kp 2.4.5.2 (2) limfoma non hodgkin dan hodgkin

7/25/2019 Kp 2.4.5.2 (2) Limfoma Non Hodgkin Dan Hodgkin

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LIMFOMA MALIGNUMLIMFOMA MALIGNUM

DANDAN

KEMOTERAPIKEMOTERAPI

( KULIAH 4 )( KULIAH 4 )


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LIMFOMA MALIGNUM NON HODGKINLIMFOMA MALIGNUM NON HODGKIN

DEFINISIDEFINISI

Sekelompok keganaan p!"me!Sekelompok keganaan p!"me!l"m#o"$l"m#o"$ %ang &apa$ 'e!aal &a!"%ang &apa$ 'e!aal &a!"

l"m#o"$ l"m#o"$ Tl"m#o"$ l"m#o"$ T &an ka&ang&an ka&ang( ama$ *a!ang ) 'e!aal &a!"( ama$ *a!ang ) 'e!aal &a!" elel

NKNK ( natural killer( natural killer )) %ang 'e!a&a%ang 'e!a&a

&alam "$"m l"m#e&alam "$"m l"m#e anga$anga$+e$e!ogen+e$e!ogen 'a"k $"pe +"$olog"'a"k $"pe +"$olog"ge*ala pe!*alanan kl"n" !eponge*ala pe!*alanan kl"n" !epon$e!ap" ma,p,n p!ogno"$e!ap" ma,p,n p!ogno"


3/27

ETIOLOGI DAN FAKTOR RISIKO

E$"olog" pa$" $"&ak &"ke$a+," 'e'e!apa#ak$o! !""ko -

Imm,n&e."en"

Agen "n#ek", epe!$" E/ HI/

Papa!an l"ngk,ngan &an peke!*aan epe!$"pe$e!nak peke!*a +,$an 0 pe!$an"an %ang&"e'a'kan papa!an +e!'""&a &an pela!,$o!gan"1 e!$a papa!an ,l$!a2"ole$

D"e$ $"ngg" lemak +e3an" &an me!okok


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A an1e! 5 l"n 67889:8-686;6


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Fo!me! F"!$ La&%

5a1>,el"ne Kenne&% Ona"


6/27

K"ng H,e"n o#5o!&an


7/27

Tele2""on $a! T+e A;Team=S%l2e$e! S$allone? a&2e!a!% "n @Ro1k% III=

BM!= T(La3!en1e T,!ea,&)


8/27

KLASIFIKASIPenggolongan +"$olog" LNHme!,pakan maala+ %ang !,m"$&an ,ka!=

Pe!kem'angan $e!ak+"! kla".ka"%ang 'an%ak &"paka" a&ala+#o!m,la" p!ak$" ( working

formulation = WF8C6) &an

Re2"e& E,!ope Ame!"1anla".1a$"on o# L%mp+o"&Neoplam 0 o!l& Heal$+


9/27

L%mp+oma la".1a$"onL%mp+oma la".1a$"on ( HO( HO6778 )6778 )

;1ell neoplam;1ell neoplam PrecursorPrecursorB-cell neoplass !" #$pes%B-cell neoplass !" #$pes%

Ma#ureMa#ureB-cell neoplass !&'%B-cell neoplass !&'% D()use lar*e B cellD()use lar*e B celll$p+oal$p+oa

B-cell prol(,era#(ons o, uncer#a(n al(*nan# po#en#(al !"%B-cell prol(,era#(ons o, uncer#a(n al(*nan# po#en#(al !"%

T;1ell NK;1ell neoplamT;1ell NK;1ell neoplam PrecursorPrecursorT-cell neoplass !%T-cell neoplass !%

Ma#ureMa#ureT-cell an. NK-cell neoplass !&/%T-cell an. NK-cell neoplass !&/%

T-cell prol(,era#(on o, uncer#a(n al(*nan# po#en#(al !&%T-cell prol(,era#(on o, uncer#a(n al(*nan# po#en#(al !&%

Ho&gk"n l%mp+omaHo&gk"n l%mp+oma la"1al Ho&gk"n l%mp+oma (4)la"1al Ho&gk"n l%mp+oma (4)

