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In recent years, with the joint efforts of clinicians, scientific researchers and people from all walks of life, the diagnosis and treatment of lymphoma has made great progress
.
Most patients undergo standardized diagnosis and treatment, and their survival period is greatly prolonged, and they are even expected to be cured
.
With the launch of ibrutinib, the treatment of lymphoma has undergone an epoch-making change, and the diagnosis and treatment of lymphoma has also tended to a "chronic disease management" model, so the importance of standardized full-process management has become more and more prominent
.
September 15, 2021 is the eighteenth "World Lymphoma Awareness Day.
" On this occasion, this issue of "Big Coffee Yiqi" invited Professor Yang Shenmiao from the Institute of Hematology, Peking University as a visitor, and also invited Shi Yuankai, Dean of Tumor Hospital of Chinese Academy of Medical Sciences, and Professor Jing Hongmei of Peking University Third Hospital as interview guests, discussed in-depth "Standardized Full-Process Management of Lymphoma Patients"
.
Pay attention to the current situation and strengthen scientific and educational publicity.
Professor Yang Shenmiao: Today is the eighteenth "World Lymphoma Awareness Day".
Please Professor Shi to popularize the current status of diagnosis and treatment of lymphoma patients in China
.
Professor Shi Yuankai: In recent years, with the increasing incidence, Chinese lymphoma patients have received more and more attention, including the constantly updated diagnosis and treatment specifications of the National Health Commission, and popular science propaganda in various online media
.
Malignant lymphoma is a type of systemic disease with a relatively young age of onset, complicated clinical manifestations, non-organ specificity, and difficult early diagnosis
.
Although not as high as solid tumors such as lung cancer and breast cancer, lymphomas are still common throughout the country
.
Therefore, on the one hand, strengthening the scientific, educational and publicity work of lymphoma is particularly important, which is conducive to early identification of the disease and active diagnosis and treatment.
On the other hand, the diagnosis and treatment of lymphoma in China is becoming more and more standardized, and we are still vigorously promoting the practice of full-process management.
The future can be expected
.
Focusing on the current challenges.
Professor Yang Shenmiao: According to statistics, 43% of lymphoma patients in China have experienced misdiagnosis, and 30% of patients have problems with standardized diagnosis and treatment
.
These figures are worrying.
What do you think of this issue, Professor Shi? Professor Shi Yuankai: Lymphoma can occur in any part of the body.
Generally, there are no specific symptoms in the early stage.
Therefore, patients often go to the department of hematology first, but choose head and neck surgery, respiratory department, gastroenterology, etc.
according to the location of the lesion
.
A series of related examinations takes a lot of time, especially to take a pathological biopsy
.
According to the latest classification of the World Health Organization, there are more than 100 pathological types of lymphoma, which are very complex, which brings great challenges to pathologists
.
Each lymphoma subtype has its own unique pathological morphology, immunophenotype, molecular genetic characteristics, etc.
This requires pathologists to be particularly professional in the field of lymphoma
.
Therefore, in clinical practice, we often see patients with local pathology slices and diagnoses in Beijing and Shanghai to find well-known pathologists for consultation, and once again confirm the diagnosis
.
On the other hand, lymphoma itself has many difficult cases and may require multiple biopsies and consultations, which brings new challenges to our diagnosis and treatment
.
But without the correct pathological diagnosis of lymphoma, it is impossible to have precise diagnosis and treatment and prognosis judgment of lymphoma
.
After the diagnosis, the patient must also be transferred to the hematology department for standardized treatment
.
Along the way, we can see that lymphoma is different from ordinary solid tumors.
It has special complexity and extremely high professional requirements.
.
These problems do exist and are challenges that we need to face directly
.
Specialist construction, full-process cooperative management Professor Yang Shenmiao: Professor Jing, as a subject leader, how do you think we can build a professional lymphoma patient management team? Professor Jing Hongmei: As Dean Shi said, lymphoma is a type of systemic disease, which may affect any part.
The MDT multidisciplinary diagnosis and treatment model centered on the department of hematology is very important
.
