Karakteristik dan Jumlah Leukosit pada Anak Penderita Leukemia Limfoblastik Akut yang Menjalani Kemoterapi Fase Induksi di Rumah Sakit Al Islam Bandung

Leukemia limfoblastik akut (LLA) adalah kelompok keganasan heterogen dengan sejumlah kelainan genetik khas yang menghasilkan berbagai perilaku klinis dan respons terhadap terapi. Pasien LLA pada umumnya identik dengan jumlah leukosit yang tinggi, terapi saat ini adalah dengan cara kemoterapi yang terdiri atas 3 fase, yaitu induksi, konsolidasi, dan pemeliharaan. Keberhasilan kemoterapi ditentukan banyak faktor antara lain adalah terjadi remisi setelah kemoterapi fase induksi. Penelitian ini bertujuan mengetahui karakteristik dan jumlah leukosit pada anak penderita LLA setelah fase induksi kemoterapi. Metode yang digunakan adalah deskriptif dengan rancangan potong lintang yang menggunakan data rekam medik pasien LLA periode tahun 2019 usia 0 - 15 tahun. Penelitian ini dilaksanakan selama bulan Oktober 2020, teknik pengambilan data menggunakan total sampling. Pada penelitian ini didapatkan 137 data rekam medik, data yang memenuhi kriteria inklusi sebanyak 74 data. Kasus LLA paling banyak terjadi pada usia 0 - 5 tahun pada 41 pasien (55%), jenis kelamin laki-laki 43 pasien (58%), status gizi baik 46 pasien (62%), morfologi sumsum tulang remisi 63 pasien (85%), dan jumlah leukosit 4500-13500/mm3 pada 52 pasien (70%), remisi sumsum tulang terbanyak pada jumlah leukosit 4 pada 45 pasien (61%). Simpulan, karakteristik pasien LLA terba500-13500/mm3nyak laki-laki, usia 0 - 5 tahun status gizi baik dan morfologi sumsum tulang remisi. Characteristics and Number of Leukocytes in Children with Acute Lymphoblastic Leukemia who Underwent Induction Phase Chemotherapy at Al Islam Hospital BandungAcute lymphoblastic leukemia (ALL) is a heterogeneous group of malignancies with a number of characteristic genetic disorders that produce a variety of clinical behaviors and responses to therapy. LLA patients are generally synonymous with high leukocyte counts. Current therapy is chemotherapy which consists of 3 phases, namely induction, consolidation, and maintenance. The success of chemotherapy is determined by many factors, including remission after induction phase chemotherapy. This study aims to determine the characteristics and number of leukocytes in children with LLA after the chemotherapy induction phase. The method used was descriptive with a cross-sectional design using medical records of LLA patients periode 2019 aged 0-15 years. study was held in October 2020. In this study, there were 137 medical record data, data that met the inclusion criteria were 74 data. LLA cases in this study mostly occurred at the age of 0 - 5 years, amounting to 41 patients (55%), male gender totaled 43 patients (58%), good nutritional status totaled 46 patients (62%). ), the morphology of bone marrow remission totaled 63 patients (85%), and for the number of leukocytes 4500 - 13500/mm3 as many as 52 patients (70%), the greatest occurrence of bone marrow remission was in the number of leukocytes 4500/mm3-13500/mm3 as many as 45 patients (61%). In conclusion, characteristics of most ALL patients are male, age of 0 - 5 years with good nutritional status and bone marrow morphology showing remission. Characteristics and Number of Leukocytes in Children with Acute Lymphoblastic Leukemia who Underwent Induction Phase Chemotherapy at Al Islam Hospital Bandung

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Correlative Study Between Nutritional Status and Remission Outcome in Childhood Acute Lymphoblastic Leukemia in Dr. Soetomo General Hospital Surabaya

Biomolecular and Health Science Journal ◽

10.20473/bhsj.v2i1.12723 ◽

2019 ◽

Vol 2 (1) ◽

pp. 27

Author(s):

