Rasio Neutrofil Limfosit sebagai Prediktor Neutropenia Akut Awitan Pertama Pascakemoterapi R-CHOP pada Pasien Diffuse Large B-cell Lymphoma

Abstract

Pendahuluan. Diffuse large B-cell lymphoma (DLBCL) merupakan limfoma yang paling sering ditemukan 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 penelitian ini adalah untuk mengetahui hubungan parameter hitung jenis leukosit sebelum kemoterapi sebagai prediktor neutropenia akut awitan pertama pascakemoterapi R-CHOP pada pasien DLBCL. Metode. Studi kohort retrospektif di RSUPN. Cipto Mangunkusumo dilakukan pada pasien DLBCL 18–60 tahun, status performa ECOG (Eastern Cooperative Oncology Group) 0–1, tanpa komorbid yang berhubungan dengan kemoterapi, serta mendapatkan 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% 0,65–0,82); sedangkan limfosit absolut, neutrofil absolut, monosit absolut, dan rasio limfosit monosit mempunyai AUROC 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%). Simpulan. rasio neutrofil limfosit sebelum kemoterapi > 4,1 merupakan prediktor neutropenia akut awitan pertama pascakemoterapi R-CHOP pada pasien DLBCL. Kata Kunci: Diffuse large B-cell lymphoma , hitung jenis leukosit, neutropenia, R-CHOP, rasio neutrofil limfosit Neutropenia After R-CHOP Chemotherapy in Diffuse Large B-cell Lymphoma Patients 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. Th is study aimed 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. A r etrospective cohort study was conducted among 18–60 years old DLBCL patients with ECOG 0–1 and no comorbidity related to chemotherapy 18–60 years old. 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 was the  most common at 7–15 days after chemotherapy. The AUC of neutrophil lymphocyte ratio was 0.74 (95% CI 0.65–0.82); while absolute lymphocytes, absolute neutrophils, absolute monocytes, and monocyte lymphocyte ratios were 4.1 neutrophil lymphocyte ratio were able to 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. Neutrophil lymphocyte ratio before chemotherapy > 4.1 is a predictor of the first onset acute neutropenia after R-CHOP chemotherapy in DLBCL patients.