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"Latar Belakang : Kemoterapi sitostatika dilaporkan meningkatkanaktivitas koagulasi (D-dimer meningkat) dan mengubah hypercoagulable statemenjadi hiperkoagulasi. Hypercoagulable state adalah suatu kondisi yangberpotensi untuk terjadinya trombosis (misal pada pasien kanker) yang ditandaidengan perubahan aktivitas koagulasi pra trombin (peningkatan fragmenprotrombin 1-2 atau kompleks TAT) dengan D-dimer yang normal.Hiperkoagulasi ditandai dengan PT dan aPTT memendek sementara fibrinogendan D-dimer meningkat. Insidens kemoterapi menimbulkan trombus pertahunsekitar 11 %. Insidens tromboemboli vena pada pasien yang dirawat inap yangmendapat kemoterapi pada populasi Thailand ttinggi, terutama pada pemberianterapi. Sampai saat ini belum ada laporan mengenai insidens TEV pada pasienkanker limfoma yang menjalani kemoterapi di Indonesia.Tujuan Penelitian : Menilai aktivitas koagulasi (D-dimer) dan sistemkoagulasi (PT,aPTT, fibrinogen) pada pasien limfoma non Hodgkin yangmendapatkan kemoterapi R-CHOPMetode Penelitian : Penelitian pre dan post prospektif pada pasienlimfoma non Hodgkin yang menjalani kemoterapi dengan rejimen R-CHOPsecara consecutive sampling di Ruang Rawat Inap Gedung A RSCM dan RuangRawat Inap RS Kanker Dharmais. Penelitian dilakukan pada April-Juni 2019.Pasien diambil darah dengan parameter aktivitas koagulasi (D-dimer) dan systemkoagulasi (PT, aPTT, fibrinogen). Analisis data untuk melihat perubahan reratapre dan post kemoterapi dilakukan uji t berpasangan (distribusi normal) dan ujiWilcoxon (tidak terdistribusi normal).Hasil Penelitian : Sebanyak 33 pasien dilibatkan dalam penelitian ini.Terdapat peningkatan D-dimer secara bermakna (p : 0.046), pemendekkan PT(0.048) dan aPTT ( <0.001) secara bermakna, disertai penurunan kadar fibrinogennamun tidak signifikan secara statistikaKesimpulan : Peningkatan D dimer secara bermakna, disertaipemendekkan PT dan aPTT secara bermakna, sedangkan fibrinogen mengalamipenurunan walaupun tidak signifikan secara statistik. Hal ini menunjukkankecenderungan pasien mengalami status hiperkoagulasi

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Background : Cytostatic chemotherapy is reported to increasecoagulation activity (increased D-dimer) and change the hypercoagulable stateinto hypercoagulation. Hypercoagulable state is a condition that has the potentialfor thrombosis (for example in cancer patients) characterized by changes in prethrombincoagulation activity (increase in prothrombin fragments 1-2 or TATcomplex) with normal D-dimers. Hypercoagulation is characterized by PT andaPTT shortening while fibrinogen and D-dimer are increasing. The incidence ofchemotherapy causes thrombus annually about 11%. The incidence of venousthromboembolism in hospitalized patients receiving chemotherapy in the highThai population, especially in the administration of therapy. To date there havebeen no reports of TEV incidence in lymphoma cancer patients undergoingchemotherapy in Indonesia.Objectives : Assess the activity of coagulation (D-dimers) andcoagulation systems (PT, aPTT, fibrinogen) in non-Hodgkins lymphoma patientsreceiving R-CHOP chemotherapyMethods : Pre and post prospective studies in non-Hodgkinslymphoma patients undergoing chemotherapy with the R-CHOP regimen byconsecutive sampling in the Inpatient Room of Building A RSCM and theInpatient Room of Dharmais Cancer Hospital. The study was conducted in April-June 2019. Patients were taken blood with parameters of coagulation activity (Ddimer)and coagulation system (PT, aPTT, fibrinogen). Data analysis to seechanges in mean pre and post chemotherapy was performed paired t test (normaldistribution) and Wilcoxon test (not normally distributed).Results: A total of 33 patients were included in this study. There was a significantincrease in D-dimer (p: 0.046), PT shortening (0.048) and aPTT (<0.001)significantly, accompanied by a decrease in fibrinogen levels but not statistically significantConclusion : D significantly increased dimer, accompanied bysignificant shortening of PT and aPTT, whereas fibrinogen decreased even thoughit was not statistically significant. This shows the tendency of patients toexperience hypercoagulable state"

