Успешная терапия периферической Т-клеточной лимфомы, ассоциированной с энтеропатией, с применением высокодозной полихимиотерапии и трансплантации аутологичных стволовых кроветворных клеток

Воробьев В.И., Кравченко С.К., Ковригина А.М. Успешная терапия периферической Т-клеточной лимфомы, ассоциированной с энтеропатией, с применением высокодозной полихимиотерапии и трансплантации аутологичных стволовых кроветворных клеток. Терапевтический архив (архив до 2018 г.). 2013;85(7):79-83.

Читать PDF

Аннотация

Т-клеточная лимфома, ассоциированная с энтеропатией (ТЛАЭ), — редкое заболевание, которое составляет не более 1,4% от всех лимфом. Наиболее часто встречается в Европе, реже в Северной Америке и Азии. В 50% случаев ассоциирована с чувствительной к глютену целиакией, подразделяется на I и II типы. Применение среднедозной CHOP-подобной терапии неэффективно — медиана общей продолжительности жизни составляет 7—10 мес. Высокодозная терапия позволяет достичь 60% 5-летней выживаемости, но ее использование возможно не более чем в половине случаев. Это связано с тяжелым соматическим статусом большинства больных на момент диагностики и медианой возраста 57—64 года. В статье представлен обзор литературы и успешный случай лечения 58-летнего пациента с ТЛАЭ I типа с использованием протокола mNHL-BFM-90 и аутологичной трансплантации стволовых кроветворных клеток.

Ключевые слова: Т-клеточная лимфома, ассоциированная с энтеропатией, целиакия, NHL-BFM-90, трансплантация ауто-логичных стволовых кроветворных клеток.

________________________________________________

Enteropathy-associated T-cell lymphoma (EATL) is a rare disease that accounts for not more than 1.4% of all lymphomas. It is most common in Europe, followed by North America and Asia. The disease is associated with gluten-sensitive celiac disease in 50% of cases and divided into types I and II. Mean-dose CHOP-like therapy is ineffective, with a median overall survival of 7—10 months. With high-dose therapy, 5-year survival rates can be 60%, but it can be used in not more than half of the cases. This is associated with the serious somatic status of most patients at diagnosis and with a median age of 57—64 years. The article presents a literature review and a case of successful therapy in a 58-year-old patient with type I EATL using the mNHL-BFM-90 protocol and autologous hematopoietic stem cell transplantation.

Key words: enteropathy-associated T-cell lymphoma, celiac disease, NHL-BFM-90, autologous hematopoietic stem cell trans-plantation.

