ANEMIA AMONG T CELL NON-HODGKIN LYMPHOMA PATIENT IN DR. SARDJITO HOSPITAL: CORRELATION WITH INTERNATIONAL PROGNOSTIC INDEX (IPI) SCORE COMPONENTS

HAFIDH ARKANANDA, Dr. dr. Indrawati, Sp.PA(K); dr. Mardiah Suci Hardianti, Ph.D., Sp.PD-KHOM

2021 | Skripsi | S1 KEDOKTERAN

Latar Belakang: Limfoma sel T merupakan salah satu jenis keganasan kelenjar getah bening yang berasal dari sel T. Walaupun insidensi kasus ini tergolong langka, beberapa penelitian menunjukkan adanya peningkatan insidensi limfoma sel T yang signifikan pada negara-negara Asia dibandingkan dengan negara-negara Eropa dan Amerika. Tetapi, jumlah penelitian yang dilakukan bersinggungan dengan topik ini belum banyak dihasilkan. Indonesia masih belum memiliki data prevalensi, karakteristik klinis, dan karakteristik histopatologis mengenai malignansi ini. Terlebih lagi, terdapat sebuah penelitian yang menunjukkan bahwa status anemia pada pasien limfoma sel T dapat menyebabkan prognosis, kesintasan, dan kualitas hidup yang lebih buruk. Hal tersebut membuat peneliti tertarik untuk berkontribusi untuk mengembangkan informasi mengenai prevalensi, karakteristik klinik, dan karakteristik histopatologis dari pasien limfoma sel T serta meneliti korelasi anemia dan komponen International Prognostic Index (IPI) karena penelitian ini belum pernah dilakukan sebelumnya di Indonesia. Tujuan: Mengetahui prevalensi, karakteristik klinis, dan karakteristik histopatologis dari pasien limfoma sel T di Rumah Sakit Umum Pusat Dr. Sardjito periode 2012-2018 dan memahami korelasi antara status anemia dan komponen International Prognostic Index (IPI). Metodologi: Penelitian ini merupakan penelitian retrospektif observasional dengan menggunakan metode deskriptif dan analitik. Data yang digunakan dalam penelitian ini didapatkan dari instalasi catatan medik Rumah Sakit Umum Pusat Dr. Sardjito. Data mengenai pasien limfoma sel T dari periode 2012-2018 akan dikumpulkan untuk selanjutnya dianalisis menggunakan aplikasi analisis secara deskriptif dan analitik. Hasil: Terdapat 58 pasien limfoma sel T pada periode 2012-2018. Karakteristik yang didapatkan ialah: mayoritas laki-laki (62.7%), berusia kurang dari atau sama dengan 60 (89.8%), berasal dari luar DIY (62.7%), bekerja sebagai nelayan/petani (89.8%), pendidikan terakhir SD (41.3%), ECOG performance status 1 (76.3%), status gizi normal (63.6%), dan kemoterapi dengan regimen CHOP (79.6%). Anemia ditemukan pada 38.5% kasus dan mayoritas tergolong anemia sedang (80%). Hitung sel darah putih, hitung jenis sel darah putih, dan hitung keping darah dalam batas normal. Mayoritas pasien datang dengan penyakit stadium I (48.3%), terdapat manifestasi ekstranodal (65.5%) dan dengan subtipe tersering adalah PTCL NOS. Predileksi ekstranodal tersering adalah hidung dan sinus paranasal (44.8%) dan predileksi nodal tersering adalah servikal (39.7%). Hasil signifikan pada uji regresi logistik univariat adalah status gizi (OR=5.60, p=0.017, CI 95%=0.04-0.73), usia (OR=4.67, p=0.040, CI 95%=1.18-18.50) dan jenis kelamin (OR=2.09, p=0.213, CI 95%=0.213). Hasil signifikan pada uji regresi logistik multivariat adalah status gizi (OR=4.87, p=0.039, CI 95%=1.08-21.89) dan usia (OR= OR=4.87, p=0.039, CI 95%=1.08-21.89). Kesimpulan: Terdapat 58 pasien limfoma sel T pada periode 2012-2018 dengan karakteristik dominan laki-laki, berusia mayoritas kurang dari 60 tahun, dan subtype paling prevalen adalah PTCL NOS. Dari variabel yang telah dianalisis, hanya status gizi kurang dan obesitas serta usia kurang dari sama dengan 33 tahun yang merupakan prediktor independen terhadap munculnya anemia pada pasien limfoma sel T.

Background: T cell NHL is a kind of lymphoid malignancies which originates from T cell. Although the incidence is quite rare, studies show that there was significant difference in the incidence in T cell NHL in Asian countries compared to Europe and American countries. However, research conducted on this topic is rather small in number. Data on the prevalence, clinical characteristics and histopathological characteristics of this type of malignancy is lacking particularly in Indonesia. Furthermore, another study points out that anemia status could leads to poor prognosis and survival as well as a worse life quality of T cell NHL patient. This prompts researcher to contribute to this scarce source of information regarding T cell NHL prevalence, clinical characteristics, and histopathological characteristics data and the correlation of anemia and International Prognostic Index (IPI) factor components as there were no evidence presented regarding this matter. Objectives: To know the prevalence, clinical characteristics, and histopathological characteristics of T cell NHL patient in RSUP Dr. Sardjito in the period of 2012-2018 and understand their correlation between anemia status and International Prognostic Index (IPI) factor component. Methodology: This study is an observational, retrospective study using both descriptive and analytical method. Data used in this study is obtained from RSUP Dr. Sardjito patient registry. Data regarding patient with T cell NHL from the period of 2012-2018 were collected. The data will then be analyzed using statistical software both descriptively and analytically. Result: There were 58 patients of T cell NHL patients during the period of 2012-2018. The characteristics observed are: male predominant (62.7%), aged equal to or less than 60 (89.8%), originated from outside DIY (62.7%), works as fisherman/farmer (27.5%), completed elementary school (41.3%), ECOG Performance Status 1 (76.3%), normal nutritional status (63.6%), and treated with CHOP (79.6%). Anemia was seen in 38.5% of patients and mostly were considered moderate (80%). WBC count, differential WBC count, and platelet count were found to be within normal range. Most patients came with stage I (48.3%), present with extranodal involvement (65.5%) and most prevalent subtype is PTCL NOS (63.9%). The most common extranodal site was nose and paranasal sinuses (44.8%) and most common nodal site was cervical (39.7%). Significant result for univariate logistic regression was nutritional status (OR=5.60, p=0.017, CI 95%=0.04-0.73), age (OR=4.67, p=0.040, CI 95%=1.18-18.50) and sex (OR=2.09, p=0.213, CI 95%=0.213). Significant result on multivariate logistic regression was nutritional status (OR=4.87, p=0.039, CI 95%=1.08-21.89) and age (OR= OR=4.87, p=0.039, CI 95%=1.08-21.89) Conclusion: There was 58 T cell NHL patients during the year of 2012-2018, most of them were male, aged less than 60 years old, and the most common subtype is PTCL NOS. Among the variables analyzed, only nutritional status of underweight and obese subgroup and age of equal to or less than 33 years old are considered independent predictor for occurrence of anemia in T cell NHL patients.

Kata Kunci : T cell lymphoma, anemia, prevalence, clinical characteristics, histopathological characteristics, International Prognostic Index (IPI)