Zain Jasmine
City of Hope National Medical Center, Duarte, CA, USA.
Cancer Treat Res. 2019;176:269-287. doi: 10.1007/978-3-319-99716-2_13.
Mature T-cell non-Hodgkin lymphomas (T-cell NHL) are a heterogeneous group of lymphoid malignancies including NK/T-cell lymphomas. Hematopoietic cell transplantation (HCT) is an important component of the management of T-cell NHL; however, the optimal timing and type of transplant for each different subtype is an ongoing debate. For the purpose of this chapter, PTCL will be classified as (1) systemic PTCL that includes nodal as well as non-nodal histologies in PTCL (2) CTCL-or cutaneous T-cell lymphomas that arise primarily in the skin and (3) NK/T-cell lymphomas both nasal and extranasal types. It is difficult to do any large trials in PTCL as they are rare diseases with variable clinical and biological characteristics and most patients are not transplant eligible due to various reasons including poor disease control. There are no randomized trials in transplant for PTCL but there is an experience based on retrospective as well as some well-designed prospective trials that have helped outline the role of HSCT in the treatment paradigm of PTCL. High-dose therapy and autologous HCT is recommended in first complete remission for most systemic (non-cutaneous) nodal subtypes, or peripheral T-cell lymphomas (PTCL). Autologous HCT can provide long-term remission for relapsed PTCL but is ineffective for refractory/chemoresistant disease. Allogeneic stem cell transplantation harnesses the graft-versus-lymphoma effect, providing long-term remission for relapsed PTCL. AlloHCT is also being used successfully to provide long-term disease control for advanced cutaneous T-cell lymphoma (CTCL). The use of transplant in NK/T-cell lymphoma is increasingly being recommended in the relapsed setting only as there are more effective treatments available for the upfront setting in limited stage disease.
成熟T细胞非霍奇金淋巴瘤（T细胞NHL）是一组异质性的淋巴系统恶性肿瘤，包括NK/T细胞淋巴瘤。造血细胞移植（HCT）是T细胞NHL治疗的重要组成部分；然而，针对每种不同亚型的最佳移植时机和类型仍在不断争论中。在本章中，外周T细胞淋巴瘤（PTCL）将被分类为：（1）系统性PTCL，包括PTCL中的淋巴结和非淋巴结组织学类型；（2）蕈样肉芽肿（CTCL）或皮肤T细胞淋巴瘤，主要发生于皮肤；（3）NK/T细胞淋巴瘤，包括鼻型和鼻外型。由于PTCL是罕见疾病，具有可变的临床和生物学特征，且大多数患者由于各种原因（包括疾病控制不佳）不适合移植，因此很难进行任何大型试验。PTCL移植方面没有随机试验，但基于回顾性研究以及一些精心设计的前瞻性试验有相关经验，这些经验有助于勾勒HSCT在PTCL治疗模式中的作用。对于大多数系统性（非皮肤）淋巴结亚型或外周T细胞淋巴瘤（PTCL），建议在首次完全缓解时进行大剂量治疗和自体HCT。自体HCT可为复发的PTCL提供长期缓解，但对难治性/化疗耐药性疾病无效。异基因干细胞移植利用移植物抗淋巴瘤效应，为复发的PTCL提供长期缓解。异基因造血干细胞移植（AlloHCT）也成功用于为晚期皮肤T细胞淋巴瘤（CTCL）提供长期疾病控制。NK/T细胞淋巴瘤仅在复发情况下越来越多地推荐使用移植，因为在局限性疾病的初始治疗中有更有效的治疗方法。
