitian merupakan analitik kuantitatif dengan pre-test dan post-test dengan populasi siswa SMP di Kecamatan Tempuran, Kabupaten Karawang. Instrumen menggunakan kuesioner yang telah tervalidasi dan dianalisis dengan menggunakan uji t. Data diambil selama pelaksanaan penelitian terpadu KKN dengan memberikan kuesioner dua kali pengambilan, yaitu dalam pre-test dan post-test diselingi dengan edukasi informasi tentang thalassemia. Data yang dianalisis adalah jenis kelamin, usia, dan perubahan pengetahuan subjek. Dari 222 siswa yang memenuhi kriteria inklusi dari SMPN 1 dan SMPN 2 di Kecamatan Tempuran, 27 orang dikeluarkan dari penelitian karena mereka tidak ikut dalam salah satu test. Responden hasil pre-test baik SMPN 1 dan SMPN 2 memperoleh nilai minimum dan maksimum berturut-turut 4 dan 6. Kemudian setelah intervensi maka post test dilakukan, dengan hasil post-test yang signifikan dengan peningkatan rata-rata 1.09 (t=-3,861; p<0,001) untuk SMPN 2 dan tidak ada peningkatan pengetahuan untuk subjek di SMP 1 (t=0,913; p=0,364);. Pendidikan publik lebih lanjut dan konseling genetik yang tersebar luas sebelum pengujian sangat penting untuk keberhasilan program. Skrining individual saat masuk ke sekolah menengah pertama sebelum komitmen apapun mungkin lebih baik daripada skrining segera pra-nikah pada pasangan untuk mencegah peningkatan insidensi thalassemia di Indonesia.

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Vitamin B9 (folic acid) and B12 (cobalamin) are essential vitamins that play roles in the process of hematopoiesis and maintaining the function of peripheral nerves. Therefore, these deficiencies may create a risk for peripheral neuropathy in beta-thalassemia major patients. The purpose of this study is to determine the relationship between vitamin B9 level, vitamin B12 level, and peripheral neuropathy in beta-thalassemia major children. It was an observational analytical study with a case-control design has been conducted at Dr. Hasan Sadikin General Hospital Bandung, Indonesia, in May–July 2019. There were 47 beta-thalassemia major children with peripheral neuropathy (case) and 41 healthy children (control). All subjects completed a general demographic questionnaire, underwent neurological examination, and were tested for vitamin B9 and B12 serum levels. Data were then analyzed using the unpaired t test to compare the vitamin levels between both groups and Spearman’s rank correlation test to investigate the correlation between vitamin levels and the number of affected nerves in the case group. Comparison of folic acid levels in the case group (21.52±6.22 ng/mL) and the control group (23.81±7.51 ng/mL) showed no significant difference (p=0.19). In contrast, cobalamin in the case group (288.57±168.61 ng/mL) and the control group (385.95±197.48 ng/mL) showed a significant difference (p=0.01). In addition, there was a moderate correlation (p=0.004, r=0.41) between folic acid level and the number of motoric nerves affected in the case group. In conclusion, cobalamin level correlates with peripheral neuropathy in beta-thalassemia major patients, and folic acid level correlates with the number of affected nerves, especially motoric nerves. HUBUNGAN ANTARA VITAMIN B9 (ASAM FOLAT), VITAMIN B12 (KOBALAMIN), DAN NEUROPATI PERIFER PADA ANAK DENGAN TALASEMIA BETA MAYORVitamin B9 (asam folat) dan B12 (kobalamin) merupakan vitamin esensial yang berperan dalam proses hematopoiesis dan menjaga fungsi saraf tepi. Defisiensi vitamin ini dapat menimbulkan risiko neuropati perifer pada pasien talasemia beta mayor. Tujuan penelitian ini mengetahui hubungan antara kadar vitamin B9, vitamin B12, dan neuropati perifer pada anak talasemia beta mayor. Metode penelitian ini adalah analitik observasional dengan rancangan studi kasus kontrol yang dilakukan di RSUP Dr. Hasan Sadikin Bandung, Indonesia pada Mei–Juli 2019. Terdapat 47 anak talasemia beta mayor dengan neuropati perifer (kelompok kasus) dan 41 anak sehat (kelompok kontrol). Seluruh subjek penelitian mengisi kuesioner demografi umum, menjalani pemeriksaan fisis neurologis, serta dilakukan tes kadar vitamin B9 dan B12 serum. Uji t test tidak berpasangan digunakan untuk membandingkan kadar vitamin pada kedua kelompok dan uji korelasi Spearman untuk membandingkan kadar kedua vitamin tersebut dengan jumlah saraf yang terkena pada kelompok kasus. Perbandingan kadar asam folat kelompok kasus (21,52±6,22 ng/mL) dan kelompok kontrol (23,81±7,51 ng/mL) menunjukkan perbedaan yang tidak bermakna (p=0,19), sedangkan perbandingan kadar kobalamin kelompok kasus (288,57±168,61 ng/mL) dan kelompok kontrol (385,95±197,48 ng/mL) menunjukkan perbedaan yang bermakna (p=0,01). Selain itu, terdapat korelasi sedang (p=0,004; r=0,41) antara kadar asam folat dam jumlah saraf motorik yang terkena pada kelompok kasus. Kesimpulan, kadar kobalamin berhubungan dengan neuropati perifer pada penderita talasemia beta mayor dan kadar asam folat berhubungan dengan jumlah saraf yang terkena, terutama saraf motorik.

