Faktor yang Berhubungan dengan Pencapaian Respons Hematologi Lengkap dalam 3 Bulan pada Pasien Leukemia Granulositik Kronik Fase Kronik yang Mendapat Terapi Imatinib Mesylate

Ikhwan Rinaldi, Arry Haryanto Reksodiputro

Abstract

Pendahuluan. Respons hematologi lengkap merupakan bagian tak terpisahkan dari pencapaian target respons sitogenetik lengkap dan respons molekular mayor terapi imatinib mesylate meskipun tidak menentukan prognosis. Respons hematologi lengkap pasien LGK fase kronik di Indonesia lebih rendah daripada kasus LGK fase kronik di dunia (74% vs. 95,3%).  Perbedaan ini karena 60% pasien di Indonesia mendapat hidroksiurea lebih dulu. Penelitian ini bertujuan untuk mengetahui faktor-faktor prognostik apa saja yang memengaruhi respons hematologi lengkap pasien LGK fase kronik yang mendapat imatinib mesylate di Indonesia.

Metode. Penelitian dilakukan dengan desain kohort retrospektif menggunakan rekam medis pasien leukemia granulositik kronik yang datang berobat ke Klinik Teratai RSCM dan Poli Hematologi RSCM lantai 2 yang mendapat terapi imatinib mesylate sejak Januari 2004-Desember 2011.

Hasil. Sebagian besar subjek penelitian laki-laki (61,5%), berumur 26-40 tahun (47,4%), lama diagnosis  <12 bulan (69,2%), lama terapi hidroksiurea <6 bulan (64,1%), konsentrasi hemoglobin <12 g/dl (69,2%), jumlah leukosit ≥50.000 (48,7%), jumlah trombosit 0-<450.000 (42,3%), besar limpa ≥10 cm (55,1%), dan skor Sokal rendah (42,3%) serta mencapai respons hematologi lengkap dalam 3 bulan (57,7%). Lama terapi hidroksiurea < 6 bulan sebelum mendapat terapi imatinib mesylate merupakan faktor prognosis tingginya angka pencapaian respons hematologi lengkap dalam 3 bulan

Simpulan. Karakteristik klinik dan laboratorik pasien LGK fase kronik di Indonesia berbeda dengan karakteristik pasien LGK fase kronik di luar negeri. Lama diagnosis sampai mendapat imatinib mesylate <12 bulan, lama terapi hidroksiurea <6 bulan, dan konsentrasi hemoglobin ≤12 g/dl berhubungan dengan pencapaian respons hematologi lengkap pada pasien LGK fase kronik. Lama terapi hidroksiurea <6 bulan merupakan faktor independen yang berhubungan dengan pencapaian respons hematologi lengkap.

Kata Kunci: Imatinib mesylate, respons hematologi sempurna

Prognosic Factors Related to The Complete Hematologic Response (CHR) in 3 Months in Leukemia Granulositic Patients Administered with Imatinib Mesylate

Introduction. The complete hematologic response is an integral part to achieve the complete cytogenetic response target and the major molecular response of imatinib mesylate therapy, although it does not determine the prognosis. The complete hematologic response in Indonesia is lower than in the world (74% vs. 95%). Sixty percent of chronic myeloid leukemia patients in Indonesia were administered hydroxyurea before imatinib mesylate. Chronic myeloid leukaemia (CML) patients in Indonesia are younger than in other countries. This study aimed to determine what prognostic factors which affect the complete hematological response of chronic phase CML patients who received imatinib mesylate in Indonesia.

Methods. The study was done by retrospective cohort design using the medical records data of chronic myeloid leukemia patients who were treated at Teratai Clinic and hematology clinic RSCM and received imatinib mesylate therapy from January 2004-December 2011.

Results. Most of the study subjects were male (61.5%), aged 26-40 years (47.4%), duration of diagnosis <12 months (69.2%), duration of hydroxyurea therapy <6 months (64.1%), hemoglobin concentration <12 g/dl (69.2%), leukocyte count ≥50,000 (48.7%), platelet count 0 – <450,000 (42.3%), spleen size ≥10 cm (55.1%), low Sokal score (42.3%), and achieve a complete hematologic response within 3 months (57.7%). Duration of hydroxyurea therapy <6 months is prognostic factor higher CHR achievement.

Conclusions. Clinical and laboratory characteristics CML patients in Indonesia are different than CML patients in the world. Duration of diagnosis until imatinib mesylate administration <12 months, duration of hydroxyurea administration <6 months, and hemoglobin concentration ≤12 g/dl were associated with the achievement of complete hematological response of chronic CML patients in Indonesia. Duration of hydroxyurea administration <6 months was identified as independent factor of achievement of complete hematological response of chronic CML patients in Indonesia.


Keywords

complete hematologic response, imatinib mesylate

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