Professor Xu Bing's team interviewEd by many parties to protect the whole process of lymphoma diagnosis and treatment, CAR-T showed its strength

Since its establishment in 2000, after more than 20 years of construction and development, the Department of Hematology of the First Affiliated Hospital of Xiamen University has become one

Lymphoma is one of the ten most common malignant tumors in China, as a senior expert in the field of lymphoma, please talk about the current diagnosis and treatment status of lymphoma in China?

Medical Pulse: The Department of Hematology of the First Affiliated Hospital of Xiamen University has become one of the advanced lymphoma diagnosis and treatment centers in China, as the person in charge of the center, please introduce the construction of the Department of Hematology of the First Affiliated Hospital of Xiamen University?

The Department of Hematology of the First Affiliated Hospital of Xiamen University has developed rapidly in recent years, especially in the field of lymphoma

Yimaitong: In view of the current difficulties in the clinical diagnosis and treatment of lymphoma, what work has been carried out by the Department of Hematology of the First Affiliated Hospital of Xiamen University?

In terms of standardized treatment, flow cytometry, immune function and monitoring of circulating tumor cells are carried out through the Key Laboratory of Hematological Tumor Diagnosis and Treatment to assist in diagnosis and precise stratification, so as to guide clinical treatment and avoid excessive treatment or insufficient treatment; At the same time, the clinical path of diagnosis and treatment of different subtypes of lymphoma is formulated, and the treatment
of patients with different lymphoma subtypes is standardized.

In terms of full management, doctors and nurses will carry out scientific education for patients when they are admitted to the hospital, giving patients confidence in treatment; Treatment requires standardized diagnosis and treatment, active management of complications, and close monitoring of the patient's immune status, and adjustment of treatment according to immune status to reduce infection and recurrence; Long-term follow-up is required after treatment
.

Through the standardized whole process management of patients to further improve the treatment effect
.

In the treatment of patients with relapse/refractory treatment, the hospital has currently carried out more than 40 clinical studies, covering many new drugs that have been approved for marketing abroad but are not yet available in China, providing new treatment opportunities for patients with relapse/refractory treatment; Active use of new treatment methods such as CAR-T has significantly improved the efficacy; At the same time, the latest scientific research results will be transformed into clinical applications in a timely manner to help achieve accurate diagnosis and treatment
.

Case sharing

An elderly female patient, first diagnosed with diffuse large B-cell lymphoma in 2017, received CR
after treatment.

In 2020, the patient relapsed, because he was not suitable for transplantation and could not tolerate high-dose chemotherapy, he was given a targeted therapy regimen, and the patient had adverse reactions such as diarrhea, which was relieved
after symptomatic treatment.

The patient then relapsed again with bone marrow involvement and finally decided to undergo CAR-T
therapy.

Patients with poor general condition before CAR-T infusion, heavy tumor burden, combined with aspergilloma infection and cardiac insufficiency, with the aid of anti-infective and supportive therapy, with CAR-T treatment, the efficacy evaluation of 1 month and 3 months was CR
.

Medical Pulse: What difficulties did your team encounter during the treatment process? What response has been taken? How are patients recovering so far?

The patient's general condition is poor at the time of recurrence, ultra-advanced age, poor physical fitness status, cardiac insufficiency and relatively long daily bed rest; Recurrence after third-line therapy, with bone marrow involvement and heavy tumor burden; Before the CAR-T return, there was a serious fungal infection of the lungs, chest pain, shortness of breath and other symptoms, and the team faced greater difficulty
in treatment.

After discussing and considering the patient's physical condition in multidisciplinary consultations such as respiratory medicine and cardiology, it was finally decided to implement CAR-T treatment
for the patient.

During the treatment process, the patient's vital signs and lung anti-infection status were closely monitored
.

One month after CAR-T therapy, 68% of the bone marrow tumor cells were involved and completely disappeared, PET/CT was shown cr, and PET/CT was reviewed at three months, and the efficacy was evaluated as continuous CR
.

