Therapeutic Responses of Imatinib and Nilotinib Among CML Patients in Hasan Sadikin Hospital Bandung

Introduction: Chronic Myeloid Leukemia (CML) is a myeloproliferative Malignancy with an estimated incidence in the world of 1-2 cases per 100,000 adults. The use of Tyrosine Kinase Inhibitors (TKI) as a therapy for CML is still the first choice for treatment, but some cases show a high level of resistance or intolerance to TKI therapy. This study aims to identify the therapeutic responses of imatinib and nilotinib among CML patients in Bandung.Method: This study is an analytical descriptive study of CML patients at Hasan Sadikin Hospital's Hematology and Medical Oncology Outpatient Clinic in 2017. The total number of samples in this study is 244 patients, consisting of 199 patients with Imatinib therapy and 45 patients with Nilotinib therapy. The data is processed using SPSS Statistics 22.0 software.Result: The results showed that CML patients had a median age of 42 years, sex ratio of 1: 1 and the highest prevalence was in Bandung City (21.3%). Hematologic response is dominated by complete hematologic response, as high as 72.86% with Imatinib and 66.67% with Nilotinib. Molecular response 3-6 months post therapy is dominated by suboptimal response in as many as 36,8% with Imatinib and failure in as many as 50% with Nilotinib. Molecular response 12-18 months post therapy is dominated by failure in as high as 69,4% with Imatinib and 52,4% with Nilotinib.Conclusion: Based on the molecular response, the rates of suboptimal response and resistance are quite high. Regular monitoring standards of therapy for CML patients are needed to identify TKI resistance so alternative therapies can be provided to improve the outcomes

The Effect of Vitamin D Supplementation on Disease Activity and Neutrophyl-Lymphocyte Count Ratio in Systemic Lupus Erythematosus Patients with Hypovitaminosis D : a Preliminary Study

Background : Previous studies showed a significant role of Vitamin D in modulating inflammation and immune abnormality in SLE. The correlation between vitamin D supplementation and SLE disease activity remains controversy. Neutrophyl-Lymphocyte count Ratio (NLCR) as an inflammation marker was significantly increased in SLE patients.Objective : To evaluate the effect of vitamin D supplementation on disease activity and neutrophyllypmhocyte count ratio (NLCR) in SLE patients with hypovitaminosis D.Methods : This is a pre-post test study without control group using a consecutive sampling method. SLE patients were enrolled from Rheumatology Clinic of HasanSadikin General Hospital from November 2013-March 2014. Subjects received vitamin D3 2000 IU/day for 3 months. Data was analyzed using Wilcoxon test.Results : We analyzed 28 subjects with 89,3% of vitamin D deficiency and 10,7% of vitamin D insufficiency, which converted to 25% of vitamin D deficiency, 32,1% vitamin D insufficiency and 42,9% normal vitamin D plasma level at the end of the study.After supplementation, Mexican Systemic Lupus Erythematosus Disease Activity Index (MEX-SLEDAI) and NLCR was significantly decreased (median 4(3-8) to 2(0-6) and median 2,95(1,17-7,27) to 2,28 (1,07-4,87), p23 kg/m2) were risks of hypovitaminosis D. Vitamin D supplementation increased mean 25(OH)D serum level by 164,7%, 46,7% decreased of MEX-SLEDAI, and 24,2% decreased of NLCR (p<0,001). Nine subjects (32,1%) achieved remission, 19 subjects (67,9%) atdisease persistence and no subjects experienced flare up after supplementation.Conclusion : The effects of vitamin D3 2000 IU/day supplementation for 3 months are reduced disease activity and NLCR in SLE patients with hypovitaminosisD. The role of NLCR as a simple inflammation marker in this pilot study needs further investigation

Overview of Anemia Among Systemic Lupus Erythematosus Patients in Reproductive Age Women Based on Reticulocyte Hemoglobin Equivalent (RET-He) Level and Reticulocyte Count

Background: Anemia is a common manifestation found among patients with Systemic Lupus Erythematosus (SLE). It may be caused by iron-deficiency, autoimmune hemolytic, and chronic inflammation. Each anemia has different therapy approachments. Without adequatemanagement, anemia may lead to poor prognosis. By identifying the etiology of anemia, appropriate management could be conducted. Reticulocyte Hemoglobin Equivalent (RET-He) and reticulocyte count test may distinguish anemia based on its etiology. This study aimed to give scientific portrayed of the proportion of anemia based on its etiology among patients with SLE using RET-He and reticulocyte count.Method: This study involved women diagnosed with SLE underwent outpatient treatment in Rheumatology Clinic, Dr. Hasan Sadikin General Hospital during SeptemberOctober 2016. Data were collected from blood exam using 35-parameters hematology Sysmex by calculating levels of hemoglobin, RET-He, and reticulocyte count.Results: Seventy four female patients were volunteered as subject in this study with median of age was 29.5 (16-70) years old. Thirty four (46%) of 74 subjects weresuffering from anemia and 12 (35%) of them were between 25-34 years old. Proportion of iron-deficiency anemia, autoimmune hemolytic anemia, and chronic inflammatory anemia were 14 ( 41%), 13 (38%), and 7 (21%), respectively.Conclusion: Based on hemoglobin, RET-He, and reticulocyte count, iron-deficiency anemia is the most common anemia among patients with SLE in repoductive age

