2021 CSCO Guidelines Update | Leukemia Update Key Points

From April 23rd to 24th, the 2021 Chinese Society of Clinical Oncology (CSCO) Guidelines Conference was successfully held.

At the meeting, Professor Gong Tiejun from the Harbin Institute of Hematology and Tumor gave a detailed and wonderful explanation on the update points of the "2021 CSCO Malignant Hematological Disease Diagnosis and Treatment Guide".

What are the updates in the Leukemia section? Let's take a look together.

1.
New "Primary Plasma Cell Leukemia" Chapter 2.
Acute Lymphoblastic Leukemia (ALL) Update 01 In the molecular examination of pre-treatment evaluation, "RNAseq" was changed from Grade III recommendation to Grade II recommendation.

In the imaging examination, "superficial lymph node ultrasound and abdominal ultrasound" were added.

02 Treatment In the induction treatment part of Philadelphia chromosome (Ph) negative ALL, the "Hyper-CVAD regimen" and "CD20 positive can be combined with rituximab" are added.

In the post-remission treatment part of Ph-negative ALL, "Belintouximab" is added.

In the treatment part of Ph-positive ALL after remission, add "Belinto olumab".

For the treatment of relapsed and refractory ALL: Add "Belinto Ouzumab" and "Ogaituzumab ± chemotherapy".

3.
Adult (<60 years old) acute myeloid leukemia (AML) (non-APL) update content "Cytogenetics/Molecular Genetic Index Risk Classification" is updated as follows: Good prognosis group: FLT3-ITD mutation, replaced with: Or with a low allelic ratio (low allelic ratio) FLT3-ITD mutation with a moderate prognosis group: NPM1 mutation accompanied by FLT3-ITD mutation, replaced with: NPM1 mutation with high allelic ratio FLT3-ITD Mutation poor prognosis group: FLT3-ITD mutation, replaced by: high allelic ratio (high allelic ratio) FLT3-ITD mutation 4.
Adult (≥60 years old) acute myeloid leukemia (non-APL) Update 01 Pathological diagnosis and typing "Cytochemical staining" is deleted from the level II recommendation.

02 Inducing remission treatment for Fit patients, the level I recommendation is increased: venecola + azacitidine/decitabine/low-dose cytarabine Unfit patients, the level I recommendation is increased: venecola + azacitidine/ground Citabine/low-dose cytarabine Unfit patients, grade II recommended increase: CD33+ patients: gemtuzumab 6mg/m² d1, 3mg/m² d8Frail patients, grade III recommended increase: venecola + azacitidine /Decitabine/Low-dose Cytarabine V.
Relapsed and refractory acute myeloid leukemia (non-APL) Updates to add "Geritinib" and "Cidamine + Decitabine + CAG program ".

6.
Acute Promyelocytic Leukemia (APL) update content "pathological diagnosis" section, "13 variant APL chromosomes and gene abnormalities" replaced with "14 variant APL chromosomes and gene abnormalities".

Add a row to the table: "NUP98-RARA t(11:17)(p15;q21)" 7.
Chronic Lymphocytic Leukemia (CLL) Update 01 The "lymphocyte immune typing" in the first-level recommendation of pretreatment evaluation "Flow cytometry lymphocyte immunotyping"; "Whole body enhanced CT" was changed to "Whole body enhanced CT (neck, chest, abdomen, pelvic cavity)". In the second-level recommendation, "bone marrow aspiration and biopsy" was changed to "bone marrow smear and biopsy + immunohistochemistry"; "direct Coombs test" was changed to "direct anti-human sphere test"; "serum immunoglobulin" was changed to "serum immunization" Globulin (lgG, lgA, IgM)”; “abdominal ultrasound” was changed to “superficial and abdominal ultrasound”; “echocardiogram” was changed to “electrocardiogram, echocardiogram”.

Note: "Detection under special circumstances: immunoglobulin quantification" is changed to "detection under special circumstances: immunoglobulin (lgG, IgA, lgM) quantification".

Note: "Echocardiography (when anthracycline or anthraquinone drugs are to be used)" is changed to "ECG, echocardiogram (when anthracycline or anthraquinone drugs are to be used)" 02 Diagnosis Class I In the recommendation, "Small, mature lymphocytes increased significantly" changed to "Small, mature lymphocytes increased significantly.
Pay attention to observing the smearing of cells" 03 The treatment "Treatment" part has been modified and increased or decreased.
Among them, Ⅰ The recommended changes are as follows.

For newly-treated patients with indications for treatment, no del(17p)/TP33 gene mutation, and severe concomitant disease (CIRS score>6), add "Veneclair + Rituximab/Otuzumab to the level I recommendation anti".

Newly treated patients have indications for treatment, no del(17p)/TP53 gene mutations, and no serious concomitant diseases (CIRS score ≤ 6 points) in the level I recommendation "fludarabine + cyclophosphamide + rituximab" Changed to "fludarabine + cyclophosphamide + rituximab, for IGHV mutations".

The first-level recommendation for newly-treated patients with indications for treatment and del(17p)/TP53 gene mutations adds "Zebutinib, Venecla + Rituximab/Otuzumab".

Relapsed and refractory patients have indications for treatment, no del(17p)/TP53 gene mutations, and no matter whether there is a serious concomitant disease (CIRS score> 6 points), the level I recommendation is to add "Ibrutinib, Zebutinib, Obu" Tinib, Venecla + Rituximab/Otuzumab".

Relapse and refractory patients who have indications for treatment and have del(17p)/TP53 gene mutations add "Ibrutinib, Zebutinib, Obutinib, Venecla + Rituximab/ Otuzumab, participate in clinical trials".

04 "Incomplete CR (Cri)" in the comment of efficacy evaluation was changed to "CR (Cri) with unrecovered bone marrow".

8.
Chronic myeloid leukemia (CML) update content adds two sections: "Conditions for stopping TKI treatment" and "Pregnancy management during TKI treatment".

Poke "read the original text" and we will make progress together