If accurate diagnosis is required by the pathology department before treatment, imaging department assistance is required for staging and efficacy evaluation, surgery and radiotherapy indications require evaluation by the surgery and radiotherapy department, and so on
.
In the Third Hospital of Beijing Medical University, we have established several different MDT models according to the location of the lymph nodes, so as to ensure that patients can get a biopsy as soon as possible and obtain a more complete treatment
.
On the other hand, the psychological care of lymphoma patients is also very important.
This is the concept of "care consultant" specially put forward in the 2021 lymphoma patient's overall management guide
.
This role may play a role as a bridge connecting patients and doctors in the future, and can provide patients with a better all-round help.
Ibrutinib, a new model of chemotherapy-free management Professor Yang Shenmiao: In recent years, lymphoma has begun to enter the era of chemotherapy-free , Please take the treatment of chronic lymphocytic leukemia with ibrutinib as an example, and tell us how to standardize the management of this oral targeted drug throughout the process? Professor Jing Hongmei: Chronic lymphoma represents a progress in our entire lymphoma treatment process, from the initial alkylating agent, to the FCR program, and now the emergence of ibrutinib, ibrutinib in the treatment of chronic lymphoma It is a milestone in history.
More and more patients are benefiting from it, leading the chronic lymphatic into the era of chemotherapy-free, and significantly improving the quality of life of patients.
Of course, while benefiting, we need to strengthen patient medication education to ensure They can maintain the efficacy of continuous medication and allow patients to have a full understanding of the adverse drug reactions, so as to obtain higher treatment compliance
.
Targeted drugs, scientific management Professor Yang Shenmiao: The BTK inhibitor ibrutinib has been on the market for 4 years, benefiting as many as 20,000 patients
.
In addition to chronic lymphocytes, patients with macroglobulinemia and mantle cell lymphoma take the drug for a long time
.
Professor Jing, what side effects do you think are common to BTK inhibitors? How to manage scientifically? Professor Jing Hongmei: For BTK inhibitors, patients take more at home, so doctors need to pass more drug information to patients.
AE events are common to BTK inhibitors
.
Taking Ibrutinib as an example, lymphocytosis may occur during the medication, and some patients will panic, worry about the ineffectiveness of the medication or even stop the medication without authorization
.
But don't panic.
Explain from the mechanism of action, the increase in lymphocytes is one of the signs that Ibrutinib is effective
.
Bleeding is another small risk of drug use, especially the elderly while taking aspirin and other antiplatelet drugs, we must explain these precautions patient, how is deactivated aspirin, platelet function check
.
AE events such as atrial fibrillation, infection, and virus activation are also common to BTK inhibitors, but most of them are grade 1-2 events, and gradually disappear with the extension of treatment time, so you don’t need to worry, follow the guidance of your attending doctor Under safe and effective medication
.
Confidence is the first choice, continuous medication has good results.
Professor Yang Shenmiao: The emergence of the oral targeted drug ibrutinib has indeed changed a treatment model for lymphoma and also changed a life>
.
Professor Jing, today happens to be the World Lymphoma Awareness Day.
What advice do you have for patients and their families? Professor Jing Hongmei: At present, the five major indications of ibrutinib have been covered by medical insurance.
The initial treatment of chronic lymphocytic disease, recurrent chronic lymphocytic disease, recurrent peristatitis, initial treatment of giant globules, and relapsed giant globules are all covered by medical insurance.
The economic burden is relatively reduced, which greatly improves the availability of medicines for patients
.
When using drugs, we do not recommend patients to stop or reduce the dose by themselves.
Stopping the drug without authorization may lead to disease progression, and continuous use of the drug can achieve the best effect.
.
There is a long way to go, and we need to move forward.
Professor Yang Shenmiao: Dean Shi, what are your expectations for the future development of the field of lymphoma, and what advice and suggestions do you have for the growth of some young doctors? Professor Yuankai Shi: The treatment of lymphoma in the future may lead the development of the tumor field, and new therapeutic targets will continue to emerge
.
