Regression of the tumor after withdrawal of cyclosporine in relapsed extranodal natural killer/T cell lymphoma following allogeneic hematopoietic stem cell transplantation
Regression of the tumor after withdrawal of cyclosporine in relapsed extranodal natural killer/T cell lymphoma following allogeneic hematopoietic stem cell transplantation
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DOI：
10.1002/ajh.20943
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发表时间：
2007-10-01
影响因子：
12.8
通讯作者：
Kurokawa, Mineo
中科院分区：
文献类型：
--
作者：
Kako, Shinichi;Izutsu, Koji;Kurokawa, Mineo
晚期结外自然杀伤/T细胞淋巴瘤，鼻型（ENKL）患者的预后普遍较差，一些轶事报告表明了同种异体造血干细胞移植（HSCT）的作用。同种异体 HSCT 的一个潜在优势可能是移植物抗淋巴瘤 (GVL) 效应。然而，对 GVL 效应的敏感性已被证明根据组织学亚型而变化，并且几乎没有记录 ENKL 是否对 GVL 效应敏感。在这里，我们报告了一名晚期 ENKL 患者，他接受了 HLA 单等位基因不匹配的相关供体的同种异体 HSCT，其 HSCT 后的临床病程表明 GVL 对 ENKL 具有有效的作用。一名 43 岁女性因晚期化学难治性 ENKL 接受同种异体 HSCT，并获得完全缓解。然而，移植后 4 个月，ENKL 多处复发。这些病变对停止使用免疫抑制剂有明显反应并消失。除了闭塞性细支气管炎机化性肺炎暂时加重外，在没有接受其他淋巴瘤治疗的情况下，她已经一年多没有患病了。当前患者的临床病程表明 GVL 对 ENKL 具有强大的作用。同种异体 HSCT，包括降低强度的方案，是高危 ENKL 的一种有前景的治疗选择。
The prognosis of patients with advanced-stage extranodal natural killer/T cell lymphoma, nasal type (ENKL) has been generally poor, and several anecdotal reports have suggested the role of allogeneic hernatopoietic stem cell transplantation (HSCT). A potential advantage of allogeneic HSCT may be the graft-versus-lymphoma (GVL) effect. The susceptibility to the GVL effect, however, has been shown to vary according to histologic subtypes, and it has been hardly documented yet whether ENKL is susceptible to the GVL effect. Here we report a patient with advanced-stage ENKL who underwent allogeneic HSCT from an HLA one-allele mismatched related donor, whose clinical course after HSCT suggested the potent GVL effect against ENKL. A 43-year-old female underwent allogeneic HSCT for advanced-stage, chemorefractory ENKL, and achieved complete response. In 4 months after the transplantation, however, the ENKL relapsed in multiple sites. These lesions markedly responded to the discontinuation of immunosuppressive agents and disappeared. Except for a temporal exacerbation of bronchiolitis obliterans organizing pneumonia, she has been free from disease for more than a year without other treatments against lymphoma. The clinical course of the current patient suggests the potent GVL effect against ENKL. Allogeneic HSCT, including that with reduced-intensity regimens, is a promising treatment option for high-risk ENKL.