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Indonesian Journal of Cancer

ijoc
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Published by National Cancer Center-Dharmais Cancer Hospital

ISSN : 19783744 EISSN : 23556811 DOI : https://www.doi.org/ 10.33371

Core Subject : Health, Science,

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

Indonesian Journal of Cancer is a peer-reviewed and open-access journal. This journal is published quarterly (in March, June, September, and December) by Dharmais Cancer Hospital - National Cancer Center. Submissions are reviewed under a broad scope of topics relevant to experimental and clinical cancer research. Articles are original research that needs to be disseminated and written in English. All submitted manuscripts will go through the double-blind peer review and editorial review before being granted acceptance for publication. The journal publishes original research articles, case reports, and review articles under the following categories: cancer management, cancer prevention, cancer etiology, epidemiology, molecular oncology, cancer diagnosis and therapy, tumor pathology, surgical oncology, medical oncology, radiation oncology, interventional radiology, as well as early detection.

Arjuna Subject : Kedokteran - Onkologi

Articles 562 Documents

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Rabdomiosarkoma pada Anak: Luaran Klinis pada Pasien yang Mendapat Terapi Djajadiman Gatot; Endang Windiastuti
Indonesian Journal of Cancer Vol 5, No 2 (2011): Apr - Jun 2011
Publisher : National Cancer Center - Dharmais Cancer Hospital

Latar belakang. Rabdomiosarkoma (RMS) merupakan keganasan jaringan lunak yang banyak terjadi pada anak umur 1 sampai 5 tahun dan remaja. Sekitar 15 % anak dengan RMS datang dalam keadaan metastasis dan prognosisnya tidak ada perbaikan dalam 15 tahun terakhir.Tujuan. Penelitian ini untuk mengetahui gambaran epidemiologi RMS, hasil penanganannya dan luaran klinis untuk pengembangan selanjutnya.Metode. Penelitian dilakukan secara retrospektif dari data pada catatan medis 44 pasien yang diterapi di RS Cipto Mangunkusumo (RSCM), Jakarta bulan Juni 2000 sampai Juli 2008. Data dikumpulkan untuk melihat gambaran epidemiologi klinik dan luaran klinis.Hasil. Terdapat 44 pasien RMS di RSCM selama tahun 2000-2008.. Perbandingan antara laki-laki dan perempuan adalah 2:1 .Kebanyakan menyerang anak umur antara 3 bulan sampai 5 tahun (47,7% ) dengan median antara 6 -7 tahun. Gambaran patologi terbanyak yaitu embrional (65,9% ). Lokasi primer terbanyak pada bagian kepala dan leher (47,7% ). Berdasarkan sistem TNM , didapatkan stadium lanjut sebesar 61,4% . Sebagian besar metastasis ditemukan pada sumsum tulang (74%). Hasil luaran klinis didapatkan yang masih dalam terapi 52,3% , meninggal 36,4% dan lost to follow up 11,3% .Kesimpulan. RMS kebanyakan didapatkan pada anak umur 3 bulan sampai 5 tahun. Gambaran histologi tipe embrional dan lokasi primer pada kepala dan leher merupakan yang tersering. Pada umumnya, pasien datang dalam stadium lanjut tetapi jika datang pada stadium awal akan memberikan hasil yang lebih baik.Kata kunci Rabdomiosarkoma, epidemiologi klinik, luaran klinis

Adaptive Response of Peripheral Blood Lymphocytes in Medical Radiation Workers using the Comet Assay: A Preliminary Studyomet Assay: A Preliminary Study Teja Kisnanto; Darlina Darlina; Arifin Musthafa; Fielda Djuita; Harry Nugroho Eko Surniyantoro; Iin Kurnia Hasan Basri
Indonesian Journal of Cancer Vol 16, No 2 (2022): June
Publisher : National Cancer Center - Dharmais Cancer Hospital

