2021 China AML Guidelines Update!

Following 2017, the first diagnosis and treatment guidelines for adults with acute myeloid leukemia (non-APL) will be updated in 2021 after a lapse of 4 years
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The first-line treatment of acute myeloid leukemia (AML) is based on strong induction chemotherapy, but many AML patients have poor tolerance to chemotherapy and have limited treatment options
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With the approval of new targeted drugs such as the BCL-2 inhibitor Veneclax in China, the treatment model for AML has been changed and the Chinese guidelines for diagnosis and treatment of AML have been rewritten
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In order to allow more cancer clinicians to learn about the latest developments in AML diagnosis and treatment in the first time, Yimaitong specially invited Professor Wang Jianxiang from the Hospital of Hematology of the Chinese Academy of Medical Sciences and Professor Wu Depei from the First Affiliated Hospital of Soochow University to share the updated contents and academic views of the guidelines
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Message from Experts The new version of the AML Guide brings together the wisdom and strength of many domestic experts in the field of hematology and tumors.
It is a clinical practice guide for AML in China.
I hope this guide will help and guide our clinical diagnosis and treatment.
I hope everyone can Refer to the guidelines to treat more patients and bring better treatment effects to patients
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——Professor Wang Jianxiang hopes that the new version of the AML guidelines can provide our hematology workers, especially hematology oncologists, with a basic and standardized diagnosis and treatment to follow, which can bring the greatest benefits to patients and enable our Chinese hematology Make the best sound on the world stage
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——Professor Wu Depei recalled that the diagnosis and treatment of AML in China has achieved a "qualitative leap" in the past.
The diagnosis and treatment of acute leukemia, including AML in China, has experienced a long period of development
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Professor Wang Jianxiang said that in terms of diagnosis, it has been difficult to determine whether it is a myeloid phenotype in the past, and now it can accurately diagnose the molecular type of the disease, which greatly improves the accuracy of AML diagnosis
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 In the treatment of AML, from the pursuit of remission in the past to the current pursuit of long-term survival, it has also experienced a "qualitative leap
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"
Professor Wang Jianxiang said that at the beginning, the treatment of AML was lacking and there was no good treatment strategy, so the remission rate of treatment at that time was very low; subsequent with the rapid development of chemotherapy regimens, the remission rate of AML has increased significantly
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Since then, we have begun to pursue higher goals, that is, how to maintain remission and even achieve "long-term cure"
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 After continuous exploration and experimentation, such as adopting high-dose chemotherapy, introducing targeted drugs, and carrying out allogeneic hematopoietic stem cell transplantation, the overall treatment level of AML in our country has finally undergone a qualitative change
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Professor Wang Jianxiang said, “At present, the level of AML treatment in some of our single-center hospitals is comparable to that of counterparts in the United Kingdom and the United States, and not inferior to them
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” Professor Wu Depei said: “We continue to promote the department of'unity, cooperation, truth-seeking and innovation, and taking advantage of the trend'.
Culture, following the latest international academic views, actively exploring, and cultivating a large number of hematology talents
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Now our hematology discipline is showing a good situation of vigorous development like our country
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"The updated highlights of the AML diagnosis and treatment guidelines are attracting attention, Professor Wu Depei said.
The update is more in line with the current clinical diagnosis and treatment situation and meets the clinical needs, and provides basic follow-up to hematological oncologists, which has strong guiding significance
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 Professor Wang Jianxiang pointed out that the 2021 adult first-diagnosed AML diagnosis and treatment guidelines have the following three changes compared with the 2017 version of the guidelines: First, based on the latest clinical research results, the new version of the guidelines adds some in terms of AML diagnostic classification and prognosis stratification.
New cognition and standards, such as redefining the mutation load ratio of the FLT3 gene
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In the past, FLT3 mutations were considered poor prognosis, but now FLT3 low-load mutations, especially those with NPM1 mutations, are classified as a good prognosis group
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In addition, some molecular mutations have been given poor prognosis, such as RUNX1 and ASXL1 gene mutations
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In addition, the monomer karyotype and complex karyotype have also been redefined
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Therefore, a more accurate prognostic stratification of patients can be carried out from the initial treatment.
Of course, this work needs to be continuously improved in the future
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 Secondly, in terms of treatment, the new guideline puts more emphasis on the dose of initial induction chemotherapy
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Although no new chemotherapeutic drugs have appeared in recent years, increasing the dose of initial induction therapy to achieve a higher quality of remission is a critical step for successful treatment
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 Third, the emergence of innovative drugs has promoted the development of the entire AML treatment field and the transformation of treatment models
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Especially for newly diagnosed elderly (≥60 years of age) AML patients, BCL-2 inhibitors, veneclax combined with demethylation drugs, are added to the low-intensity treatment regimen
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For AML patients <60 years old, if they have severe comorbidities or cannot tolerate intensive chemotherapy, low-intensity treatment is also recommended
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In addition, in the diagnosis and treatment guidelines for relapsed and refractory AML, the FLT3 inhibitor geritinib combined with chemotherapy provides a new treatment strategy for patients with relapsed and refractory disease
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At the same time, the guide also introduces the application value of IDH1 and IDH2 inhibitors and BCL-2 inhibitor Venecla in relapsed and refractory AML
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 Professor Wu Depei added: “The new version of the guidelines also increases the level of recommendation.
