New recommendations on the role of hematopoietic cell transplantation (HCT) for mature T cell and natural killer (NK)/T cell lymphomas outline clinical practice algorithms for 14 histological subtypes.
The evidence-based algorithms were developed by the American Society for Blood and Marrow Transplantation (ASBMT) and assess the role of autologous HCT or allogeneic HCT as front-line consolidation, in the relapsed-sensitive setting and in cases of refractoriness to initial therapy.
The international panel of ASBMT experts developed guidelines for mature T cell and NK/T cell lymphoma subtypes as described in the 2008 World Health Organization (WHO) classification. They are:
- ALCL-ALK positive
- ALCL-ALK negative
- NK/T cell (localized)
- NK/T cell (disseminated: extension beyond upper aerodigestive tract)
- ATLL-lymphoma type
- Mycosis fungoides/Sezary syndrome (MF/SS) (early-stage IA, IB, IIA, or patch/plaque)
- MF/SS (advanced-stage IIB-IVB or tumor/extracutaneous)
- Subacute panniculitis-like T cell lymphoma
- Enteropathy-associated T cell lymphoma (EATL)
- Hepatosplenic lymphoma
Each of the 14 histological subtypes is summarized with a graphical algorithm such as the algorithm for ALCL-ALK positive T cell lymphoma, shown below.
The ASBMT panel noted that “as more effective therapies for various mature T cell lymphomas emerge, they will be incorporated into the pre-transplantation, peripheral blood stem cells-transplantation and post-transplantation algorithms (autologous or allogeneic) aiming for optimizing efficacy and improving outcomes.”
Figure reprinted from Biol Blood Marrow Transplant, Vol 23/Issue 11: 1826-1838. Kharfan-Dabaja MA, Kumar A, et al. Clinical practice recommendations on indication and timing of hematopoietic cell transplantation in mature T cell and NK/T cell lymphomas: An international collaborative effort on behalf of the Guidelines Committee of the American Society for Blood and Marrow Transplantation. Copyright © 2017, with permission from Elsevier.