Background: Gamma irradiation can cause DNA damage in single and double-strand breaks (SSBs & DSBs), especially in peripheral blood lymphocytes. Radiotherapy medical radiation workers can be exposed to gamma radiation related to their daily work. The comet assay is a sensitive method for analyzing DNA damage, especially SSBs. This study explores DNA damage in medical radiation workers’ peripheral blood lymphocytes as an adaptive response using the comet assay.Methods: Blood samples were obtained from four radiotherapy medical radiation workers as a case study (MRW) and two non-medical radiation workers as controls, and then irradiated with various doses of 0, 1, 1.5, and 2 Gy. Lymphocytes were isolated by histopaque and processed by comet assay on the slide under alkaline conditions. The imaging results were analyzed using the Casplab_1.2.3b2 software. The comet assay parameters observed were Tail Length (TL), % Tail DNA (T.DNA), Tail Moment (TM), and Olive Tail Moment (OTM). The one-way ANOVA method was used to analyze statistically between treatment groups. Results: Based on the study results, an increase in TL, T.DNA, TM, and OTM values in all samples was directly proportional to the increase in radiation dose. However, there was no significant difference (P > 0.05) between the MRW group and the control group on each parameter of the comet assay.Conclusions: From this study, it can be concluded that the level of DNA damage of lymphocyte cells as part of the adaptive response in the MRW and control groups was relatively similar after exposure at doses of 0, 1, 1.5, and 2 Gy.

Optimasi dan Validasi KIT Immunoradiometric Assay Carbohydrate Antigen -125 untuk Pemantauan Kanker Ovarium Puji Widayati; Siti Darwati; Agus Ariyanto
Indonesian Journal of Cancer Vol 3, No 2 (2009): Apr - Jun 2009
Publisher : National Cancer Center - Dharmais Cancer Hospital

Carbohydrate Antigen-125 (CA-125) adalah glikoprotein antigenik yang dilepaskan ke darah penderita kanker ovarium, dengan kadar yang sangat rendah pada awalnya dan meningkat sesuai dengan keganasan kanker. Dengan demikian, pemantauan kanker ovarium dapat dilakukan dengan mengukur kadar rendahnya senyawa CA-125 di dalam darah. Metode yang sesuai adalah immunoradiometricassay (IRMA). PRR telah mengembangkan metode ini sejak beberapa tahun lalu, diawali dengan tahap pembuatan komponen kit IRMA CA-125, meliputi perunut CA-125 bertanda 125I dengan rendemen penandaan sebesar 96,5%. Hasil uji imunologi menunjukkan aktivitas imunologi sebesar 21,39% (%B/T) untuk standar 500 mIU/mL dan ikatan tidak spesifiknya 0,21 (%NSB) untuk standar 0 mIU/mL. Hasil uji kemurnian radiokimia 94,2%. Larutan standar CA-125 menunjukkan bahwa sensitivitas larutan standar yang digunakan adalah baik dengan daerah kerja assay yang luas, yaitu dari 0 mIU/mL sampai 200 mIU/mL. Persamaan garis regresi Y = 0,0705X + 0,7103 dan koefisien korelasi R = 0,9930. Tabung bersalut antibodi monoklonal (coated tube) dengan monoklonal jenis M86924M sebagai penyalut menunjukkan aktivitas imunologi untuk standar 0 mIU/mL sebesar 0,1% dan untuk larutan standar 500 mIU/mL sebesar 21,39%. Optimasi assay kit IRMA CA-125 meliputi radioaktivitas optimum perunut 100000 cpm, volume perunut optimum 50 ?L, volume standar optimum 50 ?L, waktu inkubasi optimum 16 jam, dan suhu inkubasi optimum sebesar 25oC sehingga menghasilkan nilai B/T = 19,05% dan NSB = 0,53%, dengan daerah kerja 0-200 mIU/mL. Validasi metode menggunakan sampel kadar tinggi (QCH) dan kadar rendah (QCL) menunjukkan nilai %CV intra assay (n=15) sebesar 9,9% (QCL) dan 2,97% (QCH) serta %CV inter assay (n=7) berturut-turut 13,1% (QCL) dan 4,9% (QCH) memenuhi syarat Protocol IAEA. Kit IRMA CA-125 ini juga menunjukkan karakter yang baik, yaitu dengan nilai %NSB dan nilai %B/T sebesar 0,1% dan 12,6%; daerah kerja kit yang luas, yaitu 0 mIU/mL sampai 200 mIU/mL); serta kestabilan kit selama 8 (delapan) minggu.Kata kunci: kanker ovarium, immunoradiometricassay(IRMA), CA-125, optimasi, validasi

