Reimer Peter, Rüdiger Thomas, Wilhelm Martin
Medizinische Poliklinik, University of Wuerzburg, Germany.
Clin Lymphoma Myeloma. 2006 Mar;6(5):373-9. doi: 10.3816/CLM.2006.n.012.
Peripheral T-cell lymphomas (PTCLs) represent a heterogeneous group of non-Hodgkin's lymphomas. With few exceptions (eg, anaplastic large-cell lymphoma expressing the anaplastic lymphoma kinase), PTCLs have generally been reported to have a worse prognosis compared with B-cell lymphomas. Despite the poor outcome after conventional therapy, the impact of high-dose therapy with autologous or allogeneic stem cell transplantation (SCT) in these rare diseases is poorly defined mainly because of the lack of prospective PTCL-restricted studies. Most data exist for high-dose therapy with autologous SCT in relapsing or refractory disease. Because most studies showed similar results for PTCL compared with aggressive B-cell lymphomas in which high-dose therapy with autologous SCT is accepted as standard therapy, this approach seems appropriate in relapsing or refractory PTCL. Results for high-dose therapy with autologous SCT as first-line therapy mainly rely on studies on aggressive lymphomas that also included lymphomas of the T-cell phenotype. Our own recently published PTCL-restricted prospective study confirmed the feasibility with only moderate toxicity and a good response rate. Overall, patients with a good remission status after induction therapy exhibited a high complete response rate after transplantation, and at least a subgroup of patients remained in long-term remission. The greatest uncertainty exists for the impact of allogeneic SCT after high-dose therapy. In refractory or relapsing PTCL, this approach might improve the outcome for eligible patients, especially when using reduced-intensity conditioning. Overall, because data on high-dose therapy for PTCL are limited, larger and randomized studies are necessary to definitely confirm the preliminary results.
外周T细胞淋巴瘤（PTCL）是一组异质性非霍奇金淋巴瘤。除少数例外情况（如表达间变性淋巴瘤激酶的间变性大细胞淋巴瘤），与B细胞淋巴瘤相比，PTCL的预后通常较差。尽管传统治疗后预后不佳，但高剂量自体或异基因干细胞移植（SCT）在这些罕见疾病中的作用仍不明确，主要原因是缺乏针对PTCL的前瞻性研究。大多数数据来自复发性或难治性疾病的高剂量自体SCT治疗。由于大多数研究表明，PTCL与侵袭性B细胞淋巴瘤的结果相似，而高剂量自体SCT治疗侵袭性B细胞淋巴瘤已被视为标准治疗方法，因此这种方法似乎适用于复发性或难治性PTCL。高剂量自体SCT作为一线治疗的结果主要依赖于对侵袭性淋巴瘤的研究，这些研究也包括T细胞表型的淋巴瘤。我们自己最近发表的针对PTCL的前瞻性研究证实了其可行性，毒性仅为中度，缓解率良好。总体而言，诱导治疗后缓解状态良好的患者移植后完全缓解率较高，至少有一部分患者保持长期缓解。高剂量治疗后异基因SCT的影响存在最大的不确定性。在难治性或复发性PTCL中，这种方法可能会改善符合条件患者的预后，尤其是在采用降低强度预处理时。总体而言，由于PTCL高剂量治疗的数据有限，需要进行更大规模的随机研究来明确证实初步结果。
