Professor Liu Qifa: The guideline treatment pattern is changing with each passing day, and the AML treatment concept is constantly improving

In recent years, the field of targeted therapy for acute myeloid leukemia (AML) has developed rapidly.
The application of new drugs represented by BCL-2 inhibitors has opened the door to targeted therapy for AML, breaking the previous focus on chemotherapy and transplantation.
The treatment mode of AML has entered a new era of individualized precision treatment
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In the recently updated 2021 Chinese Adults' newly diagnosed AML diagnosis and treatment guidelines and relapsed/refractory (R/R) AML diagnosis and treatment guidelines, it can also be seen that the AML treatment pattern has undergone earth-shaking changes, and precision targeted therapy has become a general trend
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On the occasion of this guide update, Yimaitong specially invited Professor Liu Qifa from Nanfang Hospital of Southern Medical University to interpret the updated guideline from the perspective of the transformation of AML treatment mode
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It is imperative to update the guidelines for targeted therapy by leaps and bounds.
In the past, clinical treatments for AML were scarce.
Except for chemotherapy and allogeneic hematopoietic stem cell transplantation (allo-HSCT), treatments were very limited
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However, with the continuous progress in the field of molecular biology in recent years, various new AML drugs based on different mechanisms have emerged, including BCL-2 inhibitors, FLT3 inhibitors, IDH1/IDH2 inhibitors, and so on
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These new drugs have achieved good research results in clinical trials, significantly improving the prognosis of AML patients
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 Moreover, with the launch of BCL-2 inhibitor Venecla, FLT3 inhibitor Geritinib and other drugs in China, it will bring new choices for Chinese AML patients and usher in the era of targeted AML therapy in China
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In the context of rapid progress in the field of AML and the continuous emergence of new therapeutic drugs, the 2021 Chinese Adults' newly diagnosed AML diagnosis and treatment guidelines and relapsed and refractory AML diagnosis and treatment guidelines provide new models, new standards, and new references for the standardized diagnosis and treatment of AML
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The new treatment methods are closely integrated with traditional treatment programs and work together to help efficient treatment of AML.
Both versions of the guidelines integrate new treatment methods on the basis of traditional treatment programs
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The 2021 Chinese Adult Newly Diagnosed AML Diagnosis and Treatment Guidelines1 pointed out that AML patients under the age of 60 are still mainly treated with conventional induction therapy or induction therapy with medium-dose cytarabine, but for patients with severe comorbidities, Refer to the recommendations of the treatment plan for elderly patients intolerant of intensive chemotherapy
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For elderly (≥60 years of age) AML patients, the new version of the guidelines adjusts the initial induction chemotherapy dose, and adds venacola combined with demethylation drugs to the low-intensity treatment regimen
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 The 2021 diagnosis and treatment guidelines for relapsed and refractory AML 2 highlight the important role of new targeted therapies.
The application of the treatment plan includes: ① new targeted therapies; ② combination of medium and large doses of cytarabine ③Using a new combination chemotherapy regimen composed of new drugs without cross-resistance; ④allo-HSCT; ⑤Immunotherapy
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Of particular importance is that the new version of the guidelines has increased the usage, dosage and combination of BCL-2 inhibitor venecola, increased targeted drugs geritinib and sorafenib for the treatment of patients with FLT3 mutations, and increased IDH1 Inhibitors, IDH2 inhibitors and other related content
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 It can be seen from the two editions of the guidelines that the diagnosis and treatment model of AML has undergone tremendous changes, and a variety of new treatment methods have emerged
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AML treatment has changed from the previous chemotherapy combined with allo-HSCT model to a model where multiple innovative targeted drugs such as chemotherapy, allo-HSCT, and BCL-2 inhibitor venacola have their own strengths and complement each other
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Therefore, clinical hematology oncologists should make good knowledge reserves, make full use of the integrated advantages of new treatment methods and traditional treatments, realize standardized and individualized treatment of AML, and help improve the level of AML treatment
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Innovative targeted drugs change the thinking of AML diagnosis and treatment.
The rapid development of molecular biology and targeted therapy drugs in some AML patients has changed the thinking of AML diagnosis and treatment, bringing AML diagnosis and treatment into the era of "precision medicine"
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As we all know, AML patients often have a variety of cytogenetic and molecular abnormalities, such as FLT3, NPM1, IDH1, IDH2 and other mutations, which affect the patient's disease phenotype, the efficacy and prognosis of traditional treatments
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Innovative targeted therapy drugs have shown significant therapeutic effects for patients with specific genetic abnormalities, gradually replacing the role of traditional single chemotherapy
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The new version of the relapsed and refractory AML diagnosis and treatment guidelines 2 recommends that patients with relapsed and refractory AML can choose to target FLT3 mutations geritinib, sorafenib, etc.
, and other IDH1 inhibitors Avonib and IDH2 inhibition can be selected according to the situation Ensidi is equal
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 It is worth mentioning that the BCL-2 inhibitor Venecla can overcome gene mutations and accelerate tumor cell apoptosis.
This innovative mechanism of action is an update and leap in the concept of AML treatment
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In the past, unfit and elderly patients with AML have limited treatment options, with a relatively short survival period and low remission rate.
The listing of the BCL-2 inhibitor Veneclax has brought new options and new dawns for unfit and elderly AML patients
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In the new version of the guidelines for diagnosis and treatment of newly diagnosed AML1, the treatment strategy of Venecla combined with azacitidine or decitabine replaces the original low-intensity treatment and becomes the new standard of treatment
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 In general, these innovative targeted drugs not only provide doctors with new treatment methods and standards, but also provide patients with new treatment opportunities
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At present, innovative targeted drug therapy has become the current and trend of AML treatment, changing the treatment mode and treatment outcome of many AML patients
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Not only that, innovative targeted drugs play an important role in bridging therapy before transplantation and maintenance therapy after transplantation
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The new version of the guidelines has provided scientific guidance for the standardized diagnosis and treatment of AML.
Clinicians should first follow the guidelines and give patients stratified, standardized and individualized treatment according to the treatment recommendations and the strength of the recommendations.
These innovative targeted drugs should be properly applied to allow patients Get efficient treatment and maximum benefit
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Secondly, in daily diagnosis and treatment practice, clinicians should actively accumulate the treatment experience of innovative targeted drugs, and further explore the specific dosage, treatment course and combination of these innovative drugs to further improve the therapeutic effect
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Focus on AML diagnosis and treatment standards, and continuously optimize clinical practice, so that innovative clinical diagnosis and treatment concepts and drugs can benefit more patients
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Professor Liu Qifa Chief Physician, Professor, and Doctoral Supervisor, Director of the Institute of Hematology, Southern Medical University, Chief Expert of Guangdong Province, Chief Expert of Hematology, Member of the Asia-Pacific Society of Hematology, Vice Chairman of the Hematology Branch of the Chinese Medical Association, Infectology Group of the Hematology Branch of the Chinese Medical Association Team leader, deputy leader of the Hematopoietic Stem Cell Application Group, Standing Committee Member of the Hematology Physician Branch of the Chinese Medical Doctor Association Disclaimer: This [article/share] is only for health and medical professionals in mainland China.
Academic reference, 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
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References: 1.
Chinese Medical Association Hematology Branch Leukemia Lymphoma Group.
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 of the Hematology Branch of the Chinese Medical Association.
Chinese Guidelines for the Diagnosis and Treatment of Relapsed and Refractory AML in 2021.
Chinese Journal of Hematology.
2021;42(8):624-627.
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