2022CSH Professor Song Yongping: The development of auto-HSCT needs attention, and the appropriate pre-transplant treatment scheme is crucial to improving the cure rate and safety of HSCT!

The 17th National Hematology Academic Conference of the Chinese Medical Association was grandly opened in Shanghai on September 23-25, 2022, with the theme of "respect, inheritance, collaboration and innovation", and invited well-known experts at home and abroad to talk about the latest progress
in the field of blood diseases.
On this occasion, Yimaitong specially invited Professor Song Yongping of the First Affiliated Hospital of Zhengzhou University to be interviewed to share the application status and development prospects of hematopoietic stem cell transplantation (HSCT) in blood diseases combined with clinical experience, as well as the development status
of HSCT pretreatment program.

The application status and development prospects


of HSCT in blood diseasesIs the application of HSCT in the field of blood diseases on the rise or down? What blood diseases can hematopoietic stem cell transplantation be applied to? With the clinical application of targeted therapy and immunotherapy, these questions have new answers
.

HSCTs remain an effective treatment for leukemia, lymphoma, multiple myeloma, and severe blood disorders (e.
g.
, aplastic anemia of the majority, thalassemia, and other genetic disorders of the blood system
).
From the perspective of the current situation of transplantation in China, allogeneic hematopoietic stem cell transplantation (allo-HSCT) technology has reached the international leading level
.
The "Beijing Scheme" of haplo-pooled hematopoietic stem cell transplantation (haplo-HSCT) system created by Professor Huang Xiaojun has been widely recognized by
international peers.
Among the patients currently undergoing HSCT in China, 70%-80% of patients receive allo-HSCT, while more than half of the patients in allo-HSCT receive haplo-HSCT
.
Overall, the number of non-hematopoietic stem cell transplants (URD-HSCTs) in China is increasing year by year, which indicates that the development trend of URD-HSCT is good
.

Although targeted therapy, immunotherapy, and CAR-T cell therapy have achieved good efficacy in lymphoma and multiple myeloma, autologous hematopoietic stem cell transplantation (auto-HSCT) is still an effective treatment for some lymphoma patients (high-risk, early recurrence, and sensitive to chemotherapy) and multiple myeloma
.
However, in terms of auto-HSCT, there is still a gap
between China and the international leading level.
In developed countries in Europe and the United States, the total number of auto-HSCTs has surpassed allo-HSCT, accounting for 60%-70%
of the total transplant volume.
Compared with developed countries in Europe and the United States, China's population base is huge, but the status quo of auto-HSCT is not satisfactory, and the number of cases of auto-HSCT in China throughout the year is only about
4,000.
However, compared with allo-HSCT, auto-HSCT has lower technical requirements and medical costs, and is safer
.
Therefore, in the future, the application
of auto-HSCT should be further promoted and popularized.



The development status


of pre-transplant pretreatment scheme HSCT is a system engineering, and pre-transplantation is a very important part
of this system engineering.
The purpose of pretreatment is to maximize the removal of tumor cells or abnormal cloned cells from the patient's body and prepare
for the "settlement" of transplanted hematopoietic stem cells.

Professor Thomas, the founder of HSCT, proposed a pretreatment scheme
for systemic radiotherapy (TBI) combined with cyclophosphamide through a large number of animal experiments and clinical practice.
With the development and advancement of HSCT, pretreatment schemes have also changed
.
In addition to the TBI+ cyclophosphamide regimen, there are currently pretreatment regimens for chemotherapy alone (busulfan + cyclophosphamide and the Mayfaren-based regimen
).
In 1989, Professor Yan Wenwei of the Institute of Hematology of the Chinese Academy of Medical Sciences proposed the pretreatment scheme based on Meifalen - Meipallen + cyclophosphamide + cytarabine (MAC) scheme, and in 1990 it was established as the standard pretreatment scheme
of auto-HSCT by the Hematology Branch of the Chinese Medical Association.
To date, the first patient with acute lymphoblastic leukemia who underwent auto-HSCT using the MAC pretreatment protocol has fully recovered for 33 years
.

The choice of pretreatment regimen also varies for different types of
diseases.
TBI technology is complex, difficult to implement, and can lead to a range of long-term complications
.
In recent years, with the deepening of the study of chemotherapy pretreatment regimens alone, researchers have found that chemotherapy alone has the same efficacy as
TBI+ chemotherapy in most diseases.
In leukemia, the pretreatment regimen is mainly based on the busulfan + cyclophosphamide regimen
.
In lymphoma and multiple myeloma, the pretreatment regimen is based primarily on the mepallan + other drug regimen
.
In aplastic anemia, ATG+ cyclophosphamide-based pretreatment regimens
are used.

In general, when selecting a patient pretreatment plan, the appropriate pretreatment scheme should be selected based on the patient's disease type, physical condition and organ function, so as to improve the cure rate and safety
of patients receiving HSCT.

Professor Song Yongping

• Chief physician, professor, doctoral supervisor

• Zhongyuan famous doctor, special allowance expert of the State Council

• Member of the 10th Standing Committee of the Hematology Branch of the Chinese Medical Association

• Vice President of the Hematology Branch of the Chinese Medical Doctor Association

• Vice President of Hematology Branch of Chinese Geriatrics Society

• Member of the Standing Committee of the Lymphoma Professional Committee of the Chinese Anti-Cancer Association

• President of Henan Life Care Association

• Vice President of Henan Medical Association

• Member of the Editorial Board of the Chinese Journal of Hematology

• Associate Editor, Journal of Leukemia Lymphoma

Editor: Wenting Review: Professor Song Yongping Typesetting: Quarterly Execution: moly

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