Professor Huang Xiaojun: Looking at the development of AML treatment models from the release of China's new guidelines

Recently, the long-awaited diagnosis and treatment guidelines for newly diagnosed adult acute myeloid leukemia (AML) and relapsed/refractory (R/R) AML diagnosis and treatment guidelines for 2021 are finally updated and officially published in the August 2021 issue of the Chinese Journal of Blood and Blood
.

This is another update after a lapse of 4 years after 2017, and will become an important reference for the diagnosis and treatment of AML in China
.

So what are the changes in the new guidelines, and how will they affect AML transplants? To this end, Yimaitong specially invited Professor Huang Xiaojun from Peking University People's Hospital to interpret this updated guideline from the perspective of transplantation
.

AML is the most important disease type of allo-HSCT in China From the data of Europe, America and China, AML is the most important disease type of allo-HSCT1
.

For many years, there has been a lack of effective drugs for AML, and HSCT is still the most effective way to cure AML
.

However, the timing and benefits of HSCT are different for AML patients with different risk strata
.

Overall, induction therapy to achieve complete remission (CR) is the current domestic AML transplant condition
.

For AML patients with good prognosis, it is generally not necessary to undergo allo-HSCT in CR1 phase, and transplantation can be determined based on the changes in minimal residual disease (MRD) after intensive treatment; for middle- and high-risk AML patients, transplantation is recommended in CR1 phase
.

In addition, patients who have achieved CR1 or ≥CR2 after more than 2 curative effects should strive for transplantation as soon as possible
.

If patients with R/R AML cannot obtain CR, salvage allo-HSCT can also be performed, and it is recommended to try in an experienced center2
.

However, the heterogeneity of AML disease is high, especially in some elderly patients, it is difficult to tolerate intensive chemotherapy and lose the opportunity to induce remission and receive transplantation.
These patients often have a poor prognosis, and it has always been a difficulty in clinical standardized treatment
.

The inclusion of a variety of innovative drugs in the new guidelines drives the success of AML transplantation.
This year's AML guidelines ushered in a bumper harvest.
The guidelines for the diagnosis and treatment of newly diagnosed AML for adults and the guidelines for R/R AML diagnosis and treatment have been updated simultaneously
.

The two editions of the guidelines incorporate many innovative drugs, such as BCL-2 inhibitors, FLT3 inhibitors, IDH1 inhibitors, etc.
4,5
.

The emergence of these innovative drugs not only brings more weapons to the treatment of AML, but also creates more conditions for patients to receive transplants
.

 For example, the application of innovative drugs before transplantation can increase the CR rate of AML patients and provide good support for further transplantation treatment
.

Taking the BCL-2 inhibitor Venecla as an example, the global phase III clinical trial VIALE-A study showed that the composite CR rate of Venecla combined with azacitidine reached 66.
4%, which was significantly higher than that of the azacitidine single-agent group ( 28.
3%) 5
.

Moreover, in a study announced at the 47th Annual Meeting of the European Association for Blood and Marrow Transplantation (EBMT 2021) in 2021, the combination of venexa and demethylation drugs is safe and effective in the treatment of high-risk AML patients, and nearly half of the patients in the study Accepted transplantation, suggesting that this program is an ideal program for AML bridging transplantation6
.

In addition, recurrence after transplantation is one of the important reasons for transplantation failure, and the combined use of new targeted drugs after transplantation can reduce the recurrence after transplantation for AML and provide guarantee for the long-term survival of AML patients
.

Promoted by the new guidelines, innovative drugs bring hope to patients who cannot be transplanted with AML.
Although allo-HSCT brings significant survival benefits to patients with AML, there are still many patients who are not eligible for transplantation due to various reasons, and even some patients are not suitable for receiving it.
With strong induction chemotherapy, the prognosis of these AML patients is very poor and the treatment options are very limited.
There is an urgent need for innovative and effective treatments to improve the prognosis of these patients
.

The release of the new version of the guidelines and the application of innovative drugs have brought tremendous changes to the treatment of AML, making the current treatment plan no longer limited to the standard "3+7 plan" and allo-HSCT
.

 In recent years, there have been many advances in innovative drugs for AML.
What is worth mentioning is the application of the BCL-2 inhibitor Venecla in AML, which can span gene mutations and directly act on the apoptotic pathway to exert anti-tumor effects
.

A number of studies have confirmed that veneclax combined with demethylating drugs (azacitidine or decitabine) or low-dose cytarabine can not only improve the remission rate of patients with unfit AML, but also have a faster remission and duration of remission Longer, significantly improve patient survival 5-9
.