The Effect of Vitamin D Supplementation on Disease Activity and Neutrophyl-Lymphocyte Count Ratio in Systemic Lupus Erythematosus Patients with Hypovitaminosis D : A Preliminary Study

Background : Previous studies showed a significant role of Vitamin D in modulating inflammation and immune abnormality in SLE. The correlation between vitamin D supplementation and SLE disease activity remains controversy. Neutrophyl-Lymphocyte count Ratio (NLCR) as an inflammation marker was significantly increased in SLE patients.Objective : To evaluate the effect of vitamin D supplementation on disease activity and neutrophyllypmhocyte count ratio (NLCR) in SLE patients with hypovitaminosis D.Methods : This is a pre-post test study without control group using a consecutive sampling method. SLE patients were enrolled from Rheumatology Clinic of HasanSadikin General Hospital from November 2013-March 2014. Subjects received vitamin D3 2000 IU/day for 3 months. Data was analyzed using Wilcoxon test.Results : We analyzed 28 subjects with 89,3% of vitamin D deficiency and 10,7% of vitamin D insufficiency, which converted to 25% of vitamin D deficiency, 32,1% vitamin D insufficiency and 42,9% normal vitamin D plasma level at the end of the study.After supplementation, Mexican Systemic Lupus Erythematosus Disease Activity Index (MEX-SLEDAI) and NLCR was significantly decreased (median 4(3-8) to 2(0-6) and median 2,95(1,17-7,27) to 2,28 (1,07-4,87), p&lt;0,001, respectively). SLE organ involvement such as mucocutan, hematology and renal also high BMI (&gt;23 kg/m2) were risks of hypovitaminosis D. Vitamin D supplementation increased mean 25(OH)D serum level by 164,7%, 46,7% decreased of MEX-SLEDAI, and 24,2% decreased of NLCR (p&lt;0,001). Nine subjects (32,1%) achieved remission, 19 subjects (67,9%) atdisease persistence and no subjects experienced flare up after supplementation.Conclusion : The effects of vitamin D3 2000 IU/day supplementation for 3 months are reduced disease activity and NLCR in SLE patients with hypovitaminosisD. The role of NLCR as a simple inflammation marker in this pilot study needs further investigation

Howell-Jolly Body-Like Inclusions in Coronavirus Disease 2019 (COVID-19): Possible Novel Findings

Amaylia Oehadian,1 Ian Huang,2,3 Andini Kartikasari,4 Bachti Alisjahbana,5 Delita Prihatni6 1Division of Hematology and Oncology Medic, Department of Internal Medicine Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, Indonesia; 2Department of Internal Medicine Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, Indonesia; 3Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Banten, Indonesia; 4Bandung City Regional General Hospital, Bandung, Indonesia; 5Division of Infectious and Tropical Diseases, Department of Internal Medicine Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, Indonesia; 6Department of Clinical Pathology Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, IndonesiaCorrespondence: Amaylia Oehadian, Department of Internal Medicine, Padjadjaran University/Dr. Hasan Sadikin General Hospital, Jl. Pasteur No. 38, Bandung, West Java, 40161, Indonesia, Email [email protected]: During COVID-19 pandemic, it is difficult to distinguish febrile patient infected by SARS-CoV-2 or bacterial causes. Howell-Jolly bodies are a well-known entity found in red blood cells. They are nuclear fragments, composed of deoxyribonucleic acid, commonly observed in the peripheral blood smears of hyposplenic or asplenic patients. Recently, similar inclusions often referred to as Howell-Jolly body-like inclusions (HJBLIs) have been reported in the neutrophils of patients with acquired immune deficiency syndrome (AIDS) and COVID-19 patient.Aim: To explore whether HJBLIs in peripheral blood smear could differentiate between patients with confirmed SARS-CoV-2 and bacterial pneumonia.Methods: We performed cross-sectional study using secondary data from COVID-19 database and re-evaluated peripheral blood smears to identify HJBLIs. We included confirmed COVID-19 adults age > 18 years who were hospitalized in Dr. Hasan Sadikin General Hospital, Bandung, Indonesia from March 1st 2020–May 31st 2020. We also examined peripheral blood smears in patients with confirmed bacterial pneumonia as a control group. Clinical characteristics including disease severity, CURB-65 score, comorbidity, and the present of HJBLIs in peripheral blood smears were evaluated.Results: Overall, 33 patients were included: 22 were confirmed COVID-19 and 11 were confirmed bacterial pneumonia. The median (interquartile range) age in COVID-19 and patients with bacterial pneumonia were 53 years (40– 64) vs 57 years (53– 71), respectively. Compared with patients with bacterial pneumonia, HJBLIs were significantly higher in COVID-19 patients [21/22 (80.8%) vs 5/11 (45.5%), p 0.001].Conclusion: Howell-Jolly body-like inclusions could be a potential feature to help differentiate between COVID-19 and bacterial pneumonia.Keywords: Howell-Jolly body-like inclusions, COVID-19, bacterial pneumonia, peripheral blood smea