Epperla Narendranath, Hamadani Mehdi
Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI 53226, USA; Center for International Blood and Marrow Transplant Research, Milwaukee, WI 53226, USA.
Hematol Oncol Stem Cell Ther. 2017 Dec;10(4):277-284. doi: 10.1016/j.hemonc.2017.05.004. Epub 2017 Jun 13.
Non-Hodgkin's lymphoma (NHL) constitutes a collection of lymphoproliferative disorders with diverse biologic, histologic, and clinical features. With a better understanding of the molecular pathogenesis, recently there have been major advances in the treatment of NHLs including addition of novel monoclonal antibodies, targeted therapies, and immune activators to the therapy armamentarium. Despite these remarkable developments, autologous hematopoietic cell transplantation (auto-HCT) remains not only a standard-of-care curative option for aggressive NHL but also an important therapeutic option for indolent NHL. In NHL, for patients with high-risk features, including those heavily pretreated or with refractory disease or those experiencing failure after an auto-HCT, allogeneic HCT (allo-HCT) remains the only curative option. In this review, we briefly discuss the role of transplantation in diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma (FL). In DLBCL patients, we discuss the role of HCT in clinically and biologically defined ultra-high-risk disease. In FL patients, auto-HCT is best reserved for relapsed chemosensitive patients after two to three lines of prior chemoimmunotherapies, who are not candidates for allo-HCT, either because of donor unavailability, associated comorbidities, or patient preference. Reduced-intensity conditioning allo-HCT offers the curative option for patients with relapsed/refractory FL. Although the emergence of targeted, biologic, and immunological therapies is welcoming, it is currently unclear how these new therapies might enhance or replace allo-HCT. Until we have further definitive data, allo-HCT remains the only curative option.
非霍奇金淋巴瘤（NHL）是一组具有不同生物学、组织学和临床特征的淋巴增殖性疾病。随着对分子发病机制的深入了解，近年来NHL的治疗取得了重大进展，包括在治疗手段中增加了新型单克隆抗体、靶向治疗和免疫激活剂。尽管有这些显著进展，但自体造血细胞移植（auto-HCT）不仅仍然是侵袭性NHL的标准治愈性选择，也是惰性NHL的重要治疗选择。在NHL中，对于具有高危特征的患者，包括那些经过大量预处理或患有难治性疾病的患者，或那些自体造血细胞移植后失败的患者，异基因造血细胞移植（allo-HCT）仍然是唯一的治愈性选择。在本综述中，我们简要讨论移植在弥漫性大B细胞淋巴瘤（DLBCL）和滤泡性淋巴瘤（FL）中的作用。在DLBCL患者中，我们讨论造血细胞移植在临床和生物学定义的超高危疾病中的作用。在FL患者中，自体造血细胞移植最好保留给经过两到三线先前化疗免疫治疗后复发且对化疗敏感、因供体不可用、合并症或患者偏好而不适合异基因造血细胞移植的患者。减低强度预处理的异基因造血细胞移植为复发/难治性FL患者提供了治愈选择。尽管靶向、生物和免疫治疗的出现令人欣喜，但目前尚不清楚这些新疗法如何增强或替代异基因造血细胞移植。在我们获得进一步的确切数据之前，异基因造血细胞移植仍然是唯一的治愈性选择。
