The New Treatment Of Immune Thrombocytopenic Purpura

Primary immune thrombocytopenia (ITP) is an acquired immune mediated disorder characterized by isolated thrombocytopenia, defined as a peripheral blood platelet count less than 150 x 109/L, and the absence of any underiying cause. In Europe, adult ITP has an incidence of 1.6 to 3.9 cases per 100.000 per year with increasing incidence with older age and equal for the sexes except in the mid-adult years (30-60 years), when the disease is more prevalent in women

Optimizing Diagnosis and Treatment Of NHL CD 20+

The global incidence of Non-Hodgkin's Lymphoma (NHL) has been rising continually for some years, and NHL is now the fifth most common cancer in the United States. In Indonesia have not data exactly. A recent WHO report estimated that 7.6 million people died of cancer in 2005, represeting 13% of all deaths worldwide

Manajemen Kanker Payudara Komprehensif

Kanker payudara merupakan salah satu kanker yang banyak terjadi dan sering menyebabkan kematian akibat kanker pada wanita. Berdasarkan data dari International Agency for Research on Cancer dalam GLOBOCAN (Global Cancer Statistic) 2018, jumlah kasus baru kanker payudara yang ditemukan di seluruh dunia berkisar 2,1 juta orang (11,6%) dengan jumlah kematian sebesar 626.679 orang (6.6%). Angka kejadian sampai saat ini masih terus meningkat pada wanita usia di antara 40-45 tahun, diagnosis dini serta terapi yang dilakukan secara cepat dan tepat merupakan pendekatan utama penataan pada penderita kanker payudara (Bray et al., 2018)

Venous Thrombo Embolism (VTE) In Pregnancy

Tromboemboli venosa adalah komplikasi vaskular serius yang dapat timbul pada kehamilan, diagnosis serta perawatannya merupakan masalah khusus. Dalam 30 tahun terakhir angka kejadian perdarahan, eklampsia dan sepsis sebagai penyebab kematian ibu hamil telah menurun drastis, dan saat ini emboli pulmonal menduduki peringkat atas kematian ibu hamil pada sebagian besar negara

A Breakthrough to Help Non-Small Cell Lung Cancer Patiens

Lung cancer has been a major health problem worldwide, accounting for a global incidence of 1.2 million new cases yearly and a staggering mortality of 1.1 million deaths in 2001. The majority (>80%) of lung cancers are non-small cell carcinomas (NSCLC), which are predominantly in advanced or metastatic stages upon presentation and the lack of effective treatment for advanced disease

Profile of BCR-ABL transcript levels based on Sokal prognostic score in chronic myeloid leukemia patients treated with imatinib

Tujuan: mengevaluasi pola dari respons molekular yang dinilai dengan reduksi kadar transkrip BCR-ABL berdasarkan skor prognosis sokal pada pasien leukemia mieloid kronis (LMK) fase kronis yang mendapat terapi Imatinib. Metode: penelitian dengan desain potong lintang dilakukan di Instalasi Rawat Jalan Hematologi, RSU Dr. Soetomo Surabaya, pada semua pasien LMK fase kronis, sejak Juni 2008 hingga Juni 2012. Skoring Sokal ditentukan saat sebelum terapi. Data yang dikumpulkan meliputi karakteristik subjek (usia, jenis kelamin), kadar hemoglobin, trombosit, lekosit, sel muda mieloblas, dan ukuran limpa. Pemeriksaan real-time kuantatif PCR (RT-qPCR) digunakan untuk mendeteksi residual molekular respons dari BCR-ABL. Hasil RT-qPCR yang dicatat merupakan rasio dari BCR-ABL dan gen acuan (G6PDH) sebagai standar internal. Perbedaan proporsi respons molekuler lengkap pada kelompok risiko Sokal rendah dan tinggi dianalisis dengan uji kai kuadrat, sementara perbedaan kadar transkrip BCR-ABL di antara kelompok risiko Sokal dianalisis dengan uji Kruskal-Wallis. Hasil: 40 subjek menyelesaikan penelitian. Setelah 18 bulan terapi Imatinib, kadar transkrip BCR-ABL tidak terdeteksi (molekuler respons lengkap) pada 7(70%), 8(66,7%), dan 9(50%) berturut-turut pada kelompok subjek risiko Sokal rendah-, sedang-, dan tinggi (p=0,417). Respons molekuler lengkap pada kelompok risiko Sokal rendah didapatkan lebih tinggi dibanding risiko Sokal tinggi (70% vs 50%), secara statistik tidak berbeda bermakna (p=0,557). Analisis statistik menggunakan Kruskall-Wallis menunjukkan tidak ada perbedaan secara bermakna distribusi kadar transkrip BCR-ABL di antara subkelompok skor prognostik Sokal (p=0,734). Kesimpulan: tidak ada perbedaan kadar transkrip BCR-ABL antara subkelompok skor prognostik sokal pada pasien LMK fase kronik yang diterapi dengan imatinib

