The meeting concluded with the 2020 EHA Meeting Express - Lymphoma and Myeloma Special Session.

On the morning of July 4, 2020, the "post EHA express lymphoma & amp; myeloma special session" jointly organized by the myeloma and lymphoma MSL team of Xi'an YANGSEN medical department was successfully held.Professor Qiu lugui of Hematology Hospital of Chinese Academy of Medical Sciences and Professor Li Jianyong of Jiangsu Provincial People's Hospital jointly presided over the meeting.Professor Xu Wei of Jiangsu Provincial People's Hospital, Professor Yang Shenmiao of people's Hospital of Peking University, Professor Fu Weijun of Shanghai Changzheng Hospital, Professor Li Jian of Peking Union Medical College Hospital, Professor An Gang and Professor Yi Shuhua of Hematology Hospital of Chinese Academy of Medical Sciences were invited to attend and give keynote speeches to discuss hot issues in lymphoma and myeloma at the just concluded EHA meeting.1mcl treatment progress and real world interpretation Professor Xu Wei of Jiangsu Provincial People's hospital introduced: retrospective analysis shows that compared with standard immunochemotherapy, ibutilinib can improve the survival cycle of patients with central recurrence of MCL.in the treatment of newly diagnosed MCL patients, the CR was 86% and the negative rate of MRD in peripheral blood and bone marrow was 100% after 6 months of treatment, which showed high efficacy and safety.real world data show that R / R MCL can obtain longer PFS and OS when treated with ibuprotinib.2cll has entered the era of targeted therapy. Professor Yang Shenmiao of Peking University People's Hospital shared that: compared with traditional immunochemotherapy, new targeted therapies such as ibutilinib and vinetuoc have achieved very good survival benefits for newly diagnosed and relapsed / refractory CLL.fixed course studies such as ibuprotinib + venetuoc, ibutilib + venetuoc + ga101 suggest that the first-line treatment of CLL based on ibutilinib can achieve high and sustained MRD negative rate and good tolerance.many schemes can achieve deep remission in a short time, but can deep remission last? It's true that some of the patients have progressed after the withdrawal of the drug.whether deep remission can bring longer survival and cure disease are all problems to be solved. There is no mature data support at present. The goal of CLL is still the quality of life and relatively stable survival period.centers that did not participate in clinical trials still recommend long-term treatment with ibutilib.the exploration scheme of limited course MRD is currently applicable in clinical trials.3rrmm treatment status and strategy optimization Professor Fu Weijun of Shanghai Changzheng Hospital introduced the clinical research progress of recurrent and refractory multiple myeloma.because mm is prone to relapse, clinical trials for RRMM generally try to optimize the treatment strategy through the combination of different kinds of drugs, the adjustment of treatment sequence, and the selection of relative benefit groups: for example, Lepus research shows that DVD scheme can obtain higher remission rate and MRD negative rate in Chinese population; mm-014, Icaria and other studies show that DPD, isapd and other schemes can improve the remission rate and MRD negative rate in Chinese population The results of Bellini study showed that Bcl-2 inhibitor significantly prolonged PFS in patients with high expression of T (11; 14) or BCL2, but the high-risk patients with non-T (11; 14) and low expression of BCL2 had higher early mortality.it is expected that the final results of these studies can provide a theoretical basis for the adjustment of treatment strategies for MM patients.4status and Prospect of ndmm treatment Professor Li Jian of Peking Union Medical College Hospital pointed out that bortezomib based combination of three drugs is the basic treatment strategy of ndmm, and MRD has gradually become the efficacy evaluation standard of ndmm. The first-line treatment ofmm needs further optimization. a number of clinical trials have shown that the regimen containing caffezomib can obtain a high proportion of MRD negative; the combination of four drugs containing CD38 monoclonal antibody, such as dvtd, dvrd, dkrd, isakrd, can make more than half of patients reach MRD negative. therefore, based on the MRD negative target, the optimization strategies of first-line treatment include the use of stronger proteasome inhibitors and the use of a combination of four drugs. research progress of new mechanism drugs of 5mm. In recent years, there are a lot of new drug clinical trials in the field of myeloma. Professor An Gang of Hematology hospital, Chinese Academy of Medical Sciences introduced the clinical trial data of new mechanism drugs for the treatment of multiple myeloma, such as the bispecific antibody teclstamab targeting BCMA / CD3, car-t therapy targeting BCMA, jnj-4528 and ADC drug gsk2857916, as well as other new drugs celmod, bcl-2 inhibitor and melflufen, etc., although these studies have been carried out Most of them are phase I / II clinical trials, but the emergence of new mechanism and new target drugs also bring new hope for the treatment of MM patients. Professor Yi Shuhua, hematology hospital, Chinese Academy of Medical Sciences: he explained in detail that Aspen study did not reach the main end point. The Cr + vgpr rate of zebutinib in the treatment of WM patients was not better than that of ibuprotinib, and there was no significant difference in PFS and OS between the two groups; the overall safety of the two Btk inhibitors in the treatment of WM was good, and the incidence of adverse reactions and serious AE was similar between the two groups, No patients in this study stopped taking drugs due to atrial fibrillation and hypertension. ibutilib alone or in combination can produce high activity for newly diagnosed and recurrent WM, and its safety can be controlled; ibutilib combined with rituximab can overcome the influence of MyD88 / CXCR4 gene mutation on the efficacy of WM. after the special report, Professor An Gang presided over the discussion session and actively guided the participating experts to conduct in-depth discussions on hot issues in the field of diseases. 