Asma' Athifah ◽

Siti Nurul Hidayati ◽

Sulistiawati Sulistiawati

Keyword(s):

Acute Lymphoblastic Leukemia ◽

Nutritional Status ◽

General Hospital ◽

Risk Group ◽

Lymphoblastic Leukemia ◽

High Risk Group ◽

Childhood Acute Lymphoblastic Leukemia ◽

Induction Phase ◽

Cross Sectional ◽

Term Survival

Introduction: The most common malignancy that is diagnosed in children is acute lymphoblastic leukemia. Undernourished children tend to have poorer long term survival. This descriptive analytic study is aimed towards analyzing the correlation between nutritional status at diagnosis and outcomes of induction phase therapy in childhood acute lymphoblastic leukemia at the Department of Pediatrics Dr. Soetomo General Hospital Surabaya in 2014.Methods: A cross-sectional method using the medical records of patients is used in this study. The nutritional statuses of patients are calculated using weight for length/height trough curves of WHO 2006 or CDC 2000.Results: The results show that from 45 children diagnosed with ALL, 53% are of the age ≤ 5 years old, with 58% males and 42% females. 13% of the patients are in the high risk group and 87% are in the standard risk group. Nutritional statuses of patients are 2% of them obese experienced remission after induction phase therapy, 56% normal with 80% of them experienced remission. 40% underweight with 89% of them experienced remission and 11% not experienced remission, 2% malnutrition and experienced remission. There is no correlation between the nutritional status of children with acute lymphoblastic leukemia with the outcome of induction phase (p = 0.798).Conclusion: In conclusion, there is no correlation between nutritional status and remission outcome of patients with ALL in the induction phase of therapy. However, high percentage of underweight patients shows nutrition needs special attention to improve therapy outcomes.

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Hubungan Indeks Massa Tubuh dan Tercapainya Remisi pada Anak Penderita Leukemia Limfoblastik Akut

e-CliniC ◽

10.35790/ecl.v8i1.27186 ◽

2019 ◽

Vol 8 (1) ◽

Author(s):

Venita S. Pojoh ◽

Max F. J. Mantik ◽

Jeanette I. Ch. Manoppo

Keyword(s):

Body Mass Index ◽

Acute Lymphoblastic Leukemia ◽

Body Mass ◽

Immune Cell ◽

Lymphoblastic Leukemia ◽

Cancer Center ◽

Induction Phase ◽

Cross Sectional ◽

Cross Sectional Design ◽

The Relationship

Abstract: Acute lymphoblastic leukemia (LLA) is the most common type of leukemia in children. Until now chemotherapy is still used as the main treatment. One aspect that affects the success of chemotherapy is body mass index (BMI). BMI values in children with LLA tend to be unstable, low, or high. This is triggered by natural immune cell disorders which have an impact on increasing cytokines and side effects of treatment. This study was aimed to determine the relationship between BMI and the achievement of remission in children with ALL. This was a retrospective and analytical study with a cross-sectional design. Samples were ALL patients who had been given induction phase of chemotherapy during 2015-2018 based on medical records at Estella Children's Cancer Center, Prof. Dr. R. D. Kandou Hospital Manado. The results obtained 52 samples which were evaluated and analyzed to determine the relationship of BMI and the achievement of remission. The Spearman correlation test showed a significant value of p=0.799 (p>0.05). In conclusion, there was no relationship between BMI and the achievement of remission in children with ALLKeywords: body mass index, remission, acute lymphoblastic leukemia Abstrak: Leukemia limfoblastik akut (LLA) merupakan jenis leukemia yang paling sering terjadi pada anak-anak. Sampai saat ini kemoterapi masih dipakai sebagai pengobatan utama. Salah satu aspek yang memengaruhi keberhasilan kemoterapi yaitu indeks massa tubuh (IMT). Nilai IMT pada anak penderita LLA cenderung tidak stabil, bisa kurang tetapi juga lebih. Hal ini dipicu oleh gangguan sel imun alami yang dialami penderita kemudian berdampak terhadap peningkatan sitokin serta efek samping pengobatan. Penelitian ini bertujuan untuk mengetahui hubungan antara IMT dan tercapainya remisi pada anak penderita LLA. Jenis penelitian ialah analitik retrospektif dengan desain potong lintang. Sampel penelitian ialah pasien LLA yang telah diberikan kemoterapi fase induksi periode 2015-2018, didapatkan dari rekam medik di Pusat Kanker Anak Estella RSUP Prof Dr. R. D. Kandou Manado. Hasil penelitin mendapatkan 52 sampel, kemudian dievaluasi dan dianalisis untuk melihat hubungan IMT dan tercapainya remisi pada sampel. Hasil uji korelasi Spearman menunjukkan nilai p=0,799 (p>0,05). Simpulan penelitian ini ialah tidak terdapat hubungan antara IMT dan tercapainya remisi pada anak penderita LLA.Kata kunci: Indeks massa tubuh, remisi, leukemia limfoblastik akut

