Hasil Pencarian  ::  Simpan CSV :: Kembali

Abstrak :
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 R-CHOP 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% 0,6-0,82); sedangkan limfosit absolut, neutrofil absolut, monosit absolut, dan rasio limfosit monosit mempunyai AUROC <0,70. Rasio neutrofil limfosit > 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%). ...... 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 R-CHOP 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 <0.70. The neutrophil lymphocyte ratio > 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 R-CHOP 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.

Abstrak :
Background: Diffuse large B-cell lymphoma (DLBCL) merupakan keganasan limfoid yang paling sering terjadi di dunia. DLBCL memiliki 2 subtipe yaitu germinal center B- cell-like (GCB) dan non-GCB. Programmed cell death-1 (PD-1) merupakan protein transmembran tipe 1 dari anggota imunoglobulin B7/CD28 sebagai reseptor imunomodulator yang memiliki peranan penting mencegah terjadinya kelainan autoimun. PD-1 di ekspresikan pada sel T, sel B dan sel natural killer. PD-1 memiliki ligan yaitu programmed cell death ligand-1 (PD-L1). PD-L1 banyak diekspresikan di beberapa jenis sel tumor dan di lingkungan mikro tumor. Salah satu karakteristik dari sel kanker adalah mampu menghindari destruksi dari sistem imun dengan cara mengaktivasi jalur PD-1/PD-L1. Peningkatan ekspresi PD-L1 memiliki asosiasi dengan prognosis yang buruk sedangkan peningkatan ekspresi PD-1 memiliki asosiasi dengan prognosis yang baik. Ekspresi PD-1 dan PD-L1 sudah diteliti pada kanker paru, namun jarang diteliti pada pasien DLBCL. Pada penelitian ini akan dievaluasi perbedaan antara ekspresi PD-1 dan PD-L1 pada pasien DLBCL subtipe GCB dan non-GCB. Metode: 20 kasus DLBCL subtipe GCB dan 20 kasus DLBCL subtipe non-GCB dalam sedian blok parafin (formalin-fixed paraffin-embedded tissue) dari Departemen Patologi Anatomik RSCM-FKUI pada periode tahun 2014 hingga 2017. Ekspresi PD-L1 dan PD-1 dievaluasi dengan teknik imunohistokimia. Ekspresi PD-L1 dievaluasi pada sel tumor, sedangkan ekspresi PD-1 dievaluasi di limfosit. Hasil: Terdapat perbedaan bermakna ekspresi PD-L1 pada sel tumor pasien DLBCL subtipe GCB dan non-GCB (P < 0,05), sedangkan ekspresi PD-1 tidak di diekspresikan pada limfosit pasien DLBCL subtipe GCB dan non-GCB. Kesimpulan: Terdapat peningkatan bermakna ekspresi protein PD-L1 yang diekspresikan pada sel tumor pasien DLBCL subtipe non-GCB dibandingkan subtipe GCB. Tidak terdapat ekspresi PD-1 pada limfosit pasien DLBCL subtipe GCB dan non-GCB. ......Background: Diffuse large B-cell lymphoma (DLBCL) is one of the most common lymphoid malignancies in the world and has two major molecular subtypes, germinal center B-cell-like (GCB) and non-GCB. Program cell death-1 (PD-1) is a type 1 transmembrane protein from members of immunoglobulin B7/CD28 as immunomodulator receptor that has an important role in preventing autoimmune disorder. PD-1 is expressed in T cells, B cells and natural killer cells. Program cell death ligand-1(PD-L1) is ligand of PD-1. PD-L1 is expressed in several types of tumor cells and in tumor microenvironment. One of cancer cells characteristic is the ability to avoid destruction of the immune system by activating PD-1 /PD-L1 pathway. Increased of PD-L1 expression is associated with poor prognosis while increased of PD-1 expression is associated with good prognosis. Expressions of PD-1 and PD-L1 have been studied in lung cancer, but study in DLBCL patients is limited. In this research, we evaluated the difference between PD-1 and PD-L1 expression in GCB and non-GCB subtypes of DLBCL. Methods: 20 cases of GCB subtype of DLBCL and 20 cases of non-GCB subtype of DLBCL in formalin-fixed paraffin-embedded tissue (FFPE) were taken from the archive of the Anatomical Pathology Department of RSCM-FKUI during 2014 to 2017. The expression of PD-L1 and PD-1 were evaluated by immunohistochemical technique. Expression of PD-L1 was evaluated in tumor cells, whereas PD-1 expression was evaluated in lymphocyte. Result: There was significant differences between PD-L1 expression in tumor cells of GCB subtype of DLBCL as compared to non-GCB subtype (P <0.05). The expression of PD-1 was not found in lymphocytes of GCB and non-GCB subtypes of DLBCL. Conclusion: The expression of PD-L1 in tumor cells of non-GCB subtype of DLBCL increased significantly as compared to GCB subtype. The expression of PD-1 protein was not found in lymphocyte cell of GCB as well as non-GCB subtypes of DLBCL.

