Tse Eric, Kwong Yok-Lam
Department of Medicine, Queen Mary Hospital, Pokfulam Road, Hong Kong, China.
Curr Hematol Malig Rep. 2014 Sep;9(3):233-42. doi: 10.1007/s11899-014-0216-3.
NK/T-cell lymphomas are aggressive malignancies, and the outlook is poor when conventional anthracycline-containing regimens designed for B-cell lymphomas are used. With the advent of L-asparaginase-containing regimens, treatment outcome has significantly improved. L-asparaginase-containing regimens are now considered the standard in the management of NK/T-cell lymphomas. In advanced diseases, however, outcome remains unsatisfactory, with durable remission achieved in only about 50% of cases. Stratification of patients with advanced NK/T-cell lymphomas is needed, so that poor-risk patients can be given additional therapy to improve outcome. Conventional presentation parameters are untested and appear inadequate for prognostication when L-asparaginase-containing regimens are used. Recent evidence suggests that dynamic factors during treatment and interim assessment, including Epstein-Barr virus (EBV) DNA quantification and positron emission tomography computed tomography findings, are more useful in patient stratification. The role of high-dose chemotherapy and haematopoietic stem cell transplantation requires evaluation in an overall risk-adapted treatment algorithm.
NK/T细胞淋巴瘤是侵袭性恶性肿瘤，使用针对B细胞淋巴瘤设计的含传统蒽环类药物方案时预后较差。随着含L-天冬酰胺酶方案的出现，治疗结果有了显著改善。含L-天冬酰胺酶方案目前被认为是NK/T细胞淋巴瘤管理的标准方案。然而，在晚期疾病中，结果仍不尽人意，仅约50%的病例能实现持久缓解。晚期NK/T细胞淋巴瘤患者需要分层，以便对高危患者给予额外治疗以改善结果。当使用含L-天冬酰胺酶方案时，传统的表现参数未经检验，且似乎不足以用于预后评估。最近的证据表明，治疗期间和中期评估的动态因素，包括爱泼斯坦-巴尔病毒（EBV）DNA定量和正电子发射断层扫描计算机断层扫描结果，在患者分层中更有用。在整体风险适应性治疗算法中，需要评估高剂量化疗和造血干细胞移植的作用。
