MAKALAH KEPERAWATAN KLINIK VI MAKALAH KEPERAWATAN KLINIK VI
(KEPERAWATAN MEDIKAL BEDAH) (KEPERAWATAN MEDIKAL BEDAH)
ASUHAN
ASUHAN KEPERAW
KEPERAWA
AT
TAN KLIEN
AN KLIEN DENGAN
DENGAN LEUKEMIA
LEUKEMIA
Disusun Oleh Kelompok 18 Disusun Oleh Kelompok 18
DESNI TRI UTAMI DESNI TRI UTAMI SYA
SYAFRIDA FRIDA HANUMHANUM TRI JULIANSYAH TRI JULIANSYAH UMMAMI
UMMAMI ANESA INDRIANESA INDRI
Dosen !em"im"in#$ Ye
Dosen !em"im"in#$ Yesi H%sneli si H%sneli N& S'Kp'& MNSN& S'Kp'& MNS
PROGRAM STUDI ILMU KEPERAWATAN
PROGRAM STUDI ILMU KEPERAWATAN
UNIVERSITAS RIAU
UNIVERSITAS RIAU
PEKANBARU
PEKANBARU
2012
2012
1 1KATA
KATA PENGPENGANTAR ANTAR
Se#%l% pu(i "%#i All%h S)T *%n# +el%h mem"e,ik%n kesemp%+%n kep%-% penulis un+uk Se#%l% pu(i "%#i All%h S)T *%n# +el%h mem"e,ik%n kesemp%+%n kep%-% penulis un+uk -%p%+ mem"e,ik%n se"u%h m%k%l%h *%n# "e,(u-ul .Asuh%n Kepe,%/%+%n !%-% Klien Den#%n -%p%+ mem"e,ik%n se"u%h m%k%l%h *%n# "e,(u-ul .Asuh%n Kepe,%/%+%n !%-% Klien Den#%n Le
Leukukememi%0i%0' ' TTi-i-%k %k lulup% p% pupul% l% shsh%l%%l%/%/%+ + "e"e,i,i,i,in# n# s%ls%l%m %m pepenunulilis s uu%p%pk%k%n n kekep%p%-% -% N%N%"i"i Muh%mm%- SA) *%n# +el%h mem"%/% um%+ m%nusi% -%,i %l%m ke"o-oh%n menu(u %l%m Muh%mm%- SA) *%n# +el%h mem"%/% um%+ m%nusi% -%,i %l%m ke"o-oh%n menu(u %l%m *%n# penuh +eknolo#i *%n# +el%h ki+% ,%s%k%n s%mp%i p%-% s%%+ ini'
*%n# penuh +eknolo#i *%n# +el%h ki+% ,%s%k%n s%mp%i p%-% s%%+ ini'
!%-!%-% % keskesempemp%+%n %+%n k%lk%li i ini ini penpenuliulis s (u#(u#% % in#in#in in menmen*%m*%mp%ikp%ik%n %n u%u%p%n p%n +e,i+e,im% m% k%sk%sihih kep
kep%-% %-% i"u Yei"u Yesi si H%snH%sneli& eli& N& N& S'KS'Kp'& p'& MNS MNS sel%sel%ku ku -os-osen en pempem"im"im"in"in# # p%-p%-% % m%+% m%+% kulkuli%hi%h Kepe,%/%+%n Klinik I *%n# +el%h mem"e,ik%n -ukun#%n se,+% mo+i2%si' Semo#% mo+i2%si Kepe,%/%+%n Klinik I *%n# +el%h mem"e,ik%n -ukun#%n se,+% mo+i2%si' Semo#% mo+i2%si se,+% -ukun#%n *%n# I"u "e,ik%n -%p%+
se,+% -ukun#%n *%n# I"u "e,ik%n -%p%+ men(%-i p%h%l% -i sismen(%-i p%h%l% -i sisi All%h S)Ti All%h S)T''
D%l%m pen*eles%i%n m%k%l%h ini& penulis men*%-%,i "%h/% m%sih "%n*%k +e,-%p%+ D%l%m pen*eles%i%n m%k%l%h ini& penulis men*%-%,i "%h/% m%sih "%n*%k +e,-%p%+ ke
kekuku,%,%n#n#%n%n' ' N%N%mumun n -em-emikiki%ni%n& & pepenunulilis s +el+el%h %h "e"e,u,us%hs%h% % semsem%k%ksimsim%l %l mumun#n#kikin n -e-en#n#%n%n kem%mpu%n *%n# penulis miliki' Un+uk i+u& penulis (u#% men#h%,%pk%n k,i+ik -%n s%,%n *%n# kem%mpu%n *%n# penulis miliki' Un+uk i+u& penulis (u#% men#h%,%pk%n k,i+ik -%n s%,%n *%n# mem"%n#un %#%, m%k%l%h ini -%p%+ le"ih "e,m%n3%%+ "%#i p%,% pem"%%'
mem"%n#un %#%, m%k%l%h ini -%p%+ le"ih "e,m%n3%%+ "%#i p%,% pem"%%'
!ek%n"%,u& 45 Ok+o"e, 4614 !ek%n"%,u& 45 Ok+o"e, 4614
Tim !enulis Tim !enulis
DAFTAR ISI DAFTAR ISI Halaman Halaman KATA PENGANTAR KATA PENGANTAR '''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''' ii DAFTAR ISI DAFTAR ISI'''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''' iiii BAB I PENDAHULUAN BAB I PENDAHULUAN 1' 1'1 L%+%1 L%+%, , 7e7el%l%k%k%n#n#'''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''' 11 1' 1'4 Ru4 Rumumus%n Ms%n M%s%%s%l%l%h'h''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''' 44 1'
1' TTu(u(u%u%n'n''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''' 44
BAB II TINJAUAN TEORI BAB II TINJAUAN TEORI
4'
4'1 1 DeDe3i3ininisisi'''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''' 4'
4'4 4 E+E+ioiololo#i#i'''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''' 99 4'
4' M%ni M%ni3es3es+%s+%si Klini Klinikik'''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''' 88 4'
4': E: E2%2%lulu%si %si DiDi%#%#nonos+s+ikik'''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''' 1616 4';
4'; Web Of CautionWeb Of Caution'''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''' 1111 4'
4'5 5 !e!en%n%+%+%l%kl%ks%s%n%n%%n %n MeMe-i-is's''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''' 1414 4'
4'9 9 !e!en%n%+%+%l%kl%ks%s%n%n%%n %n KeKepepe,%,%/%/%+%n+%n'''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''' 1:1:
BAB III TINJAUAN KASUS BAB III TINJAUAN KASUS
'
'1U1U,%i,%i%n %n K%K%susus's''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''' 44 '
'4 4 !e!en#n#k%k%(i(i%n %n '''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''' 44 '
' AAn%n%lilis% s% D%D%+%+%'''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''' 4:4: '
': : AAsusuh%h%n n KeKepepe,%,%/%/%+%n+%n'''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''' 4949 ';
'; Web Of CautionWeb Of Caution K%K%susus's''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''' 4<4< '
'5' 5' !e!en%n%+%+%l%l%ksks%n%n%%%%n Fn F%,%,mm%k%kololo#o#i Di D%n %n NoNon Fn F%,%,m%m%kokololo#i#i'''''''''''''''''''''''''''''''' 66 '
'9 9 TTu(u(u%u%n n !e!em"m"elel%(%%(%,%n,%n'''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''' 11
DAFTAR PUSTAKA DAFTAR PUSTAKA
BAB I BAB I
PENDAHULUAN PENDAHULUAN
11
11 La!aLa!a" B#la" B#la$an%$an%
Leukemi% me,up%k%n k%nke, *%n# +e,(%-i p%-% sel -%,%h m%nusi%' Un+uk men#e+%hui Leukemi% me,up%k%n k%nke, *%n# +e,(%-i p%-% sel -%,%h m%nusi%' Un+uk men#e+%hui +en+%n# leukemi%& ki+% h%,us men#en%l -%hulu sel=sel -%,%h *%n# no,m%l se,+% %p% *%n# +en+%n# leukemi%& ki+% h%,us men#en%l -%hulu sel=sel -%,%h *%n# no,m%l se,+% %p% *%n# +e,(%-i (ik% +e,ken% leukemi%' D%,%h m%nusi% +e,-i,i -%,i
+e,(%-i (ik% +e,ken% leukemi%' D%,%h m%nusi% +e,-i,i -%,i %i,%n *%n# -ise"u+ se"%#%i pl%sm%%i,%n *%n# -ise"u+ se"%#%i pl%sm% -%,%h& -%n +i#% kelompok sel -%,%h' Kelompok sel -%,%h i+u -i"e-%k%n men(%-i sel -%,%h -%,%h& -%n +i#% kelompok sel -%,%h' Kelompok sel -%,%h i+u -i"e-%k%n men(%-i sel -%,%h me,%h& sel -%,%h pu+ih& -%n kepin#=kepin# -%,%h' Sel=sel -%,%h +e,se"u+ -i"u%+ -i sumsum me,%h& sel -%,%h pu+ih& -%n kepin#=kepin# -%,%h' Sel=sel -%,%h +e,se"u+ -i"u%+ -i sumsum +u
+ul%nl%n#& #& -i -i ,u,u%n%n# # meme-u-ul% l% +u+ul%l%n#n#' ' !,!,ososes es pempem"en"en+u+uk%k%n n sesel=sl=sel el -%-%,%,%h h -i-ise"se"u+ u+ -e-en#n#%n%n hem%+opoiesis'
hem%+opoiesis' O,%
O,%n# n# -e/-e/%s% %s% memmemilikiliki i sumsumsum sum *%n*%n# # -i#-i#un%un%k%n k%n un+un+uk uk pempem"en"en+uk+uk%n %n sel sel "e,"e,up%up% sumsum +ul%n# me,%h *%n# +e,"%+%s p%-% +ul%n# %n##o+% +u"uh -%n +en#ko,%k' Meskipun sumsum +ul%n# me,%h *%n# +e,"%+%s p%-% +ul%n# %n##o+% +u"uh -%n +en#ko,%k' Meskipun -ise"u+ sumsum +ul%n# me,%h& +emp%+ +e,se"u+ mem"u%+ sel -%,%h me,%h m%upun sel -%,%h -ise"u+ sumsum +ul%n# me,%h& +emp%+ +e,se"u+ mem"u%+ sel -%,%h me,%h m%upun sel -%,%h pu+ih'
pu+ih' Sumsum Sumsum -i -i +ul%n# +ul%n# %n##o+% %n##o+% "%-%n& "%-%n& +ul%n#=+ul%n# +ul%n#=+ul%n# p%n(%n# p%n(%n# -%,i -%,i +u"uh& +u"uh& %-%l%h %-%l%h -%l%m-%l%m "en+uk
"en+uk sumsum sumsum lem%k lem%k kunin#& kunin#& *%n# *%n# me,up%k%n me,up%k%n %-%n#%n %-%n#%n -%n -%n +i-%k +i-%k %k+i3 %k+i3 "e,hu"un#%n"e,hu"un#%n -en#%
-en#%n n pem"upem"u%+%n sel=sel %+%n sel=sel -%,%h' Ak-%,%h' Ak%n +e+%pi& %n +e+%pi& -%p%+ "e,u"%h men(%-i sumsum +ul%n# -%p%+ "e,u"%h men(%-i sumsum +ul%n# me,%hme,%h "il%m%n% +e,-%p%+ keku,%n#%n -%,%h >?,een& 466<@'
"il%m%n% +e,-%p%+ keku,%n#%n -%,%h >?,een& 466<@' Sum
Sumsum sum +ul+ul%n# %n# menmen#%n#%n-u-un# n# sel sel s+es+em m p,imp,imi+ii+i3 3 *%n*%n# # memmemiliiliki ki kemkem%mp%mpu%n u%n un+un+uk uk "e,eplik%si&
