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All Journal Acta Interna : The Journal of Internal Medicine Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Mutiara Medika: Jurnal Kedokteran dan Kesehatan Jurnal Gizi Klinik Indonesia

Johan Kurnianda

Division Of Hematology And Medical Oncology, Department Of Internal Medicine, Faculty Of Medicine, Universitas Gadjah Mada / Dr. Sardjito Hospital Yogyakarta

Author-ID : 301448

Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Nursing Public Health

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JAK2 mutation and treatment of JAK2 inhibitors in Philadelphia chromosome-negative myeloproliferative neoplasms Susanna Hilda Hutajulu; Johan Kurnianda
Acta Interna The Journal of Internal Medicine Vol 3, No 2 (2013): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

ABSTRACTThe Philadelphia chromosome-negative (Ph-negative) myeloproliferative neoplasms (MPNs) polycythaemia vera (PV), essential thombocythaemia (ET) and primary myelofi brosis (PMF) are clonal disorders of multipotent haematopoietic progenitors. The genetic cause of these disorders was not fully defi ned until a somatic activating mutation in the JAK2 non-receptor tyrosine kinase, JAK2V617F, was identifi ed in most patients with PV and a considerable proportion of patients with ET and PMF. The discovery of JAK2 mutation has changed the molecular reclassification of MPNs and served as a genomic target for therapeutic implication. A number of JAK2 inhibitors have been developed and tested for MPNs. Several JAK2 inhibitors have reached the phases of clinical trial and included patients with intermediate-risk or high-risk MF. This population of MF is the best candidate for trials because currently it has no effective therapy besides patients’ poor survival. Considering all clinical data on Ph negative MPNs, JAK2 inhibitors have shown a clinical benefi t and reduced symptoms in the vast majority of MF cases. The most developed among JAK2 inhibitors is Ruxolitinib, which has demonstrated clinical improvement with well tolerated toxicities. However, JAK2 inhibitor was equally active in patients with and without JAK2 mutation. Other JAK2 inhibitors are less developed, but showed a similar clinical benefi t. Furthermore, its effect on the natural course of MPNs in treating patients needs to be investigated.Keywords: myeloproliferative neoplasms – JAK2 mutation – JAK2 inhibitors.

The Accuracy of Wells Clinical Model for Predicting Pretest Probability in Deep Vein Thrombosis (DVT) at Dr. Sardjito Hospital Dwi Wulansih; Johan Kurnianda; Kartika Widayati
Acta Interna The Journal of Internal Medicine Vol 4, No 1 (2014): Acta Interna The Journal Of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

ABSTRACTBackground: The diagnosis of deep vein thrombosis (DVT) is an important issue in the medical field because a large number of cases are undiagnosed. The accurate diagnosis of the DVT is essential to prevent complications of acute pulmonary embolism and long-term complications. The complication such as pulmonary hypertension and post phlebitis syndrome. It also to avoid improper anticoagulant therapy associated with a high risk of bleeding. There are several models of clinical suspicion of DVT include Hamilton’s score and Wells’ score. The Wells clinical model for predicting pretest probability for DVT has been widely used and tested its validity in several countries in Europe. The accuracy of a Wells clinical model of pretest probability for DVT has not been done for the races of Asia especially in Indonesia.Objective: This study aimed to test the accuracy and precision (sensitivity, specificity and predictive value) of Wells clinical model for predicting pretest probability for diagnose DVT for patients in the Dr. Sardjito Hospital.Methods: This study was a diagnostic study with cross-sectional design. The subjects were patients with DVT symptoms who visited Tulip clinic, outpatient and inpatient in the department of Dr. Sardjito General Hospital during January 2011-May 2012. In this study, a total of 100 patients were participated the Wells clinical model of pretest probability for DVT examination, Doppler ultrasound and D-dimer examination. The negative results on the fi rst ultrasound examination will be examined again 1 week later.Results: DVT was confi rmed in 56 patients (56%) from 100 patients. The baseline characteristics showed the number of women more than men and the mean age was 52.98 ±1.335 years. The 57% of subjects were women and the median age was ≥60 years. The most frequent risk factors of DVT were cancer 49 patients (49%), bed ridden 42 patients (42%) and elderly 33 patients (33%). The accuracy of the Wells clinical model of pretest probability for DVT was 81%, precision was 77.6%, sensitivity was 92.8%, specifi city was 65.9%, and negative predictive value was 87.9%.Conclusion: The Wells clinical model for predicting pretest probability in DVT has a high accuracy, moderate precision, high sensitivity and poor specifi city to diagnose DVT at Dr. Sardjito Hospital.Keywords: deep vein thrombosis/DVT, the Wells clinical model of pretest probability for DVT, accuracy test, precision