Case Report Of Malignant Lymphoma of the breast

Four cases of breast malignant lymphoma (BML) are discussed, diagnosed and managed. The issue of diagnosing BML, showed how different these 4 cases were, in particular in the imaging ultrasonography (USG). Generally, the USG of ductal carcinoma is irregular solid mass, while the USG of BML is compliant with cystic forms. Case 1 is 68 years old woman with left breast tumor. USG revealed hypoechoic lesion in the left breast with FNA result of malignant lymphoma, but still differential diagnosis with ductal carcinoma of the breast Mamma. Case 2 is a 52 years old woman who had left breast tumor. The USG revealed malignant lesion, left axilla node positive, although FNA result was ductal carcinoma, after simple mastectomy, the frozen section revealed malignant lymphoma. Case 3 is a 51 years old woman, USG of the left breast revealed malignant lesion, left axilla node positive, and excision biopsy revealed non-Hodgkins lymphoma diffuse large cell. Case 4 is a 51 years old woman, the USG revealed irregular hypoechoic lesions in both breasts and left supraclavicula node 5 mm. Core biopsy revealed bilateral breast non Hodgkins lymphoma subcutaneous, T-cell lymphoma. The therapeutic management of breast lymphoma is controversial and is not fully established yet. A strategy consisting of three cycles of CHOP followed by involved-field radiation therapy is reportedly superior to eight cycles of CHOP alone

Anti Rituximab antibody titer and therapeutic response in Non-Hodgkin Lymphoma Patient Receiving R-Chop Treatment

Background: Rituximab as a combination of chemotherapy (R-CHOP) is more effective in the treatment of Lymphoma Non-Hodgkini (NHL). Production of humoral immune response frequently decreases the efficacy of antibody therapy due to premature clearance of antibodies, thus limiting the effectiveness of anti-tumor responses. We determined the correlation between anti-rituximab antibody levels and the response of RCHOP-treated NHL patients who receiving. Methods: This study was an observational analytic cross-sectional study on NHL patients in the Division of Hematology of Medical Oncology at Dr.Soetomo General Hospital Surabaya. Anti rituximab antibody titer was measured by ELISA from serum samples and the treatment response was evaluated according to category of response criteria for clinical trial (complete response, partial response, stable disease or progressive disease). Results: This study was enrolled 54 subjects that consisted of 64.8% of male, mean age of patients was 49.167 ± 12,075 years old, stage III was highest (61.6%). Median anti-rituximab antibody titer of 21.55 (9.24 - 197.17) pg/mL. The most progressive disease therapeutic response group was 46.3%. Comparative analysis of anti-rituximab antibody titer in each treatment response group was not significant (p-value = 0.08). The results of the correlation test are significant (p-value = 0.04; r Spearman = -0.27). Conclusion: There was weak negative correlation between anti-rituximab antibody titer and therapeutic response in R-CHOP-treated NHL patient

Association between modified wells score and D-dimer in malignant lymphoma patients

Background: Cancer patients have a high risk of new or recurrent venous thromboembolism. Thrombosis decrease 1 year life expectancy of malignant lymphoma patients. In the last 10 years, it has been continuosly developed a method to detect early venous thrombosis by combining Modified Wells (MW), D-dimer and Doppler ultrasonography level but only 25% are detected early. Objective: We analyzed the association between MW score and D-dimer level. Method: It is an analytic observational study of LNH and LH patients based on clinical and histopathological diagnosis who had never received chemotherapy. The subjects were 35 patients with malignant lymphoma consisting of 30 LNH patients and 5 LH patients. D-dimer was measured using immunochromatography method. Result: There was a positive linear relationship between MW score and D-dimer level with p=0.001 and r=0.462. However, there was no association in LH patients (p=0.215). Conclusion: There was a moderate positive correlation between MW scores and D-dimer levels in naive LNH patients

The Effect of CHOP or RCHOP Chemotherapy Regiment on D-dimer Levels of Non-Hodgkin Lymphoma Patients

Background: One of the therapeutic modality in patients with Non-Hodgkin’s lymphoma (LNH) is chemotherapy. Chemotherapy drugs given to Non-Hodgkin’s lymphoma patients could lead to hypercoagulability state due to damage of tumour and endothelial cells. The hypercoagulable state can increase the thromboembolic event rates in Non-Hodgkin’s lymphoma patients receiving chemotherapy. The impact of chemotherapy drugs was measured by D-dimer examination as a marker of coagulation cascade activation and fibrinolysis. Objective: To determine the effects of CHOP or RCHOP chemotherapy on D-dimer levels in Non-Hodgkin’s lymphoma patients. Material and Methods: This was an observational analytic study with pre- and post-test studies. Followed by 30 Non-Hodgkin’s lymphoma patients who have never received chemotherapy. D-dimer level was measured by ELFA examination before and after 3 cycles of CHOP or RCHOP chemotherapy. Results: Most of the patients were men with mean age 49 years, stage III, and histopathology classification of International Working Formulation diffuse of large cell intermediate grade also undergoing RCHOP chemotherapy. The mean D Dimer level of pre chemotherapy was 890.92+ 436.44 ng/ml and the mean of post chemotherapy D-Dimer level was 1714+ 789.34 ng/ml. Wilcoxon sign rank test on D Dimer level pre and post chemotherapy showed significant difference. Analysis of pre and post chemotherapy D Dimer in different regimen namely CHOP and RCHOP also showed significant differences but tended to be higher in RCHOP regimen (p= 0.015). Conclusion: There was a significant increase in post-chemotherapy D Dimer level in patients receiving CHOP or RCHOP regime