Observasi Klinis Penggunaan Probiotik sebagai Terapi Pendukung pada Pasien dengan Kolitis Ulseratif dan Limfoma Non-Hodgkin

Ge Recta Geson, Titi Mutiara Kiranawati, Galih Satrio Putra, Adji Prayitno Setiadi

Abstract


Kolitis ulseratif merupakan penyakit inflamasi usus kronis yang memerlukan terapi jangka panjang dan pada kondisi tertentu dapat disertai komorbiditas keganasan, seperti Non-Hodgkin’s Lymphoma (NHL). Penatalaksanaan kondisi ini sering kali melibatkan terapi komprehensif yang berpotensi mempengaruhi kondisi gastrointestinal pasien dengan golden standard therapy yang dikenal sebagai R-CHOP. Studi kasus ini menyajikan observasi klinis terhadap satu pasien dengan kolitis ulseratif dengan NHL yang mendapatkan R-CHOP dan suplementasi probiotik multistain sebagai terapi pendukung selama masa perawatan. Data diperoleh dari rekam medis dan observasi klinis secara deskriptif tanpa analisis statistik. Selama periode observasi, pasien menunjukkan perbaikan kondisi klinis secara umum dan tidak mengalami perburukan gejala gastrointestinal yang bermakna setelah pemberian adjuvant therapy berupa probiotik multistain jika dibandingkan dengan sebelum pemberian probiotik multistain. Kombinasi standard kemoterapi R-CHOP pada kasus ini dengan suplementasi probiotik multistrain berpotensi menghambat progresi keganasan sel kanker NHL. Pemberian probiotik multistain dapat memberikan manfaat terapeutik dengan meningkatkan apoptosis pada sel kanker sekaligus menurunkan peradangan pada kolitis ulseratif berdasarkan hasil gambaran kolonoskopi. Meskipun demikian, temuan ini bersifat deskriptif antara pemberian probiotik dan perbaikan kondisi klinis pasien yang mengalami kolitis ulseratif dengan NHL. Penelitian lanjutan dengan desain yang lebih kuat diperlukan untuk menkonfirmasi potensi peran probiotik mutristrain sebagai terapi pendukung pada kondisi klinis serupa.


Keywords


Probiotik multistain, kolitis ulseratif, limfoma non-Hodgkin, observasi klinis, terapi pendukung

References


Ortiz LMG, Anselmi FJ, Rivera JR, Quiles WC, Santiago RM. Non-Hodgkin’s lymphoma presenting as ulcerative colitis. Bol Asoc Med P R. 2006;98(2):140-3.

Dipiro JT, Yee GC, Posey LM, Haines ST, Nolin TD, Ellingrod VL. Pharmacotherapy: A pathophysiologic approach. 11th ed. New York: McGraw-Hill Education; 2020.

Dyson JK, Beuers U, Jones DEJ, Lohse AW, Hudson M. Primary sclerosing cholangitis. Lancet. 2018;391(10139):2547-59. doi: https://doi.org/10.1016/S0140-6736(18)30300-3.

Grainge MJ, West J, Card TR. Venous thromboembolism during active disease and remission in inflammatory bowel disease: A cohort study. Lancet. 2010;375(9715):657-63. doi: https://doi.org/10.1016/S0140-6736(09)61963-2.

Papa A, Gerardi V, Marzo M, Felice C, Rapaccini GL, Gasbarrini A, Armuzzi A. Venous thromboembolism in patients with inflammatory bowel disease: Focus on prevention and treatment. World J Gastroenterol. 2014;20(12):3173-9. doi: https://doi.org/10.3748/wjg.v20.i12.3173.

Han K, Yu C, Yang SK, Jeong YH, Park I, Lee KH, Kim HC, Kim JC. A case of non-Hodgkin’s lymphoma in ulcerative colitis. J Korean Soc Coloproctol. 2005;21:52-6.

Yu J, Refsum E, Wieszczy P, Helsingen L, Perrin V, Högdén A, Løberg M, Blom J, Bretthauer M, Adami H, Ye W, Kalager M. Risk of malignant lymphomas in patients with inflammatory bowel disease: A population-based cohort study. BMJ Open Gastroenterol. 2023;10:e001037. doi: https://doi.org/10.1136/bmjgast-2022-001037.