Telomere and telomerase in hematological disorders Focusing on bone marrow failure syndromes and hematological malignancies Mardiah Suci Hardianti; Ibnu Purwanto; Johan Kurnianda
Acta Interna The Journal of Internal Medicine Vol 4, No 2 (2014): The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

ABSTRACTWe review the present knowledge of telomeres and telomerase with special attention to their role in hematological disorders especially bone marrow failure syndromes including acquired aplastic anemia and myelodysplastic syndromes, as well as acute and chronic myeloid leukemia. The current understanding on the role of telomere and telomeres dysfunctions in hematological disorders leads us to a better understanding on the pathology of the diseases as well as considering some possibilities to employ the measurement of telomere length and telomere activity in disease prognostication. Several treatment options targeting telomere and telomerase being developed are also reviewed.Keywords: telomere- telomerase- bone marrow failure syndromes- hematological malignancies

Prolonged Survival in a Non-Small Cell Lung Cancer with Brain Metastasis Treated with a Brain Mass Evacuation and Gefi tinib Mardiah Suci Hardianti; Johan Kurnianda
Acta Interna The Journal of Internal Medicine Vol 5, No 1 (2015): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

The incidence of brain metastasis (BM) is reported to be increase about 20-40% over the last few years in patients with non-small-cell lung cancer (NSCLC).1 The use of epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) in NSCLC patients with BM, especially those harboring EGFR mutations have been reported.

Prognostic Value Of Chemotherapy-Induced Neutropenia In Metastatic Colorectal Cancer At Rsup Dr Sardjito Yogyakarta Muhammad Ihsan Qomaruzzaman; Johan Kurnianda; Mardiah Suci Hardianti
Acta Interna The Journal of Internal Medicine Vol 6, No 1 (2016): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

Background: Colorectal cancer is the third largest incidence of cancer in the world and is the third most common cause of death in women and men . Five-year overall survival (OS) in colorectal cancer who have undergone metastasis was 10 % . Hematologic toxicity may be a marker of biological activity of cytotoxic drug on various types of cancer . Neutropeniaafter chemotherapy known to be associated with increased patient survival .Objective : To establish whether chemotherapy-induced neutropenia is predictive of better outcome in patients with metastatic colorectal cancer (mCRC).Methods: This research was a case-control study. Subjects were patients with metastatic colorectal cancer in the Cancer Instalation Center Tulip RSUP dr. Sardjito who meet the inclusion and exclusion criteria. Data were analyzed by bivariate analysis using chi square test and multivariate analysis with logistic regression.Results: Neutropenia present in 26 patients (32.5%) of the total 80 patients of the study. Neutropenia were significantly affect OS ( p = 0.001 and OR 7.73, 95% CI: 2.51-23.80). Multivariate logistic regression analysis showed neutropenia and the number of metastases affect OS with p <0.001 and p <0.003.Conclusion: Neutropenia occurring during the two first lines of chemotherapy for metastases colorectal cancer is associated with better survival. Variables that affect OS is the number of metastases and incidence of neutropenia after chemotherapy.

Validation of the Palliative Prognostic Score (PaP score) in Patients with Metastatic Cancers in Dr. Sardjito General Hospital Yogyakarta Prafita Cahya Dewanti; Johan Kurnianda; Kartika Widayati
Acta Interna The Journal of Internal Medicine Vol 9, No 1 (2019): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

