2022CSH focuses on the frontiers of transplantation and explores the way of diagnosis and treatment, and the 17th National Hematology Academic Conference of the Chinese Medical Association - Transplantation Frontier Forum is wonderful!

Listen to the sound of blood and feel the rhythm of life
.
The 17th National Hematology Academic Conference of the Chinese Medical Association, sponsored by the Chinese Medical Association and the Hematology Branch of the Chinese Medical Association, undertaken by the Shanghai Medical Association, and co-organized by Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, the First Affiliated Hospital of Soochow University, and the Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, was solemnly held
on September 23, 2022.

"Respect, inheritance, collaboration, innovation", adhering to this purpose, well-known experts at home and abroad talk about the latest progress
in the field of blood diseases.
Among the many special sessions, the hematopoietic stem cell transplantation (HSCT) venue was wonderful and not to be missed, and many academic experts explored the latest research progress of
HSCT.
The highlights of the conference are now compiled below for the benefit of readers
.

Treatment of acute leukemia (AL) in the elderly should take into account risk stratification and personal physical condition, and transplantation
should be given as soon as possible in those who have the condition.
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is an effective treatment for elderly AL patients, but the proportion of transplants in elderly AL patients in China is low, which may be due to concerns about
transplant-related complications and high risk of death.
Studies have shown that there is no significant difference
in efficacy and comorbidities between elderly AL patients who received the "Beijing Protocol" transplantation compared with young leukemia patients.
In addition, the new strategy of multiple treatment of new drugs combined with HSCT has application prospects
.

Under the co-chairmanship of Professor Chen Fangping of Xiangya Hospital of Central South University and Professor Song Yongping of the First Affiliated Hospital of Zhengzhou University, Professor Tang Xiaowen of the First Affiliated Hospital of Soochow University deeply interpreted the "Consensus of Chinese Experts on the Diagnosis and Treatment of Thrombotic Microvascular Disease (TA-TMA) Related to Hematopoietic Stem Cell Transplantation" from the aspects of incidence and pathogenesis, diagnosis and differential diagnosis, treatment principles and first-line treatment, and second-line treatment
.

TA-TMA is a highly high-mortality complication associated with post-transplant treatment, and predictive models can be established to effectively identify people
at high risk of TA-TMA.
The first-line and second-line treatment of TA-TMA greatly increases the survival rate of patients, and in addition, the standardized diagnosis and treatment process of the guidelines facilitates the full management
of TA-TMA in each center.

Under the co-chairmanship of Professor Huang He of the First Affiliated Hospital of Zhejiang University School of Medicine and Professor Sun Zimin of the First Affiliated Hospital of the University of Science and Technology of China, Professor Jiang Erlie of the Hematology Hospital of the Chinese Academy of Medical Sciences shared the progress
of aGVHD prevention and treatment.

Prevention and control of post-transplant graft-versus-host disease (GVHD) is an important factor
in the success of HSCT.
Studies have shown that antithymocyte globulin (ATG) prevents GVHD after kinship concordance transplantation
.
In addition, patients with aGVHD who failed first-line therapy had a higher 2-year non-recurrence mortality rate, patients with chronic graft-versus-host disease (cGVHD) who failed first-line therapy had a disease-specific survival rate of about 38%, and ineffectiveness of hormone therapy shortened overall survival by
about 50%.
。 Studies have shown that baliximab is safe and effective in treating hormone-resistant acute graft-versus-host disease (SR-aGVHD), rerotitinib is effective for SR-aGVHD in various organs, and α1-antitrypsin (ATT) post-therapeutic hormone-resistant graft-versus-host disease (SR-GVHD) has also shown good efficacy
.

Under the co-chairmanship of Professor Shen Zhixiang of Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine and Professor Jiang Ming of the First Affiliated Hospital of Xinjiang Medical University, Professor Zhang Xi of Xinqiao Hospital of Army Military Medical University deeply analyzed the "Chinese Expert Consensus on Chronic Graft Versus Host Disease (2021 Edition)"
.