Therefore, under the promotion of the new guidelines, the application of innovative drugs can also enable patients who do not have the conditions to receive transplants or are not suitable for intensive chemotherapy to obtain efficient treatment, allowing more AML patients to obtain long-term survival and a good quality of life
.

Summary The update of the AML guidelines has made more and more effective innovative drugs and treatments a powerful weapon in the hands of the majority of hematological oncologists
.

While transplantation technology continues to mature, the emergence of innovative drugs has continuously improved AML treatment strategies
.

The use of innovative drugs before transplantation can increase the remission rate of AML patients, expand the transplant beneficiary population, and improve the efficacy of transplantation; use innovative drugs after transplantation to reduce the risk of recurrence and prolong patient survival
.

More importantly, for those patients who are not suitable for transplantation or strong induction chemotherapy, innovative drugs can also provide long-term survival opportunities and hope of rebirth.

.

Following the new guidelines, combining innovative drugs, improving the success rate of transplantation, reducing transplant recurrence, and improving the outcome of AML patients is the direction we will continue to work hard in the future
.

Professor Huang Xiaojun, Doctoral Supervisor, Chief Physician, National "Ten Thousand Talents Program" Leading Talent, "Outstanding Youth", "Yangtze River Scholar" Director of the Institute of Hematology, Peking University, Director of the National Center for Clinical Medicine of Hematological Diseases National Key Discipline, National Clinical Key Specialist Director, Chinese Bone Marrow Bank Expert Committee Chairman, Chinese Pathophysiological Society Experimental Hematology Professional Committee Chairman, 9th Chinese Medical Association Hematology Branch Chairman, 4th Chinese Medical Doctor Association Hematology Branch Chairman, National Natural Science Foundation of China Innovation Group , Director of the Innovation Team of the Ministry of Education, Ministry of Science and Technology, Director of the Committee of Asia Pacific Hematology Consortium (IACRLR) Global Committee Member of the International Organization for Comparative Leukemia Research (IACRLR) Brit J Hematol, J Hematol & Oncol, Ann Hematol, Chin Med J and other core journals Associate Editor, Chief Editor of the 9th Chinese Journal of Hematology Disclaimer: This [article/share] is for academic reference only for health and medical professionals in mainland China, not for the general public
.

If you are not a health professional, please do not read or spread this [article/share]
.

This [article/share] is supported by AbbVie, and the specific content is independently produced, reviewed and published by Yimaitong
.

