Professor Jin Jie: From initial treatment to R/R, the new guidelines establish new standards for AML diagnosis and treatment

In the past few decades, research on new drugs for the treatment of acute myeloid leukemia (AML) has progressed slowly
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However, in recent years, with the vigorous development of targeted drugs such as the BCL-2 inhibitor Veneclax, and the continuous enrichment of evidence-based evidence, it has brought great changes to the diagnosis and treatment of AML, and promoted the diagnosis and treatment guidelines and relapse/recurrence of AML in Chinese adults in 2021.
Changes in the guidelines for the diagnosis and treatment of refractory (R/R) AML
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From initial treatment to R/R, the new version of the guidelines establishes a new standard for diagnosis and treatment of AML and provides practical guidance for the management of the whole course of AML
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On the occasion of the update of the guidelines, Yimaitong specially invited Professor Jin Jie from the First Affiliated Hospital of Zhejiang University School of Medicine to interpret the updated guidelines from the perspective of AML whole-course management
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BCL-2 inhibitor Venecla leads a new era in the treatment of newly diagnosed AML.
Early diagnosis and early treatment are essential for controlling the condition of AML, delaying the progression of the disease, and even achieving a cure
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The new version of the adult first-diagnosed AML diagnosis and treatment guidelines 1 has been updated in many aspects.
The biggest highlight is the addition and adjustment of the treatment content, especially for patients who are not suitable for intensive chemotherapy (unfit) and all elderly (age ≥ 60 years) patients.
Necla's recommendation
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In the past, for unfit and elderly patients, even if they can be diagnosed early, the lack of effective treatment is the biggest pain point for clinical treatment of these patients
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BCL-2 inhibitor Venecla made a breakthrough innovation, filled the gap in the treatment of unfit and elderly AML patients, and brought standard treatment options for these patients
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 The new version of the guidelines for the diagnosis and treatment of newly diagnosed AML in adults recommends adding venecola combined with demethylating drugs to the low-intensity treatment plan, and adding azacitidine to the demethylating drugs, and introducing specific application scenarios in detail
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For unfit elderly patients (age ≥ 60 to 75 years), and patients ≥ 75 years of age or patients with serious non-hematological comorbidities, low-intensity chemotherapy is recommended, and venecola combined with azacitidine or decitabine is recommended The level of evidence is 1a
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In addition, for fit elderly patients (age ≥ 60 to 75 years), if they have a poor prognosis, low-intensity chemotherapy containing venacola or standard-dose chemotherapy can be used.
The evidence level of the two is the same, both are 2a; if there is no poor prognosis, Standard-dose chemotherapy or low-intensity chemotherapy can also be accepted, the former is 1a and the latter is 2c
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 Except for elderly patients, for patients younger than 60 years old but with severe comorbidities, remission induction therapy can refer to the treatment plan of elderly unfit patients, using low-intensity chemotherapy
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It can be seen that the low-intensity induction program containing Veneclax can be applied to a variety of patient groups, whether it is elderly patients aged ≥60, or young patients (age <60 years old) with severe comorbidities, the treatment mode has occurred Great innovation
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Targeted therapies are advancing with each passing day.
R/R AML treatment usher in new hope.
The therapeutic advantages of targeted drugs are not only reflected in the newly diagnosed AML, but also in the performance of R/R AML
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In general, salvage chemotherapy is not effective in the treatment of R/R AML, but with the emergence of new targeted therapies such as FLT3 inhibitors, BCL-2 inhibitors, IDH1/2 inhibitors, etc.
