T-CELL LYMPHOMA TREATMENT IN CHINA
— CD7 CAR-T AND BEYOND

T-cell lymphomas are uncommon, biologically diverse, and historically under-served by drug development compared with B-cell lymphomas. Most patients respond initially to chemotherapy, but relapse rates are high and long-term outcomes have been poor for many subtypes. Until recently, the main options after relapse were salvage chemotherapy, allogeneic stem cell transplant in fit patients, and a small number of approved targeted agents in selected subtypes. CAR-T cell therapy was difficult to apply to T-cell cancers for two main reasons. First, the antigens used to target B-cell lymphomas, such as CD19 and CD20, are not present on T-cell tumours. Second, antigens shared by both healthy T cells and lymphoma cells, such as CD7, raise the risk of the engineered CAR-T cells attacking each other during manufacturing, a problem called fratricide. Chinese investigators have led much of the global work to solve these problems, using approaches such as CRISPR or gene-editing to remove CD7 from the engineered cells, donor-derived autologous CAR-T from a healthy donor instead of the patient, and off-the-shelf allogeneic CAR-T platforms. China is most relevant for T-cell lymphoma when the disease has relapsed after first-line therapy, when transplant is not feasible or has already failed, when the family wants to explore CD7 CAR-T or allogeneic cell therapy before committing to stem cell transplant, or when no further standard option exists locally.

T-cell lymphomas arise from mature or precursor T cells and natural killer cells. They make up roughly 10 to 15 per cent of non-Hodgkin lymphomas globally, with relatively higher frequency in parts of Asia, including China, Japan, and South Korea. Each subtype has its own biology and treatment pathway. Main Subtypes Relevant to This Page The exact subtype, stage, EBV status, CD30 expression, T-cell receptor gene rearrangement findings, and patient fitness all influence treatment. Several subtypes share aggressive behaviour and a tendency to relapse, which is why advanced cellular therapies are increasingly important in this space.

• Peripheral T-cell lymphoma, not otherwise specified (PTCL-NO

  Peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS) — the largest single group, often aggressive

• Angioimmunoblastic T-cell lymphoma (AITL) — usually aggressi

  Angioimmunoblastic T-cell lymphoma (AITL) — usually aggressive with characteristic clinical and molecular features

• Anaplastic large cell lymphoma (ALCL), ALK-positive and ALK-

  Anaplastic large cell lymphoma (ALCL), ALK-positive and ALK-negative — generally CD30-positive, with brentuximab vedotin as a key drug

• T-cell lymphoblastic lymphoma and T-cell acute lymphoblastic

  T-cell lymphoblastic lymphoma and T-cell acute lymphoblastic leukaemia (T-ALL) — closely related precursor T-cell malignancies treated with leukaemia-style protocols

• Extranodal NK/T-cell lymphoma, nasal type — strongly EBV-ass

  Extranodal NK/T-cell lymphoma, nasal type — strongly EBV-associated, treated with asparaginase-based regimens, common in East Asia

• Adult T-cell leukaemia/lymphoma (ATLL) — HTLV-1-related, wit

  Adult T-cell leukaemia/lymphoma (ATLL) — HTLV-1-related, with distinct treatment considerations

