2022 CSCO Guidelines

From April 23rd to 24th, the 2022 Chinese Society of Clinical Oncology (CSCO) Guidelines Conference was successfully held in a combination of online and offline methods
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During the meeting, Professor Zhu Xiaofan from the Hospital of Hematology, Chinese Academy of Medical Sciences interpreted the 2022 edition of the "CSCO Guidelines for Diagnosis and Treatment of Children and Adolescents with Leukemia"
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The main contents are organized as follows
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Guideline overview The 2022 version of the guideline for childhood acute lymphoblastic leukemia (ALL) has updated the definition and treatment of ALL recurrence, as well as Down syndrome-related ALL.
The main points are as follows: >>>> Definition of recurrence ALL Diagnosis of primitive and immature lymphocytes in the bone marrow ≥20%
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When bone marrow samples cannot be obtained, peripheral blood primitive and immature lymphocytes ≥ 20% may replace bone marrow for diagnosis
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According to the WHO 2016 diagnostic criteria, the comprehensive examination and analysis of bone marrow cell morphology-immunotyping-cytogenetics-molecular biology (MICM) can help diagnose ALL more accurately
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ALL recurrence site (1) Bone marrow recurrence alone: ​​meet any one of the following and no evidence of leukemia infiltration in other sites: primitive/naive lymphocytes in the bone marrow of the child >20% (morphological or flow cytometry); primitive/naive lymphocytes in the bone marrow Lymphocytes are 5% to 20% (morphological or flow cytometry) with evidence of molecular biology positive conversion; primitive/naive lymphocytes in bone marrow are 5% to 20% (morphological or flow cytometry) but no molecular For evidence of biological conversion to positive, at least 2 results are required, and the 2 results should be separated by 10 to 14 days and not tested by the same laboratory
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(2) Extramedullary recurrence alone: ​​recurrence in the central nervous system and/or testis with no evidence of recurrence in the bone marrow
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(3) Combined recurrence: central nervous system and/or testicular recurrence, and bone marrow recurrence at the same time
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>>>>ALL treatment ALL treatment is an overall comprehensive treatment mode based on chemotherapy.
After diagnosis, stratified treatment should be carried out according to the risk level to achieve the best treatment effect
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Only very few children with high-risk, refractory, and relapsed ALL require allogeneic hematopoietic stem cell transplantation
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Belintoumumab treatment regimen: usage: 5ug/m2/d×1w, 15ug/m2/d×3w, continuous intravenous infusion; 6-12h before infusion, dexamethasone 10mg/m2 intravenous infusion (maximum 20 mg), 30 minutes before the infusion, give dexamethasone 5 mg/m2 intravenous infusion (maximum 10 mg); for children with high tumor burden, the tumor reduction program should be given first
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>>>>Aberrant expression of CRLF2 and mutation of JAK2 are common in Down syndrome-related ALL
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Heterogeneity is evident and specific cytogenetic changes are lacking
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Based on hereditary health status and abnormal immune system, the incidence of infection during remission induction is high and serious, and the toxic and side effects of cytotoxic drugs are relatively large.
Treatment should be individualized
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The prognosis is poor, the treatment-related mortality is high, and bone marrow recurrence is easy
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Sequelae in long-term survivors include: cataracts, hearing loss, thyroid dysfunction, and severe multi-morbidity
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The 2022 version of the guidelines for childhood acute myeloid leukemia (AML) has updated the targeted therapy drugs and APL genotypes for AML (non-APL [acute promyelocytic leukemia]), the main points are as follows: >>>>Non-APL updated Targeted therapy drugs: gilritinib, veneclax, azacitidine, ivonib and drugs recommended by the FDA (adults)
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Professor Zhu Xiaofan specifically mentioned that most of the newly recommended targeted therapy drugs are based on adults, so they are only used as reference drugs
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>>>>APL supplemented with 3 genotypes: NUP98-RARA t(11;17)(p15;q21), TFG-RARA t(3;14;17)(q12;q11;q21), TNRCI8-RARA t (7;17)(p22;q21)
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Professor Zhu Xiaofan mentioned that these three genotypes should be included in the future detection of APL genotypes
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This part of infant leukemia mainly updates the treatment part, referring to 3 international diagnosis and treatment guidelines.
However, due to the low incidence of infant leukemia in China, China's own evidence-based medicine needs to be improved
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The 2022 edition of the guidelines for children with chronic myeloid leukemia (CML) has updated the treatment of children with CML.
The main points are as follows: >>>>CML treatment There is currently no recognized risk scoring system for children with CML, and it is not recommended to choose second-generation TKIs for first-line treatment.
Treatment; 6-month evaluation, if progressed, second-generation TKI may be considered; dasatinib is not recommended in Chinese CML; treatment intolerance or mutation, transplant evaluation; growth retardation, puberty delay, endocrine development during TKI treatment Abnormal functional metabolism requires specialist treatment of children's growth and development
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The 2022 Guidelines for Serious Complications in the Treatment of Childhood Leukemia have updated the asparaginase-related complications, high-dose methotrexate (MTX)-related complications, and tumor lysis syndrome among the serious complications in the treatment of childhood leukemia.
Key Points As follows: >>>>Asparaginase-related complications Class IB evidence Level III recommendation: silent inactivation (replacement); thrombosis therapy (heparin); severe pancreatitis Professor Zhu Xiaofan mentioned that although the children were treated with asparaginase There is an allergic reaction during the process, but silent inactivation may occur.
Even if the dose is increased, the drug still does not play a normal activity.
At this time, the type of asparaginase should be changed
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During asparaginase therapy, the event of thrombosis should be of concern
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Intracranial venous sinus thrombosis is a common event in thrombosis.
Imaging examinations should be given in time for children with headache or discomfort during treatment.

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In addition, attention should also be paid to the occurrence of severe pancreatitis
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>>>>High-dose MTX-related complications (1) When high-dose MTX is used, voriconazole should be used with caution, which may cause severe photosensitivity reactions
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(2) Patients with pleural and ascites are prone to delay the excretion of MTX.
If feasible, treat or drain MTX before the first administration of MTX
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>>>>Tumor lysis syndrome (TLS) LR allopurine; HR G-6PD enzyme should be measured when urate oxidase is used to prevent TLS, and debasification and dehydration should be performed when urate oxidase is used for preventive treatment
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Professor Zhu Xiaofan, Chief Physician, Doctoral Supervisor Vice-chairman of Tianjin Pediatric Oncology Professional Committee, editorial board of "Chinese Journal of Pediatrics", "Chinese Journal of Hematology", "Chinese Journal of Contemporary Pediatrics", "Chinese Journal of Practical Pediatrics", "International Journal of Pediatrics" and other journals
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Undertook a number of national and provincial-level projects
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She has won the first prize of Tianjin Natural Science Award, the third prize of Tianjin Science and Technology Progress Award, Wuzhou Women's Science and Technology Award, Soong Ching Ling Pediatric Medicine Award and other awards
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He has published more than 100 papers, and has published papers as the first author and corresponding author in "Nature Genetics", "JAMA Oncology", "Nucleic Acids Research", "Blood", "BMC Med Genomics" and "Experimental Hematology" in the past five years.
Many articles
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