Yokoyama Hisayuki, Yamada Minami F, Ishizawa Kenichi, Yamamoto Joji, Tomiya Yasuo, Harigae Hideo, Kameoka Junichi, Ichinohasama Ryo, Sasaki Takeshi
Department of Rheumatology and Hematology, Tohoku University Graduate School of Medicine, Sendai, Japan.
Tohoku J Exp Med. 2007 Apr;211(4):395-9. doi: 10.1620/tjem.211.395.
Nasal natural killer (NK)/T cell lymphoma is a rare entity of non-Hodgkin's lymphoma which mostly occurs in East Asian countries. The advanced disease above clinical stage III is often refractory to the radiation and chemotherapies, remission is transient even if achieved, and median survival is about 12 months. Thus the prognosis of advanced NK/T cell lymphoma is generally poor, however, the promising results of allogeneic hematopoietic stem cell transplantation for advanced NK/T cell lymphoma have been recently reported. In most of these cases, stem cell sources were human leukocyte antigen (HLA) matched donors and alternative sources were seldom used. We report here a case of a 36-year-old woman who was diagnosed as having an extranodal NK/T cell lymphoma, nasal type. The patient achieved a complete remission after 2 cycles of chemotherapy including Carboplatin, Etoposide, Ifosfamide, and Dexamethasone, but 3-months later relapsed during the search for HLA-matched unrelated donors. She received unrelated cord blood transplantation (CBT) in the second remission achieved by a regimen containing L-asparaginase. The conditioning regimen was 12 Gy of total body irradiation, high-dose cytarabin and cyclophosphamide. FK506 and methotrexate were used for graft-versus-host disease (GVHD) prophylaxis. GVHD involving the intestine and the oral mucosa was observed, but improved without additional immunosuppressive therapies. The patient remains in remission 33 months after CBT. Cord blood thus could be an appropriate stem cell source for patients with advanced NK/T lymphoma who have no HLA matched donors.
鼻型自然杀伤（NK）/T细胞淋巴瘤是一种罕见的非霍奇金淋巴瘤，主要发生在东亚国家。临床III期以上的晚期疾病通常对放疗和化疗耐药，即使达到缓解也很短暂，中位生存期约为12个月。因此，晚期NK/T细胞淋巴瘤的预后通常较差，然而，最近有报道称异基因造血干细胞移植治疗晚期NK/T细胞淋巴瘤取得了令人鼓舞的结果。在大多数此类病例中，干细胞来源是人类白细胞抗原（HLA）匹配的供者，很少使用替代来源。我们在此报告一例36岁女性，被诊断为鼻型结外NK/T细胞淋巴瘤。患者在接受包括卡铂、依托泊苷、异环磷酰胺和地塞米松的2个周期化疗后达到完全缓解，但3个月后在寻找HLA匹配的无关供者期间复发。她在通过含L-天冬酰胺酶的方案实现第二次缓解后接受了无关脐血移植（CBT）。预处理方案为全身照射12 Gy、大剂量阿糖胞苷和环磷酰胺。使用FK506和甲氨蝶呤预防移植物抗宿主病（GVHD）。观察到肠道和口腔黏膜发生GVHD，但未进行额外的免疫抑制治疗即有所改善。患者在CBT后33个月仍处于缓解状态。因此，对于没有HLA匹配供者的晚期NK/T淋巴瘤患者，脐血可能是合适的干细胞来源。