Список литературы

Psyrri A., Papageorgiou S., Economopoulos T. Primary extranodal lymphomas of stomach: clinical presentation, diagnostic pitfalls and management. Ann Oncol 2008; 19: 1992-1999.
Koch P., del Valle F., Berdel W.E. et al. Primary gastrointestinal non-Hodgkin's lymphoma: Anatomic and histologic distribution, clinical features, and survival data of 371 patients registered in the German Multicenter Study GIT NHL 01/92. J Clin Oncol 2001; 19: 3861-3873.
Papaxoinis G., Papageorgiou S., Rontogianni D. et al. Primary gastrointestinal nonHodgkin's lymphoma: a clinicopathologic study of 128 cases in Greece. A Hellenic Cooperative Oncology Group study (HeCOG). Leuk Lymphoma 2006; 47: 2140-2146.
de Leval L., Gaulard P. Pathology and biology of peripheral T-cell lymphomas. Histopathology 2011; 58: 49-68.
Chan J.K.C., Quintanilla-Martinez L., Ferry J.A. et al. Extranodal NK/T-cell lymphoma, nasal type. In: Swerdlow S.H., Campo E., Harris N.L. et al. (eds). World Health Organization Classification of Tumours of Haematopoietic and Lymphoid Tissues (4th ed). Lyon: IARC Press 2008: 285-288.
Mansoor A., Pittaluga S., Beck P.L. et al. NK-cell enteropathy: a benign NK-cell lymphoproliferative disease mimicking intestinal lymphoma: clinicopathologic features and follow-up in a unique case series. Blood 2011; 117: 1447-1452.
Tanaka T., Megahed N., Takata K. et al. A case of lymphomatoid gastropathy: An indolent CD56-positive atypical gastric lymphoid proliferation, mimicking aggressive NK/T cell lymphomas. Pathol Res Pract 2011; 207: 786-789.
Sieniawski M., Angamuthu N., Boyd K. et al. Evaluation of enteropathy-associated T-cell lymphoma comparing standard therapies with a novel regimen including autologous stem cell transplantation. Blood 2010; 115 (18): 3664-3670.
Gale J., Simmonds P.D., Mead G.M. et al. Enteropathy-type intestinal T-cell lymphoma: clinical features and treatment of 31 patients in a single center. J Clin Oncol 2000; 18 (4): 795-803.
Dube´ C., Rostom A., Sy R. et al. The prevalence of celiac disease in average-risk and at-risk Western European populations: a systematic review. Gastroenterology 2005; 128 (4 suppl 1): S57-S67.
Greco L., Romino R., Coto I. et al. The first large population based twin study of coeliac disease. Gut 2002; 50: 624-628.
Green P.H., Cellier C. Celiac disease. N Engl J Med 2007; 357 (17): 1731-1743.
Verbeek W.H., Van De Water J.M., Al-Toma A. et al. Incidence of enteropathy-associated T-cell lymphoma: a nation-wide study of a population-based registry in The Netherlands. Scand. J Gastroenterol 2008; 43 (11): 1322-1328.
Daum S., Cellier C., Mulder C.J. Refractory coeliac disease. Best Pract Res Clin Gastroenterol 2005; 19 (3): 413-424.
Cellier C., Delabesse E., Helmer C. et al. Refractory sprue, coeliac disease, and enteropathyassociated T-cell lymphoma. French Coeliac Disease Study Group. Lancet 2000; 356 (9225): 203-208.
Al-Toma A., Verbeek W.H., Hadithi M. et al. Survival in refractory coeliac disease and enteropathy-associated T-cell lymphoma: retrospective evaluation of single-centre experience. Gut 2007; 56 (10): 1373-1378.
Deleeuw R.J., Zettl A., Klinker E. et al. Whole genome analysis and HLA genotyping of enteropathy-type T-cell lymphoma reveals 2 distinct lymphoma subtypes. Gastroenterology 2007; 132 (5): 1902-1911.
Delabie J., Holte H., Vose J.M. et al. Enteropathy-associated T-cell lymphoma: clinical and histological findings from the International Peripheral T-Cell Lymphoma Project. Blood 2011; 118: 148-155.
Bautista-Quach M.A., Ake C.D., Chen M., Wang J. Gastrointestinal lymphomas: Morphology, immunophenotype and molecular features J Gastrointest Oncol 2012; 3 (3): 209-225.
Musshoff K. Clinical staging classification of non-Hodgkin's lymphomas. Strahlentherapie 1977; 153 (4): 218-221.