Effects of Curcumin on Vascular Endothelial Growth Factor Expression on Rattus norvegicus Cervical Cancer Xenograft Model Laili Muninggar; Widjiati Widjiati; Indra Yuliati; Brahmana Askandar; Poedjo Hartono
Indonesian Journal of Cancer Vol 12, No 3 (2018): July-September
Publisher : National Cancer Center - Dharmais Cancer Hospital

Objective: To analyze the effect of curcumin in VEGF expression on Rattus norvegicus cervical cancer cell xenograft model.Methods: An experimental study with randomized post test only control group design. The subjects were Rattus norvegicus (Sprague Dawley), inoculated with He-la cervical cancer cells from American Type Culture Collection (ATCC) processed in stem cell laboratory Institute of Tropical Disease (ITD) Airlangga University. 5x106 of He-La cells were injected subcutaneously in dorsal flank area of Rattus norvegicus. After 30 days of observation we performed histopathological examination of xenograft tissue and randomized into 2 groups which were given curcumin orally 1000 mg/kg (curcumin group) vs. no therapy (control group). After another 30 days the xenograft tissue was dissected and underwent immunochemistry examination for VEGF expression.Results: 32 samples of Rattus norvegicus were divided into 2 groups, In curcumin group the VEGF median expression was 2,2 (0,3-7,6) and in control group the VEGF median expression was 6,6 (1,2-12). There was a statistically significant difference with p value =0,009 with Mann Whitney test (p<0,05).Conclusion: VEGF expression in Rattus norvegicus xenograft model of cervical cancer was suppressed by giving Curcumin 1000 mg/kgBB orally.

Characteristics of Chest X-Ray in Patients with Cancer at the Dharmais Cancer Hospital Emergency Room during the COVID-19 Pandemic Bima Taruna Sakti; Rosalina Rosalina; Jaka Pradipta
Indonesian Journal of Cancer Vol 15, No 4 (2021): December
Publisher : National Cancer Center - Dharmais Cancer Hospital

Background: Conventional chest X-ray (chest X-ray) in Dharmais Cancer Hospital emergency room (ER) is still the primary modality to diagnose patients with cancer with dyspnoea complaints. Chest X-ray was also carried out to screen inpatients at the Dharmais Cancer Hospital ER at the beginning of the COVID-19 pandemic in Indonesia. It was essential because patients in the Dharmais Cancer Hospital ER were patients with cancer, with low immunity and a high risk of being exposed to various infections. Thus, the purpose of this study was to determine the characteristics of chest X-rays in patients with cancer at the Dharmais Cancer Hospital ER during the COVID-19 pandemic in February-May 2020. Methods: This was a descriptive study. The population involved was all patients at the Dharmais Cancer Hospital ER who received chest X-ray support, with the inclusion criteria for diagnosing lung cancer, breast cancer, cervical cancer, colorectal cancer, and blood cancer (Leukemia) from February to May 2020. Data analysis employed univariate analysis by utilizing tables and graphs in presenting the data.Results: 289 samples met the research criteria. The highest visits were patients with breast cancer (41.2%). The most common thoracic images were pleural effusion (34.3%), followed by bronchopneumonia (31.1%), normal lung (16.6%), lung mass (7.6%), pneumonia (5.2%), and others (5.2%), consisting of atelectasis, bronchitis, fibrosis/chronic pulmonary process, pulmonary emphysema, cardiomegaly, and specific process. Besides, the chest x-ray bronchopneumonia was 31.1% (90 samples), accompanied by pleural effusion of 44.4%. From the chest X-ray, pleural effusions were 34.3% (99 samples), with lung cancer being the most common with pleural effusions (48.4%).Conclusions: More than 80% of chest x-ray performed in the ER are abnormal. Also, breast cancer is the highest in the Dharmais Cancer Hospital ER cases, with the highest chest x-ray of pleural effusion.