For patients receiving CAR-T therapy, what are the precautions for long-term follow-up after discharge? Can "treatment in the vicinity" benefit patients, where medical conditions permit?

In the long-term follow-up after CAR-T infusion, first, to monitor the disease state, it is recommended to evaluate the patient's bone marrow and PET/CT test results after 1, 3, and 6 months, respectively, as well as the expansion and continuation of
CAR-T in vivo.

The second is to pay attention to the relevant adverse reactions after CAR-T treatment, such as B lymphocyte immune reconstitution, and regular monitoring of blood picture, including lymphocyte subsets and globulin levels in the body
.

In addition, CAR-T may lead to long-term resurgence of the virus, and the patient's level of the virus needs to be monitored regularly
.

"Nearby treatment" is conducive to long-term follow-up after CAR-T treatment, and clinicians will have a better understanding of the patient's medical history and disease status, can more effectively achieve disease monitoring, and respond
to sudden disease changes in a timely manner.

Medical Pulse: As a well-known blood disease diagnosis and treatment center in China, the Department of Hematology of the First Affiliated Hospital of Xiamen University has what unique features in the whole process management of CAR-T treatment?

The Department of Hematology of the First Affiliated Hospital of Xiamen University is currently in the leading position in the field of lymphoma in China, with a strong lymphoma MDT team, which can make rapid and accurate responses during the initial diagnosis and formulate appropriate treatment strategies; In the process of CAR-T treatment, we have some experience in the implementation of bridging therapy, supportive care and the selection of car-T start-up time, which may be our greater advantage
in CAR-T treatment at present.

Medical Pulse: Peripheral blood mononuclear cell collection (single collection) is a key part of CAR-T treatment, please talk about what precautions are in the process of single collection?

Prior to collection, the clinician needs to confirm that a single collection
can be performed based on the results of routine examinations such as the patient's ECOG score, blood routine, electrolyte and liver and kidney function, infection status, and infectious disease screening.

Before single sampling, the circulation amount should also be determined according to the results of the blood routine, generally the total circulation amount is 6000 to 12000mL, so as to ensure that a sufficient number of lymphocytes can be collected for the production of CAR-T cells
.

Vascular access should be evaluated before monosection, and if peripheral vascular conditions are good, the median vein is preferred and collected
by means of an external indwelling needle.

Given the potential risk of preoperative contamination, tubes are usually placed on the day of single harvest to ensure smooth
cell collection.

Before starting a single collection, the patient's identity needs to be confirmed, and then the single collection parameters
are set according to the results of the patient's blood routine examination.

In the process of single collection, we should also pay close attention to the adverse reactions of patients, pay attention to the vital signs of patients, and communicate feedback with the doctor in charge in time to deal with
adverse reactions in the first time.

As an important part of the management of the whole process of CAR-T treatment, what are the precautions before and after CAR-T cell infusion? What do I need to do with my team of doctors?

Before infusion, the nursing team should communicate closely with the medical team, do a good job in intravenous protection and passage management of patients, and rehearse the infusion process of CAR-T products; At the same time, first aid equipment and drugs should be prepared in advance, and rescue items and drugs should be placed next to the patient's bed for easy access; In addition, antiallergic drugs
should be administered as prescribed 30-60 minutes before CAR-T cell infusion.

When the transport box containing CAR-T cells is sent to the hospital, it is necessary to check the product information, check whether the transport box is complete, confirm whether the patient's identification information is consistent with the person, and check whether the accompanying documents are complete
.

Once the CAR-T cells are removed from the transport box, the reinfusion must be completed within 2 hours, and the injection is completed at a steady rate of 0.
5 ml/min during administration, and can no longer be frozen
.

Patient vital signs, including body temperature, blood pressure, heart rate, respiratory, and oxygen saturation, should be closely monitored during and 4 h after infusion
.

Within 14 days after infusion, closely observe the patient's vital signs and neuro-conscious state, and do a good job of infection prevention and critical value management
.