No&,la! l%mp+o1%$e p!e&om"nan$ Ho&gk"n l%mp+oma (8)No&,la! l%mp+o1%$e p!e&om"nan$ Ho&gk"n l%mp+oma (8)


10/27

L$p+oa 0lass(1ca#(on ( HO "22& %

A. B-Cell Neoplasms

I. Precursor B-cell neoplasm : Precursor B- acute lymphoblastic

leukemia / lymphoblastic lymphoma (B-ALL, LBL)II. Mature (peripheral) B-neoplasms

a. B-cell chronic lymphocytic leukemia / small lymphocytic lymphoma

b. B-cell prolymphocytic leukemia

c. Lymphoplasmacytic lymphoma

. Mantle cell lymphomae. !olliculer lymphoma

". #plenic mar$inal %one B-cell lymphoma (& 'illous

lymphocytes)

$. airy cell leukemia

h. Plasma cell myeloma/plasmacytoma

i. *tranoal mar$inal %one B-cell lymphoma o" MAL+ type

oal mar$inal %one B-cell lymphoma (& monocytoi B cells)

k. i""use lar$e B-cell lymphoma

l. Burkitts lymphoma/Burkitt cell leukemia


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NNon;Ho&gk"nJon;Ho&gk"nJ LL%mp+oma%mp+oma

DL

L


12/27

Klas(13as( 4F ! &'5" %Klas(13as( 4F ! &'5" %

Lo6 *ra.e al(*nanc$Lo6 *ra.e al(*nanc$Small l%mp+o1%$"1 0 plama1%$o"&Small l%mp+o1%$"1 0 plama1%$o"&

Foll"1,la! p!e&om"nan$l% mall 1lea2e& 1ellFoll"1,la! p!e&om"nan$l% mall 1lea2e& 1ell

Foll"1,la! m"e& mall 1lea2e& an& la!ge 1ellFoll"1,la! m"e& mall 1lea2e& an& la!ge 1ell

In#ere.(e#e *ra.e al(*nanc$In#ere.(e#e *ra.e al(*nanc$Foll"1,la! p!e&om"nan$l% la!ge 1ellFoll"1,la! p!e&om"nan$l% la!ge 1ell

D"#,e mall 1lea2e& 1ellD"#,e mall 1lea2e& 1ell

D",e m"e& mall an& la!ge 1ellD",e m"e& mall an& la!ge 1ell

H(*+ *ra.e al(*nanc$H(*+ *ra.e al(*nanc$

La!ge 1ell "mm,no'la$"1 La!ge 1ell "mm,no'la$"1

L%mp+o'la$"1 L%mp+o'la$"1

Small non 1lea2e& 1ellSmall non 1lea2e& 1ell


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LMPHOMA GRADATION ( NN 6787 )In&olen$ (lo3 g!o3"ng) ;1ell l%mp+omaFoll"1,la! l%mp+oma

+!on"1 l%mp+o1%$"1 le,kem"a 0 malll%mp+o1%$"1 l%mp+omaMALTSplen"1 ma!g"nal one l%mp+omaNo&al ma!g"nal oneAgg!e"2e (#a$ g!o3"ng) ;1ell l%mp+omaD",e la!ge ;1ell l%mp+oma

Man$le 1ell l%mp+omaH"g+l% agg!e"2e ;1ell l%mp+oma,!k"$$ l%mp+omaL%mp+o'la$"1 l%mp+oma

AIDS;!ela$e& ;1ell


14/27

PENDEKATAN DIAGNOSTIKPENDEKATAN DIAGNOSTIK

&7 Ananes(s&7 Ananes(s

UuUuPem'ea!an KG a$a, o!ganPem'ea!an KG a$a, o!gan

men,!,n Q 87 &alam 3ak$, < ',lan men,!,n Q 87 &alam 3ak$, < ',lan

Demam $"ngg" Q


15/27

La8ora#or(uLa8ora#or(u

R,$"n R,$"n

Da!a+ pe!"#e! lengkap ( DPL )Da!a+ pe!"#e! lengkap ( DPL )Gam'a!an &a!a+ $ep" ( GDT )Gam'a!an &a!a+ $ep" ( GDT )

