2021 CSCO Expert Interview｜Professor Ma Jun: Hematological tumors are progressing rapidly, and there is a long way to go for standardized diagnosis and treatment

The 24th National Conference on Clinical Oncology and the 2021 CSCO Annual Conference will be held on September 25-29, 2021.
The theme of this conference is "Focus on Innovative Research, Leading the Original Future"
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In recent years, there has been more research progress in the field of malignant hematological tumors, and the emergence of many new drugs and new therapies has improved the prognosis of patients with malignant hematological tumors
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However, there is still room for improvement in the level of diagnosis and treatment of malignant hematological tumors in China.
It is necessary to further promote standardized diagnosis and treatment to bring better prognosis for patients with malignant hematological tumors
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During the CSCO conference, Yimaitong was fortunate to invite Professor Ma Jun from the Harbin Institute of Hematology and Tumor to share on the current status of the treatment of malignant hematological tumors and the promotion of standardized diagnosis and treatment
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Yimaitong: First of all, could you please introduce the current status of the treatment of malignant hematological tumors, and what breakthroughs have been made in various types of hematological malignancies in recent years? Professor Ma Jun has made great progress in leukemia, lymphoma, myeloma and other diseases of malignant hematological tumors in recent years
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First of all, in acute myeloid leukemia (AML) in leukemia, many new drugs have emerged in recent years, such as FLT-3 inhibitors, BCL-2 inhibitors, and IDH1 inhibitors
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These new drugs combined with demethylation drugs and histone deacetylase inhibitors have brought better prognosis for AML patients
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For FLT-3 positive AML patients, the FLT-3 inhibitor geritinib can bring a higher complete remission (CR) rate, effectively bridging the subsequent allogeneic hematopoietic stem cell transplantation, and bringing clinical cures to some patients
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The recently approved BCL-2 inhibitor Venecla and azacitidine brings a new treatment option for elderly AML patients who cannot receive intensive chemotherapy.
This program can bring up to 18 months for elderly AML patients Survival
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IDH1-positive AML patients can also achieve long-term survival through treatment with IDH1 inhibitors
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The emergence of many high-efficiency new drugs has brought the treatment of AML into the era of individualized targeted therapy
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 Acute lymphocytic leukemia (ALL) has also seen many new drugs in recent years, including monoclonal antibodies, bispecific antibodies, and antibody-drug conjugates
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The recently approved CD19/CD3 bispecific antibody belintoux has a complete remission rate of 42% for the treatment of relapsed and refractory ALL, and the remission rate can be further increased to nearly 70% when combined with other drugs
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Belintoomab can also effectively bridge allogeneic hematopoietic stem cell transplantation, increasing the success rate of allogeneic hematopoietic stem cell transplantation to 80%
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The CD22 antibody drug conjugate Inotuzumab Ozogamicin also showed good efficacy in relapsed and refractory ALL, with a total remission rate of up to 70%.
Bridging allogeneic hematopoietic stem cell transplantation can bring long-term survival for more than 50% of relapsed and refractory ALL
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 The emergence of many breakthrough new drugs has also brought about changes in the treatment of patients with chronic leukemia
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At present, the 20-year disease-free survival rate of patients with chronic myeloid leukemia (CML) after treatment with tyrosine kinase inhibitor imatinib has reached 88%, and more than 100,000 CML patients in China have been treated with tyrosine kinase inhibitors Get long-term survival
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The BTK inhibitors ibrutinib, zebutinib, and abutinib also brought considerable long-term survival for patients with chronic lymphocytic leukemia (CLL)
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At present, some chronic leukemias can be managed throughout the whole process like hypertension, diabetes and other chronic diseases, which significantly improves the quality of life of patients
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 Multiple myeloma (MM) is a senile disease, and the median age of onset of patients is close to 60 years
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MM has also made more research progress in recent years
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The emergence of new drugs such as proteasome inhibitors, anti-angiogenesis drugs, immunomodulators, monoclonal antibodies, antibody-drug conjugates, and nuclear protein export inhibitors has extended the median survival of MM patients from about 3 years to more than 8 years
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Chimeric antigen receptor T cell (CAR-T) immunotherapy targeting BCMA has also achieved excellent results in patients with relapsed and refractory MM
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A variety of new drugs and new therapies combined with traditional immunochemotherapy and autologous hematopoietic stem cell transplantation enable MM patients to be managed in a full-process like many chronic diseases
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The field of lymphoma has also progressed rapidly in recent years.