"e,eplik%si& "e,p,oli3e,%si& "e,p,oli3e,%si& -%n -%n "e,-i3e,ensi%si' "e,-i3e,ensi%si' !em"el%h%n !em"el%h%n #%,is #%,is ke+u,un%n ke+u,un%n *%n# *%n# pe,+%m%pe,+%m% -%,i sel ini *%i+u sel m*eloi- -%n sel lim3oi-' Sel m*eloi- men#h%silk%n e,i+,osi+& m*elo"l%s+& -%,i sel ini *%i+u sel m*eloi- -%n sel lim3oi-' Sel m*eloi- men#h%silk%n e,i+,osi+& m*elo"l%s+& -%n pl%+ele+ mel%lui p,eku,so,' M*elo"l%s+ p%-% sel m*eloi- kem"%li men#h%silk%n neu+,o3il& -%n pl%+ele+ mel%lui p,eku,so,' M*elo"l%s+ p%-% sel m*eloi- kem"%li men#h%silk%n neu+,o3il& "%so3il&
"%so3il& -%n -%n eosino3il eosino3il *%n# *%n# "e,#,%nul%& "e,#,%nul%& se,+% se,+% monosi+ monosi+ *%n# *%n# +i-%k +i-%k "e,#,%nul%' "e,#,%nul%' Se-%n#k%n Se-%n#k%n selsel lim3oi- men#h%silk%n lim3o"l%s
lim3oi- men#h%silk%n lim3o"l%s *%n# memp,o-uksi lim3osi+ T& lim3osi+ 7& -%n*%n# memp,o-uksi lim3osi+ T& lim3osi+ 7& -%n Natural Killer Natural Killer '' Sel -%,%h pu+ih& +e,-i,i -%,i m*elo"l%s+ -%n lim3o"l%s se"%#%i pe,+%h%n%n +u"uh +e,h%-%p Sel -%,%h pu+ih& +e,-i,i -%,i m*elo"l%s+ -%n lim3o"l%s se"%#%i pe,+%h%n%n +u"uh +e,h%-%p se,%n#%n "en-% %sin# >?ol-smi+h& 4614@'
se,%n#%n "en-% %sin# >?ol-smi+h& 4614@'
Sel -%,%h pu+ih %+%u leukosi+ "e,3un#si un+uk melin-un#i +u"uh +e,h%-%p in3eksi %+%u Sel -%,%h pu+ih %+%u leukosi+ "e,3un#si un+uk melin-un#i +u"uh +e,h%-%p in3eksi %+%u se,%
se,%n#%n#%n n pen*pen*%ki%ki+ + l%inl%inn*%n*%' ' Sel Sel -%,-%,%h %h me,%me,%h h %+%u %+%u e,i+e,i+,os,osi+ i+ "e,"e,3un3un#si #si un+un+uk uk menmen#%n#%n#ku#ku++ oksi#en -%,i p%,u=p%,u ke selu,uh (%,in#%n +u"uh& -%n mem"%/% k%,"on-ioksi-% -%,i (%
oksi#en -%,i p%,u=p%,u ke selu,uh (%,in#%n +u"uh& -%n mem"%/% k%,"on-ioksi-% -%,i (% ,in#%n,in#%n +u"uh kem"%li ke p%,u=p%,u' Kepin#=kepin# -%,%h %+%u +,om"osi+ s%n#%+ "e,pe,%n -%l%m +u"uh kem"%li ke p%,u=p%,u' Kepin#=kepin# -%,%h %+%u +,om"osi+ s%n#%+ "e,pe,%n -%l%m p,oses
p,oses pem"eku%n pem"eku%n -%,%h' -%,%h' Ke+ik% Ke+ik% +e,(%-i +e,(%-i leukemi%& leukemi%& +u"uh +u"uh %k%n %k%n memp,o-uksi memp,o-uksi sel=sel sel=sel -%,%h-%,%h *%n
*%n# # %"n%"no,mo,m%l %l -%n -%l%m -%n -%l%m (um(uml%h l%h *%*%n# n# "es"es%,' !%-% %,' !%-% leuleukemkemi%& i%& sel sel -%,-%,%h %h *%n*%n# # %"n%"no,mo,m%l%l +e,se"u+ %-%l%h kelompok sel -%,%h pu+ih' Sel=sel -%,%h *%n# +e,ken% leukemi% %k%n s%n#%+ +e,se"u+ %-%l%h kelompok sel -%,%h pu+ih' Sel=sel -%,%h *%n# +e,ken% leukemi% %k%n s%n#%+ "e,"e-%
"e,"e-% -en#%n -en#%n sel sel -%,%h -%,%h no,m%l& no,m%l& -%n -%n +i-%k +i-%k m%mpu m%mpu "e,3un#si "e,3un#si sepe,+i sepe,+i l%*%kn*% l%*%kn*% sel sel -%,%h-%,%h no,m%l'
Le
Leukukememi% i% meme,u,up%p%k%n k%n 4&4&8 8 -%-%,i ,i seselulu,u,uh h k%k%susus s k%k%nknke,e,& & "e"elulum m %-%-% % %n%n#k#k% % p%p%s+s+ii men#en%i insi-en leukemi% -i In-onesi%' Leukemi% +e,"%#i men(%-i -u% +ipe *%i+u leukemi% men#en%i insi-en leukemi% -i In-onesi%' Leukemi% +e,"%#i men(%-i -u% +ipe *%i+u leukemi% %ku+ -%n leukemi% k,onik' Leukemi% %ku+ +e,"%#i l%#i men(%-i Leukemi% Mielo"l%s+ik Aku+ %ku+ -%n leukemi% k,onik' Leukemi% %ku+ +e,"%#i l%#i men(%-i Leukemi% Mielo"l%s+ik Aku+ >LMA@ -%n Leukemi% Lim3osi+ik Aku+ >LLA@' Di Ne#%,% m%(u sepe,+i Ame,ik% Se,ik%+& >LMA@ -%n Leukemi% Lim3osi+ik Aku+ >LLA@' Di Ne#%,% m%(u sepe,+i Ame,ik% Se,ik%+& LMA me,up%k%n 4 -%,i selu,uh k%sus leukemi%' !en*%ki+ ini le"ih se,in# -i+emuk%n p%-% LMA me,up%k%n 4 -%,i selu,uh k%sus leukemi%' !en*%ki+ ini le"ih se,in# -i+emuk%n p%-% -e/%s% >8;@ -%,i p%-% %n%k >1;@' Insi-en LMA p%-% o,%n# *%n# "e,usi% 6 +%hun %-%l%h -e/%s% >8;@ -%,i p%-% %n%k >1;@' Insi-en LMA p%-% o,%n# *%n# "e,usi% 6 +%hun %-%l%h 6&8& p%-% o,%n# *%n# "e,usi% ;6 +%hun 4&9& se-%n#k%n p%-% o,%n# *%n# "e,usi% -i %+%s 5; 6&8& p%-% o,%n# *%n# "e,usi% ;6 +%hun 4&9& se-%n#k%n p%-% o,%n# *%n# "e,usi% -i %+%s 5; +%hun %-%l%h se"es%, 1&9'
+%hun %-%l%h se"es%, 1&9'
LLA le"ih "%n*%k men*e,%n# p%-% %n%k=%n%k -en#%n pun%k usi% =; +%hun' Insi-en LLA le"ih "%n*%k men*e,%n# p%-% %n%k=%n%k -en#%n pun%k usi% =; +%hun' Insi-en LLA %-%l%h 1B56'666 o,%n# pe, +%hun& -en#%n 9; p%sien "e,usi% ku,%n# -%,i 1; +%hun' LLA %-%l%h 1B56'666 o,%n# pe, +%hun& -en#%n 9; p%sien "e,usi% ku,%n# -%,i 1; +%hun' Leukemi% k,onik +e,"%#i men(%-i -u% *%i+u Leukemi% M*eloi- K,onik >LMK@ -%n Leukemi% Leukemi% k,onik +e,"%#i men(%-i -u% *%i+u Leukemi% M*eloi- K,onik >LMK@ -%n Leukemi% Lim3osi+ik K,onik >LLK@' Ke(%-i%n LMK men%p%i 46 -%,i semu% leukemi% p%-% -e/%s%' Lim3osi+ik K,onik >LLK@' Ke(%-i%n LMK men%p%i 46 -%,i semu% leukemi% p%-% -e/%s%' !%-% umumn*%& LMK men*e,%n# usi% :6=;6 +%hun& /%l%upun -%p%+ -i+emuk%n p%-% usi% !%-% umumn*%& LMK men*e,%n# usi% :6=;6 +%hun& /%l%upun -%p%+ -i+emuk%n p%-% usi% mu-% -%n "i%s%n*% le"ih p,o#,esi3' Di Jep%n#& ke(%-i%nn*% menin#k%+ se+el%h pe,is+i/% "om mu-% -%n "i%s%n*% le"ih p,o#,esi3' Di Jep%n#& ke(%-i%nn*% menin#k%+ se+el%h pe,is+i/% "om %+om -i N%#%s%ki -%n Hi,oshim%& -emiki%n (u#% -i Rusi% se+el%h ,e%k+o, %+om Che,no"il %+om -i N%#%s%ki -%n Hi,oshim%& -emiki%n (u#% -i Rusi% se+el%h ,e%k+o, %+om Che,no"il mele-%k' LLK -i Ne#%,% 7%,%+ memiliki %n#k% ke(%-i%n B166'666' Usi% ,e,%+% p%sien s%%+ mele-%k' LLK -i Ne#%,% 7%,%+ memiliki %n#k% ke(%-i%n B166'666' Usi% ,e,%+% p%sien s%%+ -i%#nosis 5; +%hun& h%n*% 16=1; ku,%n# -%,i ;6
-i%#nosis 5; +%hun& h%n*% 16=1; ku,%n# -%,i ;6 +%hun >Su-o*o -kk& 466<@+%hun >Su-o*o -kk& 466<@ !en*
!en*e"%e"%" " leuleukemkemi% i% se(%se(%uh uh ini ini "el"elum um -ik-ike+%e+%huihui& & n%mn%mun un "%n"%n*%*%k k penpeneli+eli+i%n i%n *%n*%n## -il
-il%ku%kuk%n un+uk memek%n un+uk meme%hk%hk%n %n m%sm%s%l%h ini' %l%h ini' 7e"7e"e,%e,%p% p% penpeneli+eli+i%n menuni%n menun(uk(ukk%n "%h/k%n "%h/%% leu
leukemkemi% i% le"le"ih ih se,ise,in# n# menmen*e*e,%n,%n# # k%uk%um m p,ip,i% % -i"-i"%n-%n-in#in#k%n k%n k%uk%um m /%n/%ni+%& i+%& -%n -%n (u#(u#% % p%-p%-%% kelompok o,%n# kuli+ pu+ih -i"%n-in#k%n -en#%n o,%n# kuli+ hi+%m' N%mun s%mp%i s%%+ ini kelompok o,%n# kuli+ pu+ih -i"%n-in#k%n -en#%n o,%n# kuli+ hi+%m' N%mun s%mp%i s%%+ ini "elum -ike+%hui men#%p% h%l +e,se"u+ -%p%+ +e,(%-i'
"elum -ike+%hui men#%p% h%l +e,se"u+ -%p%+ +e,(%-i'
!e,%n pe,%/%+ s%n#%+l%h pen+in# p%-% k%sus ini' !e,%n pe,%/%+ s%n#%+ "e,#un% un+uk !e,%n pe,%/%+ s%n#%+l%h pen+in# p%-% k%sus ini' !e,%n pe,%/%+ s%n#%+ "e,#un% un+uk mem"e,ik%n %suh%n kepe,%/%+%n *%n# sesu%i -en#%n s+%n-%, kepe,%/%+%n -%n ko-e e+ik mem"e,ik%n %suh%n kepe,%/%+%n *%n# sesu%i -en#%n s+%n-%, kepe,%/%+%n -%n ko-e e+ik -%l%m men%n#%ni p%sien -en#%n -i%#nos% leukemi% sesu%i -en#%n ilmu *%n# +el%h -ipel%(%,i' -%l%m men%n#%ni p%sien -en#%n -i%#nos% leukemi% sesu%i -en#%n ilmu *%n# +el%h -ipel%(%,i'
12
12 R&m&'R&m&'an Ma'an Ma'alaala
7%#%im%n% %suh%n kepe,%/%+%n p%-% klien -en#%n leukemi% 7%#%im%n% %suh%n kepe,%/%+%n p%-% klien -en#%n leukemi% 1
1 TT&*&*&an&an
Un+uk men#e+%hui %suh%n kepe,%/%+%n *%n# +ep%+ p%-% klien -en#%n leukemi% Un+uk men#e+%hui %suh%n kepe,%/%+%n *%n# +ep%+ p%-% klien -en#%n leukemi% "e,-%s%,k%n p%+o3isiolo#i +e,(%-in*% leukemi%'
"e,-%s%,k%n p%+o3isiolo#i +e,(%-in*% leukemi%'
; ;
BAB II BAB II TINJAUAN TEORITIS TINJAUAN TEORITIS 21 21 D#+D#+,n,,n,',',