Abstrak :
Latar belakang: Respon terapi diffuse large B-cell lymphoma (DLBCL) sangat heterogen. Skor IPI dan subtype DLBCL berdasarkan algoritma Hans masih banyak dipakai untuk menentukan prognosis. Jumlah monosit absolut (AMC) dan Tumor microenviroment (TME)  memiliki peranan penting dalam memprediksi  terjadinya event pada DLBCL. Beberapa TME yang telah dikaji adalah tumor associated macrophage (TAM), dan tumor infiltrating lymphocytes (TIL), namun masih terdapat hasil yang kontradiktif terhadap tingkat survival pasien DLBCL yang mendapatkan regimen terapi RCHOP dalam dua tahun. Tujuan penelitian: Mengetahui hubungan antara AMC,  TAM dan TIL terhadap event free survival 2 Tahun  pada  DLBCL yang mendapatkan terapi RCHOP. Metode penelitian: Penelitian ini adalah studi kohort retrospektif dengan mengambil data rekam medis pasien dari Rumah Sakit dr. Cipto Mangunkusumo (RSCM) yang terdaftar sejak Januari 2014-Maret 2021. Kami mengumpulkan data demografis, hasil pemeriksaan klinis,  laboratorium, termasuk AMC, pemeriksaan radiologi dan event selama 2 tahun. Pemeriksaan CD163 dan CD8 menggunakan pewarnaan imunohistokimia antibodi dari parafin blok biopsi jaringan. Kami menganalisis nilai cut off terbaik dari AMC, CD163, dan CD8 dalam menentukan survival dua tahun dan korelasi AMC terhadap CD163 dan CD8. Hasil: Kami menganalisis sebanyak 108 pasien (52% laki-laki, 33,3% usia lebih dari enam puluh tahun). Ditemukan nilai cut off terbaik AMC, CD163, dan CD8 berturut-turut adalah 631, 23, dan 27,5%. Terdapat hubungan yang bermakna berturut-turut antara AMC dan CD163 serta CD8 (r=0,577, p<0,001; r=-0,599, p<0,001). Kesimpulan dari penelitian ini ditemukan AMC, TAM M2 (CD163) dan TIL CD8 secara kuantitatif berhubungan dengan event free survival 2 tahun pada pasien DLBCL yang mendapatkan terapi RCHOP. Terdapat hubungan korelasi positif sedang antara AMC dengan TAM M2 (CD163),  dan hubungan korelasi negatif sedang antara AMC dengan  TIL CD8. ......Background: Response to therapy of diffuse large B-cell lymphoma (DLBCL) is very heterogeneous. IPI scores and DLBCL subtypes based on Hans' algorithm are still widely used to determine prognosis. Absolute monocyte count (AMC) and tumor microenvironment (TME) are important in predicting events in DLBCL. Several TMEs studied are tumor-associated macrophages (TAM) and tumor-infiltrating lymphocytes (TIL). However, there are still contradictory results regarding the survival rate of DLBCL patients who receive RCHOP therapy regimens within two years. Objective: This study aimed to determine the correlation between AMC, TAM, and TIL on 2-year event-free survival in DLBCL receiving RCHOP therapy. Methods: This research is a retrospective cohort study by taking patient medical record data from Dr. Cipto Mangunkusumo Hospital (RSCM) registered from January 2014-March 2021. We collected demographic data, clinical and laboratory examinations, including AMC, radiological examinations, and events for 2 years. Examine CD163 and CD8 using antibody immunohistochemical staining of paraffin tissue biopsy blocks. We analyzed the best cut-off values ​​of AMC, CD163, and CD8 in determining two-year survival and the correlation of AMC to CD163 and CD8. Results: We analyzed 108 patients (52% male, 33.3% over sixty). It was found that the best cut-off values ​​for AMC, CD163, and CD8 were 631, 23, and 27.5%, respectively. There was a significant relationship between AMC and CD163 and CD8, respectively (r=0.577, p<0.001; r=-0.599, p<0.001). This study concluded that AMC, TAM M2 (CD163), and TIL CD8 were quantitatively associated with 2-year event-free survival in DLBCL patients receiving RCHOP therapy. A moderate positive correlation exists between AMC and TAM M2 (CD163) and a moderate negative correlation between AMC and TIL CD8.