Neurologi Paliatif SRI ERNI ISTIAWATI
Indonesian Journal of Cancer Vol 6, No 2 (2012): Apr - Jun 2012
Publisher : National Cancer Center - Dharmais Cancer Hospital

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v6i2.191

Istilah perawatan paliatif diperkenalkan pada 1974. Pada 1990, WHO mendefinisikan perawatan paliatif sebagai perawatan menyeluruh pada pasien dengan penyakit lanjut dan dalam fase terminal beserta keluarganya. Aktivitasnya terus berkembang dan dengan definisi WHO 2007, cakupan menjadi lebih luas, yaitu meningkatkan kualitas hidup pasien, juga keluarganya, dengan mencegah dan mengurangi penderitaan dengan cara identifikasi dini serta penatalaksanaan nyeri maupun masalah-masalah lainnya yang diterapkan sejak awal. Dalam perkembangannya, perawatan paliatif tidak hanya ditujukan untuk kasus kanker, tetapi juga untuk kasus bukan kanker. Sekitar tahun 2001, muncul kesadaran baru tentang neurologi paliatif. Pada kenyataannya, sejak diagnosis ditegakkan, beberapa penyakit neurologi sudah tidak mungkin dapat disembuhkan dan memerlukan intervensi paliatif. Dari hasil proses pendidikannya, spesialis saraf memungkinkan untuk memahami fenomena klinis pada kasus kanker dan bukan kanker serta kaitannya dengan neurosains.Dalam artikel ini akan dibahas latar belakang perawatan paliatif, neurosains, dan neurologi paliatif yang dipresentasikan dalam ilustrasi kasus.Kata kunci: paliatif, neurologi, kanker-bukan kanker

Tinjauan kasus: Penanganan Limfedema di Rumah Sakit Kanker Dharmais Indriani Indriani; Irnawati Saud; Siti Anisa Nuhonni
Indonesian Journal of Cancer Vol 1, No 1 (2007): Jan - Mar 2007
Publisher : National Cancer Center - Dharmais Cancer Hospital

Kejadian limfedema meningkat sejalan dengan progresivitas penyakit kanker dan ekstensivitas penanganan pada saluran limfatik: 25,5% pada pasca-diseksi kelenjar aksi-Ia/inguinal, 2,3%-27% pada operasi dengan tehnik konservasi, dan 38,3% bila disertai tindakan radiasi. Umumnya penderita akan mengalami gangguan fungsi pada ekstremitas yang terkena dan aktivitas/kualitas hidup.Berbagai strategi penanganan rehabilitasi medik diberikan untuk preservasi dan restorasi fungsi ekstremitas serta paliasi gejala akibat edem (: nyeri, tegang, kaku). 50% penderita yang datang ke IRM RSKD (studi retrospeksi 1999 -2001) mengalami reduksi edem >50% dalam 1-2 minggu pasca-terapi. Kepedulian dan kerjasama yang baik antar disiplin ilmu terkait akan meminimalkan kejadian limfedema.

Kolangiokarsinoma dan Infeksi Virus Hepatitis LAURENTIUS A. PRAMONO
Indonesian Journal of Cancer Vol 9, No 1 (2015): Jan - Mar 2015
Publisher : National Cancer Center - Dharmais Cancer Hospital