"Latar Belakang: Limfoma Hodgkin merupakan keganasan yang mencakup 1% kasus kanker keseluruhan. Adapun overall survival (OS) pasien limfoma Hodgkin dalam lima tahun mencapai 90%. Namun, progression-free survival (PFS) limfoma Hodgkin hanya mencapai 70-90% dalam kurun waktu 25 bulan. Setelah mengalami progresivitas, pasien mengalami penurunan PFS setelah mendapat terapi lini kedua. Sehingga, perlu diketahui faktor-faktor prediktor yang mempengaruhi PFS pasien limfoma Hodgkin.Tujuan: Mengetahui faktor-faktor prognostik PFS dua tahun pasien limfoma Hodgkin. Metode: Penelitian ini menggunakan desain kohort retrospektif yang melibatkan pasien limfoma Hodgkin yang teregistrasi dari tahun 2011-2021 di Rumah Sakit Umum Pusat Nasional Dokter Cipto Mangunkusumo. Faktor-faktor prognostik yang diteliti adalah stratifikasi risiko, skor prognosis internasional, kadar trombosit, laktat dehidrogenase, indeks komorbiditas Charlson, dan waktu sejak diagnosis hingga terapi. Analisis multivariat terhadap PFS dua tahun dilakukan menggunakan model regresi Cox.Hasil: Terdapat 115 subjek yang disertakan dalam penelitian dengan median usia 29 tahun, kadar trombosit 393.000 sel/L, LDH 340 IU/L, dan waktu sejak diagnosis hingga terapi enam minggu. Sebagian besar subjek penelitian adalah kelompok stadium lanjut (53,91%), total skor prognosis internasional 0-3 (69,57%), dan total skor indeks komorbiditas Charlson 0-1 (75,65%). Angka PFS dua tahun pasien limfoma Hodgkin di RSCM sebesar 59,13%. Hasil analisis bivariat menunjukkan waktu sejak diagnosis hingga terapi yang tidak memiliki kemaknaan secara statistik dengan HR 0,83 (IK 95% 0,42-1,59, p=0,57). Analisis multivariat menghasilkan tiga faktor prognostik independen, yakni stadium lanjut (HR 7,85 IK 95% 3,01-20,47, p<0,01), trombosit >450.000 sel/L (HR 2,77 IK 95% 1,49-5,16, p<0,01), dan LDH baik 250-500 IU/L (HR 2,57 IK 95% 1,01-3,63, p=0,04) maupun >500 IU/L (HR 3,06 IK 95% 1,20-7,82, p=0,02). Sistem skor berdasarkan ketiga variabel tersebut memiliki diskriminasi yang baik (AUROC 0,879, IK 95% 0,816-0,942, p <0,01).Kesimpulan: Stadium lanjut, trombosit >450.000 sel/L, dan LDH 250 IU/L merupakan faktor-faktor prognostik PFS dua tahun pada pasien limfoma Hodgkin.

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Background: Hodgkin's lymphoma is a malignancy that accounts for 1% of all cancer cases. The overall survival (OS) of Hodgkin's lymphoma patients in five years reaches 90%. However, progression-free survival (PFS) for Hodgkin's lymphoma only reaches 70-90% within 25 months. After experiencing progression, patients experienced a decrease in PFS after receiving second-line therapy. So, it is necessary to know the predictor factors that influence the PFS of Hodgkin's lymphoma patients.

Aim: To determine prognostic factors for two-year PFS in Hodgkin's lymphoma patients. Methods: This study used a retrospective cohort design involving Hodgkin's lymphoma patients registered from 2011-2021 at Dokter Cipto Mangunkusumo National General Hospital. The prognostic factors studied were risk stratification, international prognosis score, platelet levels, lactate dehydrogenase, Charlson comorbidity index, and time from diagnosis to therapy. Multivariate analysis of two-year PFS was performed using Cox regression models.

Results: There were 115 subjects included in the study with a median age of 29 years, platelet levels of 393,000 cells/L, LDH 340 IU/L, and time from diagnosis to therapy of six weeks. Most of the research subjects were in the advanced stage group (53.91%), the total international prognosis score was 0-3 (69.57%), and the total Charlson comorbidity index score was 0-1 (75.65%). The two-year PFS rate for Hodgkin's lymphoma patients at RSCM was 59.13%. The results of bivariate analysis showed that the time from diagnosis to therapy was not statistically significant with HR 0.83 (95% CI 0.42-1.59, p=0.57). Multivariate analysis yielded three independent prognostic factors, namely advanced stage (HR 7.85, 95% CI 3.01-20.47, p<0.01), platelets >450,000 cells/L (HR 2.77, 95% CI 1.49-5.16, p<0.01), and LDH either 250-500 IU/L (HR 2.57, 95% CI 1.01- 3.63, p=0.04) or >500 IU/L (HR 3.06 95% CI 1.20-7.82, p=0.02). The scoring system based on these three variables had good discrimination (AUROC 0.879, 95% CI 0.816- 0.942, p <0.01).

Conclusion: Advanced stage, platelets >450,000 cells/L, and LDH >250 IU/L are prognostic factors for two-year PFS in Hodgkin's lymphoma patients."