International Non-Hodgkin's Lymphoma Prognostic Factors Project. A predictive model for aggressive non-Hodgkin's lymphoma. N Engl J Med 1993; 329 (14): 987-994.
Egan L.J., Walsh S.V., Stevens F.M. et al. Celiac-associated lymphoma: a single institution experience of 30 cases in the combination chemotherapy era. J Clin Gastroenterol 1995; 21 (2): 123-129.
Novakovic B.J., Novakovic S., Frkovic-Grazio S. A single-center report on clinical features and treatment response in patients with intestinal T cell non-Hodgkin's lymphomas. Oncol Rep 2006; 16 (1): 191-195.
Daum S., Ullrich R., Heise W. et al. Intestinal non-Hodgkin's lymphoma: a multicenter prospective clinical study from the German Study Group on Intestinal Non-Hodgkin's Lymphoma. J Clin Oncol 2003; 21 (14): 2740-2746.
Wohrer S., Chott A., Drach J. et al. Chemotherapy with cyclophosphamide, doxorubicin, etoposide, vincristine and prednisone (CHOEP) is not effective in patients with enteropathy-type intestinal T-cell lymphoma. Ann Oncol 2004; 15 (11): 1680-1683.
Sabatino A., Biagi F., Gobbi P.G. Corazza G.R. How I treat enteropathy-associated T-cell lymphoma. Blood 2012; 119: 2458-2468.
Tse E., Gill H., Kim S.J. et al. Type II enteropathy-associated T-cell lymphoma: multicenter analysis from the Asia Lymphoma study Group. Am J Hematol 2012; 87 (7): 663-668.
Магомедова А.У., Кравченко С.К., Кременецкая А.М. и др. Модифицированная программа NHL-BFM-90 в лечении больных диффузной В-крупноклеточной лимфосаркомой. Тер арх 2006; 10: 44-54.
Honemann D., Prince H.M., Hicks R.J., Seymour J.F. Enteropathy-associated T-cell lymphoma without a prior diagnosis of coeliac disease: diagnostic dilemmas and management options. Ann Hematol 2005; 84 (2): 118-121.
Blystad A.K., Enblad G., Kvalay S. et al. High-dose therapy with autologous stem cell transplantation in patients with peripheral T-cell lymphomas. Bone Marrow Transplant 2001; 27 (7): 711-716.
Okuda M., Nomura J., Tateno H. et al. CD56 positive intestinal T-cell lymphoma: treatment with high dose chemotherapy and autologous peripheral stem cell transplantation. Intern Med 2002; 41 (9): 734-737.
Bishton M.J., Haynes A.P. Combination chemotherapy followed by autologous stem cell transplant for enteropathy-associated T cell lymphoma. Br J Haematol 2007; 136 (1): 111-113.
Rongey C., Micallef I., Smyrk T., Murray J. Successful treatment of enteropathy-associated T cell lymphoma with autologous stem cell transplant. Dig Dis Sci 2006; 51 (6): 1082-1086.
Al-Toma A., Verbeek W.H., Visser O.J. et al. Disappointing outcome of autologous stem cell transplantation for enteropathy-associated T-cell lymphoma. Dig Liver Dis 2007; 39 (7): 634-641.
Jantunen E., Juvonen E., Wiklund T. et al. High-dose therapy supported by autologous stem cell transplantation in patients with enteropathy-associated T-cell lymphoma. Leuk Lymphoma 2003; 44 (12): 2163-2164.
Nava V.E., Cohen P., Bishop M. et al. Enteropathy-type T-cell lymphoma after intestinal diffuse large B-cell lymphoma. Am J Surg Pathol 2007; 31 (3): 476-480.
Prochazka V., Faber E., Raida L. et al. Long-term outcome of patients with peripheral T-cell lymphoma treated with first-line intensive chemotherapy followed by autologous stem cell transplantation. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2011; 155 (1): 63-70.
Reimer P., Rudiger T., Geissinger E. et al. Autologous stem-cell transplantation as first-line therapy in peripheral T-cell lymphomas: results of a prospective multicenter study. J Clin Oncol 2009; 27 (1): 106-113.

Авторы

В.И. ВОРОБЬЕВ, С.К. КРАВЧЕНКО, А.М. КОВРИГИНА

Гематологический научный центр Минздрава России, Москва

________________________________________________

V.I. VOROBYEV, S.K. KRAVCHENKO, A.M. KOVRIGINA

Hematology Research Center, Ministry of Health of Russia, Moscow

Назад к списку

Цель портала OmniDoctor – предоставление профессиональной информации врачам, провизорам и фармацевтам.