2022CSH | Professor Chen Suning: New drugs and new technologies to promote the individualized diagnosis and treatment of AML

Listening to the sound of blood and perceiving the rhythm of life, on September 23-25, 2022, the "17th National Hematology Academic Conference of the Chinese Medical Association" was grandly opened
at the National Exhibition and Convention Center in Shanghai.
The conference was hosted by the Chinese Medical Association and the Hematology Branch of the Chinese Medical Association, hosted by the Shanghai Medical Association, 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, with the theme of "respect, inheritance, collaboration and innovation", specially invited famous experts at home and abroad to talk about the latest progress
in the field of blood diseases.
On this occasion, Professor Chen Suning of the First Affiliated Hospital of Soochow University was invited to interpret the diagnosis and treatment of acute myeloid leukemia (AML) and the progress
of new drugs for us.

The advent of the new drug era has provided more choices for the treatment of AML, and also provided more opportunities for the "cure" of AML
.
Could you please briefly introduce some of the new drug advances in the AML field?

The treatment pattern of AML has undergone very significant changes since 2017, the continuous emergence of new drugs provides more treatment options for AML patients, and the new drugs that deserve attention mainly include the following categories: The first is the improvement of traditional cytotoxic drugs, such as CPX-351, mitoxantranone liposomes, etc.
The emergence of new preparations has improved the efficacy of AML patients, which is a very important progress
。 The second category is the emergence of specific targeted drugs, including FLT3 inhibitors (midotolin, gerlotinib, quezatinib, etc.
), IDH inhibitors (evonibu, encidipine), etc.
, which bring very promising treatment options
for some AML subtypes.
The third category is pan-target drugs, such as BCL-2 inhibitors (Venekla), and many domestic pharmaceutical companies are also promoting the research and development of domestic BCL-2 inhibitors, which is worth looking forward to
.
In addition, general-targeted drugs such as MDM2 inhibitors, demethylated drugs (decitabine, azacitine), and SMO inhibitors (glasdegib) are also important treatment methods
for AML patients.
The fourth category is immunotherapy, including monoclonal antibody drugs targeting CD70, CD47, CD33 and other targets, which have shown good anti-leukemia activity and tolerability
.
Chimeric antigen receptor T cell (CAR-T) immunotherapy also has broad application prospects in the treatment of AML
.
Therefore, overall, more and more new drugs are gradually entering the clinical treatment of AML, changing the overall treatment pattern of AML, and we will have more and better treatment weapons in the
future.

Medical Pulse Pass: Today, with the increasing accessibility of new drugs, what changes have been made to the first-line treatment of AML compared with traditional chemotherapy?

The approval of a series of targeted and immunotherapy drugs has also led to changes in the first-line treatment of AML
.
For patients who cannot tolerate high-intensity chemotherapy or older AML, a combination therapy strategy based on the BCL-2 inhibitor Vinekla has proven to be a safe and effective treatment option
.
For young AML patients, BCL-2 inhibitors are being explored, including a study presented by our research group at last year's ASH conference showing that the first-line treatment of high-risk young AML patients with European Leukemia Network (ELN) in Venecra combined with decitabine can significantly improve
the efficacy.
The first affiliated hospital of Zhejiang University conducted a study of vinecra combined with daunorubicin and azacitidine for the first-line treatment of young AML patients
.
These findings suggest that not all young AML patients need to receive high-intensity induction therapy, and the treatment regimen for young AML is no longer limited to the standard "3+7 regimen" and allogeneic hematopoietic stem cell transplantation, the combination of new drugs and traditional treatment regimens, the combination of immunotherapy and targeted therapy, and the combination of new drugs with different mechanisms of action is changing the treatment mode
of young AML.
With the accumulation of clinical evidence, the treatment of young AML patients will be more detailed and precise
.

Doctor Pulse: Can you tell us about your outlook for the future of AML treatment?