At present, China has approved 54 drugs for the treatment of lymphoma, including various small molecule inhibitors, monoclonal antibodies, bispecific monoclonal antibodies, antibody-drug conjugates, and CAR- T therapy
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At present, the clinical cure rate of lymphoma patients in China's first-tier cities, that is, the 5-year disease-free survival rate has reached 70%
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However, due to differences in economic levels and standardization of diagnosis and treatment across the country, the overall 5-year survival rate of lymphoma patients in China is only 37.
2%, which is still far from the 5-year survival rate of more than 70% of lymphoma patients in Europe and the United States
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We need to further promote the standardized diagnosis and treatment of lymphoma, so as to bring longer survival for patients with lymphoma and allow more patients with lymphoma to be cured
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The Healthy China 2030 strategy proposes to increase the 5-year survival rate of lymphoma patients in China to 46%.
In order to achieve this goal, we have a long way to go
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 CAR-T therapy has opened a new era for the treatment of leukemia, myeloma, and lymphoma
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This year, China approved two CAR-T therapies, Akilunza injection and Reki Orenza injection for the treatment of relapsed and refractory large B-cell lymphoma, bringing hope of disease cure for some lymphoma patients
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CAR-T therapy has also achieved excellent results in related studies on leukemia and myeloma
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But it should be emphasized that CAR-T cells are not omnipotent, nor are they omnipotent
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Currently, studies carried out on a global scale show that the 4-year disease-free survival rate for patients with relapsed and refractory large B-cell lymphoma treated with CAR-T therapy is 44%
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In other words, CAR-T therapy cannot cure all patients with hematological malignancies
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It is hoped that clinicians, patients, and their families can correctly recognize this new therapy
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Although there are still no drugs or treatments that can cure all patients with hematological malignancies, our clinicians will continue to work hard to prolong the survival of patients and bring better quality of life to more patients
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Yimaitong: The CSCO Guide has now become an important guide book for hematology clinicians.
For the further promotion of standardized diagnosis and treatment of malignant hematological tumors nationwide in the future, what plans does the CSCO Society have? Professor Ma Jun CSCO Society has published guidelines and consensus on 42 diseases, including consensus guidelines on 11 malignant hematological diseases, covering lymphoma, myeloma, leukemia, myelodysplastic syndrome (MDS) and other diseases
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In addition, pediatric leukemia, pediatric lymphoma, and hematopoietic stem cell transplantation have also published relevant guidelines to guide clinicians in diagnosis and treatment
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The CSCO guidelines are updated annually based on the latest evidence-based medicine at home and abroad, and have become one of the most commonly used clinical guidelines in the country
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 At present, the main problem in the diagnosis and treatment of malignant hematological tumors in China is the irregular diagnosis and treatment
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The purpose of publishing the consensus on clinical guidelines is to enable doctors at all levels across the country to provide standard treatment to patients in a standardized manner
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Only by implementing the standardized treatment, precise treatment, and individualized treatment in the consensus of clinical guidelines can it benefit the majority of patients with hematological malignancies
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 In order to further promote the standardized diagnosis and treatment of malignant hematological tumors across the country, the CSCO Society organizes nearly 300 guideline presentations every year, which are implemented in the grassroots of hospitals in all provinces, cities and counties across the country, and convey the concept of standardized diagnosis and treatment of hematological malignancies to clinicians across the country
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The CSCO Society has launched a lymphoma specialist construction project with the National Health Commission’s Capacity Building and Continuing Education Center, integrated superior resources, and established a lymphoma specialist alliance consisting of four major centers: pathology center, clinical center, rehabilitation center, and full-process management center.
Promote the whole-process management and standardized diagnosis and treatment of malignant hematological tumors nationwide, and strive for a longer survival and higher cure rate for patients with malignant hematological tumors
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Professor Ma Jun, Chief Physician, Professor, and Doctoral Supervisor, Director of Harbin Institute of Hematological Oncology, Chairman of the Supervisory Board of the Chinese Society of Clinical Oncology (CSCO) Vice Chairman of the Asian Society of Clinical Oncology, Chairman of the CSCO Anti-Leukemia Alliance Former Deputy Director of the Hematology Branch of the Chinese Medical Association Committee Member, Chinese Medical Doctor Association, Hematologists Branch, Vice Chairman, Chinese Medical Doctor Association, Oncology Branch, Vice Chairman, CSCO Anti-Lymphoma Alliance Former Chairman, "Read the original text", and we will make progress together