Professor Liu Ting: New progress in the treatment of acute lymphoblastic leukemia

The 16th National Leukemia and Lymphoma Academic Conference of the Chinese Medical Association was held in Hefei, Anhui Province on October 8-10, 2021.
Hematology experts from across the country participated in the grand meeting to exchange and share the progress of the diagnosis and treatment of blood diseases
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During the conference, Yimaitong was fortunate to invite Professor Liu Ting from the Department of Hematology, West China Hospital of Sichuan University to be interviewed to share the current status of the treatment of acute lymphoblastic leukemia (ALL) and the application of new drugs
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Yimaitong: First of all, would you like to tell us about the current status of ALL treatment, and what are the unmet treatment needs of ALL patients? In the past ten years, Professor Liu Ting has seen the emergence of new therapies such as molecular targeted drugs, immunotherapy drugs, and cell therapy, which have led to rapid progress in the treatment of ALL
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The curative effect of adult and child ALL has been significantly improved, especially children with ALL have achieved very significant long-term survival
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However, adult ALL patients still face the problem of disease recurrence, and the recurrence rate is high.
Therefore, reducing the disease recurrence rate, improving the long-term survival rate, and improving the cure rate still require our further exploration and efforts
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Yimaitong: In recent years, the emergence of some new drugs and new therapies has brought new treatment options for ALL patients.
So, what new drugs and new therapies are worth paying attention to in the field of ALL treatment? Professor Liu Ting’s traditional treatments for ALL include induction chemotherapy, consolidation chemotherapy, maintenance chemotherapy, and hematopoietic stem cell transplantation
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In the past decade, molecular targeted drug therapy represented by tyrosine kinase inhibitors (TKI) has made remarkable progress
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In addition, the application of immunotherapy drugs, including new antibody drugs and cellular immunotherapy drugs (such as CAR-T) and other new therapies, has brought new treatment options for adult ALL.

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In terms of new antibody drugs, the bispecific CD3-CD19-targeting bispecific antibody belintolumab and the CD22-targeting antibody-drug conjugate Inotuzumab ozogamicin can provide a good prognosis for patients with poor efficacy of conventional chemotherapy.
The earliest clinical trials of the drug were completed in relapsed and refractory patients, so it is currently mainly used to treat relapsed and refractory patients
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For cellular immunotherapy, CAR-T cell therapy for relapsed ALL patients has a good remission rate and a negative rate of minimal residual disease (MRD)
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What needs to be emphasized is that the emergence of these new drugs and new therapies is not just superimposing curative effects on the basis of traditional treatments, but also opening up a new treatment landscape for us
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Yimaitong: MRD is an important prognostic indicator of ALL.
What treatment strategies can be selected for MRD-positive ALL patients? Professor Liu Ting’s MRD is an important indicator for predicting the treatment effect of ALL patients.
Whether the patient can achieve MRD negative indicates whether the patient can survive for a long time and even has the possibility of cure
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If MRD negative is not achieved, the standard of cure cannot be achieved
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Therefore, achieving MRD negative and achieving complete molecular remission (CMR) has become an important criterion for achieving a good prognosis for ALL patients
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In the past, patients with relapsed and refractory patients had poor prognosis after traditional chemotherapy, and it was difficult to achieve MRD negative.
In this case, the application of small molecule targeted drugs and new antibody drugs, and the rise of cellular immunotherapy CAR-T therapy have brought about With more treatment options, the emergence of these drugs makes MRD-positive patients, and even relapsed and refractory patients, have more opportunities to obtain CMR and achieve MRD-negative, so as to achieve long-term survival
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Yimaitong: In recent years, immunotherapy has progressed rapidly.
In your opinion, what other directions are worth exploring for immunotherapy in ALL? Professor Liu Ting First of all, CAR-T therapy has significant short-term effects, but there are still challenges to improve long-term prognosis.
Therefore, more exploration is still needed for CAR-T therapy to achieve long-term remission and long-term survival, and at the same time, improve the role of CAR-T targets Strength and accuracy are also issues that need to be explored
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Secondly, in the treatment of blood system diseases, immunotherapy is usually considered when the general treatment plan is ineffective.
I think we can try to advance the immunotherapy.
For example, for patients with MRD positive, immunotherapy can be advanced to MRD negative.
Transfer links
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Third, the combination of immunotherapeutic drugs and conventional treatment programs and sequential strategies can be explored in depth, including the most reasonable drug combination and the most reasonable application timing
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Finally, how to combine immunological drugs and hematopoietic stem cell transplantation is also worth exploring, and formulating and adjusting a more perfect hematopoietic stem cell transplantation plan, in order to reduce the toxicity of the treatment and obtain the best survival
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Professor Liu Ting, PhD supervisor, Director of the Institute of Hematology, West China Hospital, Sichuan University Chief Expert in Health and Family Planning, Sichuan Province (Hematology), Sichuan Province Academic Technology Leader, State Council Special Allowance Recipient, Vice President, Hematologist Branch, Chinese Medical Doctor Association, China Vice Chairman of CSCO Anti-Leukemia Alliance Vice Chairman of the Hematopoietic Stem Cell Transplantation and Cell Therapy Committee of the Chinese Society of Medical Education Vice Chairman of the Blood Branch of the Chinese Society of Rehabilitation Medicine Member of the Society of Hematology, the president of the Hematology Physician Branch of the Sichuan Medical Association stamps "read the original text", we will make progress together