In the past few years, we have had BTK inhibitors, and in the future we will have new drugs targeting different targets one after another
.
There are immune checkpoint inhibitors, including PD-1 and PD-L1 monoclonal antibodies
.
This field is developing very rapidly, and the treatment concept is constantly being updated, which puts very high requirements and a lot of expectations for our young doctors
.
Young doctors should continue to learn and master new knowledge, and transform this knowledge into effective clinical treatment methods for patients.
At the same time, they must be innovative.
Facing the problems encountered in clinical research, they must constantly set up new research topics for themselves.
Ideas to solve the problem
.
This will enable our young doctors to continue to grow and improve
.
This is a very hard road, and it takes constant hard work to gain something
.
Conclusion Although lymphatic tumors are terrible, as long as early detection, early diagnosis, standardized diagnosis and treatment, and full-process management are possible, it is completely possible to cure
.
At present, the whole-process management model of lymphoma has been initially formed.
It not only requires the participation of hematology, pathology, imaging, radiotherapy, surgery, rehabilitation, nursing department, etc.
, to develop a comprehensive and standardized diagnosis and treatment plan for patients, but also The active cooperation of patients and their families requires the joint assistance of people from all walks of life.
We look forward to seeing the progress of treatment in the field of lymphoma in China and the road to the cure of lymphoma patients under the standardized and full-process management model of lymphoma
.
Professor Yuankai Shi Doctor of Oncology, Doctoral Supervisor, Chief Physician of Oncology, Medical Oncology Expert, Clinical Research Expert of Anti-tumor Drugs, President and Professor of Chinese Academy of Medical Sciences Peking Union Medical College, Member of Shanghai Stock Exchange Science and Technology Innovation Advisory Committee, Chairman of China Cancer Foundation, Chairman of the Lymphoma Professional Committee of the Chinese Anti-Cancer Association Chairman of the Oncologist Branch of the Chinese Medical Doctor Association, member of the Drug Evaluation Expert Advisory Committee of the State Drug Administration, Deputy Director of the National Cancer Center/Tumor Hospital of the Chinese Academy of Medical Sciences Deputy Director of the Chinese Medical Journal Editor-in-chief and other positions, conducted more than 300 anti-cancer drugs and related clinical research, published more than 300 articles as the first and/or corresponding author, edited more than 20 works, and took the lead in formulating national diagnosis and treatment specifications, guidelines and expert consensus.
More than 10 items were obtained 1 first prize of the National Science and Technology Progress Award, 7 provincial and ministerial science and technology progress awards, 7 national invention patents, the first National Innovation Award Medal, the National Outstanding Scientific and Technical Worker Chinese Physician Award, and other awards, enjoy the special government allowance of the State Council Professor Yang Shenmiao, Doctor of Medicine, Deputy Chief Physician, Peking University Institute of Hematology, Deputy Chief Physician, Beijing Integrative Hematology Society, Member of Lymphoma Group, Oncology Branch of Chinese Medical Association CSCO) Member of the Chinese Anti-Lymphoma Coalition, Chinese Anti-Cancer Association Hematology Oncology Committee, Member of the First Chinese Chronic Lymphocytic Leukemia Working Group (cwCLL) Main professional direction: Proliferative diseases of the lymphatic system include: malignant lymphoma, chronic lymphocytic leukemia, etc.
Professor Jing Hongmei, Chief Physician, Professor, and Doctoral Supervisor, Director of the Department of Hematology, Peking University Third Hospital, Vice Chairman, Oncology Expert Committee, Chinese Women Physicians Association, Vice Chairman, Lymphoma Specialty Committee, Chinese Medical Education Association, Young, Chinese Medical Education Association, Blood Branch Deputy Chairman of the Committee Member of the Standing Committee of the Chinese Society of Gerontology on Geriatric Oncology Member of the Diagnostics Group of the Blood Branch of the Chinese Medical Association Member of the Blood Branch of the Chinese Medical Association Professional Direction: Lymphatic System Tumor Editor: Zhang Guixing Liu Hailing stamped "Read the original text", we make progress together
.