Looking to the future, we first need to further improve AML precision diagnosis
.
The diagnosis of AML relies primarily on a comprehensive diagnosis of MICM typing based on morphology, immunology, cytogenetics, and molecular genetics
.
With the continuous development of genomics, the connotation of molecular diagnosis has expanded from PCR to DNA sequencing, RNA sequencing and even single cell sequencing, which may provide an important weapon
for accurate diagnosis of AML in the near future.
Secondly, rapid diagnosis is also the direction of
future efforts.
The time required from the collection of the patient to the acquisition of the pathology report needs to be further reduced
.
The First Affiliated Hospital of Soochow University conducted a trial last year, hoping to obtain morphology, flow cytometry, PCR and FISH test results within 72 hours, and clarify the patient's diagnostic classification, risk stratification and treatment target information before starting induction therapy, which will help to develop a more accurate treatment plan in
the clinic.
With the development of diagnostic technology, it is believed that more patients will benefit
from it in the future.

In addition, individualized induction protocols are an important exploration direction for
AML therapy.
Elderly patients with AML who are not suitable for intensive induction chemotherapy have achieved ideal efficacy through combined targeted therapy, and the treatment of young AML patients will be further stratified
in the future.
In addition, AML consolidation therapy is currently relatively single, the research is very small, medium and high doses of cytarabine based on the regimen is the standard treatment, and whether innovative targeted drugs can replace or change this treatment mode also needs to be further explored
.
Finally, allogeneic hematopoietic stem cell transplantation is still a very important weapon in AML treatment in the new drug era, and it can even be said to be a "nuclear weapon", and allogeneic hematopoietic stem cell transplantation is still the only treatment method
in a considerable number of patients.
China's allogeneic hematopoietic stem cell transplantation technology has made great progress, especially under the leadership of Academician Lu Daopei and Professor Huang Xiaojun, haploid transplantation technology is changing with each passing day, and the future will further explore how to reduce transplant-related mortality and improve the quality of life of patients to benefit more patients
.

As the executive chairman of this conference, what are your thoughts and experiences on the successful holding of the 17th National Hematology Academic Conference of the Chinese Medical Association, as the executive chairman of this conference, on the successful holding of this conference and the achievements made in the field of blood at present?

The 17th National Hematology Academic Conference of the Chinese Medical Association was successfully held, and I am very grateful to all the colleagues of the Hematology Branch of the Shanghai Medical Association led by Professor Zhao Weichen of Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, for contributing a large-scale academic event to us
.
In the preparatory process of the conference, we did encounter many difficulties, especially in the context
of epidemic prevention and control.
At the same time, I would also like to thank the teams of the Academic Affairs Department of the Chinese Medical Association, the Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, and the First Affiliated Hospital of Soochow University for their help
in the preparation of the conference.
In addition, we would like to express our gratitude
to the representatives of enterprises and media who participated in the preparation of this meeting.
This large-scale academic conference brought together experts and scholars in the field of blood and provided a high-level academic exchange platform
for everyone.
The content covers the latest research progress in the field of blood diseases, and there are also innovations in form, and more interdisciplinary innovation conferences have been introduced on the basis of the previous traditional academic annual conferences, which have shown us the high-level development status of the blood field and promoted the academic construction and discipline development in the field of
hematology.

Professor Suning Chen

• Professor, chief physician and doctoral supervisor of the First Affiliated Hospital of Soochow University

• Deputy Director of Jiangsu Institute of Hematology

• He is a member of the Hematology Branch of the Chinese Medical Association

• Member of the Standing Committee of Experimental Hematology Branch of Chinese Society of Pathophysiology

• He is the President-designate of the Hematology Branch of Jiangsu Medical Association

• 2020 State Council special allowance expert

• He has presided over more than 10 projects such as the American Leukemia Lymphoma Association, the Jiangsu Outstanding Youth Fund, and the National Natural Science Foundation of China

• Won the 2017 Wu Mengchao Medical Youth Fund Award

• He has won 2 second prizes of the National Science and Technology Progress Award and 3 first prizes of provincial and ministerial scientific and technological progress awards

• As a corresponding author, he has published more than 50 SCI papers in Blood, Leukemia, Haematologica and other journals

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