Background. The mortality burden of cancer continues to increase in developing countries, most likely because of a late-stage at diagnosis. Identify the terminal stage is important in patients with advanced cancer because no longer aggressive therapy in patients with terminal cancer. Palliative prognostic score (PaP score)is a scoring system to predict the probability of survival within 30 days in patients with advanced cancer. PaP score divided into the heterogeneous patient sample into three iso-prognostic groups related to the chance of 30-days survival. Group A, score: 0 to 5.5 (the probability of survival within 30 days > 70%); Group B, score: 6-11 (the probability of survival in 30 days 30-70%) and group C, the score: 11.5 to 17.5 (the probability of survival in 30 days <30%).Aims. The aim of this study was to validate and to evaluate the prognostic accuracy of the palliative prognostic (PaP score) to predict 30-days survival in patients with metastatic cancers in Dr. Sardjito General Hospital Yogyakarta.Methods. The design of this prognostic study was cohort, including patients with metastatic cancers who were visited in Tulip Hematology and Medical Oncology Clinic, inpatient and outpatient care in Dr. Sardjito General hospital during May 2015 until May 2016. The PaP score calculated in 159 consecutive patients with metastatic cancers. The positive predictive value of the PaP score was evaluated and survival analysis was performed to compare the survival of the three prognostic groups.Results. PaP score tested on 159 subjects with overall median survival was 90 days, 76 subjects categorized into group A, 22 subjects into group B and 61 patients into group C. The 30-day survival probability was 98.7% for group A (median survival could not be assessed), 63.6 % probability of 30-day survival for the group B with median survival was 35 days and for group C with 3.3% probability of 30-day and median survival was 6 days. These survival differences were highly significant (log-rank test of trends, X =203.97; P<0.0001).The positive predictive value of the PaP score in predicting 30-day mortality was 96.7% with an accuracy of PaP the score was 93.1%.Conclusion. PaP score was a valid test tool in determining prognosis in patients with metastatic cancers with high accuracy and precision in predicting 30-days survival.Keywords: PaP score, validation, survival, prognostic, metastatic cancers.

Comparison of Prognostic Scores in Chronic Myeloid Leukemia (Cml) Patients with Bcr-Abl Mutation Types B3a2 and B2a2 in Dr. Sardjito General Hospital Nina Mulyani; Johan Kurnianda; Mardiah Suci Hardianti
Acta Interna The Journal of Internal Medicine Vol 10, No 1 (2020): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/actainterna.61296

Background. Chronic Myeloid Leukemia (CML) is a myeloproliperative malignancy that is caused byreciprocal translocation between chromosomes 9 and 22 which form the BCR-ABL fusion gene. Most CML patients have a major type of BCR-ABL mutation. There are b3a2 and b2a2 types, which produce different oncoproteins in 25 amino acid elements. The expression of different proteins is thought to cause differences in clinical manifestations, laboratory, and prognosis. In CML, there are several prognostic scoring systems, including Sokal, Hasford, andEUTOS scores which combine clinical and laboratory parameters. The effect of this genomic breakpoint location on clinical and biological characteristics is still controversial.Aims. The aim of this study was to determine the comparison of prognostic scores between CML patients with b3a2 and b2a2 BCR-ABL mutation types in Dr. Sardjito General Hospital.Methods. This study was a cross sectional retrospective study used secondary data from medical records of Dr. Sardjito General Hospital, from March 2014 to April 2016. The prognostic score of Sokal, Hasford, and EUTOS was calculated in the BCR-ABL mutation type groups b3a2 and b2a2. Data were analyzed by Chi Square test.Results. A total of 113 CML patients were analyzed with 74 (65.5%) b3a2 mutation type groups and 39 (34.5%) b2a2 mutation type groups. Hemoglobin levels, leukocytes, platelets, basophils, and eosinophils did not differ significantly between the two groups of mutation types. Meanwhile, the statistical test for the phase of disease when the patient was first diagnosed in both types of mutations showed a significant difference (p = 0.005). More patients with types of b2a2 mutations came in the acceleration and blast crisis phases than b3a2 types. However, Sokal, Hasford, and EUTOS prognostic scores in the b3a2 mutation type group were not significantly different from the b2a2 group (p> 0.05).Conclusions. There was no significant difference in prognostic scores of CML patients with the b3a2 BCRABL mutation type compared with the b2a2 mutation type in Dr. Sardjito General Hospital Yogyakarta.

Secondary acute myeloblastic leukemia after adjuvant chemotherapy and radiotherapy in breast cancer: A case report Mardiah Suci Hardianti; Johan Kurnianda; Kartika Widayati Taroeno-Hariadi
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 46, No 03 (2014)
Publisher : Journal of the Medical Sciences (Berkala Ilmu Kedokteran)

A rising number of long-term survivors and potential long-term outcome related to the treatment isone of the most important issue due to the advances of management in cancer. The development ofsecondary malignancy has been reported in a number of cohorts. We present a case of breast cancerpatient developing acute myeloid leukemia (AML)- M5 within a relatively short interval of two and ahalf years from her primary treatment with adjuvant chemotherapy with 4 cycles of doxorubicin andcyclophosphamide, followed by 4 cycles of three weekly paclitaxel (AC-T) and radiotherapy. Whatcould be attributed to the occurrence of secondary leukemia in this patient will be discussed.

