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All Journal Sari Pediatri Paediatrica Indonesiana Indonesian Journal of Cancer Journal of General Procedural Dermatology and Venereology Indonesia
Hikari Ambara Sjakti, Hikari Ambara
Departemen Ilmu Keseahatan Anak Fakultas Kedokteran Universitas Indonesia/Rumah Sakit Dr. Cipto Mangunkusumo, Jakarta
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Public Health

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Microbiological profiles and prognostic factors of infection mortality in febrile neutropenic children with malignancy Yuni Astria; Hindra Irawan Satari; Hartono Gunardi; Hikari Ambara Sjakti
Paediatrica Indonesiana Vol 61 No 5 (2021): September 2021
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi61.5.2021.283-90

Abstract

Background Post-chemotherapy febrile neutropenia results in high morbidity and mortality in children with malignancy. Many prognostic factors, such as microorganism patterns, as well as the use of antibiotics and antifungals can affect the outcomes. However, limited study is available in Indonesia. Objective To determine the microbial profiles, antibiotic sensitivity, and other factors that influence mortality from febrile neutropenia in pediatric malignancies with infections. Methods This retrospective cohort and descriptive study of 180 children with 252 episodes of neutropenic fever was done in Cipto Mangunkusumo Hospital, Jakarta, between 2015 and 2017. Medical history of possible predictive prognostic factors, including microorganism patterns and antibiotic sensitivity, were recorded. Prognostic factors were analyzed using multivariate logistic regression tests. Results The most common bacteria was Gram-negative (54.5%), while Candida sp. was the most common fungal infection (82.5%). Klebsiella sp. was mainly sensitive to amikacin (85.71%), while Pseudomonas aeruginosa was sensitive to ceftazidime (75%), as well as amikacin and gentamicin (100% sensitivity in combination). Staphylococcus sp. was mainly sensitive to amoxi-clav and ampi-sulbactam (76.9%). Almost all fungal groups were susceptible to fluconazole, ketoconazole, voriconazole (80-100%). Prognostic factors that increased mortality risk were central venous cannulation (RR 1.947; 95%CI 1.114 to 3.402), wasting (RR 1.176; 95%CI 1.044 to 1.325), severe wasting (RR 1.241; 95%CI 0.975 to 1.579), and hematologic malignancies (RR 0.87; 95%CI 0.788 to 0.976). Conclusion Central venous cannulation and wasting are significant prognostic factors of increased mortality in children with febrile neutropenia. Gram negative bacteria along with Candida sp. is the most common pathogen in such condition.
Survival rate of pediatric osteosarcoma in Indonesia: a single center study Hikari Ambara Sjakti; Isyanaditta Agung Putri; Endang Windiastuti
Paediatrica Indonesiana Vol 62 No 1 (2022): January 2022
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi62.1.2022.27-31

Abstract

Background Over the years, the survival rate of children with osteosarcoma has increased with improved management. However, survival tends to be lower in low-middle-income countries. Objective To report the survival rate of children with osteosarcoma in a single center in Indonesia and to evaluate the outcomes of treatment modalities currently used. Methods We performed a retrospective analysis of the medical records of pediatric osteosarcoma patients in Cipto Mangunkusumo Hospital from 2015 to 2019. Patients were categorized based on age group, sex, primary tumor location, treatment modalities, disease metastasis, and disease outcome. Results We included 83 children with osteosarcoma, with an age range of 4-17 years (median 13 years). Mean estimated overall survival and event-free survival were 28 (95%CI 24 to 32) months and 10 (95%CI 8 to 13) months, respectively. Overall survival duration between treatment modality groups was significantly different (P<0.05). The mean estimated overall duration of survival was 9 (95%CI 3 to 15) months for chemotherapy, 18 (95%CI 14 to 22) months for chemotherapy with surgery, and 21 (95%CI 14 to 27) months for chemotherapy with surgery and radiation. Conclusion The survival rate of childhood osteosarcoma in Indonesia remains low. The current treatment option currently used in our center may contribute to the low rate of survival.
Role of cytogenetic profiles as prognostic factors for complete remission after induction phase in acute myeloblastic leukemia Hikari Ambara Sjakti; Gatot Djajadiman; Pustika Amalia Wahidiyat; Agus Kosasih; Iswari Setianingsih
Paediatrica Indonesiana Vol 61 No 6 (2021): November 2021
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi61.6.2021.343-9

