摘要:
外周T 细胞淋巴瘤（PTCL），其免疫表型提示来源于胸腺后（或成熟）T 细胞，包括大组非特异性PTCL。在全球范围内，PTCL约占非霍奇金淋巴瘤（NHL ）的10％，在我国约占20% ～30% ，明显高于西方国家。大多数PTCL侵袭性强，恶性程度高，传统的化疗方法与B 细胞NHL 相比疗效不佳、预后不良，５年生存率低。近年来研究表明造血干细胞移植（HSCT）对PTCL有较好的疗效，优于传统的化疗方法。本文主要总结自体造血干细胞移植（ASCT）、异基因造血干细胞移植（allo-SCT ）和自体外周血干细胞移植联合自体骨髓移植（APBHSCT+ABMT）三种方式及其优劣。ASCT无供受者之间的免疫排斥反应，造血重建快，但其复发率相对较高；allo-SCT 具有移植物抗淋巴瘤作用，但其有较高的治疗相关死亡率；APBHSCT+ABMT对于年龄偏大、造血功能差而难以采集足够外周血干细胞、有潜在出血和感染风险较大PTCL患者意义较大。HSCT的移植方法、移植时机、预处理方案及强度等多种因素对移植疗效均有影响，如何根据不同PTCL患者的具体情况选择不同的移植方式、选择合适的移植时机等问题还值得进一步深入的研究。
Abstract:
Peripheral T-cell lymphoma (PTCL) stems from the retro-thymic (or mature) T-cell based on the immu-no-phenotype, and comprises a large group of specific PTCLs. On a global scale, PTCL approximately accounts for 10% of non-Hodgkin's lymphoma (NHL), and in China it accounts for about 20% ～30% of NHL, which is obviously higher com -pared to the Western countries. Most PTCLs feature an active invasion and high malignancy. Traditional chemotherapeutic regimens have shown less curative effects and worse prognosis in treating PTCL, than in treating B-cell NHL, with a verylow 5-year survival rate in PTCL patients. Recent studies have suggested that Hematopoietic Stem Cell Transplantation (HSCT) has a better curative effect and is superior to traditional chemotherapy for treatment of PTCL. This review summa -rizes the advantages and disadvantages of autologous hematopoietic stem cell transplantation (auto-HSCT), allogenetic he -matopoietic stem cell transplantation (allo-SCT), and autologous peripheral blood hematopoietic stem cell transplantation (APBHSCT) combined with autologous bone marrow transplantation (ABMT) (APBHSCT + ABMT). The benefit of Au -to-HSCT is the lack of immunological rejection between the donor and the recipient. Moreover, it has a rapid reconstruction of hematopoiesis, however, the relapse rate is relatively high. Allo-SCT is provided with the effect of graft-versus-lympho-ma, but the treatment-related mortality is also high. APBHSCT + ABMT has a greater significance for the older PTCL pa-tients, who might have more feeble hematopoietic functions thus failing to muster sufficient hematopoietic stem cells, and have a higher risk of bleeding and infection. Many related factors such as methodology and timing of the transplantation, plan and intensity of the pretreatment have great impact on the curative effect. Therefore, it needs further investigations on selecting the methodology, punctuality, preconditioning, and intensity of the transplantation based on individual conditions of different PTCL patients.
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