Tesis

Hitung Jenis Leukosit sebagai Prediktor Neutropenia Akut Awitan Pertama Pascakemoterapi R-CHOP pada Pasien Diffuse Large B-cell Lymphoma = Differential Count of Leukocytes as A Predictor of The First Onset Acute Neutropenia After R-CHOP Chemotherapy in Diffuse Large B-cell Lymphoma Patients.

Latar Belakang: Diffuse Large B-cell Lymphoma (DLBCL) merupakan limfoma tersering di Indonesia. Kemoterapi R-CHOP mempunyai risiko moderat untuk terjadinya neutropenia / demam neutropenia. Limfosit dapat menggambarkan imunitas pejamu, sedangkan neutrofil dan monosit dapat menggambarkan respons inflamasi. Belum ada penelitian yang menilai hitung jenis leukosit sebagai prediktor neutropenia akut awitan pertama pascakemoterapi R-CHOP pada pasien DLBCL. Tujuan: Mengetahui hubungan parameter hitung jenis leukosit sebelum kemoterapi sebagai prediktor neutropenia akut awitan pertama pascakemoterapi RCHOP pada pasien DLBCL. Metode: Kohort retrospektif di RSUPN. Cipto Mangunkusumo. Pasien DLBCL 18–60 tahun, ECOG 0–1, tanpa komorbid yang berhubungan dengan kemoterapi, yang dilakukan kemoterapi R-CHOP 3 siklus pertama tanpa profilaksis G-CSF. Hasil: Dari 95 pasien, neutropenia akut awitan pertama pascakemoterapi terjadi pada 83 (87,4%) subjek atau 83 (55,3%) siklus dari total 150 siklus kemoterapi. Demam neutropenia terjadi pada 50,6% dari awitan neutropenia. Neutropenia berat terjadi pada 34 (41,0%) siklus dari 83 episode neutropenia. Neutropenia akut awitan pertama paling sering terjadi pada 7–15 hari pascakemoterapi. Rasio neutrofil limfosit mempunyai AUROC 0,74 (IK 95% 0,65–0,82); sedangkan limfosit absolut, neutrofil absolut, monosit absolut, dan rasio limfosit monosit mempunyai AUROC 4,1 dapat memprediksi neutropenia akut awitan pertama pascakemoterapi RCHOP pada pasien DLBCL (sensitivitas 71,1%; spesivisitas 64,2%; nilai duga positif 71,1%; dan nilai duga negatif 64,2%). Simpulan: Rasio neutrofil limfosit sebelum kemoterapi > 4,1 mempunyai performa sedang (moderat) dalam memprediksi neutropenia akut awitan pertama pascakemoterapi R-CHOP pada pasien DLBCL. Nilai limfosit absolut, monosit absolut, neutrofil absolut, dan rasio limfosit monosit tidak dapat dijadikan prediktor neutropenia akut awitan pertama pascakemoterapi R-CHOP pada pasien DLBCL.
Kata kunci: diffuse large B-cell lymphoma, hitung jenis leukosit, neutropenia, RCHOP, rasio neutrofil limfosit.


Background: Diffuse Large B-cell Lymphoma (DLBCL) is the most common lymphoma in Indonesia. R-CHOP chemotherapy has a moderate risk for neutropenia / febrile neutropenia. Lymphocytes can describe host immunity, while neutrophils and monocytes can describe the inflammatory response. No study has assessed differential count of leukocytes as a predictor of the first onset acute neutropenia after R-CHOP chemotherapy in DLBCL patients. Objective: To determine the relationship between differential count of leukocytes before chemotherapy as a predictor of the first onset acute neutropenia after RCHOP chemotherapy in DLBCL patients. Methods: Retrospective cohort in RSUPN. Cipto Mangunkusumo. DLBCL patients 18–60 years old, ECOG 0–1, no comorbidity related to chemotherapy. Subjects were given with the first 3 cycles of R-CHOP chemotherapy without G-CSF prophylaxis. Results: Of the 95 patients, first onset acute neutropenia after chemotherapy occurred in 83 (87.4%) subjects or 83 (55.3%) cycles of 150 chemotherapy cycles. Febrile neutropenia occurs in 50,6% of the onset of neutropenia. Severe neutropenia occurs in 34 (41.0%) cycles of 83 neutropenic episodes. The first onset of acute neutropenia is most common at 7–15 days after chemotherapy. The neutrophil lymphocyte ratio has AUROC 0.74 (95% CI 0.65–0.82); while absolute lymphocytes, absolute neutrophils, absolute monocytes, and monocyte lymphocyte ratios have AUROC 4.1 can predict the first onset of acute neutropenia after RCHOP chemotherapy in DLBCL patients (sensitivity 71.1%; specificity 64.2%; positive predictive value 71.1%; negative predictive value 64.2%). Conclusion: The neutrophil lymphocyte ratio before chemotherapy > 4.1 has moderate performance in predicting the first onset of acute neutropenia post RCHOP chemotherapy in DLBCL patients. Absolute lymphocytes count, monocytes count, neutrophils count, and monocyte lymphocyte ratio cannot be used as a predictor of the first onset acute neutropenia post R-CHOP chemotherapy in DLBCL patients.
Keywords: differential count of leukocytes, diffuse large B-cell lymphoma, neutropenia, neutrophil lymphocyte ratio, R-CHOP.