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Hubungan Indeks Massa Tubuh dan Tercapainya Remisi pada Anak Penderita Leukemia Limfoblastik Akut

e-CliniC ◽

10.35790/ecl.8.1.2020.27186 ◽

2019 ◽

Vol 8 (1) ◽

Author(s):

Venita S. Pojoh ◽

Max F. J. Mantik ◽

Jeanette I. Ch. Manoppo

Keyword(s):

Body Mass Index ◽

Acute Lymphoblastic Leukemia ◽

Body Mass ◽

Immune Cell ◽

Lymphoblastic Leukemia ◽

Cancer Center ◽

Induction Phase ◽

Cross Sectional ◽

Cross Sectional Design ◽

The Relationship

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Pentoxifylline During Steroid Window At Induction To Remission Increases Apoptosis In Childhood Acute Lymphoblastic Leukemia

Blood ◽

10.1182/blood.v122.21.2623.2623 ◽

2013 ◽

Vol 122 (21) ◽

pp. 2623-2623

Author(s):

Oscar Gonzalez-Ramella ◽

Jimenez-Lopez Xochiquetzatl ◽

Sergio Gallegos-Castorena ◽

Pablo Ortiz-Lazareno ◽

Jose Manuel Lerma-Diaz ◽

...

Keyword(s):

