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All Journal International Journal of Integrated Health Sciences The Indonesian Journal of Infectious Diseases Indonesian Journal of Cancer
Agustini, Made Priska Arya
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Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Public Health

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Predictive Factors of Neutropenia Following First Cycle of Chemotherapy in Patients with Non-Hodgkin’s Lymphoma in Bali, Indonesia Pratiwi, Made Sindy Astri; Agustini, Made Priska Arya; Yani, Made Violin Weda; Rena, Ni Made Renny Anggreni
International Journal of Integrated Health Sciences Vol 13, No 2 (2025)
Publisher : Faculty of Medicine Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15850/ijihs.v13n2.4178

Abstract

Background: Chemotherapy-induced neutropenia (CIN) is a common hematologic toxicity that increases infection risk, hospitalization, and treatment delay. Limited data exist on predictive factors of CIN among non-Hodgkin’s lymphoma (NHL) patients in Indonesia, particularly in Bali.Objective: To identify predictive factors of neutropenia following the first cycle of chemotherapy in patients with NHL at Prof. I.G.N.G Ngoerah General Hospital, Bali, Indonesia.Methods: This retrospective cohort study included all NHL patients treated from 2020–2023. Eligible patients were aged ≥18 years, received CHOP-based regimens with or without rituximab, and did not receive G-CSF prophylaxis. Data were obtained from medical records. Assessed risk factors were age, gender, BMI, comorbidities, histopathology grading, extranodal involvement, ECOG status, Ann Arbor stage, IPI score, chemotherapy regimen, pre-treatment blood count, eGFR, LDH, and albumin. The incidence of neutropenia was evaluated after the first chemotherapy cycle.Results: The mean age of the eligible patients (n=112) was 54.53 ± 14.64 years; 46 of them (41%) developed neutropenia. Significant factors associated with neutropenia were histopathology grading (p = 0.030), Ann Arbor stage (p = 0.048), IPI score (p = 0.037), chemotherapy regimen (p = 0.019), and LDH above normal (p = 0.049). Multivariate analysis identified high IPI scores (p = 0.016; OR 6.375; 95% CI 1.416–28.698) and CHOP regimen (p = 0.016; OR 3.033; 95% CI 1.230–7.476) as independent predictors of CIN.Conclusion: High IPI scores and CHOP regimens are strong predictors of neutropenia after the first chemotherapy cycle in NHL patients. Early identification of high-risk patients is essential for preventive management and improved treatment outcomes.
Factors Associated with Mortality of B-cell Non-Hodgkin Lymphoma Patients at Tertiary Care Hospital in Bali, Indonesia Agustini, Made Priska Arya; Pratiwi, Made Sindy Astri; Yani, Made Violin Weda; Rena, Made Renny Anggreni
Indonesian Journal of Cancer Vol 19, No 4 (2025): December
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v19i4.1359

Abstract

Background: Non-Hodgkin Lymphoma (NHL) incidence has increased rapidly in recent decades. Although new treatment methods have been found, the mortality rate of NHL, especially in developing countries, is still high. Several factors can affect the mortality rate of NHL. However, data on factors related to the mortality rate of NHL patients in Bali are still not available. Therefore, this study aims to determine the survival rate and prognostic factors of mortality in NHL patients, especially those with the B-cell type, in Bali.Method: This study is a retrospective cohort study at Prof. I.G.N.G. Ngoerah General Hospital, Bali, Indonesia. The data was collected from electronic medical records from January 2020 to December 2023. The inclusion criteria for this study were all adult patients (aged ≥ 18 years) with a first-time diagnosis of B-cell NHL. Exclusion criteria included patients with other types of cancer, not undergoing chemotherapy, and incomplete medical records. Survival analysis and factors associated with mortality were analyzed using Kaplan-Meier curves, log-rank test, and Cox proportional hazards regression.Results: There were 143 B-cell NHL patients who met the inclusion criteria. The 1-year overall survival rate in this study was 59.4%, with a median survival time of 9 months. The majority of the causes of patient mortality were disease progression (76.7%). An ECOG Performance Status ≥2 (HR = 3.362; 95% CI 1.949 – 5.799; p = 0.000) and high-grade histopathological features (HR = 3.002; 95% CI 1.193 – 7.556; p = 0.020) were significantly associated with poor survival in B-cell NHL patients.Conclusion: The 1-year survival rate of B-cell NHL patients in Bali remains relatively low compared to previous studies. An ECOG performance status ≥ 2 and high-grade histopathological features are prognostic factors for mortality in B-cell NHL patients in Bali.
Diagnostic Challenges of Weil’s Disease with Acute Kidney Injury: A Case Report and Clinical Review Agustini, Made Priska Arya; Dewi, Putu Itta Sandi lesmana; Lestari, I Dewa Ayu Made Dian; Sunaka, I Wayan
The Indonesian Journal of Infectious Diseases Vol. 11 No. 2 (2025): The Indonesian Journal of Infectious Diseases
Publisher : Rumah Sakit Penyakit Infeksi Prof Dr. Sulianti Saroso

