Professor Qian Jiang: Current status and prospects of CML treatment The 16th National Leukemia and Lymphoma Conference

Sponsored by the Chinese Medical Association, Hematology Branch of Chinese Medical Association, Leukemia and Lymphoma Group of Hematology Branch of Chinese Medical Association, Hematology Hospital of Chinese Academy of Medical Sciences (Institute of Hematology, Chinese Academy of Medical Sciences), First Affiliated Hospital of University of Science and Technology of China The 16th National Leukemia and Lymphoma Academic Conference hosted by the Chinese Medical Association will be held in Hefei, Anhui Province on October 8-10, 2021
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At this conference, Yimaitong was fortunate to invite Professor Jiang Qian from Peking University People's Hospital and Peking University Institute of Hematology to share the current status and prospects of treatment of chronic myeloid leukemia (CML)
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Yimaitong: First of all, could you please introduce the current status of CML treatment.
What are the unmet treatment needs of CML patients in the context of obtaining a longer prognosis? Professor Jiang Qian With the advent of tyrosine kinase inhibitors (TKI) represented by imatinib, the treatment of CML has undergone a fundamental change in the past 20 years
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At present, there are many first- and second-generation TKIs on the market.
With the help of medical insurance policies, the accessibility of TKIs has also been greatly improved.
The diagnosis and treatment of CML is currently affordable for most patients
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About 90% of patients can control the disease well through TKI treatment and achieve the same long-term survival as normal people
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 However, there are still some unmet needs for treatment in patients with CML
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First, a small number of CML patients cannot tolerate TKI, or develop resistance to first and second generation TKIs
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Since the third-generation TKI has not yet been approved for marketing in China, the current treatment options are relatively limited for patients who are resistant or intolerant to TKI
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In addition, hematopoietic stem cell transplantation is an important treatment for CML
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Hematopoietic stem cell transplantation is recommended for CML patients with advanced multi-drug resistance or even third-generation TKI-resistant CML
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However, due to various reasons, not all CML patients can receive hematopoietic stem cell transplantation
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Yimaitong: At present, relevant research is exploring how to make CML patients still obtain long-term disease remission after stopping the TKI.
Could you please introduce the progress of the relevant research? Professor Qian Jiang Although most CML patients can obtain deep major molecular remission (MMR) through long-term treatment, these patients still suffer from adverse reactions and long-term drug toxicity during the long-term treatment
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Although the TKI currently used in CML treatment can inhibit the BCR-ABL protein, it cannot completely remove the BCR-ABL fusion gene.
Therefore, theoretically, CML patients may have disease recurrence after stopping TKI
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A small number of patients can maintain disease-free recurrence by stopping the drug under strict and standardized monitoring, but this part of patients accounts for a relatively small proportion (not more than 20%)
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Therefore, for most CML patients, it is still difficult to maintain long-term disease remission after TKI discontinuation
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 In addition, there is currently a lack of appropriate criteria to determine which part of CML patients is suitable for discontinuation
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Although the current domestic and foreign correlation studies have explored some factors related to maintaining the disease-free state after drug withdrawal, including medication time, MMR depth, NK cell level, etc.
, the relevant analysis results are not yet able to guide CML patients well.
The withdrawal of the drug
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 Considering that most CML patients can still control the disease well under the condition of long-term medication, it is not recommended that all CML patients pursue treatment-free remission (TFR) after drug withdrawal
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CML patients after drug withdrawal may lose MMR, and with the extension of drug withdrawal time, the number of patients who lose MMR may gradually increase
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For CML patients with adverse reactions during long-term medication, compared to direct withdrawal, you can try to adjust the dosage of the medication
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At present, reducing the dose of CML patients in related studies can reduce side effects and improve the quality of life of patients while maintaining disease control.
It is a more appropriate treatment strategy than stopping the drug directly
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Yimaitong: At present, what room for improvement and exploration direction is there for CML in patient efficacy monitoring? Professor Jiang Qian's current drug availability problem for CML patients has been well resolved
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With the reduction of drug prices and the improvement of medical insurance policies, even CML patients in relatively economically backward areas or geographically remote areas can receive TKI treatment
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However, the current treatment of CML patients in China still has irregular management, which leads to unsatisfactory treatment outcomes for some CML patients
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For example, in the process of monitoring the efficacy of CML patients, hematological toxicity is a relatively common phenomenon, and not all hematological toxicities require excessive intervention
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Due to insufficient management experience of CML patients, some clinicians may reduce the dose, change the dressing, and discontinue the drug when faced with hematological toxicity, leading to more serious toxic events in some CML patients and failing to obtain the ideal treatment outcome
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 The ELN guidelines clearly recommend that CML patients go to a professional center for treatment and efficacy monitoring, so that the disease can be better controlled and long-term survival is ensured
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I think that some domestic clinicians need to gain more experience in the management of CML patients, better monitor the efficacy of CML patients, and improve the prognosis of CML patients
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Yimaitong: What are your expectations for the future diagnosis and treatment of CML? For CML patients with good therapeutic effects, it is still necessary to explore the feasibility of drug reduction or even withdrawal in these patients, so as to reduce the toxicity of the patients' treatment and improve the quality of life of the patients while ensuring the curative effect
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For CML patients with poor treatment effect, it is necessary to pursue the optimization of drug dosage, bring better disease management to patients, and improve the treatment outcome of patients
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For CML patients with drug resistance, it is still necessary to develop new drugs to prolong the survival of patients while avoiding disease conversion
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Professor Jiang Qian, Doctor of Medicine, Chief Physician, Professor, PhD Supervisor, Deputy Director, Department of Hematology, Peking University People’s Hospital, Member of the National Representative Committee of the International CML Foundation, Member of the Hematology Branch of the Chinese Medical Association, and Deputy Leader of the Leukemia Lymphoma Group, Beijing Medical Association Blood Chairman-designate of the Credit Committee, Chairman of the Leukemia Branch of the Chinese Medical Education Association, Leukemia Research, Deputy Chairman of the Hematology Branch of the Chinese Medical Education Association, and the editorial board of the Chinese Journal of Hematology, Chinese Journal of Experimental Hematology, and Clinical Hematology.
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