2022CSH Professor Zhang Huilai: "No chemotherapy" improves the quality of life of patients with indolent lymphoma, and precise stratification brings the dawn of cure to R/R patients

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The 17th National Hematology 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 famous experts at home and abroad to discuss the latest progress
in the field of blood diseases.
On this occasion, Yimaitong specially invited Professor Zhang Huilai of Tianjin Medical University Cancer Hospital to give an interview on the treatment progress of diffuse large B-cell lymphoma (DLBCL), "chemo-free" treatment and precision stratified therapy
.

Yimaitong: DLBCL is the most common B-cell malignant tumor, how is the treatment progress of DLBCL? What unmet treatment needs remain?

Professor Zhang Huilai: In recent years, many advances have been made in the treatment of DLBCL, 50%~60% of DLBCL patients can achieve clinical cure through the standard first-line treatment R-CHOP regimen (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone), and the remaining 40%~50% of patients with DLBCL will still have relapse and refractory (R/R)
after first-line treatment.
Half of these R/R patients may be suitable for autologous hematopoietic stem cell transplantation (ASCT), ASCT is an important salvage treatment for patients with R/R DLLBCL, especially high-risk patients, and ASCT is
preferred if patients with DLBCL are chemotherapy-sensitive and relapse.
However, fewer patients are candidates for ASCT and can benefit from it, and patients who are unsuitable for ASCT or who relapse after receiving ASCT, and those who develop disease progression within one year of first-line therapy (suggesting that the patient may be resistant to drugs) tend to have a poorer
prognosis.
In the era of immunotherapy, such patients can choose chimeric antigen receptor T cell (CAR-T) therapy to obtain a good cure
.

Looking at domestic and foreign research data, for patients with refractory (especially chemotherapy-refractory) DLBCL, the overall response rate (ORR) of second-line salvage therapy is < 30%, the complete response (CR) rate is < 10%, and the median survival time is about 6 months<b10>.
If such patients choose CAR-T therapy, the 5-year overall survival (OS) rate can reach 42.
6%.

In general, CAR-T therapy brings good survival benefits for patients who are not suitable for ASCT or refractory DLBCL, which can be described as an important treatment direction
for DLBCL.

Medical Pulse: Due to the many advances made in the fields of targeted therapy and immunotherapy, "whether the chemotherapy-free regimen can make patients get a better prognosis" has become a topic
of great concern in the field of indolent lymphoma.
So do you think all indolent lymphomas should be treated with "no chemotherapy"? What is the place of chemotherapy in the treatment of indolent lymphoma?

Professor Zhang Huilai: In the era of new drugs, patients with indolent lymphoma can achieve long-term survival and improve their quality of life, among which improving the quality of life is the main treatment goal
of indolent lymphoma.
More patients with indolent lymphoma are candidates for a "no chemotherapy" regimen, mainly because it reduces toxicity and allows patients to achieve longer progression-free survival (PFS).

Patients with indolent lymphoma are difficult to completely cure, often have repeated recurrence and disease progression, and patients who have undergone fifth- to six-line therapy have poor survival, while "no chemotherapy" treatment regimens can make these patients achieve longer quality survival and reduce the possibility of
recurrence.

Yimaitong: In order to improve the treatment prognosis of lymphoma patients, precision stratified therapy has attracted more and more attention and advocate, can you please introduce the current situation and unmet needs of precision stratification treatment of lymphoma in China?

Professor Zhang Huilai: At present, precision stratified therapy is not easy to be carried out clinically on a large scale, involving many problems, such as 50%~60% of DLBCL patients can achieve clinical cure through first-line R-CHOP treatment, for these patients, precision treatment is not necessary
.
For the other 40%~50% of patients who have switched to R/R DLBCL, especially for high-risk patients, precision stratified therapy may have better application space
in the future.

Therefore, under the national conditions that many drugs in China have not entered medical insurance and the economic burden of patients is heavy, some low-risk DLBCL patients are not necessarily suitable for precise stratified treatment in the first-line treatment, and for R/R patients, the main treatment direction is to adopt precise stratified treatment as much as possible to give patients a chance
to cure.

Zhang Huilai Professor

Doctor of Oncology, Chief Physician, Doctoral Supervisor

He is currently the director of the Department of Lymphoma Medical Medicine, Cancer Hospital of Tianjin Medical University

His main research interests include molecular diagnosis and individualized treatment of malignant lymphoma

Vice Chairman of the Lymphoma Professional Committee of the Chinese Anti-Cancer Association

Member of the Standing Committee of the Lymphoma Expert Committee of the Chinese Society of Clinical Oncology (CSCO).

Member of the Lymphoma Group of the Oncology Branch of the Chinese Medical Association

Vice Chairman of Medical Oncology Branch of China Medical Promotion Association

Vice Chairman of the Lymphatic Disease Special Committee of the Chinese Medical Education Association

Vice Chairman of the Lymphoma Professional Committee of the Chinese Geriatric Health Care Association

Chairman of the Cancer Clinical Chemotherapy Special Committee of Tianjin Anti-Cancer Association

Vice Chairman of Tianjin Hematology Quality Control Center

Vice President of Hematologist Branch of Tianjin Medical Doctor Association

He has won 1 second prize and 3 third prizes of Tianjin Science and Technology Progress Award, and has presided over and participated in a number of National Natural Science Foundation projects and provincial and ministerial scientific research projects
.
At present, he serves as the deputy editor of "Oncology Pharmacy", "Chinese Journal of Hematology", "Leukemia Lymphoma", "Chinese Clinical Oncology", "Hematological Oncology", "Blood Research", "Discover Oncology" and other domestic and foreign journals and magazines, and is the first or corresponding author in Blood, J Exp Med, JITC, Leukemia , CTM, AJH, Clin Immunol, BJH, Blood Adv, Front Oncol, Hematol Oncol, Int J Cancer and other international professional journals, as well as Chinese series of magazines, national core journals have published more than 70 articles
.
Won the 4th "National Famous Doctor, Excellent Style" award
.