Juml%h sel -%,%h pu+ihBleukosi+ no,m%l p%-% +u"uh ki+% "ekis%, %n+%,% :;66 11'666BL Juml%h sel -%,%h pu+ihBleukosi+ no,m%l p%-% +u"uh ki+% "ekis%, %n+%,% :;66 11'666BL >Cui& 4611@' Menu,u+ Meshe, p%-% +%hun >4611@& (uml%h leukosi+ *%n# +e,-%p%+ -i -%l%m >Cui& 4611@' Menu,u+ Meshe, p%-% +%hun >4611@& (uml%h leukosi+ *%n# +e,-%p%+ -i -%l%m +u"uh -e/%s% no,m%l "e,%-% p%-% ,en+%n# 5666 11'666BL' Juml%h leukosi+ "e,2%,i%si +u"uh -e/%s% no,m%l "e,%-% p%-% ,en+%n# 5666 11'666BL' Juml%h leukosi+ "e,2%,i%si sesu%i umu, >7loom G F%/e++& 4664@' Leukemi% me,up%k%n su%+u pen*%ki+ *%n# -i+%n-%i sesu%i umu, >7loom G F%/e++& 4664@' Leukemi% me,up%k%n su%+u pen*%ki+ *%n# -i+%n-%i -en#%n p,oli3e,%si -ini *%n# "e,le"ih%n -%,i sel -%,%h pu+ih'
-en#%n p,oli3e,%si -ini *%n# "e,le"ih%n -%,i sel -%,%h pu+ih' Le
Leukukememi% i% (u(u#% #% "i"is% s% -i-i-e-e3i3ininisisik%k%n n sese"%"%#%#%i i keke#%#%n%n%s%s%n n hehem%m%+o+ololo#i#is s %k%ki"i"%+ %+ p,p,ososeses ne
neopopl%l%s+s+ik ik *%*%n# n# -i-isese,+,+%i %i #%#%n#n##u#u%n %n -i-i3e3e,e,ensnsi%i%si si p%p%-% -% "e"e,","%#%#%i %i +i+in#n#k%k%+%+%n n si si inin-u-uk k hem%+o
hem%+opoie+ipoie+ik k >H%n->H%n-%*%ni G %*%ni G H%,i"oH%,i"o/o& 4668@' /o& 4668@' Menu,Menu,u+ u+ ))onon# # -kk p%-% -kk p%-% +%hun >466<@&+%hun >466<@& leu
leukemkemi% i% %-%%-%l%h l%h seksekeloelompompok k penpen*%k*%ki+ i+ #%n#%n%s %s p%-p%-% % sumsumsum sum +ul+ul%n# %n# "el"el%k%%k%n# n# -%n -%n sis+esis+emm lim3%+ik *%n# -i+%n-%i -en#%n p,oli3e,%si +%np% "%+%s sel -%,%h pu+ih *%n# %"no,m%l -%n lim3%+ik *%n# -i+%n-%i -en#%n p,oli3e,%si +%np% "%+%s sel -%,%h pu+ih *%n# %"no,m%l -%n im%+u, >Don% G )on#& 466<@'
im%+u, >Don% G )on#& 466<@' Kesi
Kesimpmpul%ul%n n *%n*%n# # -%p-%p%+ %+ -i%-i%m"im"il l %-%%-%l%h l%h "%h"%h/% /% leuleukemkemi% i% me,me,up%up%k%n k%n su%su%+u +u penpen*%*%ki+ki+ -im%n% p,o-uksi sel -%,%h pu+ih s%n#%+ "e,le"ih%n mele"ihi (uml%h leukosi+ no,m%l -i -%l%m -im%n% p,o-uksi sel -%,%h pu+ih s%n#%+ "e,le"ih%n mele"ihi (uml%h leukosi+ no,m%l -i -%l%m +u"uh *%n# "e,si3%+ %"no,m%l -%n im%+u,' Sel=sel ini men#h%m"%+ semu% sel l%in -i sumsum +u"uh *%n# "e,si3%+ %"no,m%l -%n im%+u,' Sel=sel ini men#h%m"%+ semu% sel l%in -i sumsum +ul
+ul%n# %n# un+un+uk uk "e,"e,kemkem"%n"%n# # se%se%,% ,% no,no,m%lm%l& & sehsehin#in##% #% me,me,ek% ek% +e,++e,+im"im"un un -i -i sumsumsum sum +ul+ul%n#%n#'' K%,en% h%l +e,se"u+& leukemi% -ise"u+ su%+u #%n##u%n %kumul%+i3 sek%li#us #%n##u%n klon%l' K%,en% h%l +e,se"u+& leukemi% -ise"u+ su%+u #%n##u%n %kumul%+i3 sek%li#us #%n##u%n klon%l' Akhi,n*% sel=sel leukemik men#%m"il %lih sumsum +ul%n# -%n ini men*e"%"k%n k%-%, sel=sel Akhi,n*% sel=sel leukemik men#%m"il %lih sumsum +ul%n# -%n ini men*e"%"k%n k%-%, sel=sel nonleukemik -i -%l%m -%,%h menu,un' A-%pun kl%si3ik%si leukemi% -%p%+ -i(el%sk%n se"%#%i nonleukemik -i -%l%m -%,%h menu,un' A-%pun kl%si3ik%si leukemi% -%p%+ -i(el%sk%n se"%#%i "e,iku+$
"e,iku+$ A
A L#L#&$&$#m#m,a ,a AA$&$&!! Leu
Leukemkemi% i% %ku%ku+ + me,me,up%up%k%n k%n p,op,oli3li3e,%se,%si i sel sel leuleukoskosi+ i+ *%n*%n# # %"n%"no,mo,m%l& %l& #%n#%n%s& %s& se,ise,in#n# -ise,+%i "en+uk leukosi+ *%n# l%in -%,ip%-% no,m%l& (uml%hn*% "e,le"ih%n& se,+% -%p%+ -ise,+%i "en+uk leukosi+ *%n# l%in -%,ip%-% no,m%l& (uml%hn*% "e,le"ih%n& se,+% -%p%+ men*e"%"k%n %nemi%& +,om"osi+openi%& -%n -i%khi,i -en#%n kem%+i%n >H%n-%*%ni G men*e"%"k%n %nemi%& +,om"osi+openi%& -%n -i%khi,i -en#%n kem%+i%n >H%n-%*%ni G H%,i"o/o& 4668@' Menu,u+ Me3+% G Ho33",%n- p%-% +%hun >4668@& leukemi% %ku+ %-%l%h H%,i"o/o& 4668@' Menu,u+ Me3+% G Ho33",%n- p%-% +%hun >4668@& leukemi% %ku+ %-%l%h su%+u #%n##u%n
su%+u #%n##u%n m%li#n% -im%n% sel "l%s+ m%li#n% -im%n% sel "l%s+ hemopoe+ik +e,-%p%+ se"%n*hemopoe+ik +e,-%p%+ se"%n*%k %k le"ih -%,i 46le"ih -%,i 46 -%
-%,i ,i sel sel susumsmsum um +u+ul%l%n#n#' ' SeSel l p,p,imimi+ii+i3 3 "i"i%s%s%n*%n*% % (u#(u#% % "e"e,%,%kukumumul%l%si si -%-%l%m l%m -%-%,%,%h&h& men#in
men#in3il+,%si (%,in#%n l%in& 3il+,%si (%,in#%n l%in& -%n men*e"%"-%n men*e"%"k%n k%n #%#%l sumsum #%#%l sumsum +ul%n+ul%n#' #' LeukemLeukemi% i% %ku+%ku+ menu,u+ kl%si3ik%si FA7 >F,enh=Ame,i%n=7,i+ish@ -%p%+ -ikl%si3ik%sik%n men(%-i -u%& menu,u+ kl%si3ik%si FA7 >F,enh=Ame,i%n=7,i+ish@ -%p%+ -ikl%si3ik%sik%n men(%-i -u%& *%i+u$
*%i+u$
1.
Le
Leukukememi% i% mimieloelo"l"l%s+%s+ik ik %k%ku+ u+ %-%-%l%%l%h h susu%+%+u u pepen*n*%k%ki+ i+ *%*%n# n# -i-i+%+%n-n-%i %i -e-en#n#%n%n +,%ns3o,m%si neopl%s+ik -%n #%n##u%n -i3e,ensi%si sel=sel p,o#eni+o, -%,i se,i +,%ns3o,m%si neopl%s+ik -%n #%n##u%n -i3e,ensi%si sel=sel p,o#eni+o, -%,i se,i m*eloi->Su-o*o -kk& 466<@'
>Su-o*o -kk& 466<@'
Leukemi% mielo"l%s+ik %ku+ >LMA@ me,up%k%n leukemi% *%n# men#en%i sel s+em Leukemi% mielo"l%s+ik %ku+ >LMA@ me,up%k%n leukemi% *%n# men#en%i sel s+em hem
hem%+o%+opoepoe+ik +ik *%n*%n# # kelkel%k %k "e,"e,-i3-i3e,ene,ensi%ssi%si i ke ke semsemu% u% sel sel miemieloiloi-' -' LMA me,upLMA me,up%k%%k%nn leukemi% nonlim3osi+ik *%n# p%lin# se,in# +e,(%-i'
leukemi% nonlim3osi+ik *%n# p%lin# se,in# +e,(%-i'
Menu,u+ kl%si3ik%si FA7 >F,enh=Ame,i%n=7,i+ish@ LMA -i"%#i men(%-i en%m Menu,u+ kl%si3ik%si FA7 >F,enh=Ame,i%n=7,i+ish@ LMA -i"%#i men(%-i en%m (enis& *%i+u$
(enis& *%i+u$
M1 $ Leukemi% mielo"l%s+ik +%np% pem%+%n#%n M1 $ Leukemi% mielo"l%s+ik +%np% pem%+%n#%n
M4 $ Leukemi% mielo"l%s+ik -en#%n "e,"%#%i -e,%(%+ pem%+%n#%n M4 $ Leukemi% mielo"l%s+ik -en#%n "e,"%#%i -e,%(%+ pem%+%n#%n M $ Leukemi% p,omielosi+ik hipe,#,%nul%,
M $ Leukemi% p,omielosi+ik hipe,#,%nul%, M: $ Leukemi% mielomonosi+ik
M: $ Leukemi% mielomonosi+ik M; $ Leukemi% mono"l%s+ik M; $ Leukemi% mono"l%s+ik
M5 $ E,i+,oleukemi% >H%n-%*%ni G H%,i"o/o& 4668@' M5 $ E,i+,oleukemi% >H%n-%*%ni G H%,i"o/o& 4668@' 2
2 L#&L#&$#$#m,a Lm,a L,m+,m+-.l-.la'!a'!,$ ,$ A$A$&!/&!/ Acute Ly Acute Lymphoblastic Leukemphoblastic Leukemia ( mia ( LLALLA /ALL) /ALL) LLA %-%l%h ke#%n%s%n klon%l -%,i sel=sel p,eku,so, lim3oi-' Le"ih -%,i 86 LLA %-%l%h ke#%n%s%n klon%l -%,i sel=sel p,eku,so, lim3oi-' Le"ih -%,i 86 k%sus& sel=sel #%n%s "e,%s%l -%,i lim3osi+ 7& -%n sis%n*% me,up%k%n leukemi% sel T' k%sus& sel=sel #%n%s "e,%s%l -%,i lim3osi+ 7& -%n sis%n*% me,up%k%n leukemi% sel T' Leu
Leukemkemi% i% ini ini me,me,up%up%k%n k%n "en"en+uk +uk leuleukemkemi% i% *%n*%n# # p%lip%lin# n# "%n"%n*%k *%k p%-p%-% % %n%%n%k=%k=%n%kn%k'' )
)%l%l%up%upun un -em-emikiiki%n& %n& 46 46 -%,-%,i i k%sk%sus us LLA %-%l%LLA %-%l%h h -e/-e/%s% %s% >Su>Su-o*-o*o o -kk-kk& & 466466<@'<@' Kl%si3ik%si LLA %-%l%h se"%#%i "e,iku+$
Kl%si3ik%si LLA %-%l%h se"%#%i "e,iku+$ %'
%' Se%,% moSe%,% mo,3olo#,3olo#is& menis& menu,u+ Fu,u+ FA7 >A7 >F,enh& 7F,enh& 7,i+ish& ,i+ish& %n- A%n- Ame,i%me,i%n@ LLA -i"n@ LLA -i"%#i%#i men(%-i +i#% (enis& *%i+u$
men(%-i +i#% (enis& *%i+u$ i'
i' L1 $ LLA -eL1 $ LLA -en#n#%n se%n sel liml lim3o3o"l"l%s+ k%s+ keieil=kl=keieil& neul& neuklkleoeoli *%li *%n# +in# +i-%-%k (elk (el%s&%s& -%n me,up%k%n 8: -%,i LLA& "i%s%n*% -i+emuk%n p%-% %n%k=%n%k -%n me,up%k%n 8: -%,i LLA& "i%s%n*% -i+emuk%n p%-% %n%k=%n%k ii
ii'' L4 $ sel le"iL4 $ sel le"ih "esh "es%,%,& in& in+i i,e+i i,e#u#ulele,& k,& k,om,om%+%+in "ein "e,#,#umump%p%l& nul& nuklkleoeoli li (e(el%sl%s&& -%n
-%n si+si+oplopl%sm%sm% % %#%%#%k k "%n*"%n*%k& %k& me,me,up%up%k%n k%n 1: 1: -%,-%,i i LLALLA& & "i%"i%s%n*s%n*%% +e,(%-i p%-% o,%n# -e/%s%
+e,(%-i p%-% o,%n# -e/%s% ii
iii'i' L $ +iL $ +ipe inpe ini memi memiliiliki siki si+o+oplpl%sm%sm% "%s% "%so3o3il -eil -en#n#%n "%%n "%n*n*%k 2%%k 2%kukuolol%& -%%& -%nn h%n*% me,up%k%n 1 -%,i LLA'
h%n*% me,up%k%n 1 -%,i LLA' "'
"' Se%,% Se%,% imuno3eno+ipe imuno3eno+ipe LLA LLA -%p%+ -%p%+ -i"%#i -i"%#i men(%-i men(%-i emp%+ emp%+ #olon#%n "es#olon#%n "es%, %, *%i+u*%i+u se"%#%i "e,iku+$