ABSTRACTCholangiocarcinoma is a cancer which derived from biliary epithelial. This malignancy is rare, but have poor prognosis. Manifestation of liver flukes, primary sklerosing cholangitis, hepatolithiasis, and malformation of the biliary tree all this time are known to be risk factors for cholangiocarcinoma. In recent years, it has been shown that infection of hepatitis B and hepatitis C viral are also cholangiocarcinogenic, so it is known to become new risk factor for cholangiocarcinoma. A literature study was conducted to search for pathogenesis theory and evidence in clinical and community study. Most basic, epigenetic, pathologic, clinical, and community studies revealed that there is a link between hepatitis viral infection and intrahepatic cholangiocarcinoma. Unfortunately, the link between the infection and extrahepatic cholangiocarcinoma remain unclear. Look at the analysis, in the future, we must take more attention to chronic hepatitis patients for the risk of getting cholangiocarcinoma, while in cholangiocarcinoma, we must also consider about the risk factors such as hepatitis viral infection in the patients. Keywords: cholangiocarcinoma, hepatitis B, hepatitis C, cholangiocarcinogenicABSTRAKKolangiokarsinoma adalah kanker yang berasal dari epitel bilier. Keganasan ini termasuk jarang, namun memiliki prognosis yang buruk. Manifestasi cacing hati, kolangitis sklerosis primer, hepatolitiasis, dan malformasi bilier selama ini diketahui merupakan faktor risiko kejadian kolangiokarsinoma. Beberapa tahun terakhir diketahui bahwa infeksi virus hepatitis B dan hepatitis C juga memiliki sifat kolangiokarsinogenik sehingga menjadi faktor risiko baru bagi kejadian kolangiokarsinoma. Penelusuran literatur mengenai patogenesis dan bukti ilmiah dalam studi klinis dan epidemiologi dilakukan untuk mengkaji hubungan antara infeksi virus hepatitis B dan C dengan kolangiokarsinoma. Sebagian besar riset dasar, epigenetik, patologi, klinis, dan komunitas (populasi) menyiratkan adanya hubungan antara infeksi virus hepatitis B dan C dengan kolangiokarsinoma intrahepatik. Sayangnya, hubungan infeksi kedua virus dengan kolangiokarsinoma ekstrahepatik masih belum jelas. Melihat kajian ini, ke depan perlu perhatian lebih kepada pasien hepatitis kronis terhadap risiko kolangiokarsinoma. Sementara, bagi pasien kolangiokarsinoma, perlu pencarian faktor risiko, yang salah satunya adalah infeksi virus hepatitis kronis.Kata Kunci: kolangiokarsinoma, hepatitis B, hepatitis C, kolangiokarsinogenik

Faktor yang Memengaruhi Episode Transfusi Packed Red Cell (PRC) pada Anak dengan Keganasan DIAN A.P PURWANTO; SRI MULATSIH; TEGUH TRIYONO
Indonesian Journal of Cancer Vol 11, No 2 (2017): April - June
Publisher : National Cancer Center - Dharmais Cancer Hospital

ABSTRACTPRC transfusion is an adjuvant therapy frequently used in children with malignancy. There are some factors affecting transfusion episodes. For rational use of PRC must consider these factors. Objective: To find factors affecting transfusion episodes in children with malignancy. This retrospective cohort study evaluated children with malignancy between January 1 and December 31, 2015 who were admitted to Sardjito hospital. Patients were receiving therapy dan PRC transfusion during the four months following cancer diagnosis. Those with incomplete data or renal failure were excluded. The influence of these factors were analyzed with Chi-square or Fisher’s exact and Kolmogorov-Smirnov when iligible, and the most influential factor were analyzed by logistic regression. Out of 123 subjects receiving a PRC transfusion, 56 (45,5%) subjects received a PRC transfusion more than one times episodes. Higher episodes of transfusion were observed for patients whose bleeding (RR 6.940 (95%CI 2.563 to 18.790). Lower episodes of transfusion were observed for patients receiving transfusion previously and hematological malignancies, but the result were not significant (RR 0,524 (IK95% 0,057 – 4,852) and 0,464 (IK 95% 0,140 – 1,540) respectively). Bleeding is factor affecting transfusion episodes of PRC in children with malignancy.ABSTRAKTransfusi PRC merupakan terapi adjuvant yang sering digunakan pada anak dengan keganasan. Terdapat beberapa faktor yang memengaruhi episode transfusi sehingga penggunaan PRC rasional harus mempertimbangkan faktor tersebut. Penelitian ini bertujuan mengetahui faktor yang memengaruhi episode transfusi PRC pada anak dengan keganasan. Penelitian kohort retrospektif pada anak (0 –18 tahun) yang dirawat di RSUP Dr. Sardjito dengan penyakit keganasan yang telah terdiagnosis selama empat bulan dan mendapat terapi serta transfusi PRC sejak 1 Januari – 31 Desember 2015. Register tidak lengkap atau dengan gagal ginjal dieksklusi. Pengaruh faktor– faktor tersebut dianalisis dengan uji Chi-square atau uji Fisher serta Kolmogorov-Smirnov bila tidak memenuhi syarat, dan faktor yang paling berpengaruh dianalisis dengan uji logistic regression. Dari 123 subjek, 56 subjek dengan episode transfusi PRC > 1 kali. Keganasan hematologi, riwayat transfusi, dan perdarahan memengaruhi episode transfusi PRC > 1 kali. Analisis multivariat didapatkan perdarahan memengaruhi episode transfusi PRC > 1 kali (RR 6,940 (IK95% 2,563 – 18,790), namun riwayat transfusi dan keganasan hematologi tidak bermakna dengan nilai RR secara berturut-turut 0,524 (IK95% 0,057 – 4,852) dan 0,464 (IK 95% 0,140 – 1,540). Penelitian ini menyimpulkan bahwa perdarahan merupakan faktor yang memengaruhi episode transfusi PRC pada anak dengan keganasan.