U!"ne lengkapU!"ne lengkap

K"m"a Kl"n"k K"m"a Kl"n"k

Im,nop+eno$%p"ng Im,nop+eno$%p"ng pa!a.n panelpa!a.n panel D 67D 67D


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17/27


18/27

M"n"mal "mm,no+"$o1+em"$!% D67 "man&a$o!%


19/27

PENATALAKSANAANPENATALAKSANAAN8= Ra&"o$e!ap"8= Ra&"o$e!ap"

6= Ra&"o$e!ap" Kemo$e!ap"6= Ra&"o$e!ap" Kemo$e!ap"


20/27

LIMFOMA MALIGNUM HODGKINLIMFOMA MALIGNUM HODGKIN

K+a el Ree& S$e"n'e!gK+a el Ree& S$e"n'e!g

Klas(13as(Klas(13as(8= T"pe l%mp+o1%$e p!e&om"nan$8= T"pe l%mp+o1%$e p!e&om"nan$ p!ogno" 'a"kp!ogno" 'a"k

6= T"pe m"e& 1ell,la!"$%6= T"pe m"e& 1ell,la!"$%

p!ogno" le'"+ ',!,kp!ogno" le'"+ ',!,k


21/27

PENATALAKSANAAN

8= Ra&"o$e!ap"

6= Ra&"o$e!ap" Kemo$e!ap"


22/27

KEMOTERAPIKEMOTERAPI

KANKERKANKER FASE PERTUMBUHAN SELFASE PERTUMBUHAN SEL

MM

G"G"

G&G& G2G2

SS

Sesu.a+ (#os(s !M%:Sesu.a+ (#os(s !M%: G& !al#(, e8en#u3G& !al#(, e8en#u3

RNA: pro#e(n%RNA: pro#e(n% S ! s(n#es(s DNA%S ! s(n#es(s DNA% G" !a3#(, la*(G" !a3#(, la*(

e8en#u3 RNA: pro#e(n%e8en#u3 RNA: pro#e(n%

Sel a3#(, 8erprol(,eras(Sel a3#(, 8erprol(,eras( G& pen.e3G& pen.e3

Sel la8a# prol(,eras(Sel la8a# prol(,eras( G& pan;an*G& pan;an*


23/27

KLASIFIKASI KEMOTERAPIKLASIFIKASI KEMOTERAPI

&7&7 NONSPESIFIK TERHADAP FASE SELNONSPESIFIK TERHADAP FASE SEL

A7A7 SPESIFIK SIKLUS: NONSPESIFIK FASESPESIFIK SIKLUS: NONSPESIFIK FASE

ALKILATING: DEKARBASINALKILATING: DEKARBASIN

B7 NON SPESIFIK SIKLUSB7 NON SPESIFIK SIKLUS

STEROID: ANTIBIOTIK KE0UALI BLEOMISINSTEROID: ANTIBIOTIK KE0UALI BLEOMISIN

SPESIFIK TERHADAP FASE SELSPESIFIK TERHADAP FASE SEL

A7 FASE G 2A7 FASE G 2 SEMUA KEMOTH< AKANSEMUA KEMOTH< AKAN

REFRAKTERREFRAKTER

B7 FASE G &B7 FASE G & L- ASPARAGINASEL- ASPARAGINASE07 FASE S07 FASE S ANTIMETABOLIT: HIDROKSIUREA:ANTIMETABOLIT: HIDROKSIUREA:

PROKARBA=INPROKARBA=IN

D7 FASE G "D7 FASE G "