Bone Marrow ◽

Acute Lymphoblastic Leukemia ◽

Complete Remission ◽

Cancer Cells ◽

Lymphoblastic Leukemia ◽

Remission Induction ◽

Control Group ◽

Induction Phase ◽

Study Group ◽

Significant Difference

Abstract Introduction Acute lymphoblastic leukemia (ALL) is the most common cancer diagnostic in children, and it represents the second death cause in this population. Despite advances in the treatment of childhood ALL, there are small portion of patients whom still succumb to this disease. A reduced apoptosis in cells plays an important role in carcinogenesis. This phenomenon is an important component in the cytotoxicity induced by anticancer drugs. A currently challenge is the chemotherapy resistance of tumor cells, inhibiting the apoptosis induced by chemotherapy. Pentoxifylline, (PTX) has been studied for its role on increase of apoptosis on cancer cells by different pathways. Our group has reported its efficacy in vitro and ex vivo in increasing apoptosis induced by chemotherapy drugs such as adriamycin and cisplatin in fresh leukemic human cells, lymphoma murine models and cervical cancer cells. We conducted a phase 1 controlled randomized trial to evaluate the efficacy of adding PTX to the steroid window during the remission induction phase in new diagnosed children with ALL. Methods We included all children from both sexes from 9 months to 17 years old during October 2011 to December 2012. Patients were divided into 3 groups, the first one as a non-malignant control group (NL group) included children with a non-hematology disease in which bone marrow aspiration (BMA) was mandatory in order to reach the diagnosis. The second one, the ALL control group whom received prednisone (PRD group) for the steroid window at 40mg/m2/day PO from day -7 to day 0; and then the third one (PTX group), the study group which included children receiving the steroid phase with PRD as early described, plus PTX at 10mg/kg/day IV divided in 3 doses, at the same days as recommended in our treatment protocol (Total Therapy XV). For all 3 groups a BMA was performed at diagnosis, for PRD group as well as PTX group, a second BMA was also collected at day 0. Apoptosis was evaluated by means of Annexin V Apoptosis Detection Kit FITC/PI (eBioscience¨, San Diego, CA, USA) in 1×106 bone marrow mononuclear cells. We measured minimal residual disease (MRD) by flow cytometry at day 14 to demonstrate complete remission in leukemic patients. Statically analysis was performed by U Man Whitney. Results We enrolled 32 patients: 10 in NL group; 11 in PRD group; and 11 in PTX group. The median age of all groups was 6 years (range 9 months-17 years). In PRD group, patient 1 abandoned treatment after administration of day 0, nevertheless the second BMA sample was collected. Patient number 7 died at day 4 due to complications from tumor lysis syndrome. Consequently, in these patients we were not able to measure MRD and BM aspiration at day 14. Except one patient in PRD group, all achieved complete remission at day 14. We did not find any significant difference between NL group and PRD and PTX groups before intervention (U=32 p=0.7; U=28.5 p=0.48 respectively). There was no significant difference between treatment groups before intervention (U= 37 p=0.79). However, after treatment we found an important difference between PRD and PTX groups, we observed an increase in apoptosis in PTX group in comparison with PRD group (U=17.5 p=0.04). There were no adverse effects during treatment. Conclusions The present study is the first one that shows the efficacy of PTX in increasing apoptosis induced by PRD in new ALL diagnosed children, whom have not received any treatment yet. This might be helpful, not only in patients with relapse, but to increase the overall cure rate in ALL. Further studies are needed to prove this hypothesis. With this objective, our study group is already planning a second trial were PTX will be given during all remission induction phase. Experimental reports strongly suggest that PTX induces inhibition of the transcription factor NF-ĸB, by inhibiting survival gens and facilitating apoptosis. To prove it, we are currently processing these patients' samples to know their genetic expression. Disclosures: No relevant conflicts of interest to declare.

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Prognostic Factors and Survival Rate of Childhood Acute Lymphoblastic Leukemia in Eastern Indonesia: Kaplan–Meier and Cox Regression Approach

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2020.5230 ◽

2020 ◽

Vol 8 (T2) ◽

pp. 204-209

Author(s):

Arsin A. Arsunan ◽

Rezki Elisafitri ◽

Atjo Wahyu ◽

Aisyah Aisyah

Keyword(s):

Prognostic Factors ◽

Acute Lymphoblastic Leukemia ◽

Survival Rate ◽

Prognostic Factor ◽

Nutritional Status ◽

Cox Regression ◽

Lymphoblastic Leukemia ◽

Childhood All ◽

Kaplan Meier ◽

Leukocyte Counts

BACKGROUND: Acute lymphoblastic leukemia (ALL) is one of the most common childhood hematological malignancies with an incident each year that tends to increase. AIM: This study aims to determine the survival rate of childhood ALL in Dr. Wahidin Sudirohusodo General Hospital and the prognostic factors that influence it. METHODS: A retrospective cohort design was conducted among childhood ALL. The samples were patients ALL diagnosed since January 1, 2014, until 31, 2017, in Dr. Wahidin Sudirohusodo General Hospital. A total of 109 patients were selected by simple random sampling. Data collected through medical records observations. Data were analyzed using Kaplan–Meier and Cox regression analysis. RESULTS: The cumulative survival rate of childhood ALL was 26%. The prognostic factors associated with survival of childhood ALL were nutritional status (p = 0.028), leukocyte counts (p = 0.000), platelet counts (p = 0.000), and comorbidity (p = 0.000). Based on multivariate analysis with Cox regression, the most influencing prognostic factor on survival of ALL patients was comorbidity (p = 0.000, hazard ratio = 3.699 confidence interval 95% 1.945–7.033). Childhood ALL with comorbidities had a risk of death 3699 times higher than childhood ALL without comorbidities. CONCLUSION: Nutritional status, leukocyte counts, platelet counts, and comorbidity were prognostic factors that influence survival of childhood ALL. Comorbidity was the most influencing prognostic factor on survival of childhood ALL.