Most patients undergo standardized diagnosis and treatment, and their survival period is greatly prolonged, and they are even expected to be cured
.
With the launch of ibrutinib, the treatment of lymphoma has undergone an epoch-making change, and the diagnosis and treatment of lymphoma has also tended to a "chronic disease management" model, so the importance of standardized full-process management has become more and more prominent
.
September 15, 2021 is the eighteenth "World Lymphoma Awareness Day.
" On this occasion, this issue of "Big Coffee Yiqi" invited Professor Yang Shenmiao from the Institute of Hematology, Peking University as a visitor, and also invited Shi Yuankai, Dean of Tumor Hospital of Chinese Academy of Medical Sciences, and Professor Jing Hongmei of Peking University Third Hospital as interview guests, discussed in-depth "Standardized Full-Process Management of Lymphoma Patients"
.
Pay attention to the current situation and strengthen scientific and educational publicity.
Professor Yang Shenmiao: Today is the eighteenth "World Lymphoma Awareness Day".
Please Professor Shi to popularize the current status of diagnosis and treatment of lymphoma patients in China
.
Professor Shi Yuankai: In recent years, with the increasing incidence, Chinese lymphoma patients have received more and more attention, including the constantly updated diagnosis and treatment specifications of the National Health Commission, and popular science propaganda in various online media
.
Malignant lymphoma is a type of systemic disease with a relatively young age of onset, complicated clinical manifestations, non-organ specificity, and difficult early diagnosis
.
Although not as high as solid tumors such as lung cancer and breast cancer, lymphomas are still common throughout the country
.
Therefore, on the one hand, strengthening the scientific, educational and publicity work of lymphoma is particularly important, which is conducive to early identification of the disease and active diagnosis and treatment.
On the other hand, the diagnosis and treatment of lymphoma in China is becoming more and more standardized, and we are still vigorously promoting the practice of full-process management.
The future can be expected
.
Focusing on the current challenges.
Professor Yang Shenmiao: According to statistics, 43% of lymphoma patients in China have experienced misdiagnosis, and 30% of patients have problems with standardized diagnosis and treatment
.
These figures are worrying.
What do you think of this issue, Professor Shi? Professor Shi Yuankai: Lymphoma can occur in any part of the body.
Generally, there are no specific symptoms in the early stage.
Therefore, patients often go to the department of hematology first, but choose head and neck surgery, respiratory department, gastroenterology, etc.
according to the location of the lesion
.
A series of related examinations takes a lot of time, especially to take a pathological biopsy
.
According to the latest classification of the World Health Organization, there are more than 100 pathological types of lymphoma, which are very complex, which brings great challenges to pathologists
.
Each lymphoma subtype has its own unique pathological morphology, immunophenotype, molecular genetic characteristics, etc.
This requires pathologists to be particularly professional in the field of lymphoma
.
Therefore, in clinical practice, we often see patients with local pathology slices and diagnoses in Beijing and Shanghai to find well-known pathologists for consultation, and once again confirm the diagnosis
.
On the other hand, lymphoma itself has many difficult cases and may require multiple biopsies and consultations, which brings new challenges to our diagnosis and treatment
.
But without the correct pathological diagnosis of lymphoma, it is impossible to have precise diagnosis and treatment and prognosis judgment of lymphoma
.
After the diagnosis, the patient must also be transferred to the hematology department for standardized treatment
.
Along the way, we can see that lymphoma is different from ordinary solid tumors.
It has special complexity and extremely high professional requirements.
.
These problems do exist and are challenges that we need to face directly
.
Specialist construction, full-process cooperative management Professor Yang Shenmiao: Professor Jing, as a subject leader, how do you think we can build a professional lymphoma patient management team? Professor Jing Hongmei: As Dean Shi said, lymphoma is a type of systemic disease, which may affect any part.
The MDT multidisciplinary diagnosis and treatment model centered on the department of hematology is very important
.
