2022CSH Professor Niu Ting: Based on the present, looking to the future, the development of multiple myeloma treatment in China

Listening to the sound of blood and perceiving the rhythm of life, the much-anticipated "17th National Hematology Academic Conference of the Chinese Medical Association" has been held
on September 23-25, 2022 at the National Convention and Exhibition 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 Niu Ting of West China Hospital of Sichuan University was invited to be interviewed to talk about the current situation and challenges, clinical treatment difficulties, latest treatment progress and future development prospects
in the field of multiple myeloma (MM).

MM is the second most common malignant tumor in the blood system, please talk about the current challenges facing MM treatment in China?

MM is more common in the elderly, with the aging of China's population is becoming more and more serious, MM incidence rate is also significantly rising, but limited by age, physical condition and other reasons, the proportion of patients receiving autologous hematopoietic stem cell transplantation (ASCT) in China is a big gap
compared with the international comparison.
At the same time, standardized management of the whole process is very important
for the effective treatment and long-term benefits of MM patients.
In China, especially in some underdeveloped areas or small medical institutions, the standardization of diagnosis and treatment needs to be further improved
.
In addition, MM is not yet curable, almost all patients will face relapse/refractory dilemmas, and as the number of relapses increases, the difficulty of treatment will increase, and there is an urgent need to explore more drugs with new mechanisms of action or more accessible combination regimens
of powerful drugs.

Medical pulse communication: ASCT has always played an important role in MM treatment, and induction therapy is required before transplantation to reduce tumor burden as soon as possible, restore organ function, and create conditions
for ASCT collection.
Can you please combine your clinical experience to talk about the current induction therapy mode suitable for transplanted MM patients in China and the future development trend?

Proteasome inhibitors and immunomodulators are the cornerstones
of MM therapy.
With the successive listing of a number of domestic proteasome inhibitors and immunomodulators and included in medical insurance, the current VRd (bortezomib + lenalidomide + dexamethasone) program has become a clinically used first-line induction therapy program for transplanted MM patients, and patients can successfully implement stem cell collection and ASCT
after 4-6 courses of induction therapy to obtain partial or better remission (≥ VGPR).
Other recommended induction regimens include VTd (bortezomib + thalidomide + dexamethasone), VCd (bortezomib + cyclophosphamide + dexamethasone
).
For MM patients in China, these drugs are highly accessible, and the coverage of medical insurance policies has greatly reduced the economic burden of patients, which has benefited thousands of patients
.

Combining monoclonal antibodies on the basis of the three-drug combination regimen, such as daretoulumab (D-VTd) that has been approved for marketing and included in medical insurance, or Isatuximab (Isa-VRd), which is about to be approved for marketing, may further improve the quality of post-induction therapy and deepen the depth of remission, or will become a new trend in
MM first-line treatment.

Medical Pulse Pass: MM patients may still have relapse/refractory after receiving ASCT, which seriously threatens the survival of patients, please talk about what are the current treatment options for RRMM patients? And what other directions are there to explore in the future?

Researchers around the world are actively developing new drugs for RRMM therapy, especially for patients exposed
to the proteasome inhibitor bortezomib or the immunomodulator lenalidomide in first-line therapy.
Pomatomide is a new generation of immunomodulators after thalidomide and lenalidomide, and its combination scheme is recommended for the treatment
of RRMM by authoritative guidelines and expert consensus at home and abroad.
The first domestic pomadomide has been approved for marketing in China, which has greatly improved the accessibility of MM patients in China, and a multicenter, prospective, single-arm, phase II trial has also confirmed its combination
of low-dose dexamethasone in the treatment of Chinese RRMM patients 。 Drugs such as pomatomide plus dexamethasone (bortezomib [VPd]/carfezomib [KPd]/isazomib [IPd]), CD38 monoclonal antibody (daretoulumab [DPd]/Isatuximab [Isa-Pd]), or nuclear output protein inhibitors (celinizol [XPd]) are expected to bring additional benefits to patients with lenalidomide exposure/resistance/refractory treatment
.

In addition to CD38 monoclonal antibodies, bispecific antibodies such as Teclistamab targeting BCMA and CD3 also offer new treatment options for patients, with single-agent or combination regimens having demonstrated positive results
in multiple clinical trials.
Antibody-conjugated drugs and chimeric antigen receptor T cells (CAR-T) are also popular treatments
for RRMM.
Overall, immunotherapy has broad application prospects
in RRMM therapy.

In addition, salvage ASCT is also an effective treatment option
for patients with RRMM who do not have the opportunity or willingness to receive ASCT in first-line therapy after obtaining ≥ VGPR with re-induction therapy.

Medical Pulse Communication: The 17th National Hematology Academic Conference of the Chinese Medical Association has been successfully held, and the team of West China Hospital of Sichuan University also has many outstanding performances at this conference, including the special session of the Drug Supervision Policy Forum that you chaired and chaired, and the team of West China Hospital of Sichuan University can also be seen in the special session of domestic and foreign journal publishing houses.

West China Hospital of Sichuan University is the second largest general hospital in the country in Fudan University's list of China's best specialty reputation and best hospital, and the Department of Hematology of West China Hospital of Sichuan University is also the top ten large hematology centers in Fudan University's China's best clinical specialties, and has been actively participating in the National Hematology Conference
.

At this session, we conducted a series of academic exchanges, including the use of a new highly selective targeted histone deacetylase (HDAC) inhibitor Puyiselat for the treatment of relapsed/refractory diffuse large B-cell lymphoma and MM, and the presentation of phase I clinical trial data, and the overall remission rate in enrolled patients with relapsed/refractory diffuse large B-cell lymphoma exceeded 60%, higher than the recent decade of FDA-approved nuclear output protein inhibitor Selinisol monotherapy recurrence/ The overall remission rate of refractory diffuse large B-cell lymphoma, we are more looking forward to the national phase II clinical trial co-led by President Zhao Weicheng and West China Hospital of Sichuan University to include more patients to confirm the efficacy and safety of relapsed/refractory diffuse large B-cell lymphoma, especially double-expressed diffuse large B-cell lymphoma, and help it be put into clinical application
earlier.

Professor Niu Ting

• MD, Chief Physician, Professor, Doctoral (Post) Supervisor

• Director of the Department of Hematology, West China Hospital, Sichuan University

• He is a member of the Standing Committee of the Hematology Branch of the Chinese Medical Association and the deputy leader of the lymphocyte disease group

• Vice Chairman of China Hematology Specialty Alliance

• Member of the Standing Committee of the Hematology and Oncology Committee of the Chinese Anti-Cancer Association

• Vice Chairman of the Expert Committee of the Blood Disease Public Welfare Project of China Primary Health Care Foundation

• Vice Chairman of the Blood Committee of the Chinese Medical Education Association, Vice Chairman of the Hemostasis and Thrombosis Branch

• Deputy Editor-in-Chief of the International Journal of Blood Transfusion and Hematology, Chinese Medical Association

• External expert of the Drug Evaluation Center of the State Drug Administration

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

• Business Director of Sichuan Hematology Medical Quality Control Center

• Academic and technical leader of Sichuan Province

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