• Cutaneous T-cell lymphomas including mycosis fungoides and S

  Cutaneous T-cell lymphomas including mycosis fungoides and Sézary syndrome

• Hepatosplenic T-cell lymphoma and other rare aggressive subt

  Hepatosplenic T-cell lymphoma and other rare aggressive subtypes

First-Line Treatment For most aggressive T-cell lymphomas, first-line treatment is intensive chemotherapy. CHOP and CHOEP regimens are common, with brentuximab vedotin replacing vincristine in CD30-positive ALCL and other CD30-positive PTCL through the BV-CHP protocol. Younger and fit patients, especially those with PTCL-NOS, AITL, and ALK-negative ALCL, are often considered for autologous stem cell transplant in first remission to consolidate response. T-cell lymphoblastic lymphoma and T-ALL are usually treated with paediatric-inspired or adult acute leukaemia protocols, including induction, consolidation, CNS prophylaxis, and prolonged maintenance, with allogeneic stem cell transplant considered for high-risk patients. NK/T-cell lymphoma typically uses asparaginase-based regimens such as SMILE, P-GEMOX, or modified DDGP, often with concurrent or sandwich radiotherapy for early-stage nasal disease. Cutaneous T-cell lymphomas are treated stage-by-stage, ranging from skin-directed therapies to systemic agents and, in advanced disease, transplant or trials. Relapsed and Refractory Treatment When the disease relapses, options depend on subtype, prior therapy, and fitness. They include alternative chemotherapy regimens, brentuximab vedotin in CD30-positive disease, romidepsin, belinostat, pralatrexate, gemcitabine-based combinations, and immunomodulatory agents in selected subtypes. Allogeneic stem cell transplant is considered for fit patients with chemo-sensitive relapse and remains an important curative option for several T-cell lymphomas. For NK/T-cell lymphoma, anti-PD-1 antibodies have shown meaningful activity in relapsed disease, with several Chinese-developed agents widely used. CD7 CAR-T Cell Therapy CD7 is expressed on most T-cell lymphoblastic lymphomas, T-ALL, and several mature T-cell lymphomas, making it a logical CAR-T target. The challenge is that CD7 is also present on healthy T cells, including the very T cells used to make CAR-T, which can cause fratricide during manufacturing. Chinese centres have pioneered several solutions, including gene-edited CAR-T where CD7 is knocked out of the engineered cells, naturally selected fratricide-resistant CAR-T platforms, donor-derived CD7 CAR-T using cells from a related healthy donor instead of the patient, and off-the-shelf allogeneic CD7 CAR-T. Published and ongoing Chinese studies in CD7 CAR-T for T-ALL and T-cell lymphoblastic lymphoma have shown high response rates, including in heavily pre-treated patients, with the cell therapy often used as a bridge to allogeneic stem cell transplant. CD7 CAR-T is an evolving field rather than a fully approved standard therapy in most countries, but China has the most active clinical pipeline globally and several centres are willing to evaluate international cases. Other Cellular and Targeted Approaches Beyond CD7, additional T-cell lymphoma targets explored in Chinese trials include CD5 CAR-T, CD30 CAR-T for CD30-positive lymphomas, TRBC1-directed CAR-T, and CAR-NK platforms. Approved or trial-stage targeted and immunotherapy options include brentuximab vedotin for CD30-positive disease, anti-PD-1 antibodies for NK/T-cell lymphoma, EZH1/EZH2 inhibitors and HDAC inhibitors in selected subtypes, mogamulizumab for ATLL and cutaneous T-cell lymphomas in some markets, and combinations involving azacitidine in AITL with TET2 or DNMT3A mutations.

Eligibility is always reviewed by the treating hospital and depends on multiple factors:

• Confirmed pathology of a T-cell lymphoma or T-cell leukaemia

  Confirmed pathology of a T-cell lymphoma or T-cell leukaemia, with subtype clearly stated

• Antigen expression confirmed by IHC and flow cytometry, incl

  Antigen expression confirmed by IHC and flow cytometry, including CD7, CD3, CD5, CD30, and TRBC1 where relevant

• Relapsed or refractory disease, usually after at least one o

  Relapsed or refractory disease, usually after at least one or two prior lines of systemic therapy, depending on subtype and protocol

• For NK/T-cell lymphoma, prior asparaginase-based therapy and

  For NK/T-cell lymphoma, prior asparaginase-based therapy and where relevant anti-PD-1 exposure

• No clinically significant CNS lymphoma, or treated and stabl

  No clinically significant CNS lymphoma, or treated and stable CNS disease in selected protocols

• Adequate organ function — heart, liver, kidney, lung — and a

  Adequate organ function — heart, liver, kidney, lung — and acceptable blood counts

• ECOG performance status, typically 0 to 2, depending on prot

  ECOG performance status, typically 0 to 2, depending on protocol

• No active uncontrolled infection, including hepatitis B, hep

  No active uncontrolled infection, including hepatitis B, hepatitis C, HIV, or active EBV viraemia outside protocol allowances

• Available related healthy donor for donor-derived CAR-T path

  Available related healthy donor for donor-derived CAR-T pathways, where required by the protocol

• Realistic plan for allogeneic stem cell transplant after CD7

  Realistic plan for allogeneic stem cell transplant after CD7 CAR-T in many cases, since cell therapy is often used as a bridge to transplant in T-cell malignancies

• Travel fitness and a realistic plan for several weeks of in-

  Travel fitness and a realistic plan for several weeks of in-country care

The completeness of records often determines how quickly a meaningful plan can be built. The following are typically requested:

• Latest medical summary and treating haematologist's or oncol

  Latest medical summary and treating haematologist's or oncologist's opinion

• Original biopsy and histopathology report confirming the spe

  Original biopsy and histopathology report confirming the specific T-cell lymphoma subtype