, it has not only enriched R/R The treatment plan for AML patients also brings new hope to these patients
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The new version of R/R AML diagnosis and treatment guidelines 2 moves the "new targeted therapy drugs" of the treatment principle to the first place, highlighting its important position
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In addition, the targeted drugs geritinib and sorafenib have been added to treat patients with FLT3 mutations, and the usage, dosage and combination of BCL-2 inhibitor venacola have been increased
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 It should be noted that AML patients are often accompanied by multiple gene mutations, and the benefits of FLT3 inhibitors and IDH1/IDH2 inhibitors are limited to patients with specific gene mutations
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Unlike these targeted drugs, BCL-2 inhibitors can break the restriction of specific targeted mutations and directly act on the apoptosis pathway
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All in all, these new targeted drugs bring more choices and opportunities for remission for R/R AML patients
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Follow the new standards for AML diagnosis and treatment to promote standardized management throughout the course of the disease and maximize the benefits of patients.
Both versions of the guidelines are based on evidence-based medicine evidence, clinical actual conditions, and updates on drug availability, condensing the wisdom of Chinese hematology doctors and experts, and is helpful to China.
The standardized diagnosis and treatment of AML plays an important role in promoting
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The BCL-2 inhibitor Veneclax is recommended for newly diagnosed unfit or elderly AML patients, so that patients can receive efficient treatment at the first diagnosis; FLT3 inhibitors, BCL-2 inhibitors, IDH1/2 inhibitors, etc.
are recommended For R/R AML patients, it brings hope of rebirth to R/R patients
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The inclusion of these new drugs not only rewrites the guidelines for initial diagnosis and R/R AML diagnosis and treatment, but also brings new paths, new choices, and new standards for AML diagnosis and treatment, and brings more survival benefits to AML patients
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 In addition, from the diagnosis of AML to initial treatment, first relapse, relapse and refractory treatment, and even to the final stage of the disease, the two editions of the guidelines give specific diagnosis and treatment recommendations, which provide important references for the management of the entire course of AML
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The initial treatment plan should be dynamically adjusted based on the patient's tolerance to treatment, genetic risk stratification, and minimal residual disease (MRD) after treatment.
The treatment of R/R AML should be based on age, physical status, recurrence time, and mutation Genetic stratification therapy
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Each stage of the course of AML has different treatment methods.
Therefore, hematological oncologists should follow the new guidelines, follow the new diagnosis and treatment path, and carry out standardized treatment according to the treatment recommendations and the strength of the recommendations, and after all-round thinking, apply these new drugs.
, Make the most suitable treatment choice for AML patients, and make continuous adjustments based on the tumor progression in the long-term treatment and follow-up
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 Standardized management throughout the course of the disease is essential to improve the survival benefits of patients.
Only by implementing the treatment concept of standardized management throughout the course of the disease and bringing professional full-course management services to AML patients can the survival and quality of life of AML patients be guaranteed.
, To maximize the benefits of AML patients
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Professor Jin Jie, Doctor of Medicine, Professor, Chief Physician, Doctoral Supervisor, Director of the Department of Hematology, the First Affiliated Hospital of Zhejiang University School of Medicine, Director of the Lymphoma Center, National Health Commission, Clinical Key Subject Leader, Chinese Women Physicians Association, Hematology Committee Chairman Chinese Anti-Cancer Association Hematology Translational Medicine Committee Chairman, CSCO Anti-Leukemia Alliance, Standing Committee Member, Anti-Lymphoma Alliance, Deputy Chairman, Chinese Medical Doctor Association, Integrative Hematology, Chinese Medical Doctor Association, Standing Committee Member, Hematology Society, Disclaimer: This[Article/ Sharing] is for academic reference only for health and medical professionals in mainland China, not for the general public
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If you are not a health 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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References: 1.
Leukemia and Lymphoma Group of the Chinese Medical Association Hematology Branch.
Adult acute myeloid leukemia (non-acute promyelocytic leukemia) Chinese diagnosis and treatment guidelines (2021).
Chinese Journal of Hematology.
2021;42(8): 617-623.
2.
Leukemia and Lymphoma Group, Branch of Hematology, Chinese Medical Association.
Chinese Guidelines for Diagnosis and Treatment of Relapsed and Refractory AML in 2021.
Chinese Journal of Hematology.
2021;42(8):624-627.
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