placebo-controlled study of venetoclax with azacitidine vs azacitidine intreatment-naïve patients with acute myeloid leukemia ineligible for intensivetherapy-viale-a.
the 25th eha annual congress.
abstract #lb2601.
8.
Genentech Announces Full FDA Approval forVenclexta Combinations for Acute Mye Leukemia.
Drugs.
com.
9.
Genentech Announces FDA Grants VenclextaAccelerated Approval for People With Newly-Diagnosed Acute Myeloid Leukemia orThose Who Are Ineligible For Intensive Induction Chemotherapy.
Drugs.
com.
RECOMMEND recommended reading 1.
2021 China AML Guidelines Update! After 4 years, finally waiting for you! 2.
["Wei" has come] The first Bcl-2 inhibitor Weikelai® has been authoritatively blessed by the latest CSCO guidelines.
3.
[The big names are "coming"] Optimize clinical management and welcome a new era of AML treatment! 4.
[Big guys say "come"] Vinekala is on sale in China! Standardize clinical application and maximize patient benefits! 5.
[Come” from big names] Hope that “only” you will come, Venecla will innovate the AML treatment pattern 6.
Hope that “only” you will come | WeiKeLai® is launched in China-Innovative drugs open a new era of AML treatment 7.
Breakthrough and innovation "WeiKeLai®", the first BCL-2 inhibitor, will create a new era of first-line treatment of AML 8.
[WeiKeLai® is here] Optimize the diagnosis and treatment model of AML and explore the application of Vinekalla in China Click Read the full article to learn more about BCL-2 inhibitors the 25th eha annual congress.
abstract #lb2601.
8.
Genentech Announces Full FDA Approval forVenclexta Combinations for Acute Myeloid Leukemia.
Drugs.
com.
9.
Genentech Announces FDA Grants VenclextaAccelerated Approval for People With Newly-Diagnosed Acute Myeloid Are Ine-Diagnosed Acute Myeloid Leukemia orThose For Who Intensive Induction Chemotherapy.
Drugs.
com.
RECOMMEND recommended reading 1.
2021 China AML Guidelines Update! After 4 years, finally waiting for you! 2.
["Wei" has come] The first Bcl-2 inhibitor Weikelai® has been authoritatively blessed by the latest CSCO guidelines.
3.
[The big names are "coming"] Optimize clinical management and welcome a new era of AML treatment! 4.
[Big guys say "come"] Vinekala is on sale in China! Standardize clinical application and maximize patient benefits! 5.
[Come” from big names] Hope that “only” you will come, Venecla will innovate the AML treatment pattern 6.
Hope that “only” you will come | WeiKeLai® is launched in China-Innovative drugs open a new era of AML treatment 7.
Breakthrough and innovation "WeiKeLai®", the first BCL-2 inhibitor, will create a new era of first-line treatment of AML 8.
[WeiKeLai® is here] Optimize the diagnosis and treatment model of AML and explore the application of Vinekalla in China Click Read the full article to learn more about BCL-2 inhibitors the 25th eha annual congress.
abstract #lb2601.
8.
Genentech Announces Full FDA Approval forVenclexta Combinations for Acute Myeloid Leukemia.
Drugs.
com.
9.
Genentech Announces FDA Grants VenclextaAccelerated Approval for People With Newly-Diagnosed Acute Myeloid Are Ine-Diagnosed Acute Myeloid Leukemia orThose For Who Intensive Induction Chemotherapy.
Drugs.
com.
RECOMMEND recommended reading 1.
2021 China AML Guidelines Update! After 4 years, finally waiting for you! 2.
["Wei" has come] The first Bcl-2 inhibitor Weikelai® has been authoritatively blessed by the latest CSCO guidelines.
3.
[The big names are "coming"] Optimize clinical management and welcome a new era of AML treatment! 4.
[Big guys say "come"] Vinekala is on sale in China! Standardize clinical application and maximize patient benefits! 5.
[Come” from big names] Hope that “only” you will come, Venecla will innovate the AML treatment pattern 6.
Hope that “only” you will come | WeiKeLai® is launched in China-Innovative drugs open a new era of AML treatment 7.
Breakthrough and innovation "WeiKeLai®", the first BCL-2 inhibitor, will create a new era of first-line treatment of AML 8.
[WeiKeLai® is here] Optimize the diagnosis and treatment model of AML and explore the application of Vinekalla in China Click Read the full article to learn more about BCL-2 inhibitors Genentech Announces FDA Grants VenclextaAccelerated Approval for People With Newly-Diagnosed Acute Myeloid Leukemia or Those Who Are Ineligible For Intensive Induction Chemotherapy.
Drugs.
com.
RECOMMEND Recommended reading 1.
2021 China AML Guidelines Update! After 4 years, finally waiting for you! 2.
["Wei" has come] The first Bcl-2 inhibitor Weikelai® has been authoritatively blessed by the latest CSCO guidelines.
3.
[The big names are "coming"] Optimize clinical management and welcome a new era of AML treatment! 4.
[Big guys say "come"] Vinekala is on sale in China! Standardize clinical application and maximize patient benefits! 5.
[Come” from big names] Hope that “only” you will come, Venecla will innovate the AML treatment pattern 6.
Hope that “only” you will come | WeiKeLai® is launched in China-Innovative drugs open a new era of AML treatment 7.
Breakthrough and innovation "WeiKeLai®", the first BCL-2 inhibitor, will create a new era of first-line treatment of AML 8.
[WeiKeLai® is here] Optimize the diagnosis and treatment model of AML and explore the application of Vinekalla in China Click Read the full article to learn more about BCL-2 inhibitors Genentech Announces FDA Grants VenclextaAccelerated Approval for People With Newly-Diagnosed Acute Myeloid Leukemia or Those Who Are Ineligible For Intensive Induction Chemotherapy.
Drugs.
com.
RECOMMEND Recommended reading 1.
2021 China AML Guidelines Update! After 4 years, finally waiting for you! 2.
["Wei" has come] The first Bcl-2 inhibitor Weikelai® has been authoritatively blessed by the latest CSCO guidelines.
3.
[The big names are "coming"] Optimize clinical management and welcome a new era of AML treatment! 4.
[Big guys say "come"] Vinekala is on sale in China! Standardize clinical application and maximize patient benefits! 5.
[Come” from big names] Hope that “only” you will come, Venecla will innovate the AML treatment pattern 6.
Hope that “only” you will come | WeiKeLai® is launched in China-Innovative drugs open a new era of AML treatment 7.
Breakthrough and innovation "WeiKeLai®", the first BCL-2 inhibitor, will create a new era of first-line treatment of AML 8.
[WeiKeLai® is here] Optimize the diagnosis and treatment model of AML and explore the application of Vinekalla in China Click Read the full article to learn more about BCL-2 inhibitors