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All Journal CRJIM (Clinical and Research Journal in Internal Medicine)
Arifah, Nina Nur
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Education Health Professions Immunology & microbiology Medicine & Pharmacology Nursing Public Health Other

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Successful Modified Chemotherapy Regiment in Patient with Hairy Cell Leukemia Variant Hermanto, Djoko Heri; Hatinah, Amalia Nurul; Arifah, Nina Nur
Clinical and Research Journal in Internal Medicine Vol. 6 No. 1 (2025): Volume 6 No 1, May 2025
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.crjim.2025.006.01.14

Abstract

Hairy Cell Leukemia variant (HCLv) is distinct from Hairy Cell Leukemia classic (HCLc) and categorized as an unclassified splenic B-cell lymphoma/leukemia. HCLv is a rare disease with a 15% survival rate after 15 years, and accounts for only 0.4% of chronic lymphoid malignancies and the etiology remains unclear. In this context, it responds poorly to standard Hairy Cell Leukemia (HCL) therapy. The primary complaints of a 64-year-old patient on admission were weight loss, early satiety, fatigue, and abdominal enlargement. Physical examination showed massive splenomegaly, and laboratory results showed thrombocytopenia and leukocytosis with a predominance of lymphocytes. Meanwhile, bone marrow puncture (BMP) and flow cytometry results showed hairy cells with morphology and immunophenotyping consistent with HCLv. Due to the unavailable purine analogs, and considering potential outcomes, the patient was treated with a combination of Cytarabine, Daunorubicin, and Rituximab for 5 days. After 3 months, clinical improvement was observed, and BMP evaluation showed no evidence of hairy cells projection, leading to the patient being declared in complete remission. This case presents a new therapy regimen that has not been previously applied to HCLv cases and it may serve as an option for similar cases, subject to clinician judgment and patient preferences. Keywords: HCL variant, modified chemotherapy regimen, total remission
Circulating Tumor DNA: Unravelling the Treatment Response Uncertainty in Lymphoma: Systematic Review and Meta-Analysis Bulain, Stanley; Setiawan, Aurielle Annalicia; Nestovani, Anggella Christoferisa Ditya; Pamarta, Trisna Belani; Baliulina, Shintya Octaviana; Arifah, Nina Nur
Clinical and Research Journal in Internal Medicine Vol. 7 No. 1: Volume 7 No 1, May 2026
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.crjim.2026.007.01.08

Abstract

Background: Uncertainty in lymphomas treatment response could negatively affect the disease course. Circulating tumor DNA (ctDNA), minimally invasive biomarker, can be useful to monitor treatment response, recurrence, yet minimally invasive. Aim: To evaluate the effectiveness of ctDNA for predicting early relapse (indicated by progression-free survival (PFS) and overall survival (OS)), and for predicting non-complete response (non-CR) in lymphomas. Methods: Comprehensive searches in PubMed, ScienceDirect, Wiley, Springer and Cochrane were conducted. Critical appraisal was conducted using the ROBINS-E tool for cohort and ROB 2.0 randomized controlled trials. hazard ratios (HRs) of pretreatment CtDNA for PFS and OS. The secondary outcome was the risk ratio (RR) of non-CR in detectable posttreatment CtDNA and its diagnostic accuracy analysis. RevMan 5.4 and STATA 17 was used for quantitative analysis. Results: 14 studies (1,144 patients) were included. Higher pretreatment ctDNA significantly increase the risk of worse PFS (HR 2.20, 95% CI 1.41-3.43) and worse OS (2.20, .14-4.26), also with optimal cut-off at 2.5 log10hGE/mL for PFS (2.46, 1.70-3.54) and OS (2.36, 1.30-4.29). The value was also significant in DLBCL, both for PFS (2.46, 1.71-3.55) and OS (2.70, 1.58-4.60), P<0.05 . Detectable posttreatment CtDNA also correlated with non-CR (RR 5.56 95% CI 2.82-10.95), with pooled sensitivities 0.91 (0.71-0.98), specificities 0.76 (0.51-0.90), positive-likelihood ratios 3.74 (1.71-8.19), negative-likelihood ratios 0.12 (0.04-0.39), and area under curve (AUC) 0.91 (0.88 - 0.93). Conclusion: Higher pretreatment CtDNA strongly correlated with the disease progression and survival, specifically at log10hGE/mL. Detectable posttreatment CtDNA were significantly correlated with non-CR.
Co-Authors Baliulina, Shintya Octaviana Bulain, Stanley Hatinah, Amalia Nurul hermanto, djoko heri Nestovani, Anggella Christoferisa Ditya Pamarta, Trisna Belani Setiawan, Aurielle Annalicia