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ANGKA KEJADIAN DIARE PADA ANAK DENGAN LEUKEMIA LIMFOBLASTIK AKUT DI RSUP PROF. DR. R. D. KANDOU MANADO PERIODE TAHUN 2011-2015

e-CliniC ◽

10.35790/ecl.4.1.2016.10999 ◽

2016 ◽

Vol 4 (1) ◽

Author(s):

Fatmawati Latamu ◽

Jeanette I. Ch. Manoppo ◽

Max F. J. Mantik

Keyword(s):

Acute Lymphoblastic Leukemia ◽

Medical Records ◽

Lymphoblastic Leukemia ◽

Transmitted Disease ◽

The Body ◽

Induction Phase ◽

Inclusion Criteria ◽

Cross Sectional ◽

Common Cause ◽

Foreign Objects

ABSTRACTBackground : Leukemia is a type of non-transmitted disease that cause death with a large number of cases, especially in children. Leukemia is the most common childhood cancer. Acute Lymphoblastic Leukemia (ALL) is approximately 75% of all cases. One of the main consequences of leukemia is inability of the immune system defending the body from the invasion of foreign objects. As a result of infection or bleeding is the most common cause of death in patient with leukemia. Diarrhea is one of the infections that can be found in children with Acute Lymphoblastic Leukemia. Diarrhea in children with Acute Lymphoblastic Leukemia can occur either from the disease itself or due to chemotherapy. The purpose of this study is to describe the incidence of diarrhea in children with acute lymphoblastic leukemia in Prof. R. D. Kandou Hospital Manado year period 2011-2015.Methods : This study is a descriptive retrospective, with cross sectional approach by collecting data medical records of pediatric patient with ALL in RSUP Prof. Dr. R. D. Kandou Manado then describe the incidence of diarrhea. Samples were 60.Results : The result obtained 60 patients who met the inclusion criteria, and 17 patients had diarrhea. Diarrhea in children with ALL is more common in induction phase, and the duration of diarrhea more to less than 7 days (acute diarrhea).Conclusion : From this result, it can be concluded that the incidence of diarrhea in children with Acute Lymphoblastic Leukemia in Prof. DR. R. D. Kandou Hospital Manado year period 2011-2015 is low enough.Keywords : Acute Lymphoblastic Leukemia (ALL), Diarrhea, ChildABSTRAKLatar Belakang : Leukemia merupakan jenis penyakit tidak menular yang menyebabkan kematian dengan jumlah kasus yang tidak sedikit khususnya pada anak-anak. Leukemia adalah kanker anak yang paling sering. Leukemia Limfoblastik Akut (LLA) berjumlah kira-kira 75% dari semua kasus. Salah satu konsekuensi utama dari Leukemia adalah ketidakmampuan sistem imum mempertahankan tubuh dari invasi benda asing. Akibatnya infeksi atau perdarahan hebat adalah penyebab tersering kematian pada pasien leukemia. Diare merupakan salah satu infeksi yang dapat dijumpai pada anak dengan Leukemia Limfoblastik Akut. Diare pada anak dengan Leukemia Limfoblastik Akut dapat terjadi baik akibat dari Leukemia Limfoblastik Akut itu sendiri maupun akibat dari kemoterapi yang diberikan.Metode : Penelitian ini bersifat retrospektif deskriptif, dengan pendekatan potong lintang dengan cara mengumpulkan rekam medik pasien anak dengan LLA di RSUP Prof. Dr. R. D. Kandou Manado, kemudian mendeksripsikan kejadian diare.Hasil : Didapatkan 60 pasien yang memenuhi kriteria inklusi, dan 17 pasien mengalami diare. Diare pada anak dengan LLA lebih sering terjadi pada fase induksi, dan lamanya diare lebih banyak pada < 7 hari (diare akut).Kesimpulan : Angka kejadian diare pada anak dengan Leukemia Limfoblastik Akut di RSUP Prof. DR. R. D. Kandou periode tahun 2011-2015 cukup rendah.Kata Kunci : Leukemia Limfoblastik Akut (LLA), Diare, Anak