Abstract

Background Risk stratification for acute myeloid leukemia (AML) in children is a must in treatment strategy. This stratification is based on cytogenetic profiles, which are needed to determine proper management to gain better outcomes and reduce side effects of treatment. There is no such risk stratification available in Indonesia until now. Objective To evaluate the association between cytogenetic profiles of t(8,21) and inv(16) mutations with the complete response to induction phase of chemotherapy in pediatric AML. Methods A prospective study was conducted between year 2018 and 2020, involving children with AML from 4 pediatric oncology centers in Jakarta. Subjects were evaluated for cytogenetic profiles, especially t(8,21) and inv(16), as the favorable predictors for AML. Bone marrow remission was evaluated after 2 cycles of induction phase. The results were evaluated for remission rate and survival analysis. Results Karyotype data of 18 subjects were obtained. Translocation t(8;21) detected in 1 subject, and inv(16) mutation in 4 subjects. These two variables had no significant correlation with complete remission after induction phase. Nevertheless, favorable group had more tendencies to achieved remission than unfavorable group. Complete remission achieved in 61% subjects, 90% of theme had a relapse period with an average time 43 weeks. The relapse period in favorable group was shoter than in unfavorable group (34 weeks and 44 weeks, respectively). Conclusions This study shows that cytogenetic profiles of t(8;21) and inv(16) mutation can not be used as prognostic factors for complete remission after induction phase of chemotherapy in pediatric AML.
Langerhans cell histiocytosis: Diagnosis and Management Lusiana, Lusiana; Sjakti, Hikari Ambara; Rahmayunita, Githa; Jacoeb, Tjut Nurul Alam; Krisanti, Inge Ade
Journal of General - Procedural Dermatology & Venereology Indonesia Vol. 4, No. 1
Publisher : UI Scholars Hub

Show Abstract | Download Original | Original Source | Check in Google Scholar

Abstract

Langerhans cell histiocytosis (LCH) is a rare disorder characterized by abnormal clonal proliferation of Langerhans dendritic cells. The incidence of LCH is 1 to 3 cases per 1 million children worldwide, and occurs most frequently in children of 1–4 years of age. The etiopathogenesis of LCH, whether it is neoplastic or reactive, is still controversial. Langerhans cell histiocytosis has a wide spectrum of clinical features, and dermatological abnormalities usually occur early. The most frequent lesions are elevated yellowish-red translucent papules about 1–2 mm in diameter and generally located in seborrheic areas. The most recent classification (the Histiocyte Society study 2017) categorized LCH into four groups; a single system with involvement of unifocal or multifocal organs, lung LCH, and multi-system LCH with either low- or high-risk multiorgan involvement. The definitive diagnosis of LCH are typical morphology along with Birbeck granules and/or positive results on CD1a antigen stain on cells found on lesions. Treatment of LCH is multimodal, determined based on age, extent of lesion, organ involvement, and organ location.
Unveiling the Survival Gap: Addressing the Challenges of Acute Lymphoblastic Leukemia in Adolescents Aisyi, Mururul; Kosasih, Agus Susanto; Utomo, Ahmad Rusdan Handoyo; Saputra, Fahreza; Sari, Teny Tjitra; Sjakti, Hikari Ambara; Dwijayanti, Fifi; Harimurti, Kuntjoro; Andriastuti, Murti
Indonesian Journal of Cancer Vol 19, No 2 (2025): June
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v19i2.1396

