Terapi Leukemia Mieloblastik Akut Anak: ProtokolAra-C, Doxorubycinedan Etoposide $'(YV0RGLÀNDVLNordic Society of Pediatric Hematology and Oncology(m-NOPHO)

Eddy Supriyadi, Ignatius Purwanto, Pudjo Hagung Widjajanto

Sari


Latar belakang. Pengobatan leukemia mieloblastik akut (LMA) telah banyak mengalami kemajuan. Di
negara maju, keberhasilan pengobatan sudah mencapai 65%, sementara di Indonesia diperkirakan masih
di bawah 10%.
Tujuan.Mengetahui profil LMA mengevaluasi keberhasilan pengobatan.
Metode.Dilakukan analisis terhadap catatan medis pasien LMA yang dirawat di bangsal anak Rumah
Sakit Sardjito Jogjakarta pada tahun 1999-2011. Diagnosis ditetapkan berdasarkan analisis morfologi dan
sitokimia terhadap apus sumsum tulang dan atau darah tepi. Analisis survivaldilakukan terhadap pasien
yang diberi pengobatan dengan protokol ADE atau m-NOPHO.
Hasil.didapatkan 210 pasien berumur 0–17 tahun yang didiagnosis LMA. Enampuluh delapan mendapat
kemoterapi, 46 (32%) dengan protokol ADE, 91 (64%) dengan protokol m-NOPHO, dan 5 (4%) pasien
diobati dengan protokol lain. Event Free Survival (EFS)setelah lima tahun pada pasien yang mendapat
kemoterapi adalah 2,4%, pasien sesudah 4 tahun dengan protokol m-NOPHO (3,7% ± 2,3%), sedangkan
semua pasien yang menggunakan protokol ADE meninggal sebelum 1,5 tahun pengamatan (p=0,005).
Kesimpulan.Tingkat keberhasilan pengobatan LMA di RS Dr. Sardjito masih sangat rendah. Pengobatan
dengan protokol m-NOPHO mempunyai tingkat keberhasilan yang lebih baik dibandingkan protokol
ADE.


Kata Kunci


leukemia; event free survival (EFS); cytarabine; anthracycline

Teks Lengkap:

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Referensi


Chowdhury T, Brady HJ. Insights from clinical studies

into the role of the MLL gene in infant and childhood

leukemia. Blood Cells Mol Dis 2008;40:192-9.

Golub TR, Arceci RJ. Acute Myelogenous Leukemia.

Dalam: Pizzo PA, Poplack DG, penyunting. Princples

and Practice of Pediatric Oncology. Edisi ke-4.

Philadelphia: Lippincott Williams & Wilkins;2002.h.

-89.

Margolin JF, Steuber CP, Poplack DG. Acute Lymphoblastic Leukemia. Dalam: Pizzo PA, Poplack DG,

penyunting. Principles and practice of pediatric

oncology. Edisi ke-5. Philadelphia: Lippincott, Williams

& Wilkins; 2002.h. 1605-16.

Kinlen L. Infections and immune factors in cancer: the

role of epidemiology. Oncogene 2004;23:6341-8.

Coebergh JW, Reedijk AM, de Vries E. Leukaemia

incidence and survival in children and adolescents in

Europe during 1978-1997. Report from the Automated

Childhood Cancer Information System project. Eur J

Cancer 2006;42:2019-36.

Bhatia S, Ross JA, Greaves MF, Robinson LL. Epidemiology and etiology. Dalam: Pui CH, penyunting.

Childhood Leukemias. Cambridge: Cambridge University

Press; 1999. h. 38-49.

Supriyadi E, Widjajanto PH, Purwanto I, Cloos J,

Veerman AJ, Sutaryo S. Incidence of childhood leukemia

in Yogyakarta, Indonesia, 1998-2009. Pediatr Blood

Cancer 2011;57:588-93, Epub ahead of print.

Kaspers GJ, Creutzig U. Pediatric acute myeloid

leukemia: international progress and future directions. Leukemia 2005;19:2025-9.

Shah M, Agarwal B. Recent advances in management

of acute myeloid leukemia (AML). Indian J Pediatr

;75:831-7.

Kaspers GJ, Zwaan CM. Pediatric acute myeloid

leukemia: towards high-quality cure of all patients.

Haematologica 2007;92:1519-32.

Bacher U, Kern W, Schoch C, Schnittger S, Hiddemann

W, Haferlach T. Evaluation of complete disease remission

in acute myeloid leukemia: a prospective study based

on cytomorphology, interphase fluorescence in situ

hybridization, and immunophenotyping during followup in patients with acute myeloid leukemia. Cancer

;106:839-47.

Zwaan CM, Meshinchi S, Radich JP. FLT3 internal

tandem duplication in 234 children with acute myeloid

leukemia: prognostic significance and relation to cellular

drug resistance. Blood 2003;102:2387-94.

Rubnitz JE, Crews KR, Pounds S, et al. Combination of

cladribine and cytarabine is effective for childhood acute

myeloid leukemia: results of the St Jude AML97 trial.

Leukemia 2009;23:1410-16.

Creutzig U, Zimmermann M, Reinhardt D, Dworzak

M, Stary J, Lehrnbecher T. Early deaths and treatmentrelated mortality in children undergoing therapy for

acute myeloid leukemia: analysis of the multicenter

clinical trials AML-BFM 93 and AML-BFM 98. J Clin

Oncol 2004;22:4384-93.

Lehrnbecher T, Varwig D, Kaiser J, Reinhardt D,

Klingebiel T, Creutzig U. Infectious complications

in pediatric acute myeloid leukemia: analysis of the

prospective multi-institutional clinical trial AML-BFM

Leukemia 2004;18:72-7.

Slats AM, Egeler RM, van der Does-van den Berg A.

Causes of death--other than progressive leukemia--in

childhood acute lymphoblastic (ALL) and myeloid

leukemia (AML): the Dutch Childhood Oncology

Group experience. Leukemia 2005;19:537-44.

Howard SC, Marinoni M, Castillo L. Improving

outcomes for children with cancer in low-income

countries in Latin America: a report on the recent

meetings of the Monza International School of Pediatric

Hematology/Oncology (MISPHO)-Part I. Pediatr Blood

Cancer 2007;48:364-9.

Rubnitz JE, Gibson B, Smith FO. Acute myeloid

leukemia. Hematol Oncol Clin North Am 2010;24:35-63.

Usmani GN. Pediatric oncology in the third world. Curr

Opin Pediatr 2001;13:1-9.

Nandakumar A, Anantha N, Appaji L. Descriptive

epidemiology of childhood cancers in Bangalore, India.

Cancer Causes Control 1996;7:405-10.

Kasili EG. Leukaemia and lymphoma in Kenya. Leuk Res

;9:747-52.

Howard SC, Metzger ML, Wilimas JA. Childhood

cancer epidemiology in low-income countries. Cancer

;112:461-72.

Gibson BE, Wheatley K, Hann IM. Treatment strategy

and long-term results in paediatric patients treated in

consecutive UK AML trials. Leukemia 2005;19:2130-8




DOI: http://dx.doi.org/10.14238/sp14.6.2013.345-50

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