Palli D, Trallori G, Bagnoli S, Saieva C, Tarantino O, Ceroti M, D’Albasio G, Pacini F, Amorosi A, Masala G. Hodgkin’s disease risk is increased in patients with ulcerative colitis. Gastroenterology. 2000;119(3):647-53. doi: https://doi.org/10.1053/gast.2000.16487.

Walinjkar S, Kumar A, Sharma P, Gupta P, Bansal N, Singla V, Anikhindi S, Arora A. Multifocal colorectal non-Hodgkin’s lymphoma in a patient with ulcerative colitis: A case report. Indian J Pathol Microbiol. 2021;64(5):92. doi: https://doi.org/10.4103/IJPM.IJPM_654_19.

Van Hauwaert V, Meers S, Verhoef G, Vermeire S, Rutgeerts P, Van Assche G. Rectal non-Hodgkin’s lymphoma in an infliximab treated patient with ulcerative colitis and primary sclerosing cholangitis. J Crohns Colitis. 2010;4(6):683-6. doi: https://doi.org/10.1016/j.crohns.2010.06.006.

Rasmussen SL, Thomsen C. Rectal Hodgkin lymphoma in a patient with ulcerative colitis: A case study. Diagn Pathol. 2015;10(1):25. doi: https://doi.org/10.1186/s13000-015-0271-7.

Mustika S, Triana N. The prevalence, profile, and risk factor of patients with ulcerative colitis at Dr. Saiful Anwar Malang General Hospital. 2016.

Coiffier B, Lepage E, Brière J, Herbrecht R, Tilly H, Bouabdallah R, Morel P, Van Den Neste E, Salles G, Gaulard P, Reyes F, Lederlin P, Gisselbrecht C; Groupe d’Etude des Lymphomes de l’Adulte (GELA). CHOP chemotherapy plus rituximab compared with CHOP alone in elderly patients with diffuse large-B-cell lymphoma. N Engl J Med. 2002;346(4):235-42.

Koh A, De Vadder F, Kovatcheva-Datchary P, Bäckhed F. From dietary fiber to host physiology: Short-chain fatty acids as key bacterial metabolites. Cell. 2016;165(6):1332-45. doi: https://doi.org/10.1016/j.cell.2016.05.041.

Louis P, Flint HJ. Formation of propionate and butyrate by the human colonic microbiota. Environ Microbiol. 2017;19(1):29-41. doi: https://doi.org/10.1111/1462-2920.13589.

Kruis W, Fric P, Pokrotnieks J, Lukas M, Fixa B, Kascák M, Kamm MA, Weismueller J, Beglinge C, Stolte M, Wolff C, Schulze J. Maintaining remission of ulcerative colitis with the probiotic Escherichia coli Nissle 1917 is as effective as with standard mesalazine. Gut. 2004;53(11):1617-23. doi: https://doi.org/10.1136/gut.2003.037747.

Lamb CA, Kennedy NA, Raine T, Hendy PA, Smith PJ, Limdi JK, et al. British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults. Gut. 2019;68(Suppl 3):s1-106. doi: https://doi.org/10.1136/gutjnl-2019-318484.

Feuerstein JD, Isaacs KL, Schneider Y, Siddique SM, Falck-Ytter Y, Singh S. AGA clinical practice guidelines on the management of moderate to severe ulcerative colitis. Gastroenterology. 2020;158(5):1450-61. doi: https://doi.org/10.1053/j.gastro.2020.01.006.

Magro F, Doherty G, Peyrin-Biroulet L, Svrcek M, Borralho Nunes P, Armuzzi A, et al. ECCO guidelines on ulcerative colitis: 2022 update of the therapeutics. J Crohns Colitis. 2022;16(1):2-17. doi: https://doi.org/10.1093/ecco-jcc/jjab178.

Groupe d’Etude des Lymphomes de l’Adulte (GELA). Long-term results of the GELA study, R-CHOP vs CHOP in elderly patients with diffuse large B-cell lymphoma. Blood. 2006;104(11):1383-90.

