The role of allogeneic stem cell transplantation in peripheral T-cell lymphoma

Peripheral T-cell lymphomas (PTCLs) are rare, biologically heterogeneous malignancies associated with poor outcomes following conventional chemotherapy. Despite advances such as brentuximab vedotin-based regimens in CD30-positive disease, relapse rates remain high, particularly in relapsed/refractory (R/R) PTCL. Allogeneic hematopoietic cell transplantation (allo-HCT) represents a potentially curative treatment option through a graft-versus-lymphoma effect capable of overcoming chemoresistance. Retrospective and prospective studies report 5-year overall survival rates of approximately 40-55% in selected patients, although non-relapse mortality and graft-versus-host disease remain significant limitations. Reduced-intensity conditioning has expanded eligibility without compromising disease control. Novel targeted agents, epigenetic therapies, bispecific antibodies, and emerging cellular approaches are reshaping the therapeutic landscape and may serve as effective bridges to allo-HCT or as post-transplant maintenance strategies. This review summarizes current evidence regarding the role of allo-HCT in PTCL, discusses patient selection and transplant-related variables, and explores evolving strategies aimed at improving survival while minimizing toxicity.