If accurate diagnosis is required by the pathology department before treatment, imaging department assistance is required for staging and efficacy evaluation, surgery and radiotherapy indications require evaluation by the surgery and radiotherapy department, and so on
.
In the Third Hospital of Beijing Medical University, we have established several different MDT models according to the location of the lymph nodes, so as to ensure that patients can get a biopsy as soon as possible and obtain a more complete treatment
.
On the other hand, the psychological care of lymphoma patients is also very important.
This is the concept of "care consultant" specially put forward in the 2021 lymphoma patient's overall management guide
.
This role may play a role as a bridge connecting patients and doctors in the future, and can provide patients with a better all-round help.
Ibrutinib, a new model of chemotherapy-free management Professor Yang Shenmiao: In recent years, lymphoma has begun to enter the era of chemotherapy-free , Please take the treatment of chronic lymphocytic leukemia with ibrutinib as an example, and tell us how to standardize the management of this oral targeted drug throughout the process? Professor Jing Hongmei: Chronic lymphoma represents a progress in our entire lymphoma treatment process, from the initial alkylating agent, to the FCR program, and now the emergence of ibrutinib, ibrutinib in the treatment of chronic lymphoma It is a milestone in history.
More and more patients are benefiting from it, leading the chronic lymphatic into the era of chemotherapy-free, and significantly improving the quality of life of patients.
Of course, while benefiting, we need to strengthen patient medication education to ensure They can maintain the efficacy of continuous medication and allow patients to have a full understanding of the adverse drug reactions, so as to obtain higher treatment compliance
.
Targeted drugs, scientific management Professor Yang Shenmiao: The BTK inhibitor ibrutinib has been on the market for 4 years, benefiting as many as 20,000 patients
.
In addition to chronic lymphocytes, patients with macroglobulinemia and mantle cell lymphoma take the drug for a long time
.
Professor Jing, what side effects do you think are common to BTK inhibitors? How to manage scientifically? Professor Jing Hongmei: For BTK inhibitors, patients take more at home, so doctors need to pass more drug information to patients.
AE events are common to BTK inhibitors
.
Taking Ibrutinib as an example, lymphocytosis may occur during the medication, and some patients will panic, worry about the ineffectiveness of the medication or even stop the medication without authorization
.
But don't panic.
Explain from the mechanism of action, the increase in lymphocytes is one of the signs that Ibrutinib is effective
.
Bleeding is another small risk of drug use, especially the elderly while taking aspirin and other antiplatelet drugs, we must explain these precautions patient, how is deactivated aspirin, platelet function check
.
AE events such as atrial fibrillation, infection, and virus activation are also common to BTK inhibitors, but most of them are grade 1-2 events, and gradually disappear with the extension of treatment time, so you don’t need to worry, follow the guidance of your attending doctor Under safe and effective medication
.
Confidence is the first choice, continuous medication has good results.
Professor Yang Shenmiao: The emergence of the oral targeted drug ibrutinib has indeed changed a treatment model for lymphoma and also changed a life>
.
Professor Jing, today happens to be the World Lymphoma Awareness Day.
What advice do you have for patients and their families? Professor Jing Hongmei: At present, the five major indications of ibrutinib have been covered by medical insurance.
The initial treatment of chronic lymphocytic disease, recurrent chronic lymphocytic disease, recurrent peristatitis, initial treatment of giant globules, and relapsed giant globules are all covered by medical insurance.
The economic burden is relatively reduced, which greatly improves the availability of medicines for patients
.
When using drugs, we do not recommend patients to stop or reduce the dose by themselves.
Stopping the drug without authorization may lead to disease progression, and continuous use of the drug can achieve the best effect.
.
There is a long way to go, and we need to move forward.
Professor Yang Shenmiao: Dean Shi, what are your expectations for the future development of the field of lymphoma, and what advice and suggestions do you have for the growth of some young doctors? Professor Yuankai Shi: The treatment of lymphoma in the future may lead the development of the tumor field, and new therapeutic targets will continue to emerge
.