Update on Diagnosis of Childhood Acute Lymphoblastic Leukemia (ALL) in Indonesia Adhitya Bayu Perdana; Fahreza Saputra; Mururul Aisyi
Indonesian Journal of Cancer Vol 14, No 4 (2020): December
Publisher : National Cancer Center - Dharmais Cancer Hospital

Childhood cancer has been a global public health scourge with considerably escalating incidence each year [1]. Although the incidence is relatively lower compared to adult malignancies, it remains the leading cause of disease-related death in children. The most frequent childhood cancer is acute lymphoblastic leukemia (ALL) with an annual incidence of 3.5 per 100,000 children in the United States [2]. Similarly, in Indonesia, ALL has the highest number of cancer cases in children [3]. The total incidence of ALL in Indonesia reaches 2.5-4.0 per 100,000 children with an estimated 2,000-3,200 annually [4]. Because of its high incidence and curability, ALL is a logical initial objective for childhood cancer program developments in Indonesia. As an indicator of successful treatment of childhood ALL, the 5-year survival rate shows contrasting figures between high-income (HIC) and lower-middle-income countries (LMIC). In the United States and most European countries, the survival rates are approximately 90% and 85% respectively. However, in Southeast Asian countries, the highest 5-year survival rate for children aged 0 to 14 was reported in Malaysia (69.4%), followed by Thailand (55.1%) [5]. Furthermore, more unfavorable results were reported in Indonesia. Studies from Dharmais Cancer Hospital and Dr. Sardjito Hospital reported the 5-year survival rate of 28.9% and 31.8% respectively [6,7]. The outcome difference between Indonesia and other countries is probably due to the high rate of relapse occurrence and toxic death during the treatment. Some studies revealed the factors that affecting the worst outcome of childhood ALL in LMIC include inadequate and delayed diagnosis, limited healthcare access, treatment abandonment, and suboptimal supportive care [8]. As pediatric oncologists in HIC have become more effective at treating childhood ALL, much of the research attempts concentrated on the risk stratification of the patients. The term “risk stratification” is used to allocate the patients into various risk groups based on the notable prognostic features for specific treatment administration. Patients with a high-risk assessment could be targeted for more aggressive treatments, while patients with lower risk could be treated less intensively to avoid the side effects and toxicities [9]. In Indonesia, risk stratification strategy encompasses clinical-hematologic parameters (age, leukocyte count, extramedullary involvement), and conventional morphological examination. These assessments represent the first step in the diagnostic pathway of ALL. Though helpful, in certain cases, the residual leukemic cells might be undetectable under bone marrow morphology examination. This led to more underdiagnosed cases, thus more patients were subjected to inadequate treatment. Fortunately, immunophenotyping is currently applied to improve the diagnosis of childhood ALL by grouping the patients based on the aberrant expression of leukemic cell antigen, even though its application is only available in several centers including Dharmais Cancer Hospital. The BCR-ABL1 fusion gene examination by PCR-based techniques has also routinely been implemented to predict the poor outcome since it was detected in 12% of childhood ALL patients [10]. However, the current above-mentioned strategy is insufficient to solve the accuracy of risk stratification of childhood ALL. In HIC, childhood ALL are classified by more comprehensive examination involving morphology, immunophenotyping, cytogenetics, and molecular techniques. The approach to classifying prognosis and to personalize treatment based on the