Tesis

Pengaruh perubahan status gizi anak dan beberapa faktor yang memengaruhi pada anak leukemia limfoblastik akut terhadap kejadian remisi = The Effect of changes in nutritional status and factors associated remission in children with acute lymphoblastic leukemia.

Latar belakang : Prevalens terjadinya malnutrisi bervariasi pada berbagai siklus kemoterapi LLA. Penelitian di Malaysia mendapatkan anak LLA pasca-kemoterapi fase induksi cenderung mengalami obesitas atau status gizi lebih. Penyebab malnutrisi pada anak LLA dapat dipengaruhi oleh berbagai faktor. Perubahan status gizi selama kemoterapi dapat memengaruhi luaran kemoterapi. Tujuan: mengetahui faktor-faktor yang memengaruhi perbaikan status gizi anak LLA setelah kemoterapi fase konsolidasi, serta pengaruhnya terhadap luaran kemoterapi, sehingga dapat dipakai sebagai masukan untuk upaya mengatasi malnutrisi pada anak LLA. Metode : Penelitian ini dengan uji retrospektif, di Rumah sakit Cipto Mangunkusumo, selama tahun 2016-2018. Total sampling pada pasien leukemia limfoblastik akut yang terdiagnosis, dan menjalani kemoterapi di RSCM hingga fase konsolidasi. Hasil : Seratus empat puluh satu subyek pasien anak LLA diikutsertakan dalam penelitian ini. Terdapat 69,5% subyek mengalami perbaikan status gizi, dan 30,5% mengalami perburukan status gizi, dengan 60% perburukan ke arah overnutrition pascakemoterapi fase konsolidasi. Faktor risiko independen terhadap terjadinya perbaikan status gizi pasca-kemoterapi fase konsolidasi ialah tidak timbulnya efek samping kemoterapi (RR 1,36, 95% IK 1,02 – 1,81). Jenis makanan dan cara pemberian makan tidak memengaruhi perubahan status gizi anak LLA pasca-fase konsolidasi. Terdapat hubungan antara perbaikan status gizi anak LLA pasca-fase konsolidasi dengan kejadian remisi (RR 1,24, 95% IK 1,03 – 1,5). Simpulan : Status gizi pasca-kemoterapi fase konsolidasi mengalami perbaikan dibandingkan sebelum kemoterapi, sedangkan yang mengalami perburukan status gizi cenderung mengalami overnutrition. Perbaikan status gizi anak LLA pasca-kemoterapi fase konsolidasi dipengaruhi oleh tidak timbulnya efek samping kemoterapi. Terdapat hubungan antara perbaikan status gizi anak LLA pasca-kemoterapi fase konsolidasi dengan kejadian remisi.
Kata Kunci : malnutrisi, leukemia limfoblastik akut, obesitas


Background: Acute lymphoblastic leukemia (ALL) is the most common malignancy in childhood. The prevalence of malnutrition varies in phase of ALL chemotherapy. Study in Malaysia showed ALL children after induction phase of chemotherapy tended to be obese or overweight. The causes of malnutrition in ALL children can be influenced by various factors. Changes in nutritional status during chemotherapy can affect the outcome of chemotherapy. Aim: To investigate factors that influence nutritional status improvement of ALL children after consolidation phase, as well as the effect on the outcomes of chemotherapy, so it can be used as an input to overcome malnutrition in ALL children. Method: A retrospective design was performed in Cipto Mangunkusumo Hospital from 2016 until 2018. Total sampling in patients with acute lymphoblastic leukemia who was diagnosed and started chemotherapy at Cipto Mangunkusumo Hospital until the consolidation phase. Result: A total of 141 subjects were included in this study. After consolidation phase, 69.5% of subjects experienced nutritional status improvements, and 30.5% worsened, of which 60% become over nutrition post-consolidation phase. Independent risk factor for the improvement of nutritional status after consolidation phase was the absence of chemotherapy side effects (RR 1.36, 95% CI 1.02 - 1.81). There were no association between type of food and route of feeding with nutritional status improvement of ALL children after consolidation phase. There was association between improvement in nutritional status of ALL children after consolidation phase with the incidence of remission (RR 1.24, 95% CI 1.03 - 1.5). Conclusion: Nutritional status at post-consolidation phase has improved compared to pre- chemotherapy, while those who worsening nutritional status tend to overnutrition. The absence of chemotherapy side effects affects nutritional status improvement of ALL children after consolidation phase. There is a relationship between nutritional status improvement of ALL children after consolidation phase with the incidence of remission.
Key words : malnutrition, acute lymphoblastic leukemia, obesity.