BLEOMISIN: ALKALOID TANAMANBLEOMISIN: ALKALOID TANAMAN

E7 FASE ME7 FASE M ALKALOID TANAMANALKALOID TANAMAN

GOLONGANGOLONGAN SUBSUB O B A TO B A T


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GOLONGANGOLONGAN SUBSUBGOLONGANGOLONGAN

O B A TO B A T

ALKILATORALKILATOR MUSTAR NITROGENMUSTAR NITROGEN

DERI/AT ETILENAMINDERI/AT ETILENAMIN

ALKIL SULFONATALKIL SULFONAT

NITROSURIANITROSURIA

SIKLOFOSPAMID MELFALAN KLORAMUSILSIKLOFOSPAMID MELFALAN KLORAMUSIL

TIOTEPATIOTEPA

USULFANUSULFAN

KARMUSTIN LOMUSTIN SAMUSTINKARMUSTIN LOMUSTIN SAMUSTIN

ANTIANTIMETAOLITMETAOLIT

ANALOG PIRIMIDINANALOG PIRIMIDIN

ANALOG PURINANALOG PURIN

ANTAGONIS FOLATANTAGONIS FOLAT

;FU SITARAIN : AAURIDIN FLOKSURIDIN;FU SITARAIN : AAURIDIN FLOKSURIDIN

:;MERKAPTOPURUN :;TIOGUANID:;MERKAPTOPURUN :;TIOGUANID

METOTREKSATMETOTREKSAT

PRODUKPRODUK

ALAMIAHALAMIAH

ALKALOID /INKAALKALOID /INKA

ANTIIOTIKANTIIOTIK

ENIMENIM

/INLASTIN /INKRISTIN/INLASTIN /INKRISTIN

DAKTINOMISIN MITOMISINDAKTINOMISIN MITOMISIN

ANTRASIKLIN -ANTRASIKLIN - DAUNORUISIN DOORUISINDAUNORUISIN DOORUISIN

L;ASPARAGINASEL;ASPARAGINASE

HORMONHORMON ADRENOKORTIKOIDADRENOKORTIKOID

PROGESTINPROGESTINESTROGENESTROGEN

ANDROGENANDROGEN

PREDNISONPREDNISON

HIDROKSIPROGESTERON MEGESTROLHIDROKSIPROGESTERON MEGESTROLDIETILSTILESTEROL ETINILESTRADIOLDIETILSTILESTEROL ETINILESTRADIOL

TESTOTERON FLUOKSIMESTERONTESTOTERON FLUOKSIMESTERON

ISOTOPISOTOPRADIOAKTIFRADIOAKTIF

FOSFORFOSFOR

ODIUMODIUM

NATRIUM FOSFATNATRIUM FOSFAT

NATRIUM ODIDANATRIUM ODIDA

LAIN;LAINLAIN;LAIN SUSTITUSI UREASUSTITUSI UREADERI/AT METIHIDRAINDERI/AT METIHIDRAIN

HIDROKSIUREAHIDROKSIUREAPROKARAINPROKARAIN


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P E R H A T I A NP E R H A T I A N

TOKSISITAS OBATTOKSISITAS OBAT

SST SALURAN ERNA SEL FOLIKEL RAMUTSST SALURAN ERNA SEL FOLIKEL RAMUT KONTRA INDIKASIKONTRA INDIKASI

KU URUK KU URUK SKALA KARNOFSK KURANG EFEK IRITASI KULITEFEK IRITASI KULIT

EFEK KARSINOGENIK EFEK KARSINOGENIK

EFEK MUTAGENIK EFEK MUTAGENIK


26/27

KARNOFSK SALEKARNOFSK SALE877 877 - AKTIFITAS NORMAL KELUHAN (;) GE5ALA PENAKIT (;)- AKTIFITAS NORMAL KELUHAN (;) GE5ALA PENAKIT (;)

C7 C7 - AKTIFITAS NORMAL KELUHAN () GE5ALA PENAKIT ()- AKTIFITAS NORMAL KELUHAN () GE5ALA PENAKIT ()

7 7 - AKTIFITAS NORMAL DENGAN USAHA EERAPA GE5ALA- AKTIFITAS NORMAL DENGAN USAHA EERAPA GE5ALA7 7 -- AKTIFITAS NORMAL (;) DAPAT MENGURUS DIRI SENDIRIAKTIFITAS NORMAL (;) DAPAT MENGURUS DIRI SENDIRI

:7 :7 -- AKTIFITAS NORMAL (;) KADANG PERLU ANTUANAKTIFITAS NORMAL (;) KADANG PERLU ANTUAN

7 7 - ANAK PERLU NATUAN- ANAK PERLU NATUAN

47 47 - PERLU PERAATAN DAN ANTUAN KHUSUS- PERLU PERAATAN DAN ANTUAN KHUSUS


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PERSIAPAN KEMOTERAPIPERSIAPAN KEMOTERAPI

8=8= INFORM ONSENTINFORM ONSENT

6=6= INFORMASI MANFAAT DAN EFEK SAMPINGINFORMASI MANFAAT DAN EFEK SAMPING

kp 2.4.5.2 (2) limfoma non hodgkin dan hodgkin

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