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Blood component therapy, demographic and outcome feature of pediatric acute lymphoblastic leukemia

Journal of Preventive Epidemiology ◽

10.34172/jpe.2021.37 ◽

2021 ◽

Vol 6 (2) ◽

pp. e37-e37

Author(s):

Mehran Noroozi ◽

Farid Ghazizadeh ◽

Saba Fani

Keyword(s):

Bone Marrow ◽

Acute Lymphoblastic Leukemia ◽

Lymphoblastic Leukemia ◽

Fresh Frozen Plasma ◽

Study Data ◽

Blood Component ◽

Cross Sectional ◽

Blood Component Therapy ◽

Pediatric All ◽

The Mean

Introduction: Acute lymphoblastic leukemia (ALL) is the most common childhood malignancy, with an annual incidence rate of three to four cases per 100000 children. Most children with ALL frequently receive blood products including packed cells, platelets, fresh frozen plasma (FFP) and whole blood in the course of chemotherapy and these transfusions may affect ALL outcomes. Objectives: This study aimed to evaluate blood component therapy together with demographic and outcome features of pediatric ALL patients. Patients and Methods: Demographic information of 208 patients with pediatric ALL from February 2011 to August 2019 enrolled in this cross-sectional study. Data is gathered and rechecked from archive files and e-files of Motahari hospital. Results: The mean age of patients at diagnosis was 5.48±3.38 years and Pre-B ALL was the most common phenotype (94.3%). 130 Out of 208 patients were treated with the new protocol and 78 patients were treated with the BFM98 protocol. The majority of relapses were in the bone marrow. The average of received packed cell, platelet and FFP were 4.32±2.93, 5.97±7.09 and 5.29±6.6 units, respectively. The mean overall survival of patients was 3.42±2.58 years in 10 years. Conclusion: According to this study, most of the patients were 5 to 15 years old. Dominant subtype of disease was B-cell type. Most of the deaths were one to 6 years after diagnosis. The relapse rate was about 31% and most of them were in the bone marrow.

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Blood glucose level during induction phase chemotherapy in childhood acute lymphoblastic leukemia

Paediatrica Indonesiana ◽

10.14238/pi60.4.2020.197-2 ◽

2020 ◽

Vol 60 (4) ◽

pp. 197-2

Author(s):

Nunki Andria ◽

Annang Giri Moelyo ◽

Muhammad Reza

Keyword(s):

Blood Glucose ◽

Acute Lymphoblastic Leukemia ◽

Nutritional Status ◽

Blood Glucose Level ◽

Glucose Level ◽

Side Effect ◽

Lymphoblastic Leukemia ◽

Childhood Acute Lymphoblastic Leukemia ◽

Induction Phase ◽

Remission Status

Background Steroids and L-asparaginase (L-Asp) are agents used in induction phase chemotherapy for childhood acute lymphoblastic leukemia (ALL). Both agents are often reported to have the side effect of hyperglycemia, and native L-Asp is also reported to cause hypoglycemia. In ALL patients, hyperglycemic events during chemotherapy can cause lower 5-year overall and relapse-free survival. Objective To investigate the incidence of abnormal blood glucose level (BG) as the side effect of prednisone and L-Asp during induction phase chemotherapy, its predisposing factors, and its effect on remission status. Methods This cohort prospective study was conducted in 36 children aged 1-18 years who were newly diagnosed with childhood ALL at Dr. Moewardi Hospital, Surakarta, Central Java. Subjects’ nutritional status consist of wellnourished and undernourishment. Subjects underwent BG monitoring. At the end of induction phase chemotherapy, subjects underwent bone marrow puncture (BMP) evaluation to assess their response to chemotherapy and the effect of abnormal BG on remission status. Results Hypoglycemia, a combination of hypoglycemia and hyperglycemia, hyperglycemia, as well as euglycemia, were experienced by 9, 7, 6, and 14 subjects, respectively. Nutritional status was found to be a significant risk factor for abnormal BG. There was no significant difference in remission status at the end of induction phase chemotherapy between the euglycemic group and abnormal BG groups (P=0.533). Conclusion Abnormal BG during induction phase chemotherapy did not affect remission status at the end of induction phase. Undernourishment is also found to be a predisposing factor in abnormal BG.

