Tesis

Deteksi Dini Vincristine-Induced Peripheral Neuropathy (VIPN) Menggunakan Total Neuropathy Score-Pediatric Vincristine (TNS©-PV) Dengan Baku Emas Uji Kecepatan Hantar Saraf (KHS) = Early Detection of Vincristine-Induced Peripheral Neuropathy (VIPN) using Total Neuropathy Score-Pediatric Vincristine (TNS©-PV) with Nerve Conduction Study (NCS) as Gold Standard.

Latar belakang. Anak leukemia limfoblastik akut (LLA) berisiko mengalami neuropati perifer yang disebabkan oleh agen kemoterapi. Vinkristin merupakan agen kemoterapi penting dalam kemoterapi LLA. Sistem skoring merupakan salah satu cara evaluasi Vincristine-Induced Peripheral Neuropathy (VIPN). Salah satu sistem skoring untuk evaluasi VIPN pada anak adalah Total Neuropathy Score-Pediatric Vincristine (TNS©- PV). Tujuan. Menguji performa skoring TNS©-PV untuk deteksi dini VIPN pada anak dengan LLA di RSUPN dr. Cipto Mangunkusumo (RSCM) Jakarta. Metode. Penelitian ini merupakan uji diagnostik skoring TNS©-PV dengan baku standar uji kecepatan hantar saraf (KHS). Pemeriksaan TNS©-PV dan KHS dilakukan terhadap 42 anak LLA usia 6-18 tahun di RSCM. Kemudian dilakukan penghitungan sensitivitas, spesifisitas, dan area under curve (AUC) berdasarkan nilai potong optimal yang ditentukan dengan kurva receiving operating characteristics (ROC). Hasil. Sebanyak 20 subjek penelitian mengalami VIPN berdasarkan KHS (47,6%). Nilai potong optimal TNS©-PV untuk deteksi dini VIPN adalah ≥ 1 dengan sensitivitas 80% (95% IK 56,3% – 94,3%), spesifisitas 81,8% (95% IK 59,7% – 94,8%), dan area under curve (AUC) 0,863 (95% IK 0,742 – 0,983). Kesimpulan. Skoring TNS©-PV memiliki sensitivitas dan spesifisitas yang cukup baik untuk deteksi dini VIPN pada pasien LLA berusia ≥6 tahun. Namun, belum dapat menggantikan pemeriksaan KHS dalam diagnosis VIPN.
Kata kunci: Leukemia limfoblastik akut (LLA), neuropati, Vincristine-Induced Peripheral Neuropathy (VIPN), TNS©-PV, anak.


Background. Children with acute lymphoblastic leukemia (ALL) are at risk of developing peripheral neuropathy caused by chemotherapy agents. Vincristine is an important chemotherapy agent in ALL therapy. The scoring system is one way to assess Vincristine-Induced Peripheral Neuropathy (VIPN). Total Neuropathy Score-Pediatric Vincristine (TNS©-PV) is one of the scoring systems for evaluating VIPN in children aged ≥6 years. Objective. To determine the performance of TNS©-PV scoring as a VIPN screening test in children with ALL at RSUPN Dr. Cipto Mangunkusumo (RSCM) Jakarta. Method. This research is a diagnostic test on 42 children diagnosed with ALL aged 6-18 years at RSCM. Nerve conduction study (NCS) and TNS©-PV examinations are carried out to evaluate VIPN. Then, the sensitivity and specificity were calculated based on the optimal cutoff value determined by the receiving operating characteristics (ROC) curve. Results. Among 42 subjects who participated in this research, 20 subjects experienced VIPN based on NCS examination (47.6%). The optimal TNS©-PV cutoff value for early detection ofVIPN is ≥ 1 with sensitivity 80% (95% CI 56.3% – 94.3%), specificity 81.8% (95% CI 59.7% – 94.8%), and area under curve (AUC) 0.863 (95% CI 0.742 – 0.983). Conclusion. TNS©-PV scoring system has good sensitivity and specificity as a screening tool for VIPN in ALL patients ≥6 years old. However, it cannot substitute NCS to diagnose VIPN.
Keywords: Acute lymphoblastic leukemia (ALL), neuropathy, Vincristine-Induced Peripheral Neuropathy (VIPN), TNS©-PV, children.