2022CSH Professor Zhang Huilai: "No chemotherapy" improves the quality of life of patients with indolent lymphoma, and precise stratification brings the dawn of cure for R/R patients

The 17th National Hematology Academic Conference of the Chinese Medical Association was grandly opened in Shanghai on September 23-25, 2022, with the theme of "respect, inheritance, collaboration and innovation", and invited well-known experts at home and abroad to talk about the latest progress
in the field of blood diseases.
On this occasion, Yimaitong specially invited Professor Zhang Huilai of Tianjin Medical University Cancer Hospital to be interviewed to express his views on
the treatment progress of diffuse large B-cell lymphoma (DLBCL), "chemo-free" treatment and precision stratification therapy.

DLBL is the most common B-cell malignancy, how is the current treatment of DLBCL? What are the remaining unmet treatment needs?

In recent years, many advances have been made in DLBCL therapy, with 50% to 60% of DLBCL patients achieving clinical cure through standard first-line treatment R-CHOP regimens (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone), and the remaining 40% to 50% of DLBCL patients will still have relapse refractory (R/R)
after first-line treatment 。 Probably half of these R/R patients are suitable for autologous hematopoietic stem cell transplantation (ASCT) therapy, which is an important salvage treatment for R/R DLBCL patients, especially high-risk patients, and patients with DLBCL who are sensitive to chemotherapy relapse are preferred for ASCT therapy
.
However, fewer patients who are suitable for ASCT and can benefit from it, those who are not suitable for ASCT or who relapse after receiving ASCT, and those who develop disease progression within one year of first-line therapy (suggesting that patients may develop drug resistance) tend to have a poorer
prognosis.
In the era of immunotherapy, such patients can choose chimeric antigen receptor T cell (CAR-T) therapy to obtain a good cure
.

Looking at domestic and foreign research data, for patients with refractory (especially chemotherapy-refractory) DLBCL, the overall response rate (ORR) of second-line salvage therapy <30%, the complete response (CR) rate < 10%, and the median survival time is about 6 months<b10>.
If such patients choose CAR-T therapy, the overall 5-year survival (OS) rate can reach 42.
6%.

Overall, CAR-T therapy brings better survival benefits to patients who are not suitable for ASCT or refractory DLBCL, which can be described as an important treatment direction
for DLBCL.

Since indolent lymphoma has made many progress in targeted therapy, immunotherapy and other fields, "whether no chemotherapy regimen can make patients get a better prognosis" has become a topic
of concern in the field of indolent lymphoma.
So do you think indolent lymphomas should all be treated "chemotherapy-free"? What is the status of chemotherapy in the treatment of indolent lymphoma?

In today's new drug era, patients with indolent lymphoma can achieve long-term survival and improve the quality of life, of which improving the quality of life is the main treatment goal
of indolent lymphoma.
More patients with indolent lymphoma are suitable for a "chemotherapy-free" regimen, mainly because it reduces toxicity and allows patients to achieve longer progression-free survival (PFS
).

Patients with indolent lymphoma are difficult to completely cure, often have repeated recurrence and disease progression, and patients survive poorly after five to six lines of treatment, while the "no chemotherapy" treatment regimen can allow these patients to obtain a longer and better quality of survival and reduce the possibility of
recurrence.

In order to improve the treatment prognosis of lymphoma patients, precision stratification therapy has received more and more attention and advocacy, can you please introduce the current situation and unmet needs of precision stratified lymphoma treatment in China?

At present, it seems that precision stratification therapy is not easy to carry out in a wide range of clinical areas, involving many problems, such as 50% to 60% of DLBCL patients can achieve clinical cure through first-line R-CHOP therapy, for this part of the patient, precision treatment is not necessary program
.
For another 40% to 50% of patients who have switched to R/R DLBCL, especially for high-risk patients, precision stratification therapy may have better application space
in the future.

Therefore, under the national conditions that many drugs in China have not entered medical insurance and the economic burden of patients is heavy, some low-risk DLBCL patients are not necessarily suitable for precision stratification treatment in the first-line treatment, and for R/R patients, the main treatment direction is to take precision stratified treatment as much as possible to allow patients to get a chance of
cure.

Zhang Huilai Professor

• Doctor of Oncology, Chief Physician, Doctoral Supervisor

• He is currently the director of the Department of Lymphoma Internal Medicine, Cancer Hospital of Tianjin Medical University

• His main research interests are molecular diagnosis and individualized treatment of malignant lymphoma

• Vice Chairman of the Lymphoma Professional Committee of the Chinese Anti-Cancer Association

• Member of the Standing Committee of the Lymphoma Expert Committee of the Chinese Society of Clinical Oncology (CSCO).
  

• Member of the Lymphoma Group of the Oncology Branch of the Chinese Medical Association

• Vice Chairman of the Medical Oncology Branch of the Chinese Medical Promotion Association

• Vice Chairman of the Lymphatic Disease Committee of the Chinese Medical Education Association

• Vice Chairman of the Lymphoma Professional Committee of the Chinese Geriatric Health Care Association

• Chairman of the Clinical Chemotherapy Committee of Oncology of Tianjin Anti-Cancer Association

• Vice Chairman of Tianjin Blood Disease Quality Control Center

• Vice President of Hematology Physician Branch of Tianjin Medical Doctor Association

• He has won 1 second prize and 3 third prizes of Tianjin Science and Technology Progress Award, and presided over and participated in a number of National Natural Science Foundation of China projects and provincial and ministerial scientific research projects
  .
  At present, he is the deputy editor of "Oncology Pharmacy", "Chinese Journal of Hematology", "Leukemia • Lymphoma", "Chinese Oncology Clinical", "Hematological Oncology", "Blood Research", "Discover Oncology" and other domestic and foreign journals and journals, with the first or corresponding author in Blood, J Exp Med, JITC, Leukemia, CTM, AJH, Clin Immunol, BJH, Blood Adv, Front Oncol, Hematol Oncol, Int J Cancer and other international professional magazines, as well as Chinese series magazines, national core journals have published more than 70 articles
  .
  Won the 4th "Famous Doctor of the Country Excellent Style" award
  .
  

Editor: Quarter Year

Reviewer: Mia

Typesetting: Quarterly year

Execution: moly

Poke "Read the original article" and go to the micro-official website to get more meeting information