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Hypertension, high-dose corticosteroids, and renal infiltration in children with acute lymphoblastic leukemia

Paediatrica Indonesiana ◽

10.14238/pi54.6.2014.372-6 ◽

2014 ◽

Vol 54 (6) ◽

pp. 372 ◽

Cited By ~ 1

Author(s):

Andry Juliansen ◽

Murti Andriastuti ◽

Sudung Pardede ◽

Rini Sekartini

Keyword(s):

Acute Lymphoblastic Leukemia ◽

Lymphoblastic Leukemia ◽

Cross Sectional Study ◽

High Dose ◽

Induction Phase ◽

Newly Diagnosed ◽

Sectional Study ◽

Cross Sectional ◽

Common Risk Factors ◽

The Difference

Background Hypertension is a rarely recognized complicationof acute lymphoblastic leukemia (ALL). The incidence ofhypertension in ALL patients in Indonesia remains unknown,but the most common risk factors are corticosteroid use duringinduction-phase chemotherapy and renal leukemic infiltration.Objective To determine the incidence of hypertension in childrenwith ALL, and to assess for associations of high-dose corticosteroids,renal infiltration, and hyperleukocytosis to hypertension.Methods This was a cross-sectional study involving 100 childrenaged 2-18 years. Subjects were newly diagnosed ALL patients andthose underwent induction-phase chemotherapy in the PediatricWard or Outpatient Clinic at Cipto Mangunkusumo or DharmaisHospitals.Results Hypertension occurred in 6 (10%) of 60 newly diagnosedALL patients and 8 (20%) of 40 patients who had receivedhigh-dose corticosteroids, but the difference was not statisticallysignificant (OR=2.25; 95%CI 0.72 to 7.07; P=0.239). Hypertensionwas reported in 8 of 29 subjects who received dexamethasone,but in none of the subjects who received prednisone. However, thedifference in these subgroups was also not statistically significant.Renal enlargement was found in 1 of 14 hypertensive patients, butit was not associated with hypertension (OR=0.80; 95%CI 0.52to 1.24; P=0.417). Hyperleukocytosis was also not associated withhypertension (OR= 0.79; 95% CI 0.20 to 3.11; P=1.000).Conclusion The incidence of hypertension in ALL patients was14%. Hypertension is not associated with renal infiltration orhyperleukocytosis. Furthermore, hypertension is not associatedwith corticosteroid dose, though is found only in subjects whoreceive dexamethasone. [Paediatr Indones. 2014;54:372-6.].

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Hubungan Pemberian Kortikosteroid terhadap Kenaikan Berat Badan pada Anak Penderita Leukemia Limfoblastik Akut Fase Induksi di RSUP Haji Adam Malik Medan

SCRIPTA SCORE Scientific Medical Journal ◽

10.32734/scripta.v2i2.3409 ◽

2021 ◽

Vol 2 (2) ◽

pp. 76-83

Author(s):

Isni Dhiyah Almira ◽

Selvi Nafianti

Keyword(s):