Diffuse Large B-Cell Lymphoma Complicated by Small Bowel Obstruction after Radiotherapy: a Case Study Diah Ari Safitri; Kartika Widayati Taroeno-Hariadi; Johan Kurnianda; Ibnu Purwanto
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 48, No 3 (2016)
Publisher : Journal of the Medical Sciences (Berkala Ilmu Kedokteran)

ABSTRACTAlthough the spleen is frequently involved in disseminated non-Hodgkin’s lymphoma (NHL), splenic presentation as the initial or only site of disease is uncommon. Treatment modalities include surgery, chemotherapy, and radiation therapy. The priority of cancer follow up is to perform surveillance for recurrent cancer and evaluation of treatment response. Side effects of treatment are frequently missed or overlooked. A 66-year-old woman was presented to our hospital with a month history of spleen enlargement. On physical examination the spleen was palpated at Schuffner 2. Abdominal MSCT scan was suggestive of lymphoma. Surgery revealed adhesion and obstruction of the stomach. Biopsy and gastrojejunostomy shunting were done, but splenectomy was difficult. The pathology anatomy findings confirmed the diagnosis of diffuse non Hodgkin’s lymphoma large B-cell type. Immunohistochemistry showed positive CD3 and CD20. She underwent 6 cycles of rituximab, cyclophosphamide, adriamycin, vincristine, and prednisolone (RCHOP) chemotherapy. CT evaluation done 7 months later revealed that the hilus lienalis lymph nodes and spleen has decrease in size. However, a lumbosacral x-ray done due to back pain revealed metastasis on her 1st and 2nd lumbal spine. After a single fraction of radiotherapy, nausea, vomiting and abdominal distension occurred. A 3 position abdominal x-ray revealed signs of small bowel obstruction. After surgery she has received 9 cycles of zoledronic acid and remained in good condition and ambulatory. Splenic presentation as the initial or only site of non-Hodgkin’s lymphoma (NHL) is uncommon. Acute small bowel obstruction and fistula due to palliative radiation therapy for bone metastasis needs prompt and appropriate treatment.

Convalescent plasma for COVID-19: A reasonable option for the pandemic based on both scientific and practical point of views Mardiah Suci Hardianti; Syahru Agung Setiawan; David Dwi Putera; Teguh Triyono; Jarir At Thobari; Johan Kurnianda
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 52, No 3 (2020): Special Issue: COVID-19
Publisher : Journal of the Medical Sciences (Berkala Ilmu Kedokteran)

Convalescent plasma treatment has become a promising adjunctive option to treat COVID-19. Several case reports consistently supported the feasibility of this approach by showing the safety and improvements of clinical and laboratory aspects from the treated patients. However, more clinical trials are still required to establish the definitive statement about its potential effectiveness. We review the scientific basis for the application of convalescent plasma in COVID-19 to understand its potentials better. We also cover the potential risks and benefits for this treatment in order to be more selective and careful when preparing and deciding to apply this approach. Lastly, we summarize any important points to monitor after the administration of this treatment to prioritize safety and measure the effectiveness of the treatment.

Co-Authors A. Harijadi Agus Siswanto Astuti, Herni David Dwi Putera Diah Ari Safitri Dwi Rohmawati Dwi Wulansih Eiji Tatsumi Ganda Hidayat Herni Astuti Hiroyuki Sakoda I Dewa Putu Pramantara I Dewa Putu Pramantara I Ketut Suada I Wayan Dwija Karyasa Ibnu Purwanto Jamhari Jamhari Jarir At Thobari Kaho Furuta Kartika W. Taroeno-Hariadi Kartika Widayati Taroeno Hariadi Karyasa, I Wayan Dwija Katsuyasu Saigo Kayoko Masuda Ken-Ichi Nagai Mardiah Suci Hardianti Meilani Syampurnawati Muhammad Ihsan Qomaruzzaman Nina Mulyani Noor Asyiqah Sofia Nugroho Wiyadi Prafita Cahya Dewanti Puntodewo Puntodewo Qomaruzzaman, Muhammad Ihsan Sagiri Mangunsudirjo Seiji Kawano Selvyana, Dita Ria Setsuki Isono Shin-Ichi Kondo Shunichi Kumagai Sofia M. Haryana Sukendro Sendjaja Susetyowati Syahru Agung Setiawan Takayuki Takahashi Teguh Triyono Wahyu Wulaningsih Yenita . Yenita Yenita Yoshitaka Hayashi

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