• IHC report including CD3, CD2, CD4, CD5, CD7, CD8, CD30, CD5

  IHC report including CD3, CD2, CD4, CD5, CD7, CD8, CD30, CD56, TIA-1, granzyme B, ALK, Ki-67, and other relevant markers

• Flow cytometry report from blood, marrow, or tissue

  Flow cytometry report from blood, marrow, or tissue

• T-cell receptor gene rearrangement study where performed

  T-cell receptor gene rearrangement study where performed

• Bone marrow aspiration and biopsy report

  Bone marrow aspiration and biopsy report

• EBV studies, including EBER in situ hybridisation for NK/T-c

  EBV studies, including EBER in situ hybridisation for NK/T-cell lymphoma and EBV viral load in blood

• HTLV-1 status if relevant by region or clinical features

  HTLV-1 status if relevant by region or clinical features

• Recent PET CT report covering neck to thigh, and any prior P

  Recent PET CT report covering neck to thigh, and any prior PET CT for comparison

• CT, MRI, and ENT or skin imaging where relevant

  CT, MRI, and ENT or skin imaging where relevant

• Lumbar puncture and CSF analysis if performed

  Lumbar puncture and CSF analysis if performed

• Complete blood count, LDH, beta-2 microglobulin, liver and k

  Complete blood count, LDH, beta-2 microglobulin, liver and kidney function tests

CancerFax supports T-cell lymphoma cases through a structured pathway:

• Case review — subtype, stage, EBV status, CD7 and CD30 expre

  Case review — subtype, stage, EBV status, CD7 and CD30 expression, prior treatments, current disease behaviour, and transplant history are reviewed against the most relevant treatment options.

• Pathology and biomarker check — IHC, flow cytometry, and mol

  Pathology and biomarker check — IHC, flow cytometry, and molecular reports are checked, and missing investigations such as CD7 expression, EBV studies, or repeat biopsy are flagged before hospital review.

• Hospital and trial matching — the case is shared with approp

  Hospital and trial matching — the case is shared with appropriate Chinese cancer centres running CD7 CAR-T programmes, allogeneic CAR-T trials, anti-PD-1 protocols for NK/T-cell lymphoma, or other relevant trials.

• Bridging strategy — for patients with progressing disease, C

  Bridging strategy — for patients with progressing disease, CancerFax helps coordinate timing between current local treatment and CAR-T or trial admission in China, and helps plan a possible bridge to allogeneic transplant.

• Cost and stay planning — patients receive a clear picture of

  Cost and stay planning — patients receive a clear picture of expected hospital charges, lymphodepletion, infusion, monitoring, accommodation, and follow-up timelines.

• Travel and admission support — visa guidance, interpreter co

  Travel and admission support — visa guidance, interpreter coordination, hospital communication, and admission planning are handled in one pathway.

• Continuity after return home — CancerFax helps maintain comm

  Continuity after return home — CancerFax helps maintain communication between the Chinese treating team and the patient's local oncologist for follow-up scans, lab work, transplant planning, and any further therapy.

This comparison is general. Many patients with T-cell lymphoma receive CAR-T as a bridge to allogeneic transplant rather than as an alternative. The treating haematology team makes the final decision based on subtype, prior treatments, donor availability, and overall fitness.

Advanced T-cell lymphoma care, including CD7 CAR-T programmes, allogeneic CAR-T trials, anti-PD-1 protocols for NK/T-cell lymphoma, and stem cell transplant, is offered at major academic and specialist centres across China. This includes leading institutions in Beijing, Shanghai, Guangzhou, Tianjin, and other cities, with strong programmes at the Chinese Academy of Medical Sciences and National Cancer Center, Fudan University Shanghai Cancer Center, Renji Hospital, Ruijin Hospital, Peking University Cancer Hospital, Sun Yat-sen University Cancer Center, and several dedicated haematology and cell therapy units. T-cell lymphoma cell therapy is concentrated in a smaller number of centres than B-cell CAR-T, because the science is newer and the manufacturing more complex. The right centre depends on subtype, planned target (CD7, CD5, CD30, TRBC1, or other), donor availability, and trial status rather than hospital name alone. CancerFax helps match the case with a centre that fits the clinical situation, not the other way around.

Frequently Asked Questions

Answers to common questions from patients and families.

Structured reference data summarizing key information for this topic.