Search Result  ::  Save as CSV :: Back

"ABSTRAKLatar belakang. Pada penderita thalassemia yang telah lama mendapat transfusi, nilai hemoglobin pasca transfusi tidak bertahan sesuai dengan yang diharapkan. Telah dilaporkan mengenai terbentuknya aloantibodi dan autoantibodi pada penderita thalassemia, yang kemungkinan menyebabkan hemoglobin tidak bertahan pasca transfusi.Tujuan. Penelitian ini bertujuan untuk mencari faktor-faktor yang berhubungan dengan kegagalan mempertahankan hemoglobin pasca transfusi pada penderita thalassemia, terkait dengan terbentuknya aloantibodi dan autoantibodi terhadap eritrosit.Metodologi. Studi potong lintang di poliklinik Hematologi Onkologi Medik IPD RSCM bulan Juli-September 2012 pada penderita thalassemia dewasa yang tergantung transfusi, tanpa penyakit autoimun lain. Dilakukan pemeriksaan sampel darah dengan teknik column gel aglutination untuk melihat adanya aloantibodi dan autoantibodi. Sebelas sel panel reagen digunakan untuk mendeteksi dan mengidentifikasi aloantibodi. Aloantibodi dan autoantibodi positif didefinisikan sebagai pemeriksaan IAT dan DAT yang positif. Dilakukan analisis bivariat antara aloantibodi dan autoantibodi dengan jenis kelamin, jenis rhesus, kadar feritin, jenis kelasi besi, dan aloantibodi.Hasil. Dari 88 subjek, didapatkan 37,5% subjek nilai hemoglobin pasca transfusi tidak bertahan seperti yang diharapkan. Dari 33 subjek tersebut didapatkan aloantibodi dan autoantibodi positif masing-masing 78,6% dan 72,7%. Dari 24 pasien dengan autoantibodi didapatkan 25% dengan derajat hemolitik yang secara klinis bermakna. Aloantibodi positif berhubungan dengan terbentuknya autoantibodi (p < 0,000). Aloantibodi positif [odss ratio (OR) = 26,32; p < 0,000), autoantibodi positif (OR = 11,99; p < 0,000), dan feritin > 3000 ng/ml (OR = 6,36; p < 0,042) berhubungan dengan kegagalan mempertahankan hemoglobin pasca transfusi.Simpulan. Proporsi hemoglobin pasca transfusi tidak bertahan sesuai dengan yang diharapkan pada penderita thalassemia dewasa sebesar 37,5%. Proporsi terbentuknya aloantibodi dan autoantibodi pada kelompok tersebut sebesar 78,6% dan 72,7%. Faktor yang berhubungan dengan kegagalan mempertahankan hemoglobin pasca transfusi adalah aloantibodi positif, autoantibodi positif, dan feritin > 3000 ng/ml. Aloantibodi positif berhubungan dengan terbentuknya autoantibodi.

---

ABSTRACTBackground. In transfusion dependent thalassemia patients who has got repeated transfusion for a period of time, the haemoglobin level after transfusion could not be maintained appropriately to be expected. The production of erythroyte alloantibody and autoantibody in transfusion dependent thalassemia patients has been reported before. These antibodies were probable related to the failure on maintaning haemoglobin level after transfusion.Objective. To find related factors of failure on maitaining haemoglobin level after transfusion in adult transfusion dependent thalassemia patients related to erythroyte alloantibody and autoantibody production.Material and Methods. Cross sectional study of adult transfusion dependent thalassemia patient without others autoimune disease at Haematology and Medical Oncology outpatient clinic in Cipto Mangunkusumo hospital from July to September 2012 was done. The specimen was subjected to erythroyte alloantibody and autoantibody evaluation by column gel agglutination technique. Eleven cell reagent panel were used in screening and identification of alloantibody and autoantibody respectively. Positive alloantibody is defined as positivity of indirect antiglobulin test and positive autoantibody is defined as positivity of direct antiglobulin test. Statistic analysis between erythrocyte alloantibody and autoantibody positivity and sex, type of rhesus, feritin level, type of iron chelation, and alloantibody were done.Results. From 88 subjects, there were 37,5% thalassemia patients that did not maintain haemoglobin level after transfusion. From 33 of those subjects, there were 78,6% subjects with alloantibody and 72,7% subjects with autoantibody. From 24 patients with autoantibody, there were 25% subjects with severe hemolytic anemia that clinically significant. Positif alloantibodi related to autoantibody production (p < 0,000). Positive alloantibody [odds ratio (OR) = 26,32; p < 0,000], positive autoantibody (OR = 11,99; p < 0,011), and feritin level > 3000 ng/ml (OR = 6,36; p < 0,042) related to failure on maintaining haemoglobin level.Conclusion. The proportion of failure on maintaining haemoglobin level in adult thalassemia patients were 37,5%. The proportion alloantibody and autoantibody production in adult thalassemia patients that failure on maintaining haemoglobin level were 78,6% and 72,7% respectively. Related factors of those were positive alloantibody and autoantibody, and feritin level > 3000 ng/ml. Positive alloantibody related to autoantibody production."