Abstract

Background: Acute Lymphoblastic Leukemia (ALL) remains the most common pediatric cancer, yet survival outcomes vary widely across age groups. In Indonesia, comprehensive data on ALL survival rates are sparse, particularly for adolescents who often fare worse than younger children. The underlying factors contributing to the difference in adolescent survival rates still need to be fully understood. This study aimed to evaluate and compare the survival rates of children and adolescents with ALL treated at Dharmais Cancer Hospital.Method: We conducted a retrospective cohort analysis of 94 ALL patients, including 37 adolescent patients and 71 patients with B-lineage ALL. All patients with ALL from 2021 to 2023 were identified. Children aged 1–18 years, diagnosed with ALL based on bone marrow results and not yet treated, are included in the study. Patients were stratified by risk stratification (Standard Risk [SR] vs. High Risk [HR]), lineage (B-lineage vs. T-lineage), and age group (children under 10 vs. adolescents 10 years and above). The survival curve was analyzed using the KaplanMeier method, and the log-rank test was used to assess and compare survival across groups.Results: The overall survival (OS) rate for ALL patients was 49.5%. Adolescents had a significantly lower OS rate of 23.2% compared to children. SR patients exhibited an OS rate of 95.7%, while HR patients had a 33.3%. B-cell lineage had a higher OS rate (59.8%) than T-cell lineage (15.9%). In B-cell ALL, OS was 61.4% in children but only 28.1% in adolescents. Conclusion: The survival rate for adolescents with acute lymphoblastic leukemia (ALL) is significantly lower than that of children, influenced by risk stratification, lineage, and age. Further research is needed to identify these risk factors through genetic and molecular analyses.Conclusion: The survival rate for adolescents with acute lymphoblastic leukemia (ALL) is significantly lower than that of children, influenced by risk stratification, cell type, and age. Unexplained factors, including lineage differences, remain a challenge in adolescents. Further research into genetic and molecular factors is essential to enhance treatment precision and improve survival rates for ALL patients in Indonesia, especially adolescents.Keywords: Overall Survival, Leukemia, Adolescent ALL, Stratification
Associations between genomic copy number alterations and clinical and laboratory results in pediatric B-cell acute lymphoblastic leukemia Aisyi, Mururul; Andriastuti, Murti; Kosasih, Agus Susanto; Utomo, Ahmad Rusdan Handoyo; Saputra, Fahreza; Sari, Teny Tjitra; Sjakti, Hikari Ambara; Dwijayanti, Fifi; Harimurti, Kuntjoro
Paediatrica Indonesiana Vol. 65 No. 2 (2025): March 2025
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi65.2.2025.89-95

Abstract

Background Copy Number Alterations (CNAs) are changes in DNA structure that lead to gain or loss of copies of DNA sections in the genome. They correlate with unfavorable prognostic outcomes in pediatric leukemia, influencing treatment resistance, relapse rates, and overall survival. Identifying high-risk patients with a likelihood of CNA positivity is essential for understanding its association with clinical characteristics and laboratory findings. Since routine CNA testing is costly, recognizing simple clinical and laboratory markers that predict CNA presence can help focus screening efforts, enabling more efficient risk stratification and prognosis assessment in acute leukemia Objective To describe the characteristics and analyze for associations between CNA, clinical characteristics, and laboratory findings in pediatric ALL patients. Methods This cross-sectional observational study included B-cell acute lymphoblastic leukemia (ALL) patients from three hospitals, excluding those above 18 years. Data collected encompassed demographics, clinical features, and laboratory results. We performed multiplex ligation-dependent probe amplification (MLPA) testing to identify CNA positivity. Results From January to December 2019, there were 74 pediatric ALL patients incuded in our study; 26 of them had positive results and the remaining 48 had negative results. CNA-positive status was commonly found in subjects aged ? 5 years (38.6%), while CNA-negative status was highest in patients aged ? 10 years (72.7%). CNA-positive status was significantly higher in patients with lymphadenopathy, lower hemoglobin level (7.73 g/dL), and lower platelet level (52,019/µL) (P<0.05). Conclusion Patients with lymphadenopathy, lower hemoglobin, and lower platelet levels are more likely to test positive for CNA. However, more research is needed to fully understand the implications of this finding and its potential impact on patient care.
Co-Authors Agus Kosasih Agus Susanto Kosasih, Agus Susanto Aman Bhakti Pulungan Arwin AP Akib Arwin AP Akib Attika Adrianti Andarie Aulia Fitri Swity Bernie Endyarni Medise Damayanti Rusli Syarif Dewi Anggraeni Dian Puspita Sari Djajadiman Gatot Eka Laksmi Hidayati, Eka Laksmi Endang Windiastuti Endang Windiastuti Evita Bermansyah Ifran Fatimah Saidah Fifi Dwijayanti Gatot Djajadiman Githa Rahmayunita Hartono Gunardi Hindra Irawan Satari Irawan Mangunatmadja Iswari Setianingsih Isyanaditta Agung Putri Jacoeb, Tjut Nurul Alam Krisanti, Inge Ade Kristin Handojo Kuntjoro Harimurti lmral Chair Luh Karunia Wahyuni, Luh Karunia Lusiana Lusiana Murti Andriastuti, Murti Mururul Aisyi Muzal Kadim Najib Advani Nur Hayati Piprim B. Yanuarso Pustika Amalia Wahidiyat Resyana Putri Nugraheni Rosary Rosary Saputra, Fahreza Soepardi Soedibyo Teny Tjitra Sari Teny Tjitra Sari, Teny Tjitra Utomo, Ahmad Rusdan Handoyo Yoga Devaera Yuni Astria