Page 240 - Abstract Book KONIKA 18

Hemato-Oncology

P-HO-024
Multiple Myeloma in a 15-year-old Boy: A Rare Case Report

Ludi Dhyani Rahmartani
Hematology Oncology Division, Department of Child Health, Faculty of Medicine Universitas Indonesia/
Dr. Cipto Mangunkusumo National Hospital, Jakarta, Indonesia
Abstract
Background Multiple myeloma (MM) is a plasma cell malignancy characterized by abnormal proliferation
of plasma cells in the bone marrow that produce monoclonal immunoglobulins. Most cases are diagnosed
in the elderly, and only a few reported cases of pediatric multiple myeloma in the world. To our knowledge,
this is the first reported case of pediatric multiple myeloma in Indonesia. Objective To describes a rare case
of multiple myeloma in an adolescent boy. Case A 15-year-old boy presented with progressive pain and
bone mass on the left shoulder and right knee. The boy was diagnosed with a primary bone tumor initially
and underwent a biopsy. The histopathology showed a round cell tumor lead to plasmacytoma, with positive
CD38, CD138, lambda monoclonal in immunohistochemistry. There were slight anemia, normal serum
calcium and serum creatine. The immunofixation revealed the monoclonal IgG Lambda, with an IgG level
was 7040 mg/dL. The β-microglobulin was high (10,22 mg/L). The bone marrow immunophenotyping showed
positive CD138, CD38, CD56, and LAMBDA correlated with myeloma markers. The boy was treated with
thalidomide and dexamethasone because bortezomib and autologous bone marrow transplantation were
unaffordable. A clinical improvement was seen at the first three months, but the patient died from severe
pneumonia during the six months of treatment. Conclusion Multiple myeloma is uncommon in pediatric
population and should be included in the differential diagnosis of bone lesion. The optimal treatment is still
uncertain due to the paucity of the case and needed to improve the patient’s outcome.
Keywords: pediatric; multiple myeloma; bone mass, treatment

P-HO-025
Incidence and Risk Factor of Central Nervous System Leukemia
in Children with Acute Lymphoblastic Leukemia: Manado Experience

Meirin Fatmawati Lukum, Stefanus Gunawan, Max Mantik
Department of Child Health, Faculty Medicine, Universitas Sam Ratulangi/Prof Dr. R. D. Kandou Hospital,
Manado, North Sulawesi, Indonesia
Abstract
Background Acute lymphoblastic leukemia (ALL) is the most frequent cancer in children. Early diagnosis
and treatment of central nervous system (CNS) can result a better prognosis. Objective To evaluate incidence
and risk factors of CNS leukemia in pediatric ALL. Methods This was a retrospective study of 124 ALL
patients aged < 18 years treated at Estella Clinic, Prof DR. R. D. Kandou General Hospital, Manado from
January 2017 to December 2020. We evaluate several possible risk factors for CNS leukemia: age, initial
leukocyte count, blast percentage, immunophenotype, hepatomegaly and splenomegaly. We compared these
risk factors between non-CNS leukemia ALL group and CNS-leukemia ALL group using Mann-Whitney
test. Results Out of 124 ALL patients, 92 patients (74%) had CNS leukemia. The incidence of ALL with or
without CNS leukemia were more often in male (67%). Among the tested risk factors, only initial leukocyte
3
count (25x10 /µL versus 121x x10 /µL, P=0.001) and blast percentage (50.44% + 20.37% vs. 69.67 + 23.25,
3
P=0.001) that were significantly different between non-CNS leukemia ALL group and CNS-leukemia ALL
group, respectively. Age, sex, hepatomegaly, splenomegaly, ALL type and immunophenotype were not
significantly different between two groups. Conclusion Leukocyte count and blast percentage are higher
in CNS-leukemia ALL. Children with ALL who present with high initial leukocyte and blast have higher
probability of having CNS leukemia.
Keywords: acute lymphoblastic leukemia; central nervous system

192 KONIKA XVIII Abstract Book