se"%#%i "e,iku+$ i'
i' Common ALLCommon ALL& 3,ekuensi ,el%+i3 p%-% %n%k=%n%k 95 -%n -e/%s% ;1'& 3,ekuensi ,el%+i3 p%-% %n%k=%n%k 95 -%n -e/%s% ;1' ii'
ii' Null ALL Null ALL& 3,ekuensi ,el%+i3 p%-% %n%k=%n%k 14 -%n -e/%s% 8'& 3,ekuensi ,el%+i3 p%-% %n%k=%n%k 14 -%n -e/%s% 8' iii'
iii' T-ALLT-ALL& 3,ekuensi ,el%+i3 p%-% %n%k=%n%k 14 -%n -e/%s% 16'& 3,ekuensi ,el%+i3 p%-% %n%k=%n%k 14 -%n -e/%s% 16' i2'
i2' B-ALL B-ALL& & 3,3,ekekueuensnsi i ,e,el%l%+i+i3 3 p%p%-% -% %n%n%k%k=%=%n%n%k k 1 1 -%-%n n -e-e/%/%s% s% 44 >H%n-%*%ni G H%,i"o/o& 4668@
>H%n-%*%ni G H%,i"o/o& 4668@
De3enisi su"+ipe imunolo#i ini "e,-%s%,k%n %+%s %-% %+%u +i-%kn*% "e,"%#%i %n+i#en De3enisi su"+ipe imunolo#i ini "e,-%s%,k%n %+%s %-% %+%u +i-%kn*% "e,"%#%i %n+i#en pe,muk%%n sel' Su"+ipe imunolo#i *
pe,muk%%n sel' Su"+ipe imunolo#i *%n# p%lin# se,in# -i+emuk%n %-%l%h%n# p%lin# se,in# -i+emuk%n %-%l%h common ALL.common ALL. Null cell
Null cell ALLALL "e,%s%l "e,%s%l -%,i s-%,i sel *%n# el *%n# s%n#%+ p,imi+i3 s%n#%+ p,imi+i3 -%n le"ih -%n le"ih "%n*%k p%-% "%n*%k p%-% -e/%s%'-e/%s%' B-
B-9 9
ALL
ALL me,me,up%up%k%n k%n pen*pen*%ki%ki+ + *%n*%n# # s%n#s%n#%+ %+ (%,%(%,%n#& n#& -en-en#%n #%n mo,mo,3ol3olo#i o#i L L *%n*%n# # se,ise,in#n# "e,pe,il%ku se"%#%i lim3om% %#,esi3 >Su-o*o -kk& 46
"e,pe,il%ku se"%#%i lim3om% %#,esi3 >Su-o*o -kk& 466<@'6<@'
B
B L#L#&$&$#m#m,a K,a K"-"-n,n,$$
Leukemi% k,onik memiliki sel -%,%h *%n# %"no,m%l m%sih -%p%+ "e,3un#si& -%n o,%n# Leukemi% k,onik memiliki sel -%,%h *%n# %"no,m%l m%sih -%p%+ "e,3un#si& -%n o,%n# -en#%n leukemi% (enis ini mun#kin +i-%k menun(ukk%n #e(%l%' !e,l%h%n=l%h%n& leukemi% -en#%n leukemi% (enis ini mun#kin +i-%k menun(ukk%n #e(%l%' !e,l%h%n=l%h%n& leukemi% k,onik mem"u,uk -%n mul%i menun(ukk%n #e(%l% ke+ik% sel leukemi% "e,+%m"%h "%n*%k k,onik mem"u,uk -%n mul%i menun(ukk%n #e(%l% ke+ik% sel leukemi% "e,+%m"%h "%n*%k -%n p,o-uksi sel
-%n p,o-uksi sel no,m%no,m%l l "e,ku"e,ku,%n#' !%-% ,%n#' !%-% s+%-ius+%-ium m -ini leukemi% k,onik& sel -ini leukemi% k,onik& sel leukemleukemi%i% -%p%+ "e,3un#si h%mpi, sepe,+i sel no,m%l'
-%p%+ "e,3un#si h%mpi, sepe,+i sel no,m%l' 1
1 L#&L#&$#$#m,a Mm,a M#l#l-, K-, K"-"-n,$ n,$ (LM(LMK)K)
Leukemi% m*eloi- k,onik me,up%k%n leukemi% *%n# pe,+%m% -i+emuk%n se,+% Leukemi% m*eloi- k,onik me,up%k%n leukemi% *%n# pe,+%m% -i+emuk%n se,+% -ik
-ike+%he+%hui ui p%+p%+o#eo#enesinesisn*sn*%' %' !%-!%-% % +%h+%hun un 1<51<56 6 No/No/ell ell -%n -%n HunHun#e,#e,3o,3o,- - menmenemuemuk%nk%n kel%in%n k,omosom *%n# sel%lu s%m% p%-% p%sien LMK& *%i+u 44 %+%u hil%n#n*% kel%in%n k,omosom *%n# sel%lu s%m% p%-% p%sien LMK& *%i+u 44 %+%u hil%n#n*% se"
se"%#%#i%n i%n lelen#n#%n %n p%p%n(%n(%n# n# -%-%,i ,i k,k,omomososom om 4444& & *%*%n# n# s%s%%+ %+ inini i kiki+% +% keken%n%l l se"se"%#%#%i%i k,omosom !hil%-elphi% >!h@' Sel%n(u+n*% -i +%hun 1<9 Ro/le menemuk%n "%h/% k,omosom !hil%-elphi% >!h@' Sel%n(u+n*% -i +%hun 1<9 Ro/le menemuk%n "%h/% k,omosom !h +e,"en+uk %ki"%+ %-%n*% +,%nslok%si ,esip,ok%l %n+%,% len#%n p%n(%n# k,omosom !h +e,"en+uk %ki"%+ %-%n*% +,%nslok%si ,esip,ok%l %n+%,% len#%n p%n(%n# k,omosom < -%n 44' Den#%n kem%(u%n -i "i-%n# "iolo#i molekul%,& p%-% +%hun 1<86 k,omosom < -%n 44' Den#%n kem%(u%n -i "i-%n# "iolo#i molekul%,& p%-% +%hun 1<86 -ik
-ike+%he+%hui ui "%h"%h/% /% p%-p%-% % k,ok,omosmosom om 44 44 *%n*%n# # menmen#%l#%l%mi %mi pempemen-en-ek%ek%n n +%-+%-i& i& +e,+e,n*n*%+%%+% -i-%p%+k%n %-%n*% #%"un#%n %n+%,% #en *%n# %-% -i len#%n p%n(%n# k,omosom < -i-%p%+k%n %-%n*% #%"un#%n %n+%,% #en *%n# %-% -i len#%n p%n(%n# k,omosom < *%kni A7L >
*%kni A7L > Abelson Abelson@ -en#%n #en 7CR >@ -en#%n #en 7CR > Break Cluster Region Break Cluster Region@ *%n# +e,le+%k -i len#%n@ *%n# +e,le+%k -i len#%n p%n(%n#
p%n(%n# k,omosom k,omosom 44' 44' ?%"un#%n ?%"un#%n ke-u% ke-u% #en #en ini ini se,in# se,in# -i+ulis -i+ulis se"%#%i se"%#%i 7CR=A7L7CR=A7L -i
-i-u-u#% #% kuku%+ %+ se"se"%#%#%i %i pepen*n*e"e"%" %" u+u+%m%m% % +e,+e,(%-(%-in*in*% % kekel%il%in%n%n n p,p,ololi3i3e,%e,%si si -%-%,i ,i se,se,ii #,%nulosi+ +%np% #%n##u%n -i3e,ensi%si sehin##% p%-% %pus%n -%,%h +epi ki+% -%p%+ #,%nulosi+ +%np% #%n##u%n -i3e,ensi%si sehin##% p%-% %pus%n -%,%h +epi ki+% -%p%+ -en
-en#%n #%n mu-mu-%h %h melmelih%ih%+ + +in+in#k%#k%+%n +%n -i3-i3e,ee,ensi%nsi%si si se,i se,i #,%#,%nulnulosiosi+ + p%-p%-% % p%sp%sien ien LMK LMK >Su-o*o -kk& 466<@'
>Su-o*o -kk& 466<@'
2
2 L#&L#&$#$#m,a Lm,a L,m+,m+-',-',!,$ K!,$ K"-"-n,$ (n,$ (LLKLLK))
Leukemi% lim3osi+ik k,onik %-%l%h su%+u ke#%n%s%n hem%+olo#ik *%n# -i+%n-%i Leukemi% lim3osi+ik k,onik %-%l%h su%+u ke#%n%s%n hem%+olo#ik *%n# -i+%n-%i oleh p,oli3e,%si klon%l -%n
oleh p,oli3e,%si klon%l -%n penumpenumpuk%n lim3osipuk%n lim3osi+ + 7 7 neopl%neopl%s+ik -%l%m s+ik -%l%m -%,%h& sumsum-%,%h& sumsum +ul
+ul%n#%n#& & limlim3on3ono-io-i& & limlimp%& p%& h%+h%+i& i& -%n -%n o,#o,#%n=%n=o,#o,#%n %n l%il%inn*nn*%' %' LLK LLK ini ini m%sm%suk uk -%l-%l%m%m kel%in
kel%in%n %n lim3oplim3op,oli3e,,oli3e,%+i3' %+i3' TT%n-%n-%=+%n-%%=+%n-%n*% n*% melipumelipu+i +i lim3olim3osi+osissi+osis& & lim3%-lim3%-enop%+enop%+i& i& -%n-%n splenome#%li' Ke"%n*%k%n LLK ><;@ %-%l%h neopl%sm% sel 7& sis%n*% neopl%sm% splenome#%li' Ke"%n*%k%n LLK ><;@ %-%l%h neopl%sm% sel 7& sis%n*% neopl%sm% sel T >Su-o*o -kk& 466<@'
sel T >Su-o*o -kk& 466<@'
Menu,u+ RAI& LLK +e,"%#i men(%-i ; s+%-ium *%i+u$ O >Lim3osi+osis -%,%h +epi Menu,u+ RAI& LLK +e,"%#i men(%-i ; s+%-ium *%i+u$ O >Lim3osi+osis -%,%h +epi -%n sumsum +ul%n#@& I >Lim3osi+osis pem"es%,%n lim3ono-i@& II >Lim3osi+osis -%n sumsum +ul%n#@& I >Lim3osi+osis pem"es%,%n lim3ono-i@& II >Lim3osi+osis
splenome#%liBhep%+ome#%li@& III >Lim3osi+osis %nemi%& H" ku,%n# -%,i 11 #,%mB-L@& splenome#%liBhep%+ome#%li@& III >Lim3osi+osis %nemi%& H" ku,%n# -%,i 11 #,%mB-L@& I >Lim3osi+osis +,om"osi+openi%& +,om"osi+ ku,%n# -%,i 166'666BuL@' Se-%n#k%n I >Lim3osi+osis +,om"osi+openi%& +,om"osi+ ku,%n# -%,i 166'666BuL@' Se-%n#k%n menu,u+ 7ine+& LLK +e,"%#i men(%-i s+%-ium *%i+u$ A >Lim3osi+osis -%,%h +epi -%n menu,u+ 7ine+& LLK +e,"%#i men(%-i s+%-ium *%i+u$ A >Lim3osi+osis -%,%h +epi -%n sumsum +ul%n# @& 7 >ku,%n# -%,i -%e,%h lim3oi- *%n# mem"es%,& Lim3osi+osis sumsum +ul%n# @& 7 >ku,%n# -%,i -%e,%h lim3oi- *%n# mem"es%,& Lim3osi+osis -%,%h +epi& -%n sumsum +ul%n# @& C > -%e,%h lim3oi- *%n# mem"es%,& s+%-ium 7 -%,%h +epi& -%n sumsum +ul%n# @& C > -%e,%h lim3oi- *%n# mem"es%,& s+%-ium 7 %nemi%& H" ku,%n# -%,i 11 #B-L p%-% p,i% -%n ku,%n# -%,i 16 #,B-L p%-% pe,empu%n %nemi%& H" ku,%n# -%,i 11 #B-L p%-% p,i% -%n ku,%n# -%,i 16 #,B-L p%-% pe,empu%n %+%u +,om"osi+openi% >ku,%n# -%,i
%+%u +,om"osi+openi% >ku,%n# -%,i 166'666BL@'166'666BL@'
!%sien -en#%n LLK -%p%+ menun(ukk%n "e,"%#%i komplik%si %ki"%+ p,o#,esi2i+%s !%sien -en#%n LLK -%p%+ menun(ukk%n "e,"%#%i komplik%si %ki"%+ p,o#,esi2i+%s pen*%ki+n*%'
pen*%ki+n*%' a
a IInn++##$$'',,
In3eksi me,up%k%n komplik%si -%n pen*e"%" u+%m% kem%+i%n'
In3eksi me,up%k%n komplik%si -%n pen*e"%" u+%m% kem%+i%n' S. pneumoniaeS. pneumoniae&& S.
S. auraureuseus& -& -%%nn . . influen!ainfluen!a me,up%me,up%k%n o,#%nism *%n# se,in# -i(ump%i p%-%k%n o,#%nism *%n# se,in# -i(ump%i p%-% p%sien LLK *%n# +i-%k -i"e,ik%n +e,%pi imuno
p%sien LLK *%n# +i-%k -i"e,ik%n +e,%pi imunosup,esi'sup,esi' .
