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EVALUASI EFEKTIVITAS PENGGUNAAN FILGRASTIM DAN LENOGRASTIM TERHADAP WAKTU ANC RECOVERY PADA PASIEN KANKER PAYUDARA DI RSUD CIBABAT CIMAHI

Master Theses from JBPTITBPP / 2018-07-02 08:08:59
Oleh : NABILAH NADHIF NIM: 20716034, S2 - Pharmacy-SF
Dibuat : 2018-07-02, dengan 1 file

Keyword : Neutropenia, Waktu ANC recovery, Filgrastim, Lenograstim, Kanker payudara

Neutropenia akibat kemoterapi merupakan komplikasi yang sering terjadi yaitu 20-

40% pada solid tumor dan 50-70% pada keganasan hematologi. Neutropenia ditandai

dengan nilai Absolute Neutrofil Count (ANC) <1500/mm

3

. Ada dua jenis granulocyte

colony stimulating factor (G-CSF) yang direkomendasikan untuk neutropenia di

RSUD Cibabat Cimahi yaitu filgrastim dan lenograstim. Tujuan penelitian ini adalah

untuk mempelajari efektivitas penggunaan filgrastim dan lenograstim dalam

mencapai waktu ANC recovery pada pasien kanker payudara di RSUD Cibabat

Cimahi. Penelitian ini dilakukan dengan melihat pengaruh pemberian filgrastim atau

lenograstim dalam mencapai ANC recovery dengan umur, IMT, regimen kemoterapi,

stadium kanker, siklus kemoterapi dan grade neutropenia sebagai variabel. Penelitian

ini dirancang dengan metode cohort retrospektif, menggunakan medical record Juni

2016 sampai Maret 2018. Pada periode tersebut terdapat 200 insidensi neutropenia,

135 insiden memenuhi kriteria inklusi dan eksklusi. Sebanyak 38 pasien (61 insiden)

diobati dengan filgrastim dan 50 pasien (74 insiden) diobati dengan lenograstim.

Hasil menunjukkan terdapat perubahan ANC yang bermakna (p<0.05) pada

pemberian filgrastim ataupun lenograstim (pada kelompok filgrastim ANC sebelum

1210.28±317.48/mm

3

dan sesudah 9988.48±6555.80/mm

3

. Pada kelompok

lenograstim ANC sebelum 1248.01±277.47/mm

3

dan sesudah

9982.38±6250.69/mm

3

). Analisis Cox Regresi menunjukkan terdapat pengaruh IMT

18.5-24.9 kg/m

2

dengan (p=0.075) dan siklus pertama kemoterapi (p=0.088) terhadap

pemberian lenograstim dalam mencapai waktu ANC recovery. Terdapat pengaruh

stadium kanker 2b dan 3a terhadap pemberian filgrastim dalam mencapai waktu ANC

recovery (p=0.059 dan p=0.052). Semakin tinggi grade neutropenia, semakin lama

waktu mencapai ANC recovery baik pada kelompok yang diberi filgrastim ataupun

lenograstim. Secara statistik, tidak ada perbedaan waktu ANC recovery setelah

pemberian filgrastim ataupun lenograstim pada pasien kanker payudara di RSUD

Cibabat Cimahi. Data ini memberi indikasi bahwa filgrastim dan lenograstim

memiliki potensi yang sama dalam mencapai ANC recovery.

Deskripsi Alternatif :

Neutropenia as the side effects of chemotherapy is a common complication it happens

in approximately 20-40% patients with solid tumor and 50-70% in patients with

hematological malignancy. Neutropenia is defined as an Absolute Neutrofil Count

(ANC) of less than 1500/mm

3

. There are two granulocyte colony-stimulating factor

(G-CSF) recommended to be used for the treatment of neutropenia at RSUD Cibabat

Cimahi that are filgrastim and lenograstim. This study aimed to evaluate the

effectiveness of use of filgrastim and lenograstim in achieving ANC recovery time in

breast cancer patients at RSUD Cibabat Cimahi. The study was conducted by looking

at the effect of filgrastim and lenograstim in achieving ANC recovery with age, IMT,

chemotherapy regimen, cancer stage, cycle of chemotherapy and grade neutropenia

as variables. A retrospective cohort design was applied in this study, using data from

medical record during the period of June 2016 until March 2018. In that period, 200

incidences of neutropenia were found, 135 incidences fulfilling inclusion and

exclusion criteria. A total of 38 patients (61 incidences) treated with filgrastim, and

50 patients (74 incidences) treated with lenograstim. The result showed that there

was a very significant ANC recovery (p<0.01) on the neutropenia treatment that uses

filgrastim or lenograstim (in the filgrastim-treated group, ANC increased from

1210.28±317.48/mm

3

to 9988.48±6555.80/mm

3

, that in lenograstim-treated group,

ANC is increased from 1248.01±277.47/mm

3

to 9982.38±6250.69/mm

3

). Cox

Regression analysis revealed, that in lenograstim-treated group, the ANC recovery

time was significantly associated with IMT 18.5-24.9 kg/m

2

(p=0.075) and the first

cycle of chemotherapy (p=0.088). In the filgrastim-treated group, the ANC recovery

time was significantly associated with stage 2b of cancer (p=0.059) and stage 3a of

cancer (p=0.052). The higher the grade of neutropenia, the more time are needed to

reach ANC recovery in either the filgrastim or lenograstim group. Statistically, there

is no significant difference in duration of ANC recovery between neutropenia

treatments using filgrastim or lenograstim in breast cancer patients at RSUD Cibabat

Cimahi. This data indicates that filgrastim and lenograstim have the same potential

in achieving ANC recovery.

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