abstrak perbandingan persentase sel nk teraktivasi di darah tepi

ADLN - PERPUSTAKAAN UNIVERSITAS AIRLANGGA
ABSTRAK
PERBANDINGAN PERSENTASE SEL NK TERAKTIVASI DI DARAH
TEPI SEBELUM DAN SESUDAH KEMOTERAPI FASE INDUKSI
DIHUBUNGKAN DENGAN LUARAN KEMOTERAPI PADA PASIEN
LEUKEMIA LlMFOBLASTIK AKUT ANAK
Syntia TJ1, Endang Retnowati2, I Dewa Gede Ugrasena3, Soeprapto Ma’at4
1
Program Pendidikan Dokter Spesialis Patologi Klinik, Fakultas Kedokteran
Universitas Airlangga/Rumah Sakit Umum Daerah Dr. Soetomo, Surabaya.
2
Departemen Patologi Klinik, Fakultas Kedokteran Universitas Airlangga/Rumah
Sakit Umum Daerah Dr. Soetomo, Surabaya.
3
Departemen Ilmu Kesehatan Anak, Fakultas Kedokteran Universitas Airlangga/
Rumah Sakit Umum Daerah Dr. Soetomo, Surabaya.
Pendahuluan. Leukemia limfoblastik akut(LLA) adalah keganasan sel progenitor
limfoid berasal dari sumsum tulang, ditandai proliferasi lekosit. Insiden LLA
masih tinggi sehingga perlu meneliti peran sel NK melawan leukemia. Tujuan
penelitian menganalisis perbedaan persentase sel NK teraktivasi sebelum dan
sesudah terapi induksi dan menganalisis hubungan persentase sel NK teraktivasi
sebelum terapi induksi dengan luaran kemoterapi pasien LLA anak.
Metode. Penelitian analitik observasional dengan rancang bangun cohort
prospektif. Subyek penelitian 27 pasien diRuang Rawat Inap Hemato-Onkologi
Anak RSUD Dr.Soetomo Surabaya, Maret-Juli 2016. Metode pemeriksaan
flowcytometry alat BD FACSCaliburTM. Analisis statistik dengan Wilcoxon Signed
Rank Test dan uji regresi logistik.
Hasil. Terdapat perbedaan bermakna rerata persentase sel NK teraktivasi sebelum
terapi induksi 0,57%(SD 0,53%) dan sesudah terapi induksi 2,01%(SD 1,86%)
p=0,000. Menunjukkan peningkatan bermakna sel NK teraktivasi sesudah terapi
induksi. Korelasi sel NK teraktivasi sebelum terapi induksi dengan luaran
kemoterapi remisi dan meninggal R=0.723 berarti korelasi kuat.
Pembahasan. Peningkatan persentase sel NK teraktivasi sesudah terapi induksi
disebabkan kemoterapi meningkatkan produksi MICA/B dan kerja activating
receptors sel NK (NKG2D) yang bersifat sitotoksik kuat. Persentase sel NK
teraktivasi sebelum terapi induksi yang rendah disebabkan mekanisme tumor
escape pada LLA
Simpulan dan Saran. Terdapat perbedaan bermakna persentase sel NK
teraktivasi sebelum dan sesudah terapi induksi. Hasil dapat menjadi prediktor
keberhasilan pemberian kemoterapi LLA anak. Persentase sel NK teraktivasi
sebelum kemoterapi fase induksi berpengaruh kuat terhadap luaran kemoterapi
remisi dan meninggal. Hasil dapat digunakan sebagai penentuan prognosis. Perlu
dilakukan penelitian pengamatan jangka panjang sampai selesai manajemen
pemberian kemoterapi.
Kata kunci. LLA anak, sel NK teraktivasi, luaran kemoterapi.
ix
KARYA AKHIR
PERBANDINGAN PERSENTASE SEL ...
SYNTIA TANU JUWITA, dr
ADLN - PERPUSTAKAAN UNIVERSITAS AIRLANGGA
ABSTRACT
COMPARISON OF PERCENTAGE PERIPHERAL BLOOD ACTIVATED
NK CELL BEFORE AND AFTER CHEMOTHERAPY INDUCTION
PHASE RELATED WITH OUTCOME OF CHEMOTHERAPY IN
PEDIATRIC ACUTE LYMPHOBLASTIC LEUKEMIA.
Syntia TJ1, Endang Retnowati2, I Dewa Gede Ugrasena3, Soeprapto Ma’at4
1
Clinical Pathology Specialist Program, Faculty of Medicine. Airlangga
University / Dr.Soetomo Hospital, Surabaya.
2
Department of Clinical Pathology, Faculty of Medicine. Airlangga University /
Dr.Soetomo Hospital, Surabaya.
3
Department of Pediatric, Faculty of Medicine. Airlangga University/Dr.Soetomo
Hospital, Surabaya.
Preliminary. Acute lymphoblastic leukemia (ALL) is a malignant of lymphoid
progenitor cells from the bone marrow, characterized by proliferation of
leukocytes. The incidenced ALL is still high so that the necessary efforts are
needed to examine role of NK cell against leukemia cells. The aim of this study
was to analyze the difference of activated NK cell percentage before and after
chemotherapy induction phase and analyze the correlation between the activated
NK cell percentage before chemotherapy induction phase with outcome of
chemotherapy in pediatric ALL.
Method. This was an analytical observational study with cohort prospective
design. Subjects were 27 ALL patient in the Hemato - Oncology Pediatric Ward
Dr. Soetomo Hospital Surabaya in March-July 2016. Examination was done by
BD FACSCaliburTM using flowcytometry. The analyzed statistically using
Wilcoxon Signed Rank Test and logistic regression.
Results. Significant improvement was shown, the mean of activated NK cell
percentage before chemotherapy induction phase was 0.57% (SD 0.53%) and after
chemotherapy induction phase was 2.01% (SD 1.86%) with p=0.000. These
results showed that the activated NK cell percentage was increased after
chemotherapy induction phase. Correlation activated NK cell before
chemotherapy induction phase with outcome of chemotherapy is remission or died
R=0,723 mean strong correlation.
Discussion. Increased of activated NK cell percentage after chemotherapy
induction phase was due to chemotherapy drug effect which increased MICA/B
production and increased the role of NK cell activating receptors (NKG2D) have
high cytotoxicity effect. Activated NK cell percentage before chemotherapy is low
because of tumor escape mechanism.
Conclussion and suggestion. Significant improvement of activated NK cell
percentage before and after chemotherapy induction phase. The results can be
predictor of chemotherapy succesfully. Activated NK cell percentage before
chemotherapy influential strong against the outcome of chemoterapi remission
x
KARYA AKHIR
PERBANDINGAN PERSENTASE SEL ...
SYNTIA TANU JUWITA, dr
ADLN - PERPUSTAKAAN UNIVERSITAS AIRLANGGA
and died. The results can be used as a prognostic factor. Important to observations
long-term until completed management chemotherapy.
Keywords. ALL, activated NK cell, outcome of chemotherapy
xi
KARYA AKHIR
PERBANDINGAN PERSENTASE SEL ...
SYNTIA TANU JUWITA, dr