The incidence of cGVHD is high (30%-70%), it can affect any organ in the body, the pathological mechanism is complex, and the clinical manifestations are diverse
.
The treatment of cGVHD is a long-term process, should be given sufficient time to judge the efficacy of the drug, avoid frequent drug changes, in addition, cGVHD can be managed as a chronic disease, regular cGVHD organ dynamic scoring, judging the therapeutic effect, with the comprehensive treatment of cGVHD (such as infection prevention, nutritional support, functional exercise, psychological intervention, etc.
), and gradually improve the patient's quality of life to achieve the purpose of
cure.

Under the co-chairmanship of Professor Chen Wenming of Beijing Chaoyang Hospital Affiliated to Capital Medical University and Professor Liu Zhuogang of Shengjing Hospital Affiliated to China Medical University, Professor Luo Yi of the First Affiliated Hospital of Zhejiang University School of Medicine gave a wonderful sharing
on the topic of "Allogeneic Hematopoietic Stem Cell Transplant Donor Selection".

Selecting the best donor for the patient's disease status and age improves patient survival and reduces recurrence rates, and the best haplogram donors tend to choose young, male, and child donors
.
Younger high-risk patients prefer haplozygous sibling donors (HSD) with lower recurrence rates and improved survival rates than sibling total concordance donor (MSD) transplantation, while paraphylactic haploportation can be used as an alternative to
non-direct donors.
In addition, a positive hepatitis B surface antigen (HBsAg) is no longer a contraindication
to donor choice.
In the future, it is necessary to overcome the anti-human leukocyte antigen (HLA) barrier to further expand the donor source
.

Under the co-chairmanship of Professor Liu Daihong of the General Hospital of the People's Liberation Army of Chinese and Professor Wu Bingyi of the Cancer Prevention and Control Center of Sun Yat-sen University, Professor Xu Kailin of the Affiliated Hospital of Xuzhou Medical University made a report
on "CAR-T and Transplantation".

Pre-Allo-HSCT tumor burden is closely related to the long-term efficacy of transplantation, and relapsed/refractory acute B lymphoblastic leukemia (B-ALL) can better improve transplant efficacy
by using chimeric antigen receptor (CAR)-T cell therapy to clear tumor burden before transplantation.

Bridging allo-HSCT timing should be within 3-6 months of CAR-T infusion (a full evaluation of CAR-T therapy 30 days after infusion and preparation for allo-HSCT).

Studies have confirmed that CAR-T therapy is safe and effective
in patients with B-ALL who relapse after allo-HSCT.

Under the co-chairmanship of Professor Li Chunfu of the Southern Chunfu (Children's) Institute of Hematology and Professor Chen Jing of Shanghai Children's Medical Center affiliated to Shanghai Jiao Tong University School of Medicine, Professor Cheng Yifei of Peking University People's Hospital shared the progress
in the field of child transplantation.

The children's HSCT business is booming, the number of transplants is increasing year by year, and transplantation can be combined with new technologies and drugs to improve transplant results
.
Immunotherapy in combination with allo-HSCT in childhood leukemia is effective in inducing patients to achieve complete remission (CR), and long-term survival
is achieved by post-CR bridging grafting.
In addition, HSCT normalization is critical
to the clinical efficacy of stem cell transplantation.

Under the co-chairmanship of Professor Wang Fengrong of Peking University People's Hospital and Professor Guo Mei of the Fifth Medical Center of the General Hospital of the People's Liberation Army of Chinese, Professor Sun Yuqian of Peking University People's Hospital deeply interpreted the "Expert Consensus on the Treatment of Blood System Diseases by Allogeneic Hematopoietic Stem Cell Transplantation in China (2021 Updated Edition)"
.

Immunotherapy, such as CAR-T therapy in combination with or bridging with haploid transplantation, makes treatment of post-transplant recurrence feasible
.
Studies have shown that in patients with relapsed refractory acute lymphoblastic leukemia (ALL), CAR-T therapy bridging haploid transplantation consolidation therapy significantly improves patient survival
.
In addition, in hematological malignancies such as leukemia, the optimal selection principle of "preferred donor-specific antibody (DSA)-negative, young, and male donor" has been formed, and for patients with aplastic anemia (SAA), father, mother, siblings and children are all suitable donors for patients, and the survival outcome of transplantation is similar
.