. H,H,--%a%ama%ma%l-l-.&.&l,nl,n#m#m,a,a H%l
H%l ini -i(umini -i(ump%i p%i le"le"ih ih -%,-%,i i 55 p%sien %khi, 55 p%sien %khi, penpen*%k*%ki+ i+ iniini' ' SemSemu% u% kelkel%s%s immuno#lo"ulin >I#?& I#A& -%n I#M@ "i%s%n*%
immuno#lo"ulin >I#?& I#A& -%n I#M@ "i%s%n*% menu,un& meskipun (u#% -i(ump%imenu,un& meskipun (u#% -i(ump%i h%n*% s%+u %+%u -u%
h%n*% s%+u %+%u -u% immuno#lo"ulin s%(% *%n# +u,un'immuno#lo"ulin s%(% *%n# +u,un' 3
3 T"T"an'+an'+-"ma-"ma', M#n*', M#n*a, K#%aa, K#%ana'ana'an L,m+-,n L,m+-, an% A an% A%"#%"#',+ ',+ T,%ns3o,m%si ini +e,(%-i seki+%,
T,%ns3o,m%si ini +e,(%-i seki+%, 16 1;' Y%16 1;' Y%n# p%lin# se,in# %-%l%h sn# p%lin# se,in# %-%l%h sin-,om%in-,om% Ri+
Ri+hehe, , >;>;@ @ -%n -%n leuleukemkemi% i% p,op,olimlim3os3osi+iki+ik' ' !%s!%sien ien -en-en#%n #%n sinsin-,o-,om% m% Ri+Ri+hehe, , >lim3om
>lim3om% % sel sel "es%,@ se,in# "es%,@ se,in# -i-%p-i-%p%+k%n lim3%-eno%+k%n lim3%-enop%+i p%+i -%n -%n hep%+hep%+osplenosplenome#%lome#%lii *%n# p,o#,esi3& -em%m& n*e,i %"-omen& penu,un%n "e,%+ "%-%n& %nemi%& -%n *%n# p,o#,esi3& -em%m& n*e,i %"-omen& penu,un%n "e,%+ "%-%n& %nemi%& -%n +,om"osi+openi% p,o#,esi3'
+,om"osi+openi% p,o#,esi3'
K-mlK-ml,$a',$a', A, A$,.a! $,.a! P#nP#na$,! a$,! A&A&!-,m&!-,m&nn
Komplik%si +e,(%-i (ik% +e,-%p%+ +es %n+i #lo"ulin
Komplik%si +e,(%-i (ik% +e,-%p%+ +es %n+i #lo"ulin "irect "irect *%n# posi+i3 >Coom"s *%n# posi+i3 >Coom"s Test
Test @& %nemi% hemoli+ik& +,om"osi+openi%& neu+,openi%& -%n %pl%si% sel -%,%h me,%h mu,ni@& %nemi% hemoli+ik& +,om"osi+openi%& neu+,openi%& -%n %pl%si% sel -%,%h me,%h mu,ni >Su-o*o -kk& 466<@'
>Su-o*o -kk& 466<@' 22
22 E!,E!,-l--l-%,%, Se"%#
Se"%#i%n i%n "es%, pen-e,i+% leukemi% "es%, pen-e,i+% leukemi% memilikmemiliki i 3%k+o,3%k+o,=3%k+o=3%k+o, , pen*epen*e"%" "%" *%n# +i-%k *%n# +i-%k -%p%+-%p%+ -ii-en
-ii-en+i3ik%si+i3ik%si& & +e+%pi %-% +e+%pi %-% "e"e,%p"e"e,%p% % 3%k+o, *%n# 3%k+o, *%n# +e,"u+e,"uk+i k+i -%p%+ men*e"%"-%p%+ men*e"%"k%n leukemi% k%n leukemi% sesu%isesu%i -en#%n kl%si3ik%sin*%'
-en#%n kl%si3ik%sin*%' A
A L#&$L#&$#m,a #m,a M,#l-M,#l-.la'!.la'!,$ ,$ A$&A$&!/!/ Acute Myeloid L Acute Myeloid Leukemia ( eukemia ( LMALMA /AML) /AML)
E+iolo#i -%,i LMA se"%#i%n "es%, +i-%k -ike+%hui' Meskipun -emiki%n %-% "e"e,%p% E+iolo#i -%,i LMA se"%#i%n "es%, +i-%k -ike+%hui' Meskipun -emiki%n %-% "e"e,%p% 3%k+o, *%n#
3%k+o, *%n# -ike+%-ike+%hui hui -%p%+ men*e"%"-%p%+ men*e"%"k%n %+%u k%n %+%u se+i-%kse+i-%kn*% men(%-i n*% men(%-i 3%k+o, p,e-ispo3%k+o, p,e-isposisisisi LMA p%-% popul%si +e,+en+u' 7enene su%+u sen*%/% kimi% *%n# "%n*%k -i#un%k%n p%-% LMA p%-% popul%si +e,+en+u' 7enene su%+u sen*%/% kimi% *%n# "%n*%k -i#un%k%n p%-%
< <
in-u
in-us+,i s+,i pen*pen*%m%k%n kuli+ %m%k%n kuli+ -i -i ne#%,% *%n# ne#%,% *%n# se-%n# "e,kem"se-%n# "e,kem"%n#& -ike+%hui me,up%k%%n#& -ike+%hui me,up%k%n n %+%+ leuko
leukomo#enmo#enik ik un+uun+uk k LMA' Sel%in LMA' Sel%in i+u ,%-i%si i+u ,%-i%si ionik (u#% -ike+%hui -%p%+ ionik (u#% -ike+%hui -%p%+ men*men*e"%"k%e"%"k%nn LMA' Ini -ike+%hui -%,i peneli+i%n +in##in*% insi-iensi k%sus leukemi%& +e,m%suk LMA& LMA' Ini -ike+%hui -%,i peneli+i%n +in##in*% insi-iensi k%sus leukemi%& +e,m%suk LMA& p%-% o,%n#
p%-% o,%n# o,%n# *%n# o,%n# *%n# sel%m%+ sel%m%+ -%,i -%,i se,%n#%n "om se,%n#%n "om %+om -i %+om -i Hi,oshim% -%n Hi,oshim% -%n N%#%s%ki N%#%s%ki p%-%p%-% +%hun 1<:;' E3ek -%,i leukomo#enik -%,i p%p%,%n ion ,%-i%si +e,se"u+ mul%i +%mp%k se(%k +%hun 1<:;' E3ek -%,i leukomo#enik -%,i p%p%,%n ion ,%-i%si +e,se"u+ mul%i +%mp%k se(%k 1&; +%hun sesu-%h pen#e"om%n -%n men%p%i pun%kn*% 5 s
1&; +%hun sesu-%h pen#e"om%n -%n men%p%i pun%kn*% 5 s %mp%i 9 +%hun'%mp%i 9 +%hun' B
B L#&L#&$#$#m,a L,m+m,a L,m+-.-.la'la'!,$ A!,$ A$&!$&!// Acute Ly Acute Lymphoblastic Leukemphoblastic Leukemia ( mia ( LLALLA /ALL) /ALL)
!en*e"%" LLA p%-% -e/%s% se"%#i%n "es%, +i-%k -ike+%hui' F%k+o, ke+u,un%n -%n !en*e"%" LLA p%-% -e/%s% se"%#i%n "es%, +i-%k -ike+%hui' F%k+o, ke+u,un%n -%n sin-,om% p,e-isposisi #ene+ik le"ih "e,hu"un#%n -en#%n LLA *%n# +e,(%-i p%-% %n%k= sin-,om% p,e-isposisi #ene+ik le"ih "e,hu"un#%n -en#%n LLA *%n# +e,(%-i p%-% %n%k= %n%k' 7e"e,%p% 3%k+o, lin#kun#%n -%n kon-isi klinis *%n# "e,hu"un#%n -en#%n LLA& %n%k' 7e"e,%p% 3%k+o, lin#kun#%n -%n kon-isi klinis *%n# "e,hu"un#%n -en#%n LLA& *%i+u$
*%i+u$ 1'
1' R%-i%R%-i%si ioniksi ionik' O,%n#' O,%n#=o,%n# *=o,%n# *%n# sel%m%n# sel%m%+ -%,i le-%+ -%,i le-%k%n "o%k%n "om %+om -i Hm %+om -i Hi,oshii,oshim% -%nm% -%n N%#%s%ki mempun*%i ,isiko ,el%+i3 keselu,uh%n un+uk "e,kem"%n# m
N%#%s%ki mempun*%i ,isiko ,el%+i3 keselu,uh%n un+uk "e,kem"%n# men(%-i LLAen(%-i LLA 4'
4' !%!%p%p%,%n ,%n -e-en#n#%n %n "e"ennenene e k%k%-%-%, , +i+in#n##i #i -%-%p%p%+ + memen*n*e"e"%"%"k%k%n n keke,u,us%ks%k%n %n susumsmsumum +ul%n#& ke,us%k%n k,omosom
+ul%n#& ke,us%k%n k,omosom '
' Me,okMe,okok se-iok se-iki+ menki+ menin#k%in#k%+k%n ,is+k%n ,isiko LLiko LLA pA p%-% usi% -%-% usi% -i%+%s 56 +i%+%s 56 +%hun'%hun'
4
4 L#&$L#&$#m,a #m,a M#lM#l-, K-, K"-n"-n,$ (L,$ (LMK)MK)
!en*e"%" p%s+i LMK "elum -ike+%hui se%,% p%s+i' Te+%pi LMK menin#k%+ se+el%h !en*e"%" p%s+i LMK "elum -ike+%hui se%,% p%s+i' Te+%pi LMK menin#k%+ se+el%h pe,is+i/%
pe,is+i/% "om %+om "om %+om -i N%-i N%#%s%ki -%n #%s%ki -%n Hi,oshim%& -%n Hi,oshim%& -%n (u#% -i (u#% -i Rusi% Rusi% se+el%h se+el%h ,e%k+o, ,e%k+o, %+om%+om Che,no"il mele-%k' Den#%n k%+% l%in& ,%-i%si ionik men*e"%"k%n +e,(%-in*% LMK'
Che,no"il mele-%k' Den#%n k%+% l%in& ,%-i%si ionik men*e"%"k%n +e,(%-in*% LMK' D
D L#&$L#&$#m,a #m,a L,m+-L,m+-',!,$ ',!,$ K"-K"-n,$ (n,$ (LLK)LLK) !e
!en*n*e"e"%" %" LLLLK K m%m%sih sih "e"elum lum -i-ikeke+%+%huhui' i' KemKemunun#k#kinin%n %n *%*%n# n# "e"e,p,pe,e,%n %n %-%-%l%%l%hh %"no,m%li+%s k,omosom& onko#en& -%n ,e+,o2i,us >
%"no,m%li+%s k,omosom& onko#en& -%n ,e+,o2i,us >RNA +umRNA +umou, 2i,us@'ou, 2i,us@' 2
2 Man,Man,+#'!+#'!a', Kl,n,a', Kl,n,$ $ A.
A. L#&$#m,a M,#l-.la'!,$ A$&!/L#&$#m,a M,#l-.la'!,$ A$&!/ Acute Mye Acute Myeloid Leukemia ( loid Leukemia ( LMALMA /AML) /AML) LMA "e,"
LMA "e,"e-% e-% -en-en#%n #%n %n#%n##%p#%p%n %n umuumum m sel%sel%m% m% ini ini -im-im%n% %n% p%-p%-% % p%sip%sien en LMA +i-%k LMA +i-%k sel%lu -i(ump%i leukosi+osis' Leukosi+osis +e,(%-i p%-% seki+%, ;6 k%sus LMA& se-%n# sel%lu -i(ump%i leukosi+osis' Leukosi+osis +e,(%-i p%-% seki+%, ;6 k%sus LMA& se-%n# 1; p%sien mempun*%i %n#k% leukosi+ *%n# no,m%l& -%n seki+%, ; p%sien men#%l%mi 1; p%sien mempun*%i %n#k% leukosi+ *%n# no,m%l& -%n seki+%, ; p%sien men#%l%mi ne+,openi%'
ne+,openi%'
T%n-% -%n #e(%l% u+%m% LMA %-%l%h %-%n*% ,%s% lel%h& pe,-%,%h%n& -%n in3eksi *%n# T%n-% -%n #e(%l% u+%m% LMA %-%l%h %-%n*% ,%s% lel%h& pe,-%,%h%n& -%n in3eksi *%n# -ise"
-ise"%"k%n oleh %"k%n oleh sin-,osin-,om m ke#%#%ke#%#%l%n l%n sumsum +ul%n# se"%#%im%nsumsum +ul%n# se"%#%im%n% % -ise"u-ise"u+k%n -i +k%n -i %+%s'%+%s' !e,-%,%h%n "i%s%n*% +e,(%-i -%l%m "en+uk pu,pu,% %+%u pe+eki% *%n# se,in# -i (ump%i !e,-%,%h%n "i%s%n*% +e,(%-i -%l%m "en+uk pu,pu,% %+%u pe+eki% *%n# se,in# -i (ump%i
p%-% eks+,emi+%s "%/%h %+%
p%-% eks+,emi+%s "%/%h %+%u "e,up% epis+%ksis& pe,-%,%h%n u "e,up% epis+%ksis& pe,-%,%h%n #usi& -%n ,e+in%' #usi& -%n ,e+in%' In3eksi se,in#In3eksi se,in# +e,(%-i -i
+e,(%-i -i +en##+en##o,ok%o,ok%n& n& p%,u=pp%,u=p%,u& kuli+& %,u& kuli+& -%n -%e,%h -%n -%e,%h pe,i ,ek+%& pe,i ,ek+%& sehin#sehin##% #% o,#%o,#%n=o,#n=o,#%n%n +e,se"
+e,se"u+ h%,us -ipe,iu+ h%,us -ipe,iks% ks% se%,% +eli+i p%-% p%sise%,% +eli+i p%-% p%sien LMA -en LMA -en#%n -emen#%n -em%m >Su-o*o -kk%m >Su-o*o -kk&& 466<@' H%l ini -%p%+ -ise"%"k%n -i3e,ensi%si sel ke "%#i%n m*eloi- khususn*% monosi+' 466<@' H%l ini -%p%+ -ise"%"k%n -i3e,ensi%si sel ke "%#i%n m*eloi- khususn*% monosi+' Monosi+ "e,pe,%n -%l%m sis+em ,e+ikuloen-o+eli%l >RES@ *%n# melipu+i m%k,o3%# %l2eol%, Monosi+ "e,pe,%n -%l%m sis+em ,e+ikuloen-o+eli%l >RES@ *%n# melipu+i m%k,o3%# %l2eol%, -%l%m p%,u& kuli+& -%n m%k,o3%#