underlying genetic biology has already implemented for understanding the pathogenesis of childhood ALL. According to studies, the molecular features of childhood ALL have been shown to have a significant prognostic value [11], and the survival rate was improved when genetic examinations are applied [12]. In recent years, high-resolution array-based genomic technologies have revolutionized the understanding of the genetic basis of childhood ALL. Several biomarkers have successfully been identified that are provenly associated with poor prognosis in childhood ALL, including the deletion/mutation of IKZF1 (IKAROS), CDKN2A, ETV6, EBF1, JAK2, and many more [13]. The majority of these genetic changes were originally identified by sophisticated methods such as single nucleotide polymorphism (SNP) arrays, gene expression profiling (GEP), array-based comparative genomic hybridization (aCGH), and more recently next-generation sequencing (NGS) [14]. Despite being highly sensitive for detection of multiple copy number changes, these approaches are not feasible for routine diagnostic use in LMIC which requires significant financial investment. Therefore, molecular techniques that suit available resources and infrastructure should be developed in LMIC, and most importantly the cost should be affordable for patients. One feasible method is Multiplex Ligation-dependent Probe Amplification (MLPA). MLPA is a rapid multiplex PCR-based technique that enables the comparative analysis of multiple mutation spots [15]. MLPA provides a low-cost, simple alternative to array-based techniques for much routine clinical practice, even though it is unsuitable for whole-genome analysis. Furthermore, one benefit compared to other quantitative PCR-based techniques is that MLPA allows 50 or more different genomic DNA to be analyzed in a single tube reaction. Several studies have demonstrated the implementation of specific MLPA probe mixes for hematological malignancies, including ALL, chronic lymphocytic leukemia (CLL), and myelodysplastic syndrome (MDS). These studies have also shown the sensitive and accurate identification of clinically significant diseasespecific copy number changes [16]. Currently, MLPA has been established as a routine diagnostic of childhood ALL patients in Dharmais Cancer Hospital by a research-based service setting. It reliably detects small focal deletions, even from the low amount of specimens. In general, the results demonstrated the concordance between mutated genes reported in highrisk patients (deletion of IKZF1, CDKN2A, CDKN2B, PAX5). These findings surely can guide the doctors in Dharmais Cancer Hospital to assign the specific patients for the intensive treatment protocol, which is expected to increase the patient’s survival. Therefore, concerning the future clinical application, the inclusion of mutation status by MLPA for childhood ALL risk stratification should be widely promoted to a large health community, especially the Indonesian Pediatric Society, which views this as a consideration for refinement of standard diagnosis protocol for childhood ALL in Indonesia.

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Journal Mail Official admin@indonesianjournalofcancer.or.id

Editorial Address National Cancer Center - Dharmais Cancer Hospital Research and Development Building, 3rd-floor Jl. Letjen S. Parman Kav. 84-86, Slipi West Jakarta

Location Kota adm. jakarta barat, Dki jakarta INDONESIA

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Contact Name
Bayu Brahma

Contact Email
journal.cancer@gmail.com

Phone
+628176389956

Journal Mail Official
admin@indonesianjournalofcancer.or.id

Editorial Address
National Cancer Center - Dharmais Cancer Hospital Research and Development Building, 3rd-floor Jl. Letjen S. Parman Kav. 84-86, Slipi West Jakarta

Location
Kota adm. jakarta barat,

Dki jakarta

INDONESIA