1. In the era of targeted therapy, how do you think about the application of ibuprotinib monotherapy and combination regimen in MCL? Professor Xu Wei reported at this year's EHA meeting that ibutilinib combined with Bcl-2 inhibitor and CD20 mAb in the treatment of newly diagnosed MCL patients. At 6 months, the complete remission rate (CR) was more than 80%, and the negative rate of MRD in peripheral blood and bone marrow was 100%. Although the follow-up time was short, PFS data had not been seen yet, but the combination regimen based on ibuprotinib should be further studied. reports on data from real world studies in the UK show that early use of ibutilib in frail patients can lead to longer outcomes. in the era of targeted therapy, it is worth exploring the direction to optimize the scheme of ibutilib in MCL, one is combination therapy, the other is early use for some special groups. Professor Yi Shuhua, some high-risk MCL patients relapse quickly after standard treatment. For these patients, we can explore whether the first-line combination of new drugs can obtain more benefits. however, for special population, ibutilib can be considered as early as possible. 2. What high-risk factors of multiple myeloma patients will affect the choice of treatment options? At present, Professor Li Jian does not rely on cytogenetics to select treatment plan, and usually adopts fixed treatment mode. patients with extramedullary invasion or plasma cell leukemia may be treated with different treatment modes, such as combination of cytotoxic drugs. for patients with 17p -, t (4; 14) and 1q +, there is no need to adjust the treatment mode, there is no better choice at present. compared with the traditional treatment, the combination of new drugs can overcome the high-risk factors to a certain extent, and the new mechanism drugs may bring survival benefits, but this is not really to overcome the high-risk factors. if the high-risk factors are finally overcome, the same scheme can achieve similar efficacy for standard and high-risk patients. the high-risk patients with negative MRD can obtain the same survival benefits as the standard risk patients, but with the extension of follow-up time, it is found that these high-risk factors can not be overcome by only achieving MRD negative, and the proportion of high-risk patients getting MRD negative is significantly lower than that of standard risk patients. these high-risk factors will not be considered in the selection of clinical treatment plan, but other factors such as patient's age, tolerance, drug availability, economic status and so on will be considered more. Professor An Gang has no better drugs to overcome these high-risk factors. there was no significant difference in treatment mode among patients with different risk stratification. 3. What do you think is the therapeutic goal of CLL? Deep remission or long-term survival? For the first-line treatment of CLL, what is your consideration? Professor Yang Shenmiao is an inert lymphoma, and OS is the most important. at present, there are many schemes that can achieve deep remission in a short period of time. However, there is no mature data to support whether the deep remission is durable and can bring longer survival. the current treatment goal of CLL is still to pursue the quality of life and stable survival. MRD is really important. It is difficult to mention the cure if the MRD is not negative. Some patients still maintain deep remission after the withdrawal of MRD negative drug, but some patients do observe the loss of efficacy and disease progression after drug withdrawal. therefore, long-term single drug therapy of ibutilib is still recommended in addition to clinical trials. The combination regimen with limited course of treatment must be explored in conditional central clinical trials, and the toxicity of the combined regimen should be paid attention to and patients should be closely monitored. Professor Yi Shuhua's treatment goal of CLL is survival, and deep remission is only a means to achieve long-term survival. indolent diseases need to make treatment planning according to the patient's condition, patient's expectation and patient's genetic condition, so as to achieve long-term survival rather than pursue short-term deep remission. the current data can not fully explain which method of withdrawal is appropriate, and the limited course of treatment is still worth exploring. in addition, there are still many problems in the detection methods and accuracy of MRD. Therefore, it is necessary to stop the drug under the strictly limited clinical trial specifications. Professor An Gang, some patients have achieved deep remission but still relapse. Maybe we can explore the nature of residual tumor cells. MRD detection, including flow cytometry and second-generation sequencing, mainly detects the number of tumor cells. The malignancy of residual tumor cells is unknown, which may be the cause of recurrence. 4. How to choose the new mechanism drug and car-t in patients with relapsed myeloma after multi line treatment? Compared with other new drugs, the curative effect of car-t is relatively better, but car-t treatment has higher requirements on the patient's physical condition and has stronger toxic and side effects. for example, the success rate of T cell collection and the speed of disease progression will affect the treatment choice. in clinical trials, if the general condition of patients is better, car-t treatment will be considered first, which can achieve deeper remission and bring longer PFS. if the patient's general condition is poor, other new mechanism drug treatment can be considered. there may be different directions for clinical application. Professor Li Jian's clinical trials of some new drugs require the exclusion of patients who have previously received car-t treatment, so they may give priority to clinical trials of new drugs, and then receive car-t treatment after the disease progresses; at the same time, drug accessibility should also be considered if