-%l%m p%,u& kuli+& -%n m%k,o3%# p%-% usus >Meh+% G p%-% usus >Meh+% G Ho33",%n-& 4668@'Ho33",%n-& 4668@'
!%sien -en#%n %n#k% leukosi+ *%n# sen#%+ +in##i >le"ih -%,i 166 ,i"uBmm
!%sien -en#%n %n#k% leukosi+ *%n# sen#%+ +in##i >le"ih -%,i 166 ,i"uBmm@& se,in#@& se,in# +e,(%-i leukos+%sis& *%i+u +e,(%-in*% #ump%l%n leukosi+ *%n# men*um"%+ %li,%n pem"uluh +e,(%-i leukos+%sis& *%i+u +e,(%-in*% #ump%l%n leukosi+ *%n# men*um"%+ %li,%n pem"uluh -%,
-%,%h %h 2en2en% % m%um%upun pun %,+%,+e,i' e,i' ?e(?e(%l% %l% leuleukoskos+%si+%sis s s%ns%n#%+ #%+ "e,"e,2%,2%,i%sii%si& & +e,+e,#%n#%n+un+un# # loklok%si%si sum"%+%nn*%' ?e(%l% *%n# se,in# -i(ump%i %-%l%h #%n##u%n kes%-%,%n& ses%k n%3%s& n*e,i sum"%+%nn*%' ?e(%l% *%n# se,in# -i(ump%i %-%l%h #%n##u%n kes%-%,%n& ses%k n%3%s& n*e,i
-%--%-%& %& -%n -%n p,ip,i%pi%pismusmus' s' AnAn#k% #k% leuleukoskosi+ i+ *%n*%n# # s%ns%n#%+ #%+ +in+in##i ##i (u#(u#% % se,inse,in# # menmenim"im"ulkulk%n%n #%n##u%n me+%"olisme "e,up% hipe,u,isemi%' Hipe,u,isemi% +e,(%-i %ki"%+ sel=sel leukosi+ #%n##u%n me+%"olisme "e,up% hipe,u,isemi%' Hipe,u,isemi% +e,(%-i %ki"%+ sel=sel leukosi+ *%n# "
*%n# "e,p,oli3e,%si e,p,oli3e,%si se%,% ep%+ -%l%m se%,% ep%+ -%l%m (uml%h *%n# (uml%h *%n# "es%,'"es%,' In3il+,
In3il+,%si %si sel=sel "l%s+ sel=sel "l%s+ %k%n men*e"%"k%k%n men*e"%"k%n %n +%n-%B+%n-%B#e(%l% *%n# #e(%l% *%n# "e,2%"e,2%,i%si +e,#%n+un,i%si +e,#%n+un## o,#
o,#%n *%n# %n *%n# -i in3il+,%si' In3il+,%si sel=sel "l%s+ -i in3il+,%si' In3il+,%si sel=sel "l%s+ -i kuli+ -i kuli+ %k%n men*e"%"%k%n men*e"%"k%n leukemi% ku+isk%n leukemi% ku+is *%i+u "e,up% "en(ol%n *%n# +i-%k "e,pi#men -%n +%np% ,%s% s%ki+& se-%n# in3il+,%si -i sel= *%i+u "e,up% "en(ol%n *%n# +i-%k "e,pi#men -%n +%np% ,%s% s%ki+& se-%n# in3il+,%si -i sel= sel "l%s+
sel "l%s+ -i (%,in#%n lun%k %k%n men*e"%"k-i (%,in#%n lun%k %k%n men*e"%"k%n %n no-uno-ul l -i "%/%h kuli+ -i "%/%h kuli+ >klo,o>klo,om%@' m%@' In3il+In3il+,%si,%si sel=sel "l%s+ -i -%l%m +ul%n# %k%n men*e"%"k%n n*e,i +ul%n# *%n# spon+%n %+%u -en#%n sel=sel "l%s+ -i -%l%m +ul%n# %k%n men*e"%"k%n n*e,i +ul%n# *%n# spon+%n %+%u -en#%n s+imul%si ,in#%n' !em"en#k%k%n #usi se,in# -i(ump%i se"%#%i m%ni3es+%si in3il+,%si sel=sel s+imul%si ,in#%n' !em"en#k%k%n #usi se,in# -i(ump%i se"%#%i m%ni3es+%si in3il+,%si sel=sel "l%s+ ke -%l%m #usi'
"l%s+ ke -%l%m #usi'
B
B L#&L#&$#$#m,a L,m+m,a L,m+-.l-.la'!a'!,$ A,$ A$&!$&!// Acute Ly Acute Lymphoblastic Leukemphoblastic Leukemia ( mia ( LLALLA /ALL) /ALL)
!,esen+%si klinis LLA s%n#%+ "e,2%,i%si' !%-% umumn*% #e(%l% klinis men##%m"%,k%n !,esen+%si klinis LLA s%n#%+ "e,2%,i%si' !%-% umumn*% #e(%l% klinis men##%m"%,k%n ke#%#%l%n sumsum +ul%n# %+%u ke+e,li"%+%n eks+,%me-ul%, oleh sel leukemi%' Akumul%si ke#%#%l%n sumsum +ul%n# %+%u ke+e,li"%+%n eks+,%me-ul%, oleh sel leukemi%' Akumul%si sel=sel lim3o"l%s #%n%s -i sumsum +ul%n# men*e"%"k%n ku,%n#n*% sel=sel no,m%l -i sel=sel lim3o"l%s #%n%s -i sumsum +ul%n# men*e"%"k%n ku,%n#n*% sel=sel no,m%l -i -%,%h pe,i3e, -%n #e(%l% klinis -%p%+ "e,hu"un#%n -en#%n %nemi%& in3eksi& -%n pe,-%,%h%n -%,%h pe,i3e, -%n #e(%l% klinis -%p%+ "e,hu"un#%n -en#%n %nemi%& in3eksi& -%n pe,-%,%h%n >Su
>Su-o*-o*o o -kk-kk& & 466466<@' <@' AnAnemiemi% % p%-p%-% % p%sp%sien ien LLA men*eLLA men*e"%""%"k%n k%n kelkelem%em%h%nh%n& & -*s-*spnepne%&%& "%hk%n
"%hk%n #%#%l #%#%l (%n+un# (%n+un# kon#es+i3' kon#es+i3' Se-%n#k%n Se-%n#k%n pe,-%,%h%n pe,-%,%h%n *%n# *%n# +e,(%-i +e,(%-i me,up%k%n me,up%k%n %ki"%+%ki"%+ -%,i +,om"osi+openi% >7u,ke& 4614@' Dem%m %+%u in3eksi *%n# (el%s -%p%+ -i+emuk%n p%-% -%,i +,om"osi+openi% >7u,ke& 4614@' Dem%m %+%u in3eksi *%n# (el%s -%p%+ -i+emuk%n p%-% sep%
sep%,uh ,uh p%sip%sien en LLALLA& & se-%se-%n#kn#k%n %n #e(#e(%l% %l% pe,pe,-%,-%,%h%n %h%n p%-p%-% % sepsepe,+e,+i#% i#% p%sp%sien ien *%n*%n# # "%,"%,uu -i-i%#nosis LLA' !e,-%,%h%n *%n# "e,%+ (%,%n# +e,(%-i'
-i-i%#nosis LLA' !e,-%,%h%n *%n# "e,%+ (%,%n# +e,(%-i'
4
4 L#&$L#&$#m,a #m,a M#M#l-, l-, K"-K"-n,$ n,$ (LMK(LMK))
11 11
LMK -i"%#i men(%-i 3%se "e,-%s%,k%n pe,(%l%n%n pen*%ki+n*%& *%kni 3%se k,onik& LMK -i"%#i men(%-i 3%se "e,-%s%,k%n pe,(%l%n%n pen*%ki+n*%& *%kni 3%se k,onik& 3%se %ksele,%si& -%n
3%se %ksele,%si& -%n 3%se k,isis 3%se k,isis "l%s+' !%-% "l%s+' !%-% umumumumn*% s%%+ n*% s%%+ pe,+%mpe,+%m% % -i%#n-i%#nosis -i+e#%kk%osis -i+e#%kk%n&n& p%sien
p%sien m%sih m%sih -%l%m -%l%m 3%se 3%se k,onis& k,onis& "%hk%n "%hk%n se,in# se,in# k%li k%li -i%#nosis -i%#nosis LMK LMK -i+emuk%n -i+emuk%n se%,%se%,% ke"e+ul%n& mis%ln*% p%-% pe,si%p%n p,% ope,%si& -im%n% -i+emuk%n leukosi+osis he"%+ ke"e+ul%n& mis%ln*% p%-% pe,si%p%n p,% ope,%si& -im%n% -i+emuk%n leukosi+osis he"%+ +%n
+%np% p% #e(#e(%l% %l% #e(#e(%l% %l% in3in3ekseksi' i' !%-!%-% % 3%s3%se e k,ok,onisnis& & p%sp%sien ien se,ise,in# n# menmen#el#eluh uh me,me,%s% %s% epep%+%+ ken*%n#' H%l ini -ise"%"k%n k%,en% pem"es%,%n limp% -im%n% limp% men-es%k l%m"un#' ken*%n#' H%l ini -ise"%"k%n k%,en% pem"es%,%n limp% -im%n% limp% men-es%k l%m"un#' Keluh%n l%in se,in# +i-%k spesi3ik& mis%ln*%$ ,%s% ep%+ lel%h& lem%h& -em%m *%n# +i-%k Keluh%n l%in se,in# +i-%k spesi3ik& mis%ln*%$ ,%s% ep%+ lel%h& lem%h& -em%m *%n# +i-%k +e,l%lu +in##i& ke,in#%+ m%l%m'
+e,l%lu +in##i& ke,in#%+ m%l%m'
!enu,un%n "e,%+ "%-%n +e,(%-i se+el%h pen*%ki+ "e,l%n#sun# l%m%' Semu% keluh%n !enu,un%n "e,%+ "%-%n +e,(%-i se+el%h pen*%ki+ "e,l%n#sun# l%m%' Semu% keluh%n +e,
+e,se"se"u+ u+ me,me,up%up%k%n k%n #%m#%m"%,"%,%n %n hiphipe,me,me+%"e+%"oliolisme sme %ki%ki"%+ "%+ p,op,oli3li3e,%se,%si i sel=sel=sel sel leuleukemkemi%'i%' Se+el%h 4= +%hun& "e"e,%p% p%sien pen*%ki+n*% men(%-i le"ih p,o#,esi3 %+%u men#%l%mi Se+el%h 4= +%hun& "e"e,%p% p%sien pen*%ki+n*% men(%-i le"ih p,o#,esi3 %+%u men#%l%mi %k
%kselsele,%e,%sisi' ' 7i7il% l% s%%s%%+ + -i-i%#%#nonos% s% -i-i+e+e#%#%kkkk%n%n& & p%p%siesien n "e"e,%,%-% -% p%p%-% -% 3%3%se se k,k,ononis& is& m%m%k%k% kel%n
kel%n#sun##sun#%n hi-up "e,kis%, %n+%,% 1 %n hi-up "e,kis%, %n+%,% 1 s%mp%i 1&; +%hun' Ci,i s%mp%i 1&; +%hun' Ci,i kh%s 3%se kh%s 3%se %ksele,%%ksele,%si %-%l%hsi %-%l%h leu
leukoskosi+oi+osis sis *%n*%n# # sulsuli+ i+ -ik-ikonon+,ol +,ol oleoleh h o"%o"%+=o+=o"%+ "%+ miemieloslosup,up,esi3esi3& & miemielo"lo"l%s l%s -i -i pe,pe,i3e, i3e, men%p%i 1;=6& p,omielosi+ le"ih -%,i 6& -%n +,om"osi+ ku,%n# -%,i 166'666Bmm men%p%i 1;=6& p,omielosi+ le"ih -%,i 6& -%n +,om"osi+ ku,%n# -%,i 166'666Bmm'' Se%,% klinis& 3%se ini -%p%+ -i-u#% "il% limp% *%n# +%-in*% su-%h men#eil -en#%n +e,%pi& Se%,% klinis& 3%se ini -%p%+ -i-u#% "il% limp% *%n# +%-in*% su-%h men#eil -en#%n +e,%pi& kem
kem"%l"%li i memmem"es%"es%,& ,& kelkeluhuh%n %n %nem%nemi% i% "e,"e,+%m+%m"%h "%h "e,"e,%+& %+& +im+im"ul "ul pe+pe+ekiekie& e& ekimekimosiosis' s' 7il7il%% -ise,+
-ise,+%i %i -em%m& "i%s%n*-em%m& "i%s%n*% % +e,-%p+e,-%p%+ %+ in3eksin3eksi' i' !%-% seki+%, 1B !%-% seki+%, 1B pen-epen-e,i+%& pe,u"%h%n +e,(%-i,i+%& pe,u"%h%n +e,(%-i se%,% men-%-%k +%np% -i-%hului m%s% p,o-,om%l& ke%-%%n ini -ise"u+ k,isis "l%s+'
se%,% men-%-%k +%np% -i-%hului m%s% p,o-,om%l& ke%-%%n ini -ise"u+ k,isis "l%s+' D
D L#&$L#&$#m,a #m,a L,m+-L,m+-, K, K"-n"-n,$ (,$ (LLK)LLK) A/%l
A/%l -i%#n-i%#nosis& ke"%n*%k%osis& ke"%n*%k%n n p%sien LLK p%sien LLK +i-%k menun(ukk+i-%k menun(ukk%n %n #e(%l% >%simp+om%+#e(%l% >%simp+om%+ik@'ik@'
!%-!%-% % p%sp%sien ien -en-en#%n #%n #e(#e(%l%& %l%& p%lp%lin# in# se,ise,in# n# -i+-i+emuemuk%n k%n limlim3%-3%-enoenop%+ip%+i& & penpenu,uu,un%n n%n "e,"e,%+%+ "%-%n&
