Transplantation.
Transplantation.
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DOI：
10.1007/978-3-319-99716-2_13
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发表时间：
2019-01-01
影响因子：
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通讯作者：
Zain, Jasmine
中科院分区：
文献类型：
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作者：
Zain, Jasmine
成熟t细胞非霍奇金淋巴瘤（t细胞NHL）是一种异质性淋巴样恶性肿瘤，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，每种不同亚型的最佳移植时间和移植类型仍在争论中。为了本章的目的，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；(2)主要发生在皮肤上的ctcl或皮肤t细胞淋巴瘤；(3)鼻型和鼻外型NK/ t细胞淋巴瘤。由于PTCL是一种罕见的疾病，临床和生物学特征多变，而且由于疾病控制不佳等各种原因，大多数患者不适合移植，因此很难进行大规模的试验。目前尚无针对PTCL的移植随机试验，但有一项基于回顾性和一些精心设计的前瞻性试验的经验，这些试验有助于概述HSCT在PTCL治疗范例中的作用。对于大多数全身性（非皮肤）淋巴结亚型或周围t细胞淋巴瘤（PTCL），推荐在首次完全缓解时采用大剂量治疗和自体HCT。自体HCT可以为复发的PTCL提供长期缓解，但对难治性/化疗耐药疾病无效。同种异体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。同种异体ct也被成功地用于晚期皮肤t细胞淋巴瘤（CTCL）的长期疾病控制。NK/ t细胞淋巴瘤的移植越来越多地被推荐用于复发的情况，因为在有限期疾病的前期有更有效的治疗方法。
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.