"Latar belakang Kanker kepala leher adalah kanker yang paling sering ketujuh di dunia dengan 890.000 kasus baru dan 450.000 kematian tiap tahunnya. Diperkirakan prevalensi karsinoma nasofaring di Indonesia adalah 6,2/100.000 dengan 12.000 kasus baru tiap tahunnya. Terapi definitif untuk kanker kepala leher adalah operasi dengan kemoradiasi sebagai terapi adjuvan sedangkan untuk kanker nasofaring kemoradiasi adalah terapi definitif untuk stadium lokal lanjut, yang paling sering terdiagnosis di Indonesia. Toksisitas kemoradiasi berkaitan dengan malnutrisi dan massa dan kekuatan otot yang rendah. Dengan melakukan intervensi nutrisi dan latihan fisik aerobik dan resistensi, diharapkan angka toksisitas kemoradiasi berkurang. Di Indonesia latihan fisik aerobik resistensi pada kanker kepala leher belum menjadi panduan tatalaksana nasional. Untuk itu diperlukan evaluasi keamanan dan kepatuhan latihan fisik aerobik dan resistensi pada kanker kepala leher dengan malnutrisi yang menjalani kemoradiasi.Tujuan Mengetahui proporsi malnutrisi pada kanker kepala leher yang akan menjalani kemoradiasi dan mengetahui keamanan dan kepatuhan latihan fisik aerobik dan resistensi untuk dapat dilakukan selama kemoradiasi pada kanker kepala leher degan malnutrisi.Metode. Penelitian pendahuluan menggunakan desain potong lintang dengan kriteria inklusi pasien kanker kepala leher dan karsinoma nasofaring stadium III-IV yang akan menjalani kemoradiasi, dengan pengambilan sampel secara konsekutif. Subjek akan dievaluasi penapisan malnutrisi dengan Malnutrition screening tool (MST) dan evaluasi data klinis dan laboratorium lainnya. Penelitan utama dengan desain intervensi single arm pre-post study bersama terapi standar nutrisi dengan kriteria inklusi subjek dari penelitian pendahuluan dengan skor MST lebih besar sama dengan 2, usia dewasa 18-59 tahun, status performan ECOG 0-1 dan tanda vital baik. Intervensi yang diberikan berupa latihan fisik aerobik dan resistensi yang terdiri dari uji latih dan latihan selama kemoradiasi. Pengamatan selama kemoradiasi akan dievaluasi kepatuhan dan keamanan serta evaluasi kekuatan genggam tangan, skor MST, skor kualitas hidup dan toksisitas kemoradiasi.Hasil Sebanyak 36 subjek eligible. Proporsi subjek kanker kepala leher sebelum menjalani kemoradiasi dengan malnutrisi adalah 25 (69,5%) dan berisiko malnutrisi 7 (19,4%). Dari 15 subjek yang eligible untuk latihan fisik aerobik dan resistensi, sebanyak 10 subjek telah menjalani latihan. Dari 13 sesi latihan yang dikerjakan, seluruhnya dapat dilakukan hingga akhir dan tanpa efek samping terkait latihan. Latihan ini hanya terlaksana 13 (31,7%) sesi latihan. Alasannya karena masalah medis dan jadwal untuk dapat terlaksana latihan aerobik dan resistensi. Dengan latihan fisik aerobik dan resistensi terjadi penurunan skor MST 1,7+0,05 p 0,04, kenaikan kekuatan genggam tangan 0,6+0,45 kg p 0,36 dan berat badan 1,93+0,3 kg p 0,521 di akhir minggu kedua. Terdapat perbaikan skor kualitas hidup untuk domain skala gejala mulut kering, pemakaian sonde makan, dukungan nutrisi namun tidak berbeda bermakna secara statistik.Simpulan Proporsi malnutrisi pada kanker kepala leher sebelum kemoradiasi 69,5%. Latihan fisik aerobik dan resistensi aman untuk dapat dilakukan selama kemoradiasi namun belum mampu laksana karena kepatuhannya 31,7%. Latihan fisik aerobik dan resistensi belum dapat dievaluasi apakah menyebabkan perbaikan malnutrisi, kekuatan otot, dan skor kualitas hidup.