Body Weight ◽

Weight Gain ◽

Acute Lymphoblastic Leukemia ◽

Lymphoblastic Leukemia ◽

Induction Phase ◽

Spearman Correlation ◽

Event Free Survival ◽

Cross Sectional ◽

Corticosteroid Administration ◽

Free Survival

Background: Glucocorticoid corticosteroids have vasoconstrictive, anti-proliferation, anti-inflammatory, and immunosuppressant effects through interactions with glucocorticoid receptors which have also been found in one type of leukemia, acute lymphoblastic leukemia (ALL). The most common side effect long-term use of high dose corticosteroids is increase in body weight resulting in obesity. It is one of the main problems in ALL patients, because it leads to persistent leukemia, increase of the risk of recurrence, and poor event-free survival. This has been associated with the use of glucocorticoids namely dexamethasone and prednisone in the induction phase chemotherapy process. Objectives: This study was intended to determine the association of corticosteroid administration to weight gain in children with ALL induction phase. Methods: The study was analytic-cross sectional. A total of 62 medical records of pediatric patients with ALL in Haji Adam Malik General Hospital Medan in 2015-2018. The data obtained were processed using the Wilcoxon statistical test, the Mann-Whitney test, and the Spearman-Correlation Rank test. Results: Wilcoxon test showed the effect of corticosteroid administration on body weight in the sample (p = 0.001). The Mann-Whitney test showed a difference in the influence of the use of prednisone and dexamethasone on sample body weight (p = 0.001), but it was not found regarding the nutritional status of the sample (p = 0.149). The Spearman-correlation test showed that there was no association of weight gain with the total corticosteroid dose given (p = 0.251). Conclusion: There is an association of corticosteroid administration to body weight in children with ALL induction phase. There are differences in the influence of the use of prednisone and dexamethasone on body weight, while there is no such difference on nutritional status in children with ALL induction phase. There is no association of weight gain based on the total corticosteroid dose given during the induction phase in children with ALL. Keywords: acute lymphoblastic leukemia, corticosteroid, induction phase chemotherapy, weight gain Latar Belakang: Kortikosteroid golongan glukokortikoid memiliki efek vasokontriksi, anti-proliferasi, anti-inflamasi, dan imunosupresan melalui interaksinya dengan glucocorticoid receptor yang juga telah ditemukan pada salah satu jenis leukemia yaitu leukemia limfoblastik akut (LLA). Efek samping paling sering dari penggunaan kortikosteroid jangka panjang dengan dosis tinggi adalah peningkatan berat badan berlebih yang berakibat pada obesitas. Hal ini menjadi salah satu masalah utama pada pasien LLA, karena dapat menyebabkan leukemia persisten, meningkatkan risiko kekambuhan, dan event-free survival yang buruk. Hal tersebut telah dikaitkan dengan penggunaan glukokortikoid deksametason dan prednisone dalam proses kemoterapi LLA fase induksi. Tujuan: Penelitian ini dimaksudkan untuk mengetahui hubungan pemberian kortikosteroid terhadap kenaikan berat badan pada anak penderita leukemia limfoblastik akut fase induksi. Metode: Penelitian yang dilakukan bersifat analitik-cross sectional. Dikumpulkan sebanyak 62 rekam medis pasien anak penderita LLA di RSUP Haji Adam Malik Medan tahun 2015-2018. Data yang diperoleh diolah menggunakan uji statistik Wilcoxon, uji Mann-Whitney, dan uji Rank Spearman-Correlation. Hasil: Uji Wilcoxon menunjukkan adanya pengaruh pemberian kortikosteroid terhadap berat badan pada sampel (p = 0,001). Uji Mann-Whitney menunjukkan adanya perbedaan pengaruh penggunaan prednison dan deksametason terhadap berat badan sampel (p = 0,001), tetapi tidak terhadap status gizi sampel (p = 0,149). Uji Rank Spearman-Correlation menunjukkan tidak terdapat hubungan kenaikan berat badan terhadap total dosis kortikosteroid yang diberikan (p = 0,251). Kesimpulan: Terdapat hubungan pemberian kortikosteroid terhadap berat badan anak penderita LLA fase induksi. Terdapat perbedaan pengaruh penggunaan prednison dan deksametason terhadap berat badan anak penderita LLA fase induksi, tetapi tidak terhadap status gizi. Tidak terdapat hubungan kenaikan berat badan berdasarkan total dosis kortikosteroid yang diberikan selama fase induksi pada anak penderita LLA. Kata kunci: kemoterapi fase induksi, kenaikan berat badan, kortikosteroid, leukemia limfoblastik akut

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