Extranodal natural killer/T cell lymphoma, nasal type, is one of the more common subtypes of mature T cell lymphoma, especially in the Far East Asian population. This aggressive histologic subtype of peripheral T cell lymphomas is frequently susceptible to exposure of Epstein–Barr virus infection. The optimal treatment is not well elucidated. For stage IV disseminated extranodal natural killer/T cell lymphoma, induction chemotherapy with consolidative autologus or allogeneic hematopoietic stem cell transplantation is recommended as the major first-line treatment. However, there is controversy over which type of chemotherapy is most appropriate and effective as a bridge to autologus or allogeneic hematopoietic stem cell transplantation in patients with newly diagnosed disseminated advanced-stage or relapsed extranodal natural killer/T cell lymphoma because of cancer chemoresistance or associated complications. Pralatrexate is the first US Food and Drug Administration-approved novel agent for the treatment of refractory/recurrent peripheral T cell lymphomas. In our case, pralatrexate was used as a successful bridge to allogeneic hematopoietic stem cell transplantation in a patient with advanced-stage disseminated extranodal natural killer/T cell lymphoma refractory to first-line chemotherapy. We presented a case report of a 29-year-old Asian man diagnosed as having stage IV disseminated extranodal natural killer/T cell lymphoma, nasal type, with skin and bone marrow involvement, whose disease was primary refractory to first-line dexamethasone, methotrexate, ifosfamide, L-asparaginase, and etoposide chemotherapy, but obviously responded to treatment with two cycles of single-agent pralatrexate treatment. Monitoring Epstein–Barr virus viremia revealed dramatic downregulation. In addition to complete remission of the involvement of bone marrow and nasal cavity, skin involvement also obtained partial remission. The extranodal natural killer/T cell lymphoma successfully achieved complete remission after a bridge to allogeneic hematopoietic stem cell transplantation. This is the first study to present pralatrexate as a successful bridge to allogeneic hematopoietic stem cell transplantation in a 29-year-old Asian male patient with advanced-stage extranodal natural killer/T cell lymphoma refractory to first-line dexamethasone, methotrexate, ifosfamide, L-asparaginase, and etoposide chemotherapy. This case provides a novel treatment opinion for extranodal natural killer/T cell lymphoma, especially for the Far East Asian population.

中文翻译：

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一期化疗难以治愈的晚期结外鼻型自然杀伤/ T细胞淋巴瘤患者使用普拉瑞沙特作为异基因造血干细胞移植的桥梁

鼻外结节性自然杀伤/ T细胞淋巴瘤是成熟T细胞淋巴瘤的较常见亚型之一，尤其是在远东亚洲人群中。这种周围性T细胞淋巴瘤的侵袭性组织学亚型通常易受爱泼斯坦-巴尔病毒感染的影响。最佳治疗方法尚未充分阐明。对于IV期弥散性结外自然杀伤/ T细胞淋巴瘤，推荐采用合并自体或异体造血干细胞移植的诱导化疗作为主要的一线治疗。然而，对于因癌症化学耐药性或相关并发症而新诊断为弥散性晚期或复发性结外自然杀伤/ T细胞淋巴瘤的患者，哪种化学疗法最合适和最有效地作为自体或异基因造血干细胞移植的桥梁存在争议。Pralatrexate是美国食品药品监督管理局批准的首个用于治疗难治性/复发性外周T细胞淋巴瘤的新型药物。在我们的案例中，对于一线化疗难以治愈的晚期弥漫性结外自然杀伤性/ T细胞淋巴瘤患者，使用pralatrexate作为异基因造血干细胞移植的成功桥梁。我们提供了一个病例报告，其中一名29岁的亚洲男子被诊断患有IV期弥漫性鼻外自然杀伤/ T细胞淋巴瘤，鼻部类型，皮肤和骨髓受累，其疾病是一线地塞米松难治性甲氨蝶呤，异环磷酰胺，L-天冬酰胺酶和依托泊苷化学疗法，但显然对两个疗程的单药pralatrexate治疗有反应。监测爱泼斯坦-巴尔病毒的病毒血症显示出明显的下调。除了完全缓解了骨髓和鼻腔的受累外，皮肤受累也获得了部分缓解。异体造血干细胞移植的桥梁后，结外自然杀手/ T细胞淋巴瘤成功实现了完全缓解。这是第一项针对将29岁的亚洲男性晚期交界性自然杀伤/ T细胞淋巴瘤对一线地塞米松，甲氨蝶呤，异环磷酰胺，难治性晚期患者进行异体造血干细胞移植成功桥接的研究L-天冬酰胺酶和依托泊苷化疗。该病例为结外自然杀手/ T细胞淋巴瘤，尤其是远东亚洲人群提供了新颖的治疗意见。