Under the co-chairmanship of Professor Hu Liangjian of the Fifth Medical Center of the General Hospital of the Chinese People's Liberation Army and Professor Song Xianmin of the First People's Hospital of Shanghai, Professor Zhu Xiaoyu of the First Affiliated Hospital of the University of Science and Technology of China gave a wonderful report
entitled "Cord Blood Transplantation for the Treatment of Malignant Blood Diseases".

Cord blood transplantation (UCBT) has a strong graft anti-leukemia (GVL) effect and a low incidence of cGVHD, and is a better type
of transplantation for GVHD and GVL separation.
With the increasing understanding of HLA matching, the selection of the most suitable umbilical cord blood, the improvement of pretreatment protocols, the management of transplant complications such as preimplantation syndrome (PES) and post-transplant recurrence, UCBT has achieved overall survival comparable to other allo-HSCT types and better GVHD-free survival (GRFS)
in transplant patients.
In the future, the research direction should focus on the innovative research of the basic biology of umbilical cord blood stem cells, the precise treatment of PES and GVHD, and the prevention and treatment of recurrence after transplantation, so as to further improve the GRFS of UCBT and benefit more patients
with UCBT.

Under the co-chairmanship of Professor Fu Yuewen of Henan Provincial Cancer Hospital and Professor Gao Feng of the Affiliated Hospital of North China University of Science and Technology, Professor Xuan Li of Nanfang Hospital of Southern Medical University gave a wonderful sharing
on the application of HSCT in patients with acute myeloid leukemia.

Stratified treatment of genetics and dynamic minimal residual disease (MRD) improves efficacy in acute myeloid leukemia (AML
).
The addition of new AML drugs during induction, consolidation, and pretreatment can optimize HSCT treatment strategies
.
In addition, preemptive donor lymphocyte infusion (DLI) and the application of interferon (IFN-α) have helped reduce post-transplant recurrence rates, hypomethylated drugs (HMAs) have shown good application prospects in maintenance therapy after AML transplantation, and BCL2 inhibitor maintenance therapy has also received widespread attention
.

Under the co-chairmanship of Professor Liu Li of Tangdu Hospital of Air Force Military Medical University and Professor Zhang Mei of the First Affiliated Hospital of Xi'an Jiaotong University, Professor Wang Ying of the First Affiliated Hospital of Soochow University gave a report
entitled "MDS for Transplant Therapy".

The median age of onset of patients with myelodysplastic syndrome (MDS) is about 70 years old, and domestic MDS transplant patients are relatively young and have a large room
for improvement.
Allo-HSCT is an effective treatment method for high-risk MDS patients, and there is a large clinical demand for elderly MDS patients in China, which requires the optimization of the whole technology system to further improve the efficacy
of allo-HSCT.
In addition, post-transplant recurrence is still a pain point of treatment, bridging therapy has the potential to reduce post-transplant recurrence, and the plan of bridging therapy is constantly improving with the emergence of new treatment methods
.

Under the co-chairmanship of Professor Wan Dingming of the First Affiliated Hospital of Zhengzhou University and Professor Wang Zhiguo of the Harbin Institute of Hematology and Oncology, Professor Hu Jiong of Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine made a report
on "Transplant Treatment ALL".

Allo-HSCT is an important treatment for ALL, significantly reducing the recurrence rate of standard-risk and high-risk ALL, and maintenance therapy after allo-HSCT can further reduce the recurrence rate
.
In addition, the integration of targeted therapy and immunotherapy improves the efficacy
of Ph-chromosome-negative (Ph-)ALL and Ph-chromosome-positive (Ph+)ALL in initial therapy.

After a warm academic collision and unfinished discussion, the conference came to an end
.
With the continuous maturity of HSCT technology, the continuous expansion of transplant diseases, the continuous breakthrough of the age of transplant patients, and the rapid growth of HSCT cases at home and abroad, but the exploration is endless, the road is long and long, the line is coming, the line is coming, and the future can be expected
.
Looking forward to more innovative drugs and advanced technologies coming out in the future to benefit more patients!

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