2022 SHS Professor Fu Chengcheng: Jointly build a "blood think tank" and explore a new direction of MM diagnosis and treatment optimization

Multiple myeloma (MM) is a malignant plasma cell disease that accounts for about 10% of hematologic malignancies, second only to non-Hodgkin lymphoma, and is more common in middle-aged and elderly people
.
In recent years, with the continuous advent of new drugs and the innovation of treatment methods, MM treatment has been gradually optimized and improved, but MM is still incurable, and patients with relapsed/refractory (R/R) after multi-line treatment are still trapped in the dilemma
of limited treatment options and poor prognosis.

On October 8, 2022, the "2022 Suzhou Hematology Summit" was held in Suzhou, inviting well-known hematology experts at home and abroad to conduct in-depth discussions
on the new progress in the diagnosis and treatment of blood diseases, precision medicine and leukemia, and the construction of big data platform.
On this occasion, Yimaitong sincerely invited Professor Fu Chengcheng from the First Affiliated Hospital of Soochow University to be interviewed to share the difficulties in the diagnosis and treatment of MM and the future development direction
.

MM is highly heterogeneous, and with the continuous advancement of diagnosis and treatment, the diagnosis and treatment of MM have been further improved, but MM is still incurable
.
Can you tell us about the current challenges of MM diagnosis and treatment?

MM is still not curable, and with the continuous advent of new drugs, the overall survival of MM patients is expected to reach more than
10 years.
However, with the increase in the number of recurrences of patients, there are still many difficulties in the diagnosis and treatment of MM: (1) With the increase of the number of recurrences, patients become resistant to existing treatment drugs, the time for remission is getting shorter and shorter, the follow-up treatment options are limited, and the difficulty of treatment increases
.
(2) The incidence of malignant gene mutations in relapsed patients is increasing, such as 1Q amplification, p53 mutation and other high-risk factors, the incidence of relapsed patients is as high as 70%-90%, and there is currently no targeted treatment drug
.
(3) More and more MM patients relapse with special types such as plasma cell leukemia and extramedullary tumors, which means that the patient's disease is developing in the advanced direction, and the treatment will be more difficult
.

Therefore, some clinicians become very anxious when they find a relapse during MM care, but not all patients with relapse need immediate treatment
.
For patients who relapse after complete remission (CR), such as the reappearance of M protein in the patient's blood or urine, the so-called biological recurrence, most of them do not need to be treated immediately, unless there is light chain escape and the lesion is measurable to start treatment
.
Patients without clinical manifestations of SLiM-CRAB can be observed first, and some patients can maintain a state of biological recurrence for several years, and if the patient has SLiM-CRAB manifestations, treatment needs to be started immediately
.

*SLiM-CRAB, increased blood calcium, renal impairment, anemia, bone disease and other manifestations

In addition to relapse, the treatment of patients with disease progression is not optimistic
.
These patients are defined as a short-term rapid increase in some indicators, such as an increase in serum or urine M protein content, or a new soft tissue plasma cell tumor lesion, peripheral plasma cell infiltration, and so on
.

Yimaitong: As one of the important promoters of the multi-center construction of the multiple myeloma database of the "Blood Think Tank" was launched this year, can you please talk about the significance of this initiative in MM diagnosis and treatment?

"Blood Think Tank" is a multiple myeloma special database established by five centers in Shanghai, Jiangsu and other places under the guidance of the China Primary Health Care Foundation, and our center has also participated in the construction of the "Blood Think Tank", and has now completed the construction of a single-center database, and launched the construction
of a multi-center database in August this year.

Although MM is a tumor type with a relatively low incidence, China has a large land and a large population base, so the incidence population is relatively large, and MM treatment needs more attention
.
At present, there are few large-scale phase III multi-center clinical studies in China, which is closely related to weak clinical data management, so the construction and management of databases is very important
.
It is hoped that by carrying out more clinical studies in some large centers, more clinical data will be obtained, and clinicians will understand the survival and treatment plan data of MM patients in China in the real world, so as to further optimize the clinical diagnosis and treatment
of MM.

Yimaitong: With the joint efforts of many scholars over the years, MM diagnosis and treatment has made great progress
.
What are your outlooks for MM in the future?

In the future, MM diagnosis and treatment should take into account standardization and individualization, train clinicians across the country to standardize diagnosis and treatment, and carry out individualized treatment for particularly high-risk patients, including the combination of CAR-T therapy, new monoclonal antibodies or bispecific antibody drugs, so that these patients can obtain better efficacy in the case of poor efficacy
of existing therapies.
The short-term goal of MM diagnosis and treatment is to make the median disease-free survival of MM patients in China exceed 5 years, and the overall survival time exceeds 10 years, reaching the international advanced level
.
The long-term goal is to discontinue or even achieve clinical cure
for patients at risk after existing treatment.

Due to the late diagnosis of MM patients in China, more than 80% of patients with high tumor burden in the late stage of diagnosis, it is very critical to find early MM patients in early detection, early diagnosis and early treatment, especially high-risk smoking myeloma patients, it is necessary to carry out early screening
.
After the early stage of the disease is detected, the possibility of stopping the progression of the disease and curing the disease in the treatment needs to be worked
together by the whole country.

Prof.
Fu Cheng

• Deputy Director of the Department of Hematology, Chief Physician, Associate Professor, Doctoral Supervisor, The First Affiliated Hospital of Soochow University

• Deputy leader of the Plasma Cytology Group of the Hematology Branch of the Chinese Medical Association

• Member of Myeloma Expert Committee of Hematology Branch of Chinese Medical Doctor Association

• Member of Hematology and Oncology Branch of Chinese Anti-Cancer Association

• Member of the Targeted Therapy Committee of the Association of Women Physicians

• Deputy Head of the Specialty Group of Multiple Myeloma and Related Diseases of the Association of Women Physicians

• Hematology and Oncology Branch of Jiangsu Anti-Cancer Society, Hematology Branch of Jiangsu Medical Association, Deputy Head of Plasma Cell Disease Group of Jiangsu Research Hospital Association

• Chairman of the Standing Committee of Hematology Professional Committee of China Medical Education Association

• Member of the Asia-Pacific Myeloma Network

• Member of the International Myeloma Society

• As the project leader, he has successively won the Key Talent Fund of Jiangsu Provincial Department of Health, National Natural Science Foundation of China, Natural Science Foundation of Jiangsu Province, and Hematology and Oncology Professional Committee of
  China Anti-Cancer Association.
  He has won the second prize of scientific and technological progress of the Ministry of Education and the Ministry of Science and Technology, and the new technology introduction award of
  Jiangsu Province.