Faktor Prediktor Kematian Pasien Acute Lymphoblastic Leukemia (All) Relaps yang Menggunakan Protokol All HR 2016 di RS Sardjito Yogyakarta

Roberto Suhartono, dr. Suryono Yudha Patria, Ph.D., Sp.A(K) dan dr. Alexandra Widita S.P, M.Sc., Sp.A(K),

2026 | Tesis | S2 Kedokteran Klinik

Latar Belakang: Acute lymphoblastic leukemia (ALL) merupakan keganasan hematologi tersering pada anak dengan relaps yang terjadi pada sekitar 15–25% pasien. Di negara berkembang seperti Indonesia, mortalitas relaps mencapai 70–80% akibat disparitas akses terhadap monitoring MRD dan perawatan suportif. Di RS Sardjito, insidensi relaps sebesar 26 ?ngan dominasi very early relaps (<18>

 Tujuan: Mengetahui faktor prediktor kematian (waktu relaps, lokasi relaps, pencapaian CR2, durasi demam neutropenia pertama pada fase induksi) serta menganalisis kesintasan Overall survival (OS) pada pasien anak ALL relaps yang menerima Protokol ALL High Risk (HR) 2016 di RS Sardjito.

 Metode: Studi kohort retrospektif pada 101 pasien anak usia 1 bulan–18 tahun dengan ALL relaps (Juni 2016–Desember 2025) yang menjalani protokol ALL HR 2016. Data diperoleh dari rekam medis dan register hemato-onkologi. Analisis menggunakan Kaplan-Meier untuk OS, uji log-rank untuk perbandingan kelompok, serta regresi Cox multivariat untuk prediktor independen mortalitas (p < 0>

 Hasil: Dari 101 pasien, 77 (76,2%) meninggal dengan 3 tahun overall survival (OS) 20 %. Dua faktor signifikan yang berhubungan dengan kematian adalah relaps sangat dini (p = 0,020) dan gagal mencapai CR2 (p < 0>

 Kesimpulan: Kegagalan mencapai remisi lengkap kedua (CR2) merupakan prediktor independen kematian terkuat pada pasien anak ALL relaps. Waktu relaps sangat dini signifikan secara bivariat, namun tidak independen secara multivariat. Sementara lokasi relaps serta durasi demam neutropenia pertama pada fase induksi tidak berpengaruh terhadap mortalitas. Kesintasan pasien terbatas dengan OS rendah serta angka mortalitas tinggi.

Background: Acute lymphoblastic Leukemia (ALL) is the most common hematologic cancer in children, with relapse occurring in about 15–25% of patients. In developing countries like Indonesia, mortality caused by relapse reaches 70–80?cause of disparities in access to MRD monitoring and supportive care. At Sardjito Hospital, the relapse rate is 26 %, mostly very early relapses (<18>

Objective: To identify predictors of mortality (such as time of relapse, site of relapse, achievement of CR2, and duration of first neutropenic fever during the induction phase) and to analyze overall survival (OS) in children with relapsed ALL receiving the 2016 ALL High Risk (HR) Protocol at Sardjito Hospital.

Methods: A retrospective cohort study involving 101 pediatric patients aged 1 month to 18 years with relapsed ALL (June 2016–December 2025) who received the 2016 ALL HR protocol. Data were extracted from medical records and the hemato-oncology registry. The analysis included Kaplan-Meier estimates for OS, log-rank tests for group comparisons, and multivariate Cox regression to identify independent predictors of mortality (p< 0>

Results: Of 101 patients, 77 (76.2%) died, with 3-year overall survival (OS) 20 %. Two significant factors associated with mortality were very early relapse (<18 xss=removed>

Conclusion: Failure to achieve a second complete remission (CR2) is the strongest independent predictor of death in children with relapsed ALL. Very early relapse are significant in bivariate analysis but not in multivariate analysis. Additionally, the site of relapse and the duration of the first neutropenic fever during induction did not influence mortality. Patient survival remains limited, with low OS , and high mortality rates.

Kata Kunci : ALL relaps, Protokol ALL HR 2016, kesintasan, remisi kedua