---

Background Head and neck cancer is the 7th most common cancer in world with 890,000 new cases and 450,000 mortality every year. Approximately the prevalence of nasopharyngeal cancer in Indonesia is 6.2/100,000 with 12,000 new cases every year. Definitive treatment for head neck cancer is surgery continue with chemoradiation as adjuvant therapy, whereas chemoradiation in nasopharyngeal cancer is definitive treatment for locally advance settings which the most common diagnosed in Indonesia. Chemoradiation toxicity related to malnutrition and low muscle mass and strength. Nutritional and aerobic and resistance training can decrease the incidence of chemoradiation toxicity. In Indonesia, these training in head neck cancer have not yet included in national management guideline. Thus, there is a need to evaluate the safety and compliance of aerobic and resistance training in head neck cancer with malnutrition who underwent chemoradiation.

To know the proportion of malnutrition in head neck cancer who underwent chemoradiation and to know the safety and compliance of aerobic and resistance training to be able to be done during chemoradiation in head neck cancer with malnutrition.

Method The cross-sectional study of preliminary study included consecutively head neck cancer and nasopharyngeal cancer stage III-IV who will underwent chemoradiation. The subject will be evaluated for malnutrition screening with malnutrition screening tool (MST) together with other clinical and laboratory baseline data related to malnutrition. The main study was using intervention single arm pre and post study design together with nutritional standard therapy, which included subject from the preliminary study with MST score 2 or higher, adult 17-59 years old, performance status ECOG 0-1 and good vital sign. Subjects will be given aerobic and resistance training as an intervention arm during chemoradiation. Evaluation of safety and compliance together with hand grip strength, MST score, quality of life score using EORTC-QLQ C30 and HN35 and chemoradiation toxicity using National cancer institute common toxicity criteria version 4.0 will be done periodically to included subject.

Result A total of 36 eligible subjects were included. The proportion of malnutrition and disease at risk malnutrition in head neck cancer before underwent chemoradiation was 25 (69.5%) and 7 (19.4%) respectively. Ten of 15 eligible subjective have done aerobic and resistance training. From 13 training session, all of them were done until the end without any complication. There were only 13 (31.7%) training can be done by the subjects during chemoradiation. There were medical and schedule problems explaining why the training have not been able to be done as schedule. Aerobic and resistance training were associated with decreased MST score 1.7+0.05 p value 0.04, increased hand grip strength 0.6+0.45 kg p value 0.36 and body weight 1.93+0.3 kg p value 0.521 at the end of second week. There was an improvement of quality-of-life score for domain symptoms scale dry mouth, tube feeding and nutritional support, however there was not statistically significant.

Conclusion The proportion of malnutrition in head neck cancer before chemoradiation was 69.5%. Aerobic and resistance training safe to be done during chemoradiation. The compliance or feasibility of aerobic and resistance training during chemoradiation was only 31.7%. Aerobic and resistance training was not able to evaluate weather associated with improvement of malnutrition, muscle strength, and quality of life."