"%-%n& -%n -%n kelel%h%n' kelel%h%n' ?e(%l% ?e(%l% l%in l%in melipu+i melipu+i hil%n#n*% hil%n#n*% n%3su n%3su m%k%n m%k%n -%n -%n penu,un%npenu,un%n kem%mpu%n l%+ih%nBol%h,%#%' Dem%m& ke,in#%+ m%l%m& -%n in3eksi (%,%n# +e,(%-i p%-% kem%mpu%n l%+ih%nBol%h,%#%' Dem%m& ke,in#%+ m%l%m& -%n in3eksi (%,%n# +e,(%-i p%-% %/%l
%/%ln*%n*%& & +e++e+%pi %pi semsem%ki%kin n menmen*o*olok se(%l%lok se(%l%n n -en-en#%n pe,(%l#%n pe,(%l%n%%n%n n pen*pen*%ki%ki+n*+n*%' %' AkAki"%+i"%+ penumpuk%n
penumpuk%n sel sel 7 7 neopl%s+ik& neopl%s+ik& p%sien p%sien *%n# *%n# %simp+om%+ik %simp+om%+ik p%-% p%-% s%%+ s%%+ -i%#nosis -i%#nosis p%-%p%-% %khi,n*% men#%l%mi lim3%-enop%+i& splenome#%li& -%n hep%+ome#%li'
%khi,n*% men#%l%mi lim3%-enop%+i& splenome#%li& -%n hep%+ome#%li'
25
25 E6al&E6al&a', D,a%a', D,a%n-'!n-'!,$ ,$ !eme,i
!eme,iks%%n -i%#nos+iks%%n -i%#nos+ik k *%n# -il%kuk*%n# -il%kuk%n %n p%-% klien p%-% klien -en#%-en#%n n leukemleukemi% i% %-%l%h se"%#%i%-%l%h se"%#%i "e,iku+$
1'
1' D%,%h len#k%p$ D%,%h len#k%p$ menun(ukk%n menun(ukk%n %-%n*% penu,un%-%n*% penu,un%n hemo#lo"%n hemo#lo"in& hem%+ok,i+& in& hem%+ok,i+& (uml%h sel(uml%h sel -%,%h me,%h& -%n +,om"osi+' Juml%h sel -%,%h pu+ih menin#k%+ p%-% leukemi% k,onik& -%,%h me,%h& -%n +,om"osi+' Juml%h sel -%,%h pu+ih menin#k%+ p%-% leukemi% k,onik& +e+%pi (u#% -%p%+ +u,un& no,m%l& %+%u +in##i p%-% leukemi% %ku+
+e+%pi (u#% -%p%+ +u,un& no,m%l& %+%u +in##i p%-% leukemi% %ku+ 4'
4' Aspi,%si sumsum +ul%n# -%n Aspi,%si sumsum +ul%n# -%n "iopsi mem"e,ik%n -%+% -i%#n"iopsi mem"e,ik%n -%+% -i%#nos+ik -e3ini+i3os+ik -e3ini+i3 '
' As%m u,%+ se,um menin#k%+ As%m u,%+ se,um menin#k%+ k%,en% pelep%s%n oksipu,in se+el%h kelu%, mk%,en% pelep%s%n oksipu,in se+el%h kelu%, m%sukn*% sel=%sukn*% sel= sel leukemi% ep%+
sel leukemi% ep%+ -%n pen##-%n pen##un%%%n o"%+ un%%%n o"%+ si+o+oksi+si+o+oksi+ :'
:' Sin%, -%Sin%, -%-%$ un+u-%$ un+uk men#e+k men#e+%hui lu%%hui lu%sn*% pen*sn*% pen*%ki+%ki+ ;'
;' !,o3il kimi%& EK?& -%n kul+u, spesimen un+uk !,o3il kimi%& EK?& -%n kul+u, spesimen un+uk men*in#ki,k%n m%s%l%h %+%u pen*%ki+men*in#ki,k%n m%s%l%h %+%u pen*%ki+ l%in *%n# +im"ul'
l%in *%n# +im"ul'
1 1
27
27Web Of CautionWeb Of Caution (WOC)(WOC)
Kel%in%n k,omosom& ,%-i%si ionik& Kel%in%n k,omosom& ,%-i%si ionik& +e,p%(%n "%h%n="%h%n kimi%& pen##un%%n +e,p%(%n "%h%n="%h%n kimi%& pen##un%%n
o"%+=o"%+ imunosup,esi3 o"%+=o"%+ imunosup,esi3
!,oli3e,%si sel k%nke, !,oli3e,%si sel k%nke,
Sel k%nke, "e,s%in# -en#%n sel no,m%l Sel k%nke, "e,s%in# -en#%n sel no,m%l
un+uk men-%p%+k%n nu+,isi un+uk men-%p%+k%n nu+,isi
Sel no,m%l -i#%n+i -en#%n sel k%nke, Sel no,m%l -i#%n+i -en#%n sel k%nke,
In3il+,%si In3il+,%si Akumul%si sel -%,%h Akumul%si sel -%,%h pu+ih -i sumsum pu+ih -i sumsum +ul%n# +ul%n# In3il+,%si In3il+,%si Eks+,%me-ul%, Eks+,%me-ul%, !em"es%,%n limp% !em"es%,%n limp% >splenome#%li@ -%n >splenome#%li@ -%n pem"es%,%n h%+i pem"es%,%n h%+i >hep%+ome#%li@ >hep%+ome#%li@ T,om"osi+ T,om"osi+ menu,un menu,un E,i+,osi+ E,i+,osi+ menu,un menu,un M$8 M$8 Gan%%&an Gan%%&an "a'a "a'a naman naman n#", n#", Men-es%k l%m"un# Men-es%k l%m"un# M$8 In!-l#"an', M$8 In!-l#"an', a$!,6,!a' a$!,6,!a' T,om"osi+openi%& T,om"osi+openi%& p+ekie& epis+%ksis p+ekie& epis+%ksis Anemi% Anemi% Ano,eksi%& mu%l& Ano,eksi%& mu%l& -%n mun+%h -%n mun+%h Kelem%h%n Kelem%h%n Sel keku,%n#%n Sel keku,%n#%n oksi#en -%n nu+,isi
oksi#en -%n nu+,isi !e,-%,%h%n!e,-%,%h%n
M$8 M$8 A$!&al/R,'A$!&al/R,',$- ,$-!,n%%, #n&"&nan !,n%%, #n&"&nan 6-l&m# 3a,"an 6-l&m# 3a,"an 77 77 menu,un menu,un M$8 Gan%%&an M$8 Gan%%&an $#.&!&an n&!",', $#.&!&an n&!",', $&"an% a", $&"an% a", $#.&!&an !&.& $#.&!&an !&.&
29
29 P#na!ala$'anaP#na!ala$'anaan an M#,'M#,' 7e,i
7e,iku+ ku+ %-%l%-%l%h %h penpen%+%l%+%l%ks%ks%n%%%n%%n n se%se%,% ,% me-me-is is *%n*%n# # -%p-%p%+ %+ -i"-i"e,ike,ik%n %n kepkep%-% %-% p%sp%sienien leukemi% "e,-%s%,k%n kl%si3ik%si %+%u +ipe -%,i leukemi%'
leukemi% "e,-%s%,k%n kl%si3ik%si %+%u +ipe -%,i leukemi%' A
A L#&$L#&$#m,a #m,a M,#l-M,#l-.la'!.la'!,$ ,$ A$&A$&!/!/ Acute Myeloid L Acute Myeloid Leukemia (LMAeukemia (LMA/AML)/AML) Te
Te,%pi *%n# -%p%+ -i"e,ik%n kep%-% ,%pi *%n# -%p%+ -i"e,ik%n kep%-% p%sien LMA %-%l%h se"%#%i "e,iku+$p%sien LMA %-%l%h se"%#%i "e,iku+$ 1'
1' KeKemomo+e+e,%,%pi pi meme,u,up%p%k%k%n n "e"en+n+uk uk +e,+e,%p%pi i u+u+%m%m% % -%-%n n p%p%-% -% "e"e"e"e,%p,%p% % k%k%susus s -%-%p%p%++ men#h%silk%n pe,"%ik%n *%n# "e,l%n#sun# s%mp%i se+%hun %+%u le"ih' O"%+ *%n# men#h%silk%n pe,"%ik%n *%n# "e,l%n#sun# s%mp%i se+%hun %+%u le"ih' O"%+ *%n# "i%s%n*%
"i%s%n*% -i#un%k%n mel-i#un%k%n melipu+i ipu+i -%uno,u"iin& h-%uno,u"iin& h*-,ohlo,i-e >e,*-,ohlo,i-e >e,u"i-ine@& u"i-ine@& *+%,%"ine*+%,%"ine >C*+os%,=U@& -%n me,%p+opu,ine >pu,ine+hol@
>C*+os%,=U@& -%n me,%p+opu,ine >pu,ine+hol@ 4'
4' !em"e!em"e,i%n p,i%n p,o-u,o-uk -%,%k -%,%h -%n h -%n pen%npen%n#%n%n #%n%n in3ekin3eksi -ensi -en#%n se##%n se#e,%e,% '
' T,T,%nsp%nspl%nl%n+%si +%si sumsumsum sum +ul+ul%n#%n#''
Se"%ikn*% p%sien -i,u(uk ke spesi%lis pen*%ki+ -%l%m >su" 7%#i%n Hem%+olo#i@ un+uk Se"%ikn*% p%sien -i,u(uk ke spesi%lis pen*%ki+ -%l%m >su" 7%#i%n Hem%+olo#i@ un+uk pen%+%l%ks%n%%n le"ih l%n(u+ >Mu++%in -kk& 466<@'
pen%+%l%ks%n%%n le"ih l%n(u+ >Mu++%in -kk& 466<@'
B
B L#&L#&$#$#m,a L,m+m,a L,m+-.-.la'la'!,$ A!,$ A$&!$&!// Acute Ly Acute Lymphoblastic Leukemphoblastic Leukemia ( mia ( LLALLA /ALL) /ALL)
7en+uk +e,%pi u+%m% -%l%m pen%n#%n%n m%s%l%h LLA %-%l%h kemo+e,%pi' Kemo+e,%pi 7en+uk +e,%pi u+%m% -%l%m pen%n#%n%n m%s%l%h LLA %-%l%h kemo+e,%pi' Kemo+e,%pi un+uk LLA *%n# p%lin# men-%s%, +e,-i,i %+%s p%n-u%n o"%+'
un+uk LLA *%n# p%lin# men-%s%, +e,-i,i %+%s p%n-u%n o"%+' II'' IInn--uukkssi i ,,eemmiissii
Tu(u%n -%,i +e,%pi in-uksi ,emisi %-%l%h men%p%i ,emisi kompli+ hem%+olo#ik Tu(u%n -%,i +e,%pi in-uksi ,emisi %-%l%h men%p%i ,emisi kompli+ hem%+olo#ik sehin##% hem%+opoiesis -%p%+ kem"%li no,m%l'
sehin##% hem%+opoiesis -%p%+ kem"%li no,m%l' %'
%' O"%O"%+ *+ *%n# %n# -i#-i#un%un%k%n k%n +e,-+e,-i,i i,i %+%%+%s$s$ 1@
1@ iin,in,is+ins+ine >e >CR@ CR@ 1& 1&; m; m#Bm#Bm44Bmin##u se%,% IBmin##u se%,% I 4@
4@ !,!,e-e-ninisoson >!n >!,e,e-@ 5 m-@ 5 m#B#Bmm44Bh%,i se%,% o,%lBh%,i se%,% o,%l @
@ L'AL'Asp%sp%,%#,%#in%in%se >Lse >L'%sp'%sp@ 16@ 16'66'666 UBm6 UBm44 :@
:@ D%uD%uno,no,u"iu"iin in >DN>DNR@ R@ 4; 4; m#Bm#Bmm44Bmin##u=: min##u'Bmin##u=: min##u' "'
"' Re#imen *%n# -i#un%k%n un+uRe#imen *%n# -i#un%k%n un+uk LLA -en#%n ,isiko s+%n-%, +e,-i,i %+%s$k LLA -en#%n ,isiko s+%n-%, +e,-i,i %+%s$ 1@
1@ !,!,e-e-ninisoson n CCRR 4@
4@ !,e!,e-ni-nison son CR LCR L' A' Asp%sp%,%#,%#in%in%se'se' '
' Re#imeRe#imen un+uk n un+uk ALL ALL -en#%-en#%n ,isiko +inn ,isiko +in##i %+%u ##i %+%u ALL ALL p%-% o,%p%-% o,%n# -e/%sn# -e/%s% %n+%,%% %n+%,% l%in $
l%in $ 1@
1@ !,e-n!,e-nison ison CR DCR DNR -enNR -en#%n %+%#%n %+%u +%npu +%np% L'Asp% L'Asp%,%#in%,%#in%se%se 4@
4@ DNDNR R CR CR !,!,e-e-ninisoson n L'L'AsAsp%p%,%,%#i#in%n%se se -e-en#n#%n %n %+%+%u %u +%+%npnp%% siklo3os3%mi-'
siklo3os3%mi-' IIII'' TTee,,%%ppi pi pooss++==,,eemmiissii
%%'' TTee,,%%ppi i uunn++uukk sanctuar# sanctuar# p$asep$ase >mem"%smi sel leukemi% *%n# "e,sem"un*i>mem"%smi sel leukemi% *%n# "e,sem"un*i -%l%m SS! -%n +es+is@
-%l%m SS! -%n +es+is@ "'
"' TeTe,%pi ,%pi in+ensi3ik%siBkonsoli-%si$ in+ensi3ik%siBkonsoli-%si$ pem"e,i%n pem"e,i%n ,e#imen,e#imen non-non-crocross ss resiresistant stant +e,h%-%p ,e#imen in-uksi ,emisi *%n# "e,+u(u%n un+uk mene#%h ,el%ps -%n +e,h%-%p ,e#imen in-uksi ,emisi *%n# "e,+u(u%n un+uk mene#%h ,el%ps -%n (u#% +im"uln*% sel *%n# ,esis+en o"%+
(u#% +im"uln*% sel *%n# ,esis+en o"%+
1; 1;
'
