Analisis Kemoterapi pada Pasien Tn. “AM” dengan Acute Lymphoblastic Leukaemia (ALL) disertai HIV Positif dan Hepatitis B

Hartati Hartati

Abstract


Leukemia Limfoblastik Akut (ALL/LLA) adalah proliferasi ganas sel limfoid yang tersumbat pada tahap awal diferensiasi yang dapat menyerang sumsum tulang, darah, dan situs ekstrameduler. Penatalaksanaan leukemia meliputi terapi kuratif dan suportif. Studi kasus ini bertujuan untuk memperoleh gambaran tentang regimen kemoterapi pasien ALL yang disertai Hepatitis B Kronik dan HIV positif. Pengumpulan data menggunakan desain deskriptif dengan metode wawancara serta observasi langsung kondisi pasien dan e-rekam medik, e-resep yang dikaji kesesuaiannya berdasarkan protokol kemoterapi. Berdasarkan sequencing regimen kemoterapi diperoleh bahwa pasien menerima regimen Hyper CVAD dengan nilotinib, dimana penilaian resiko Chemotherapy Induced Nausea Vomiting diperoleh bahwa protokol kemoterapi yang diterima termasuk dalam kategori Moderate Emetogenic. Regimen ini juga disertai dengan pemberian Methotrexate dosis tinggi sebagai profilaksis CNS. Akan tetapi, untuk mengurangi resiko nefrotoksisitas akibat pemberian Methotrexate dosis tinggi, maka diperlukan tambahan natrium bikarbonat dan allopurinol untuk mencegah TLS pada pasien dengan ALL.

Acute Lymphoblastic Leukaemia (ALL) is a malignant proliferation of lymphoid cells that are occlude at an early stage of differentiation and can invade the bone marrow, blood, and extramedullary sites. Management of leukemia includes curative and supportive therapy. This case study aims to obtain an overview of the chemotherapy regimen of ALL patients with chronic hepatitis B and HIV. Data were collected in a descriptive design with interview methods and direct observation of patient conditions and e-medical records. E-prescriptions were reviewed for suitability based on chemotherapy protocols. Based on the chemotherapy regimen sequencing, it was found that the patient received the hyper-CVAD regimen with nilotinib, while the chemotherapy-induced nausea and Vomiting risk assessment found that the chemotherapy protocol received was included in the Moderate Emetogenic category. This regimen is also accompanied by the administration of high doses of Methotrexate as CNS prophylaxis. However, to reduce the risk of nephrotoxicity due to the administration of high doses of Methotrexate, it is necessary to add sodium bicarbonate and allopurinol to prevent TLS in patients with ALL.


Keywords


Kemoterapi; Hyper CVAD; Nilotinib

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References


Assa, Novita, and Ketut Ariawati. 2019. “Leukaemia Cutis in a 12-Year-Old Boy with Acute Myeloblastic Leukaemia and Severe Malnutrition: A Case Report.” Medicina 50 (3): 550–56. https://doi.org/10.15562/medicina.v50i3.566.

Brown, Patrick A., Bijal Shah, Anjali Advani, Patricia Aoun, Michael W. Boyer, Patrick W. Burke, Daniel J. DeAngelo, et al. 2021. “Acute Lymphoblastic Leukemia, Version 2.2021.” JNCCN Journal of the National Comprehensive Cancer Network. Harborside Press. https://doi.org/10.6004/jnccn.2021.0042.

ELJack, Ammar, Mohamad el Abdallah, Kadhim Al-Banaa, Kashif Chaudhry, and Faisal Musa. 2019. “a New Challenging Strategy in the Prevention and Management of Tumor Lysis Syndrome in Patients with Chemo-Sensitive Hematological Malignancies.” Case Reports in Oncological Medicine 2019 (May): 1–3. https://doi.org/10.1155/2019/3740547.

Herdrich, K. & Weinberger, H. 2011. “Baxter 16th Edition”. Amerika: American Society of Oncology, 3-16.

Kurniawan, Andree, and Andri Sanityoso Sulaiman. 2013. “Role of Lamivudine as Preemptive Therapy in Cancer Patients with Hepatitis B Undergoing Chemotherapy.” The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy 14(3): 189-194

Law, Man Fai, Hay Nun Chan, Shun Yin Kong, Ho Kei Lai, Chung Yin Ha, Celia Ng, Yiu Ming Yeung, and Sze Fai Yip. 2022. “Clinical Outcomes of Patients with Acute Lymphoblastic Leukemia Receiving the Hyper-CVAD Regimen and Assessment of the Risk of Hepatitis Flares Due to Hepatitis B Virus Reactivation after Chemotherapy.” Archives of Medical Science 18 (1): 121–28. https://doi.org/10.5114/aoms/103606.

Malard, Florent, and Mohamad Mohty. 2020. “Acute Lymphoblastic Leukaemia.” The Lancet 395 (10230): 1146–62. https://doi.org/10.1016/S0140-6736(19)33018-1.

NCCN. 2022. “Acute Lymphoblastic Leukaemia” National Comprehensive Cancer Network (NCCN) Guidelines, https://www.nccn.org/professionals/physician_gls/pdf/all.pdf

Rausch, Caitlin R., Elias J. Jabbour, Hagop M. Kantarjian, and Tapan M. Kadia. 2020. “Optimizing the Use of the HyperCVAD Regimen: Clinical Vignettes and Practical Management.” Cancer. John Wiley and Sons Inc. https://doi.org/10.1002/cncr.32606.

Reed, Daniel R., Eric J. Pierce, Jeremy M. Sen, and Michael K. Keng. 2019. “A Prospective Study on Urine Alkalization with an Oral Regimen Consisting of Sodium Bicarbonate and Acetazolamide in Patients Receiving High-Dose Methotrexate.” Cancer Management and Research 11: 8065–8072. https://doi.org/10.2147/CMAR.S190084.

RISKCINV. 2022. “CINV Risk Assessment” https://www.riskcinv.org/#/chemoEmtoLevel.

Scheibler, Elusa, Maria Claudia Rosa Garcia, Renata Medina da Silva, Maria Antonia Figueiredo, Fernanda Gonçalves Salum, and Karen Cherubini. 2017. “Use of Nystatin and Chlorhexidine in Oral Medicine: Properties, Indications and Pitfalls with Focus on Geriatric Patients.” Gerodontology 34(3): 291-298 Blackwell Munksgaard. https://doi.org/10.1111/ger.12278.

Sekimizu, Masahiro, Yuka Yamashita, Hideaki Ueki, Nobuhiro Akita, Hiroyoshi Hattori, Naoko Maeda, and Keizo Horibe. 2014. “Nilotinib Monotherapy Induced Complete Remission in Pediatric Philadelphia Chromosome-Positive Acute Lymphoblastic Leukemia Resistant to Imatinib and Dasatinib.” Leukemia and Lymphoma 55(7): 1652-1653 Informa Healthcare. https://doi.org/10.3109/10428194.2013.842984.

Thomas, Deborah A., Susan O’Brien, Stefan Faderl, Guillermo Garcia-Manero, Alessandra Ferrajoli, William Wierda, Farhad Ravandi, et al. 2010. “Chemoimmunotherapy with a Modified Hyper-CVAD and Rituximab Regimen Improves Outcome in de Novo Philadelphia Chromosome - Negative Precursor B-Lineage Acute Lymphoblastic Leukemia.” Journal of Clinical Oncology 28 (24): 3880–3889. https://doi.org/10.1200/JCO.2009.26.9456.




DOI: http://dx.doi.org/10.52365/jecp.v3i2.617

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