Objective: The objective of the study was to determine and describe the characteristics of allergic reactions to Escherichia coli-Asparaginase (E. coli-ASP). Methods: This cross-sectional study was performed at Hasan Sadikin Bandung General Hospital on acute lymphoblastic leukemia patients diagnosed from January 1, 2018, to August 31, 2019, confirmed by bone marrow examination. Data were extracted from Bandung Online Pediatric Cancer Registry, medical records, protocol therapy documents, and interview with patient’s guardian. Results: Out of 68 patients, 26 patients (37.6%) were allergic to E. coli-ASP. Twenty-two patients with recorded manifestation’s data evoked 35 symptoms and graded according to common terminology criteria for adverse event v3.0., fever, and urticaria are the most frequent manifestation. While Grade 2 and Grade 3 are the most often developed allergic reaction, patients with age range from 1 to 14 years, male and high risk is mainly allergic. Conclusion: Allergic rate to E. coli-ASP at Hasan Sadikin General Hospital is 37.6%. The most frequent manifestation is fever and urticaria (20%, respectively), Grades 2 and 3 (32%, respectively), and emerged mostly after administration of fourth dose E. coli-ASP (26.9%). Despite the characteristic differences between allergic and non-allergic group, it is not statistically significant.

Background: Transfusion is an essential component of supportive management for cancer patients with anemia and thrombocytopenia. It is generally safe; however, it has several risks and complications including those caused by transfusion reactions. This study aimed to describe transfusion reactions in pediatric cancer patients in a tertiary hospital in Indonesia. Methods: This was a descriptive cross-sectional study with a total sampling method. A prospective analysis was performed on episodes of blood transfusion in pediatric patients aged younger than 18 years old with cancer and were hospitalized at the Department of Child Health of the hospital from July to August 2019. After the consent of the parents, the patients were interviewed for various transfusion reactions. Data collected were presented using tables and charts. Results: Leukemia was the most frequent cancer in children cancer patients who need transfusion. Out of 42 children included, 155 episodes of transfusion were observed with 22 episodes showed transfusion reactions (14.2%). The most frequent manifestations were pruritus (31.8%), followed by combination of pruritus and erythema (27.4%) and fever (13.6%). These reactions appeared mostly in 1 to 2 hours (27.2%), with most were mild reactions (59.1%). Conclusion: Transfusion reactions mostly occurred among pediatric patients with cancer in the acute phase with clinical manifestation of allergic reactions, predominantly mild. Early identification of these reactions would result in better treatment and prevention for recurrence of transfusion reactions.