' TTee,%,%pi ppi pememelelihih%,%,%%%%n >n >maintenance%maintenance%$ umumn*% -i#un%k%n 5 me,%p+opu,ine >5$ umumn*% -i#un%k%n 5 me,%p+opu,ine >5 M!@ pe, o,%l& -i"e,ik%n sel%m% 4= +%hun -en#%n -iselin#i +e,%pi konsoli-%si' M!@ pe, o,%l& -i"e,ik%n sel%m% 4= +%hun -en#%n -iselin#i +e,%pi konsoli-%si'
4
4 L#&$L#&$#m,a #m,a M#lM#l-, K-, K"-n"-n,$ (L,$ (LMK)MK) Me-ik%si %+%upun +e,%pi *%n#
Me-ik%si %+%upun +e,%pi *%n# -%p%+ -i"e,ik%n kep%-% p%sien -%p%+ -i"e,ik%n kep%-% p%sien -en#%n LMA *%i+u$-en#%n LMA *%i+u$ %'
%' 7usul7usulph%n >mph%n >m*le,%*le,%n@$ -osin@$ -osis 6&1=6s 6&1=6&4 m#B&4 m#Bk# 77k# 77Bh%,i& +e,%pBh%,i& +e,%pi -imuli -imul%i (ik% le%i (ik% leukosiukosi++ n%i
n%ik k menmen(%-(%-i i ;6';6'666666BmmBmm'' E3E3ek ek s%ms%mpipin# n# "e"e,u,up% p% %p%pl%l%si% si% susumsmsum um +u+ul%nl%n## "e,kep%n(%n#%n& 3i",osis p%,u& -%n "%h%*% +im"uln*
"e,kep%n(%n#%n& 3i",osis p%,u& -%n "%h%*% +im"uln*% leukemi% %ku+% leukemi% %ku+ "'
"' Hi-,oksiu,e%$ Hi-,oksiu,e%$ -osis -osis -i+i+,%si -i+i+,%si -%,i -%,i ;66=4'666 ;66=4'666 m#& m#& kemu-i%n kemu-i%n -i"e,ik%n -i"e,ik%n -osis-osis pemelih%,%%n
pemelih%,%%n un+uk un+uk men%p%i men%p%i leukosi+ leukosi+ 16'666=1;'666Bmm16'666=1;'666Bmm& e3ek s%mpin#n*%& e3ek s%mpin#n*% le"ih se-iki+
le"ih se-iki+ '
' InIn+e,+e,3e,3e,on on %l3%l3%$ %$ "i"i%s%%s%n*n*% % -i-i"e"e,i,ik%k%n n se+se+el%el%h h (u(umlml%h %h leleukukososi+ i+ +e+e,k,konon+,+,ol ol ololeheh hi-,oksiu,e%'
hi-,oksiu,e%' -'
-' TT,%,%npnpl%l%n+n+%s%si i susumsmsum um +u+ul%l%n#n#& & memem"m"e,e,ikik%n %n h%h%,%,%p%p%n n pepen*n*emem"u"uh%h%n n (%(%n#n#k%k% p%n(%n#&
p%n(%n#& +e,u+%m% +e,u+%m% un+uk un+uk pen-e,i+% pen-e,i+% *%n# *%n# "e,usi% "e,usi% ku,%n# ku,%n# -%,i -%,i :6 :6 +%hun'+%hun' !en%n#%n%n umum *%n# -i"e,ik%n %-%l%h
!en%n#%n%n umum *%n# -i"e,ik%n %-%l%h allogeneic perip$eral bloo" stem cell allogeneic perip$eral bloo" stem cell transplantation
transplantation'' e'
e' TeTe,%pi ,%pi -en#%-en#%n mn mem%k%i em%k%i p,insp,insip "ip "iolo#iolo#i mi molekulolekule, e,
O"%+ "%,u in%+ini" mesil%+e >#lee2e@ *%n# -%p%+ menek%n %k+i2i+%s +*,osine O"%+ "%,u in%+ini" mesil%+e >#lee2e@ *%n# -%p%+ menek%n %k+i2i+%s +*,osine kin%se& sehin##% menek%n p,oli3e,%si sel m*eloi-'
kin%se& sehin##% menek%n p,oli3e,%si sel m*eloi-'
D
D L#&$L#&$#m,a #m,a L,m+-L,m+-, , K"-K"-n,$ n,$ (LLK(LLK))
!en#o"%+%n se"%ikn*% +i-%k -i"e,ik%n p%-% klien +%np% #e(%l%& k%,en% h%l ini +i-%k !en#o"%+%n se"%ikn*% +i-%k -i"e,ik%n p%-% klien +%np% #e(%l%& k%,en% h%l ini +i-%k mem
mempe,pe,p%np%n(%n(%n# # hi-hi-up' up' H%l H%l *%n*%n# # pe,pe,lu lu -ih-ih%-%%-%pi pi %-%l%-%l%h %h kliklien en *%n*%n# # menmenun(un(ukkukk%n%n p,o#,esi2i+%s
p,o#,esi2i+%s lim3%-enop%+i lim3%-enop%+i %+%u %+%u splenome#%li& splenome#%li& %nemi%& %nemi%& +,om"osi+openi%& +,om"osi+openi%& %+%u %+%u #e(%l%#e(%l% %ki"%+ -es%k%n +umo,' O"%+=o"%+%n *%n# pe,lu -i"e,ik%n %-%l%h s
%ki"%+ -es%k%n +umo,' O"%+=o"%+%n *%n# pe,lu -i"e,ik%n %-%l%h s e"%#%i "e,iku+$e"%#%i "e,iku+$ %'
%' KloKlo,%m,%m"us"usil 6&il 6&1=61=6& m& m#Bk#Bk# 77B# 77Bh%,h%,i pe, oi pe, o,%l,%l "'
"' Ko,+ikos+e,oi- se"%ikn*% "%,u -i"e,ik%n "il% Ko,+ikos+e,oi- se"%ikn*% "%,u -i"e,ik%n "il% +e,-%p%+ AIHA +e,-%p%+ AIHA %+%u +,om"osi+openi%%+%u +,om"osi+openi% %+%u -em%m +%np% sein3eksi
%+%u -em%m +%np% sein3eksi '
' R%-R%-io+io+e,%pe,%pi i -en-en#%n men##%n men##un#un%k%%k%n n sinsin%, %, k%-k%-%n#=%n#=k%-k%-%n# men#%n# men#un+un+un#un#k%n "il%k%n "il% %-% keluh%n pen-es%k%n k%,en% pem"en#k%k%n kelen(%, #e+%h "enin# se+emp%+' %-% keluh%n pen-es%k%n k%,en% pem"en#k%k%n kelen(%, #e+%h "enin# se+emp%+'
2: P#na!ala$'anaan K##"a;a!an 2: P#na!ala$'anaan K##"a;a!an
Menu,u+ H%n-%*%ni G H%,i"o/o p%-% +%hun >466<@& l%n#k%h=l%n#k%h kepe,%/%+%n *%n# Menu,u+ H%n-%*%ni G H%,i"o/o p%-% +%hun >466<@& l%n#k%h=l%n#k%h kepe,%/%+%n *%n# -%p%+ -il%kuk%n +e,h%-%p klien -en#%n leukemi% %-%l%h se"%#%i "e,iku+$
-%p%+ -il%kuk%n +e,h%-%p klien -en#%n leukemi% %-%l%h se"%#%i "e,iku+$ A
A P#P#n%n%$a$a*,*,anan
1
1
I-en+i3ik%si "%+%s%n +%n-%=+%n-% -%n #e(%l%=#e(%l% *%n# -il%po,k%n oleh p%sienI-en+i3ik%si "%+%s%n +%n-%=+%n-% -%n #e(%l%=#e(%l% *%n# -il%po,k%n oleh p%sien -%l%m ,i/%*%+ kepe,%/%+%n -%n peme,iks%%n 3isik2
2
?%m"%,%n klinis %k%n "e,%#%m -en#%n +ipe leukemi% *%n# +e,(%-i *%i+u kelem%h%n?%m"%,%n klinis %k%n "e,%#%m -en#%n +ipe leukemi% *%n# +e,(%-i *%i+u kelem%h%n -%n-%n kele+ihkele+ih%n& %n& keenkeen-e,un#-e,un#%n %n pe,-%pe,-%,%h%n& pe+eki% ,%h%n& pe+eki% -%n ekimosis& n*e,i& -%n ekimosis& n*e,i& s%ki+s%ki+ kep%l%& mun+%h& -em%m& -%n in3eksi
kep%l%& mun+%h& -em%m& -%n in3eksi
!em!eme,ike,iks%%n s%%n -%,-%,%h %h munmun#ki#kin n menmenun(un(ukkukk%n %n pe,pe,u"%u"%h%n h%n sel=sel=sel sel -%,-%,%h %h pu+pu+ih ih -%n-%n +,om"osi+openi%'+,om"osi+openi%'
B
B D,aD,a%n-%n-'a 'a K#K##"#"a;aa;a!an!an 7e,
7e,-%s-%s%,k%,k%n %n -%+-%+% % -%s-%s%, %, penpen#k%#k%(i%n(i%n& & -i%-i%#no#nosis sis kepkepe,%/e,%/%+%n %+%n *%n*%n# # mumununul l %-%l%-%l%h%h se"%#%i "e,iku+$
se"%#%i "e,iku+$ 1'
1' N*e,i *N*e,i *%n# "e,hu"%n# "e,hu"un#%n un#%n -en#%n in-en#%n in3il+,%si leukosi+ 3il+,%si leukosi+ (%,in#%n sis+emik(%,in#%n sis+emik 4'
4' ?%n##u%n nu+,isi k?%n##u%n nu+,isi ku,%n# -%,i ke"u+uu,%n# -%,i ke"u+uh%n +u"uh *h%n +u"uh *%n# "e,hu"un#%n %n# "e,hu"un#%n -en#%n mu%l&-en#%n mu%l& mun+%h& %no,eksi%& -%n e3ek +oksik o"%+ kemo+e,%pi
mun+%h& %no,eksi%& -%n e3ek +oksik o"%+ kemo+e,%pi '
' In+ole,%nsi In+ole,%nsi %k+i2i+%s %k+i2i+%s "e,hu"un#%n "e,hu"un#%n -en#%n -en#%n %nemi%%nemi% :'
:' Risiko +in##i Risiko +in##i penu,un%n penu,un%n 2olume %i,%n 2olume %i,%n "e,hu"un#%n "e,hu"un#%n -en#%n p-en#%n pe,-%,%h%ne,-%,%h%n ;'
;' ?%?%n#n##u#u%n %n inin+e#+e#,i+,i+%s %s kukuli+li+$ $ %l%lopopesiesi% % *%*%n# n# "e"e,h,hu"u"unun#%#%n n -e-en#n#%n %n e3e3ek ek +o+oksksik ik kemo+e,%pi
kemo+e,%pi 5'
5' ?%n?%n##u##u%n %n #%m#%m"%,%"%,%n n -i,-i,i i "e,"e,hu"hu"un#un#%n %n -en-en#%n #%n pe,pe,u"%u"%h%n h%n penpen%mp%mpil%n il%n -%l-%l%m%m 3un#si -%n pe,%n
3un#si -%n pe,%n 9'
9' 7e,7e,-uk-uk% % *%n*%n# # "e,"e,hu"hu"un#un#%n %n -en-en#%n #%n kehkehil%nil%n#%n #%n kemkemun#un#kinkin%n %n +e,+e,(%-(%-i i k%,k%,en%en% pe,u"%h%n pe,%n -%n 3un#si -i,i'
pe,u"%h%n pe,%n -%n 3un#si -i,i'
4
4 In!#"6#n', K##"a;a!anIn!#"6#n', K##"a;a!an 7e
7e,i,ikuku+ + %-%-%l%%l%h h pepen(n(elel%s%%s%n n memen#n#enen%i %i inin+e+e,2,2enensi si -%-%,i ,i m%m%sisin#n#=m%=m%sinsin# # -i-i%#%#nonos%s% kepe,%/%+%n *%n# +el%h -i%m"il$
kepe,%/%+%n *%n# +el%h -i%m"il$ a
a D,D,a%a%n-n-'a $'a $###"#"a;a;a!a!an 1an 1 N*e,i *%n# "e,hu"un#%n
N*e,i *%n# "e,hu"un#%n -en#%n in3il+,%si leukosi+ (%,in#%n sis+emik'-en#%n in3il+,%si leukosi+ (%,in#%n sis+emik' T&*&an
T&*&an$ Se+el%h -il%kuk%n +in-%k%n kepe,%/%+%n n*e,i %k%n "e,ku,%n#'$ Se+el%h -il%kuk%n +in-%k%n kepe,%/%+%n n*e,i %k%n "e,ku,%n#' K",!#",a Ha',l
K",!#",a Ha',l$ 1' Mel%po,k%n penu,un%n +in#k%+ n*e,i$ 1' Mel%po,k%n penu,un%n +in#k%+ n*e,i
4' Men(el%sk%n "%#%im%n% kele+ih%n -%n ke+%ku+%n memen#%,uhi n*e,i 4' Men(el%sk%n "%#%im%n% kele+ih%n -%n ke+%ku+%n memen#%,uhi n*e,i ' Mene,im% me-ik%si n*e,i sesu%i -en#%n ,esep *%n# -i,esepk%n
' Mene,im% me-ik%si n*e,i sesu%i -en#%n ,esep *%n# -i,esepk%n
:' Menun(ukk%n penu,un%n +%n-%=+%n-% 3isik -%n pe,il%ku +en+%n# n*e,i :' Menun(ukk%n penu,un%n +%n-%=+%n-% 3isik -%n pe,il%ku +en+%n# n*e,i ;' Men#%m"il pe,%n %k+i3 -%l%m pem"e,i%n %n%l#e+ik
;' Men#%m"il pe,%n %k+i3 -%l%m pem"e,i%n %n%l#e+ik 5' Men#i-en+i3ik%si s+,%+e#i pe,e-%%n n*e,i
5' Men#i-en+i3ik%si s+,%+e#i pe,e-%%n n*e,i
9' Men##un%k%n s+,%+e#i pe,e-%%n n*e,i -en#%n +ep%+' 9' Men##un%k%n s+,%+e#i pe,e-%%n n*e,i -en#%n +ep%+'
IInn!!##""66##nn'',, RRaa'',,--nnaall K%(i k%,%k+e,is+ik n*e,i$ lok%si& ku%li+%s&
K%(i k%,%k+e,is+ik n*e,i$ lok%si& ku%li+%s& 3,ekuensi& -%n -u,%si'
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