Department of Medicine, University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong, China.
Bone Marrow Transplant. 2009 Dec;44(11):709-14. doi: 10.1038/bmt.2009.239. Epub 2009 Sep 21.
Natural killer (NK)-cell lymphomas are aggressive. Patients with early (stage I/II) diseases respond favorably to radiotherapy and chemotherapy. Patients with relapses and advanced (stage III/IV) diseases have poor outcome. To improve treatment results, high-dose chemotherapy with hematopoietic SCT (HSCT) has been performed. A review of 57 published cases of autologous HSCT showed the status pre-HSCT as the only significant prognostic factor. HSCT at CR had the best survival. As patients achieving CR with chemotherapy and radiotherapy also have favorable outcome, a definite advantage of autologous HSCT cannot be established. Patients with advanced, relapsed or refractory diseases had dismal survivals after autologous HSCT. Allogeneic HSCT had been reported in about 30 patients, with a 2-year OS of 40%. To evaluate the efficacy of allogeneic HSCT, optimal conditioning regimens and a clear graft-versus-lymphoma effect should be defined. Furthermore, clinicopathological characteristics predicting benefits from allogeneic HSCT need to be determined. HSCT is a potential option in NK-cell lymphoma. However, autologous HSCT may not be necessary for good-risk patients in CR. Whether poor risk patients will have improved outcome with autologous HSCT remains to be defined. The role of allogeneic HSCT requires more rigorous future studies.
自然杀伤 (NK) 细胞淋巴瘤具有侵袭性。早期（I/II 期）疾病患者对放化疗反应良好。复发和晚期（III/IV 期）疾病患者预后较差。为了提高治疗效果，已经进行了大剂量化疗联合造血干细胞移植（HSCT）。对 57 例自体 HSCT 发表病例的回顾表明，HSCT 前状态是唯一的显著预后因素。在完全缓解（CR）时进行 HSCT 的患者生存情况最好。由于接受化疗和放疗达到 CR 的患者也有良好的预后，因此不能确定自体 HSCT 的明确优势。接受自体 HSCT 的晚期、复发或难治性疾病患者的生存情况较差。约有 30 例患者接受了异基因 HSCT，2 年总生存率为 40%。为了评估异基因 HSCT 的疗效，需要明确最佳的预处理方案和明确的移植物抗淋巴瘤效应。此外，还需要确定预测异基因 HSCT 获益的临床病理特征。HSCT 是 NK 细胞淋巴瘤的一种潜在选择。然而，对于处于 CR 的低危患者，自体 HSCT 可能并非必需。自体 HSCT 是否会改善高危患者的预后仍有待确定。异基因 HSCT 的作用需要更严格的未来研究。