After discharge, patients should do a good job in the education and follow-up of patients and their families
.

The Lymphoma Diagnosis and Treatment Center of the First Affiliated Hospital of Xiamen University has a systematic diagnosis and treatment system and experienced experts, and is currently exploring the application of a number of commercial CAR-T cases, which is the first successful case
of commercial CAR-T treatment in Fujian Province.

Patients are elderly, have repeated relapses after chemotherapy and targeted drug therapy, and have complicated cardiac insufficiency and severe pulmonary fungal infections, making treatment more
difficult.

However, with the support of the hospital's MDT team, the diagnosis, CAR-T treatment and long-term follow-up have been carried out smoothly, so that the patient has achieved deep remission and is expected to achieve sustained remission
.

This reflects the value of multidisciplinary diagnosis and treatment, and at the same time reflects the level of the Department of Hematology of the First Affiliated Hospital of Xiamen University in the treatment of lymphoma and the treatment of complications, and can also give more patients confidence
.

Our team has accumulated some experience in the use of CAR-T, and will work harder in the future to contribute more strength and love
to more patients with relapsed/refractory lymphoma.

Bing Xu, Professor

• Grade II chief physician, professor, doctoral supervisor

• Special allowance expert of the State Council

• Outstanding contribution of young and middle-aged experts in Fujian Province

• Director of the Department of Hematology of Xiamen University, Director of the Institute of Hematology of Xiamen University

• He is a member of the Council of the First Affiliated Hospital of Xiamen University, the director of the Department of Hematology and the director of the Department of Internal Medicine, and the director of the Internal Medicine Training Base

• Member of the Standing Committee of the Hematologist Branch of the Chinese Medical Doctor Association

• Leader of the Follicular Lymphoma Working Group in China

• Member of the Standing Committee of the Hematology-Oncology and Lymphoma Professional Committee of the Chinese Anti-Cancer Association

• Chairman of the Leukemia Academic Working Committee of the Chinese Geriatrics Society

• He has won 1 first prize and 3 second prizes for scientific and technological progress at the provincial and ministerial levels, presided over 5 national natural science foundations, and published more than 200 papers in BLOOD, JHO and other journals as the first or corresponding author, including more than 70 SCI papers, 27 papers with more than 5 points, 6 with more than 10 points, and a total impact factor of 369 points
  .
  
  

Professor Lin Zhijuan

• Deputy Chief Physician, Department of Hematology, First Affiliated Hospital of Xiamen University

• Graduated from Peking University in the eight-year clinical medicine program

• Visiting Scholar, Cleveland Medical Center, USA

• Hematology and Tumor Committee of China Anti-Cancer Association

• He is a young member of the Blood Disease Rehabilitation Professional Committee of the Chinese Rehabilitation Medicine Association

• Vice President of the Youth Committee of the Hematology Physician Branch of Fujian Medical Doctor Association

• Vice Chairman of the Youth Committee of the Lymphoma Professional Committee of Fujian Anti-Cancer Association

• He has presided over 1 project of the National Natural Science Foundation of China and 1 project of the Natural Science Foundation of Fujian Province

• The first author has published several articles in SCI magazines such as Blood

Li Lichun Head Nurse

• Undergraduate Chief Nurse

• Chief Nurse, Department of Hematology, First Affiliated Hospital of Xiamen University

• Member of Blood Disease Nursing Branch of China Medical Education Association

• Member of the Nursing Group of the Anti-Lymphoma Alliance of the Chinese Society of Clinical Oncology (CSCO).
  

• Vice Chairman of the Intravenous Therapy Nursing Professional Committee of Xiamen Nursing Association

• In 2016, he was rated as "Excellent Nursing Management Worker" by Xiamen Municipal Health Bureau

• The main participant's "ECG-guided PICC Tip Positioning Puncture Technology" won the 2015 Xiamen Medical Innovation Award

Poke "Read the original article" to see more