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32667/ijid.v11i2.409

Abstract

Background: Severe leptospirosis or Weil’s disease can cause multi-organ failure, which is characterized by jaundice and acute kidney injury in approximately 10% of cases. Its nonspecific symptoms often lead to misdiagnosis with other acute febrile illnesses, resulting in delayed diagnosis. Case Presentation: A 48-year-old male construction worker presented with fever, headache, myalgia, epigastric pain, nausea, and vomiting for four days without any signs of bleeding. The patient lived and worked at a project site adjacent to rice fields. Physical examination revealed fever, icteric sclera, conjunctival suffusion, and tenderness of the gastrocnemius muscle. Laboratory tests showed leukocytosis, thrombocytopenia, impaired renal function, elevated liver enzymes, hyponatremia, and hypokalemia. The patient was diagnosed with Weill’s disease. He was treated with antibiotics and supportive therapy. Sixteen days after discharge, the patient reported gradual improvement and had resumed normal activities. Discussion:  Patients presenting with acute febrile illness should undergo a comprehensive evaluation, and leptospirosis should be considered when leukocytosis, neutrophilia, and thrombocytopenia are observed in a complete blood count. A detailed history focusing on risk factors and associated symptoms, along with additional diagnostic tests based on the criteria, can help guide the diagnosis. Antibiotic therapy should be initiated immediately in patients with suspected or probable leptospirosis without waiting for serological confirmation. Conclusion: This case highlights the diagnostic challenges of leptospirosis, particularly in resource-limited healthcare settings. Enhancing clinical awareness, improving access to rapid diagnostic tools, and optimizing preventive measures are crucial to reducing morbidity and mortality rates
Risk Factors and Infection Patterns of Febrile Neutropenia after Induction Chemotherapy in Patients with Acute Myeloid Leukemia Pratiwi, Made Sindy Astri; Agustini, Made Priska Arya; Rena, Ni Made Renny Anggreni; Bakta, I Made
Indonesian Journal of Cancer Vol 20, No 1 (2026): March
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v20i1.1495

Abstract

Background: Febrile neutropenia (FN) is a serious cause of mortality in acute myeloid leukemia (AML), with a mortality rate of 10-30%. FN often occurs after receiving induction chemotherapy in AML. Patients with FN are susceptible to various infections, but the pathogens are often unknown. It is important to predict FN and identify the specific pathogen of infection. This study aims to identify risk factors and infection patterns of FN after induction chemotherapy in AML patients.Methods: This research was a retrospective cohort study located at Prof. I.G.N.G Ngoerah General Hospital, Bali. The samples were AML patients aged ≥ 18 years treated with induction chemotherapy, cytarabine plus daunorubicin, from 2018 to 2022. The risk factors assessed were age, gender, body mass index, ECOG status, comorbidity, and pre-treatment blood count. The patients who had FN would be assessed for the incidence of infection through microbiological examination.Results: This study included 92 patients aged 19 to 76 years old. As many as 68 patients (73.9%) had FN. A multivariate analysis showed ECOG status (p = 0.004; OR 6.680; 95% CI 1.830 – 24.385), comorbidity (p = 0.010; OR 7.394; 95% CI 1.628 – 33.575), and haemoglobin level ≤ 8 g/dL (p = 0.015; OR 6.043; 95% CI 1.449 – 33.265) as significant risk factors. The most common site of infection was the respiratory tract (63.75%), followed by genitourinary (15%) and skin (8.75%). Most specimens were obtained from sputum (35%), blood (26.25%), and urine (15%). Streptococcus sp., Staphylococcus sp., and Escherichia coli were the top three most common pathogens found. Conclusions: ECOG status, comorbidity, and low haemoglobin level were associated with FN after induction chemotherapy of AML. Patients with FN are susceptible to various infections. The identification of risk factors and infections of FN will facilitate consideration of further treatment in AML.
Co-Authors Dewi, Putu Itta Sandi Lesmana I Made Bakta Lestari, I Dewa Ayu Made Dian Pratiwi, Made Sindy Astri Rena, Made Renny Anggreni Rena, Ni Made Renny Anggreni Sunaka, I Wayan Yani, Made Violin Weda