Professor Wei Hui talks about the progress and prospects of treatment of acute myeloid leukemia

On October 8-10, 2021, the 16th National Leukemia and Lymphoma Academic Conference of the Chinese Medical Association was successfully held in Hefei, Anhui Province
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At the meeting, domestic and foreign hematology experts gathered together to participate in the academic feast and look forward to the future of hematology.
Yimaitong specially invited Professor Wei Hui from the Hematology Hospital of the Chinese Academy of Medical Sciences to be interviewed on acute myeloid leukemia (AML).
Share the current status, latest progress and future prospects of the treatment
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Yimaitong: First of all, could you please introduce the current status of AML treatment? And what unmet needs exist in the field of AML treatment? Professor Wei Hui's main treatment for AML is chemotherapy and hematopoietic stem cell transplantation.
In recent years, many new treatment methods have emerged, such as small molecule targeted drugs and immunotherapy drugs
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Newly-treated adult AML patients usually use 3+7 regimen or 3+7 regimen plus other drugs for induction chemotherapy.
After induction of remission, allogeneic hematopoietic stem cell transplantation (allo-HSCT) or chemotherapy is selected for post-remission treatment according to the prognostic risk stratification.

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For unfit adult patients, or elderly patients >75 years old, or patients with other severe comorbidities, supportive treatment or low-intensity chemotherapy can be selected
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Although AML patients can obtain better curative effects through chemotherapy and hematopoietic stem cell transplantation, some patients will still develop relapse and refractory.
At present, patients with relapse and refractory AML (R/R AML) lack effective treatment methods.
It is a very difficult problem for doctors.
It is necessary to explore more risk factors that affect the prognosis in order to predict R/R AML patients and adopt effective treatment methods
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In addition, many AML patients cannot tolerate the side effects of combined chemotherapy, so reducing the toxicity of chemotherapy drugs and improving the quality of life are very important for patients
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Compared with chemotherapy, small-molecule targeted drugs have less toxicity, higher patient comfort, and greater acceptability.
Therefore, molecular targeted therapy of AML has a bright future and is worth looking forward to
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Yimaitong: In recent years, targeted therapies for AML have progressed rapidly and targeted drugs have appeared frequently.
Could you please briefly introduce which drugs are included? Professor WEI Hui targeted therapies include BCL-2 inhibitor, FLT3 inhibitor, IDH1 / 2 inhibitor, XPO-1 inhibitors, PI3K inhibitors, EZH2 inhibitors
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Among them, BCL-2 inhibitors, FLT3 inhibitors, IDH1/2 inhibitors all have drugs on the market at home and abroad
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First of all, the listing of the BCL-2 inhibitor Venecla has enriched the diagnosis and treatment strategies of AML.
For unfit, elderly and relapsed and refractory AML patients who lack effective treatments in the past, Venecla provides a new treatment option, and there are other options at present.
BCL-2 inhibitors are in the stage of research and development and clinical trials
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Followed by FLT3 inhibitors, gerritinib has been marketed in China, quezatinib and sorafenib have been marketed abroad, and other FLT3 inhibitors are in the clinical development stage
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Lastly, IDH inhibitors.
Foreign IDH1 and IDH2 inhibitors are all on the market.
I believe that IDH inhibitors can be marketed soon in China in the future
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Yimaitong: What is the current development of immunotherapy for AML? Professor Wei Hui currently, targeted drugs have become an important treatment option for AML patients.
In addition to targeted drug therapy, the treatment of AML also includes immunotherapy
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At present, the immunotherapy CAR-T cell therapy has made great progress in the treatment of lymphoma.
Corresponding products have been marketed at home and abroad, but the efficacy in myeloid hematological tumors is relatively poor
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Because AML lacks unique targets in lymphocytic leukemia and lymphoma (such as CD19, CD22), the application of CAR-T therapy and other cellular immunotherapy in AML still has a long way to go
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Generally speaking, the development of AML immunotherapy is relatively backward, and it is currently in the preliminary stage of exploration.
It is believed that immunotherapies to improve the efficacy of AML will continue to emerge in the next few years, and will play a greater role in the treatment of AML patients
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Yimaitong: What are your prospects for more optimized treatment of AML in the future? Professor Wei Hui First of all, the current first-line treatment of adult AML is mainly based on chemotherapy and transplantation.
In the future, it may be combined with targeted drugs and immunotherapy drugs to further improve the cure rate and reduce side effects
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Secondly, for elderly patients and relapsed and refractory patients, chemotherapy combined with targeted drug therapy has become the recommended guideline for the treatment of AML.
With the continuous advent of new targeted drugs in the future, a combination of multiple targeted drugs, or targeted drugs and immunotherapy This "chemo-free" regimen combined with therapeutic drugs may be able to further improve tolerability and efficacy.
If this "chemo-free" regimen achieves better results in relapsed and refractory patients and elderly patients, it is also expected to enter AML adult patients In the first-line treatment
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At present, acute promyelocytic leukemia (APL) and Ph-positive ALL have appeared without chemotherapy.
It is expected that adult AML can also enter the era of chemotherapy-free in the future
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Professor Wei Hui Chief Physician, Doctoral Supervisor, Chinese Academy of Medical Sciences Institute of Hematology, Hematology Hospital, Leukemia Diagnosis and Treatment Center, Deputy Director, National Hematological Diseases Clinical Medicine Research Center, Member of the Chinese Medical Association Hematology Branch, Deputy Group Leader, Hematological Oncology, Deputy Group Leader, Hematological Oncology The editor-in-chief graduated from China Medical University in 2000 and received a master's degree.
Graduated from Peking Union Medical College in 2006 and received a doctorate degree.
From 2010 to 2013, he worked as a postdoctoral fellow at the National Institutes of Health, mainly engaged in basic and clinical research on leukemia.
"We make progress together