Aim: To explore the circulating plasma miRNA-21 potential as an early detection biomarker by comparing early-stage breast cancer (BG) and healthy control (HG) in Indonesian population. Materials and methods: The enlisted patients were twenty-six adult female early-stage breast cancer patients (stage 1A, 1B, 2A, and 2B) of Airlangga University Hospital from August until October 2019. Sixteen volunteers were recruited as matched healthy subjects. MiRNA-21 expression was quantified by plasma qRT-PCR. Data analysis performed using IBM SPSS Statistics v.24. MiRNA-21 cutoff , sensitivity, and specificity were analyzed using receiver operating characteristic (ROC) curve. Results: The subject includes 26 BG and 16 HG subjects. The miRNA-21 expression in BG group was 3.933 (1.181-11.794) and 0.905 (0.164-4.532) in HG group (4.34 folds; p=0.001), with 1.66 cutoff (92.3% sensitivity; 81.2% specificity). MiRNA-21 expression separated analysis in HG showed a 0.578 times lower expression in menopause subjects [0.651 (0.164-0.414)] compared to pre-menopause [(1.123 (0.758-4.532); p=0.031]. Yet, in BG group 1.729 times higher miRNA-21 expression was observed in menopause subjects (6.021±3.583) compared to pre-menopause subjects (3.500±1.517;p=0.022). Conclusion: Circulating miRNA-21 expression is a potential biomarker for early detection of breast cancer and might act as a breast cancer risk predictor.

Retinoblastoma is a malignant retinal tumor associated with apoptotic deregulation. Retinoblastoma cells are sensitive to NK cells. These cells can stimulate apoptosis. Apoptosis in retinoblastoma occurs in the early phase and is paradoxical. The increasing amounts of Bcl-2 and Caspase-3 as apoptotic executors are inversely proportional to apoptosis. Calcium and ATP as second messengers and signaling molecules play role in mediating cell responses including retinoblastoma cell development and death. Apoptosis requires sufficient energy from ATP and its mediated by Calcium. This study aimed to perceive the effects of Calcium and ATP in the process of retinoblastoma cell death through Caspase-3 pathway. The subjects were poorly differentiated retinoblastoma cell cultures treated with NK cells (treatment group) compared to those which were not exposed to NK cells (control group). Through the cell flowcytometry test that expresses Caspase-3 and apoptosis is calculated, meanwhile the levels of Calcium and ATP activity produced during the apoptosis process are quantitatively calculated. Examination of ATP activity uses a colorimetric method while the calcium content is calculated using a clinical chemistry system. Calcium and ATP were negatively correlated at 27.4% (p <0.05). ATP also showed a very significant negative correlation of 75.8% (p <0.01) against Caspase-3 and is significantly positively correlated with apoptosis of 46.8% (p,0.05). Whereas Caspase-3 is negatively correlated with apoptosis by 46.6% (p <0.05). In the Caspase-3 pathway, allogeneic NK cell administration in retinoblastoma cells increases the level of Calcium which plays a role in the early phase apoptosis process, whereas ATP which was formed is insufficient to cause maximal apoptosis due to extracellular calcium entry into NK cells. Extracellular ATP does not play a role in the induction of apoptosis in retinoblastoma cells treated with NK cells.

Background: Hasford score is a scoring system which was made in interferon treatment era to assess chronic myelocytic leukemia (CML) prognosis. Complete hematologic response (CHR) is the milestone of prognosis evaluation. CHR achievement will significantly increase survival. Imatinib is a revolutionized treatment that change the prognosis of CML. With the advent of Imatinib, lessened the prognostic impact of the Hasford score to predict prognosis.Materials and Methods: An observational analytic with prospective cohort study conducted in oncology outward division Dr. Soetomo hospital Surabaya, from July until October 2018. Hasford score determined in 32 patients at the beginning of the study, given imatinib and followed up regularly for 3 months to know the hematologic response. Data were analyzed using Fisher exact test which was considered significant if p<0.05.Results: Median age was 39 years old, male 37.5% and female 62.5%, the median spleen was 18 cm, median hemoglobin was 9.1 g/dL, median leukocyte was 180x109 /L, median thrombocyte was 645x109 /L, median eosinophil was 2.9%, median basophil was 4.6%, median myeloblast was 6%. Hasford score showed 3.1% in low risk, 25% in intermediate risk and 71.9% in high risk. As much as 78.1% complete hematologic response was found in patient, and 21.9% was incomplete.Conclusion: There was no association between Hasford scoring system and hematologic response in chronic and accelerated phase of chronic myelocytic leukemia patient with imatinib for three month. Hasford score had no impact in hematologic response with imatinib.Keywords: Hasford score, hematologic response, CML, imatinib

Background: Waldenstrom macroglobulinemia (WM) is a rare, dormant hematologic disease. It often manifests in people over 60 years of age and considered a hereditary disorder with MYD88 and CXCR4 genes mutation. In Indonesia, WM medical records is limited, causing potential misdiagnose or mistreatment. This article reported a case of WM patient and its challenging diagnosis establishment. Case Presentation: A 67-year-old woman was referred with chief complaints of extremities swelling with recurrent anemia, bone pain, and elevated renal function. Protein electrophoresis indicated monoclonal gammopathy, suspected as multiple myeloma. However, further examinations did not support the diagnosis of multiple myeloma as the results revealed increased B2 microglobulin (5.65mg/L). IgM immunofixation suggested IgM lambda monoclonal gammopathy. Bone marrow aspiration (BMA) showed dominant lymphoplasmacytic cells (68%) and flowcytometry test of serum plasma indicated positive CD10 and CD34, whereas CD5 and CD19 were negative. The differential diagnoses have also been ruled out one by one to provide appropriate treatment for the patient. After all examinations, the patient was finally diagnosed with WM and treated with bortezomib, low-dose dexamethasone, and rituximab (BDR) regimen for five cycles. Conclusion: WM is rare case of hematologic disease and the diagnosis of the case could face challenges due to diagnostic difficulty. Protein electrophoresis and BMA could help to improve the diagnosis process.

Leukostasis adalah suatu keadaan patologik terjadinya sumbatan leukosit pada mikrovaskular. Leukostasis merupakan salah satu komplikasi yang paling sering terjadi pada leukemia myelositik kronik dengan presentasi 60% pada fase kronik. Keadaan leukostasis merupakan kegawatdaruratan dalam bidang hematologi, sehingga memerlukan tindakan sitoreduksi segera yaitu leukafaresis. Kami laporkan seorang wanita usia 59 tahun yang telah terdiagnosa leukemia myelositik kronik sejak 2 bulan yang lalu, datang dengan keluhan utama nyeri kepala, telinga berdenging dan mual yang menetap selama 2 minggu. Leukostasis didiagnosa dari klinis dan laboratorium dengan adanya hiperleukositosis dan gejala hipoksia jaringan saraf akibat hiperviskositas. Pada pasien dilakukan tindakan leukafaresis selama 4 jam, darah diproses 3.414 cc, leukosit yang terbuang 556 cc. Setelah leukafaresis dilakukan, gejala nyeri kepala dan telinga berdenging pada pasien menjadi hilang dan disertai dengan penurunan jumlah leukosit. Leukafaresis merupakan tindakan yang dapat mengontrol jumlah leukosit dalam jangka pendek. Keterlambatan atau tidak mendapatkan terapi leukafaresis pada pasien dengan leukostasis menyebabkan resiko kematian pada minggu pertama meningkat 20-40%.