In the past few years, we have had BTK inhibitors, and in the future we will have new drugs targeting different targets one after another
.
There are immune checkpoint inhibitors, including PD-1 and PD-L1 monoclonal antibodies
.
This field is developing very rapidly, and the treatment concept is constantly being updated, which puts very high requirements and a lot of expectations for our young doctors
.
Young doctors should continue to learn and master new knowledge, and transform this knowledge into effective clinical treatment methods for patients.
At the same time, they must be innovative.
Facing the problems encountered in clinical research, they must constantly set up new research topics for themselves.
Ideas to solve the problem
.
This will enable our young doctors to continue to grow and improve
.
This is a very hard road, and it takes constant hard work to gain something
.
Conclusion Although lymphatic tumors are terrible, as long as early detection, early diagnosis, standardized diagnosis and treatment, and full-process management are possible, it is completely possible to cure
.
At present, the whole-process management model of lymphoma has been initially formed.
It not only requires the participation of hematology, pathology, imaging, radiotherapy, surgery, rehabilitation, nursing department, etc.
, to develop a comprehensive and standardized diagnosis and treatment plan for patients, but also The active cooperation of patients and their families requires the joint assistance of people from all walks of life.
We look forward to seeing the progress of treatment in the field of lymphoma in China and the road to the cure of lymphoma patients under the standardized and full-process management model of lymphoma
.
Professor Yuankai Shi Doctor of Oncology, Doctoral Supervisor, Chief Physician of Oncology, Medical Oncology Expert, Clinical Research Expert of Anti-tumor Drugs, President and Professor of Chinese Academy of Medical Sciences Peking Union Medical College, Member of Shanghai Stock Exchange Science and Technology Innovation Advisory Committee, Chairman of China Cancer Foundation, Chairman of the Lymphoma Professional Committee of the Chinese Anti-Cancer Association Chairman of the Oncologist Branch of the Chinese Medical Doctor Association, member of the Drug Evaluation Expert Advisory Committee of the State Drug Administration, Deputy Director of the National Cancer Center/Tumor Hospital of the Chinese Academy of Medical Sciences Deputy Director of the Chinese Medical Journal Editor-in-chief and other positions, conducted more than 300 anti-cancer drugs and related clinical research, published more than 300 articles as the first and/or corresponding author, edited more than 20 works, and took the lead in formulating national diagnosis and treatment specifications, guidelines and expert consensus.
More than 10 items were obtained 1 first prize of the National Science and Technology Progress Award, 7 provincial and ministerial science and technology progress awards, 7 national invention patents, the first National Innovation Award Medal, the National Outstanding Scientific and Technical Worker Chinese Physician Award, and other awards, enjoy the special government allowance of the State Council Professor Yang Shenmiao, Doctor of Medicine, Deputy Chief Physician, Peking University Institute of Hematology, Deputy Chief Physician, Beijing Integrative Hematology Society, Member of Lymphoma Group, Oncology Branch of Chinese Medical Association CSCO) Member of the Chinese Anti-Lymphoma Coalition, Chinese Anti-Cancer Association Hematology Oncology Committee, Member of the First Chinese Chronic Lymphocytic Leukemia Working Group (cwCLL) Main professional direction: Proliferative diseases of the lymphatic system include: malignant lymphoma, chronic lymphocytic leukemia, etc.
Professor Jing Hongmei, Chief Physician, Professor, and Doctoral Supervisor, Director of the Department of Hematology, Peking University Third Hospital, Vice Chairman, Oncology Expert Committee, Chinese Women Physicians Association, Vice Chairman, Lymphoma Specialty Committee, Chinese Medical Education Association, Young, Chinese Medical Education Association, Blood Branch Deputy Chairman of the Committee Member of the Standing Committee of the Chinese Society of Gerontology on Geriatric Oncology Member of the Diagnostics Group of the Blood Branch of the Chinese Medical Association Member of the Blood Branch of the Chinese Medical Association Professional Direction: Lymphatic System Tumor Editor: Zhang Guixing Liu Hailing stamped "Read the original text", we make progress together
