Chronic myelogenous leukemia fase akselerasi pada anak dengan asidosis metabolik dan gizi kurang : Suatu laporan kasus

Riadi Wirawan, Nuri Dyah Indahsari, Djayadiman Gatot - Leukemia mielogenik kronik fase akselerasi pada anak dengan asidosis metabolik dan gizi kurang: Suatu laporan kasua Telah dilaporkan suatu kasus pada anak perempuan berusia 12 tahun yang dirawat dengan diagnosis leukemia mielogenik kronik (CML) dengan asidosis metabolik dan gizi kurang. Keluhan utama perut membesar, tanpa rasa nyeri, kedua tungkai dan bokong merasa nyeri yang hilang timbul, tanpa bengkak dan kemerahan. Pada pemeriksaan fisik didapatkan hepatosplenomegali, limfadenopati multipel, persentase berat badan terhadap usia (54%) dan berat terhadap tinggi badan (60%)berada di bawah presentile 65%. Kelainan laboratorium darah tepi yang didapat berupa anemia normositik normokromik, leukositosis dengan pergeseran ke kiri, dominasi mielosit dan neutrofil, trombositosispada sumsum tulang dijumpai kepadatan sel hiperselular, granulopoiesis dan megakariosit hiperaktif, eritropoiesis tertekan, skor NAP rendah dan pada pemeriksaan anaisis gas darah didapatkan asidosis metabolik terkompensasi sebagian dengan hipoksemia

Current status of cancer care for young patients with nasopharyngeal carcinoma in Jakarta, Indonesia.

BACKGROUND:Nasopharyngeal carcinoma (NPC) is endemic in Indonesia and 20% of the patients are diagnosed before the age of 31. This study evaluates presentation and treatment outcome of young patients in Jakarta, in a tertiary referral centre. METHODS:Forty-nine patients under the age of 31, diagnosed with NPC between July 2004 and January 2007, were evaluated. Baseline data included histological type, stage of disease and presenting symptoms. We intended to follow all patients after diagnosis to reveal treatment outcome and overall survival (OS). RESULTS:All but two patients had advanced stage disease (94%), 7 (14%) had distant metastasis. The median interval between start of complaints and diagnosis was 9 months. Forty-two patients were planned for curative intent treatment. Eleven patients (26%) never started treatment, 2 patients did not complete treatment and 3 patients did not return after finishing treatment. Four patients died before radiation could start. Three patients died within 4 months after treatment. Nine patients (21%) had a complete response. Due to the high number of patients who were lost to follow-up (LFU), OS was analyzed as follows: a best-case (patients censored at last contact) and a worst-case scenario (assuming that patients who did not finish treatment or had disease at last contact would have died). The 2-year OS for patients without distant metastases was 39-71%. CONCLUSION:Treatment outcome for young patients with NPC in this institute was poor. Improvement can be achieved when NPC is diagnosed at an earlier stage and when there is better treatment compliance

Patient overview.

<p>LTFU =  lost to follow-up.</p

Patient & tumor characteristics.

<p>Patient & tumor characteristics.</p

Overall survival: best-case scenario.

<p>All patients who were lost to follow up were censored at the moment of last contact (Log rank is p = 0.021, when comparing patients without distant metastasis: 0–15 vs. 16–30 year). DM  =  distant metastasis at diagnosis; OS  =  overall survival.</p

Overall survival: worst-case scenario.

<p>All patients who were lost to follow up before treatment (n = 11) or during treatment (n = 2), or who had disease at last moment of follow up (n = 6) are assumed to be death (Log rank p =  0. 142, when comparing patients without distant metastasis: 0–15 vs. 16–30 year). DM  =  distant metastasis at diagnosis; OS  =  overall survival.</p

Radiotherapy treatment.

<p>Radiotherapy treatment.</p

Complaints at diagnosis and interval between first appearance and diagnosis.

<p>Complaints at diagnosis and interval between first appearance and diagnosis.</p

Overall survival.

<p>Overall survival.</p