The level of evidence is in accordance with Oxford University’s EBM Center’s five-level standard for document types, which improves clinical operability
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” Improved cognition and emphasis on practice to help maximize the value of new drugs.
With the emergence of innovative drugs, the treatment plan for AML has undergone major changes
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Professor Wu Depei said that in the past, some elderly patients and patients who were not suitable for intensive chemotherapy had poor prognosis and lacked consistent treatment opinions.
The emergence of innovative drugs such as the BCL-2 inhibitor Veneclax brought the dawn of life to these patients and provided them with A relatively standardized and standard treatment plan
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It is worth mentioning that these drugs not only have significant effects on patients who cannot receive intensive chemotherapy and elderly patients, but also help to improve the elimination of minimal residual disease (MRD) and create conditions for patients' long-term survival
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Therefore, hematology oncologists need to make good knowledge reserves, make full use of these weapons, and bring more benefits to patients
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 Professor Wang Jianxiang said that after Venecla is listed, many doctors will try to use it in various types of myeloid leukemia to improve the treatment effect
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However, it should be noted that when using the BCL-2 inhibitor combination program, everyone must have a full understanding of this drug
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Because the curative effect is improved, the drug sensitivity is also improved, which will affect the body's normal hematopoietic stem cells and progenitor cells, which may have varying degrees and time effects on the suppression of bone marrow and hematopoietic function
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 Therefore, in clinical practice, the specific dosage and course of treatment require long-term practical exploration and accumulation of experience
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In addition, the optimal time and dosage for different patients and different treatment periods (such as induction therapy, consolidation therapy, maintenance therapy) are also different, so it is necessary for everyone to fully understand before using this drug
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In short, we should fully understand the benefits of innovative drugs, and further improve the effectiveness of treatment on the basis of continuous exploration of safe dosages and treatment courses in clinical practice
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AML research is constantly exploring.
We have been working hard with the continuous deepening of understanding of AML diseases and the accumulation of more clinical research data, there will be more new discoveries and new cognitions in the future
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Professor Wang Jianxiang pointed out that AML is a highly heterogeneous disease.
There are still great challenges in the fine division and hierarchical management of AML patients.
This is where we need to continue to improve in the future
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 In terms of treatment, many new drugs continue to emerge, including inhibitors such as BCL-2, IDH1, IDH2, and FLT3.
It is believed that more targeted drugs will appear in the future to make AML treatment strategies more perfect
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Both professors said that how to better combine chemotherapy with targeted drugs, even between different targeted drugs, and whether low-intensity chemotherapy or even targeted drugs can be used instead of chemotherapy.
These are all open Sexual scientific issues need to be further explored
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 Professor Wang Jianxiang also said, “At present, immunotherapy has made major breakthroughs in the field of lymphatic system diseases, but its efficacy in myeloid system diseases is relatively poor.
This requires us to do more work on immune escape and immune suppression mechanisms
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At present .
Immunotherapy is still in the initial introduction stage in the treatment of AML.
It is believed that more immunotherapy drugs will emerge in the future, which will play a greater role in the treatment of AML, and the efficacy will be steadily improved
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"Professor Wang Jianxiang, Chief Physician, Professor, Doctoral Supervisor, Deputy Director of the Hematology Hospital (Institute of Hematology), Chinese Academy of Medical Sciences, and Director of the Leukemia Clinic Center; Former Chairman of the Hematology Branch of the Chinese Medical Association; Former Chairman, Chinese Physician Vice President of the Society of Hematologists, Deputy Chairman of the Experimental Hematology Branch of the Chinese Society of Pathophysiology, Professor Wu Depei, Member of the American Society of Hematology, Chief Physician, Professor, and Doctoral Supervisor, Director of the Department of Hematology, The First Affiliated Hospital of Soochow University, National Clinical Medical Research on Hematological Diseases Executive Deputy Director of the Center Deputy Director of Jiangsu Institute of Blood Disclaimer: This [article/share] is only for academic reference by health and medical professionals in mainland China, not for the general public
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If you are not a health and medical professional, Please do not read or spread this [article/share]
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This [article/share] is supported by AbbVie, and the specific content is independently produced, reviewed and published by Yimaitong
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