Hou S, Yang W. A meta-analysis on rituximab combined CHOP chemotherapy for non-Hodgkin lymphoma in China. Saudi Med J. 2011;32(7):675-80.

Nakamura N, Abe Y, Ito K, et al. A randomized phase 2/3 study of R-CHOP vs CHOP combined with dose-dense rituximab for DLBCL: the JCOG0601 trial. Blood Adv. 2021;5(4):984-99.

Tilly H, Seymour JF, et al. R-CHOP with or without bevacizumab in previously untreated DLBCL: final MAIN study outcomes. Haematologica. 2015;100(12):1727-35.

Zhou Z, Sehn LH, Ritchie D, et al. Randomized phase III trial of ibrutinib and rituximab plus CHOP in non-germinal center B-cell diffuse large B-cell lymphoma. J Clin Oncol. 2019;37(15):1285-95.

National Cancer Institute. Chemotherapy and you: support for people with cancer. Bethesda, MD: National Cancer Institute; 2021.

Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J. Harrison’s principles of internal medicine. 20th ed. New York: McGraw-Hill Education; 2018.

Kufe DW, Pollock RE, Weichselbaum RR, Bast RC, Gansler TS, Holland JF, Frei E. Holland-Frei cancer medicine. 6th ed. Hamilton: BC Decker; 2003.

Scotti C, Hutchinson CR. Enhanced antibiotic production by manipulation of the Streptomyces peucetius dnrH and dnmT genes involved in doxorubicin (adriamycin) biosynthesis. J Bacteriol. 1996;178(24):7316-21.

Yang S, Gui J, Zhang Z, Tang J, Chen S, et al. Enhancement of doxorubicin production in Streptomyces peucetius by genetic engineering and process optimization. AMB Express. 2024;14:41.

Van der Zanden SY, Qiao X, Neefjes J, et al. New insights into the activities and toxicities of the old anticancer drug doxorubicin. FEBS J. 2021;288(21):6095-111.

Aliyah R, As’ad S. Prebiotics for chemotherapy-induced lower intestinal mucositis (CIM) with moderate protein energy malnutrition: A case report. Curr Dev Nutr. 2022;6:734. doi: https://doi.org/10.1093/cdn/nzac062.003.

Rodriguez-Arrastia AM, Martinez-Ortigosa A, Rueda-Ruzafa L, Folch Ayora A, Ropero-Padilla C. Probiotic supplements on oncology patients’ treatment-related side effects: A systematic review of randomized controlled trials. Int J Environ Res Public Health. 2021;18(8):4265. doi: https://doi.org/10.3390/ijerph18084265.

Qiu X, Han X, Zhang X, Teng LA, Sriwastva MK, Zhen L, Li Z, Liu M, Ren Y, Wang S. Lactobacillus rhamnosus alleviates colitis caused by chemotherapy via biofilm formation. J Gastroenterol Hepatol. 2023;38(7):1158-69. doi: https://doi.org/10.1111/jgh.16164.

Huang F, Li S, Chen W, Han Y, Yao Y, Yang L, Li Q, Xiao Q, Wei J, Liu Z, Chen T, Deng X. Postoperative probiotics administration attenuates gastrointestinal complications and gut microbiota dysbiosis caused by chemotherapy in colorectal cancer patients. Nutrients. 2023;15(2):356. doi: https://doi.org/10.3390/nu15020356.

Yuniarti F, Syahrir M, Ali Z, Andayani YD, Djamaluddin N. The effect of probiotics on short chain fatty acid levels in colorectal cancer patients who undergoing chemotherapy at Dr. Mohammad Hoesin General Palembang Hospital. J Med Health Stud. 2022;3(4):71-5. doi: https://doi.org/10.32996/jmhs.2022.3.4.10.

Bjarnason I, Sission G, Hayee B. A randomised, double-blind, placebo-controlled trial of a multi-strain probiotic in patients with asymptomatic ulcerative colitis and Crohn’s disease. 2019.




DOI: https://doi.org/10.18860/jip.v10i2.36720

Refbacks

  • There are currently no refbacks.


Copyright (c) 2026 Journal of Islamic Pharmacy

Creative Commons License
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

© 2023 Journal of Islamic Pharmacy