Focus on the frontier and help ASCT flourish - CSCO Autologous Transplantation Working Group 2022 Tour (Wuhan Station) ended perfectly

Big coffee gathers, based on clinical practice, sharing academic hot spots! On October 30, 2022, the CSCO Autologous Transplantation Working Group 2022 Tour (Wuhan Station), hosted by the Chinese Society of Clinical Oncology (CSCO), CSCO Lymphoma Expert Committee, CSCO Leukemia Expert Committee and CSCO Autologous Hematopoietic Stem Cell Transplantation Working Group, and undertaken by Tongji Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology, was successfully held
online.
Professor Zhang Yicheng of Tongji Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology and Professor Xia Linghui of Union Hospital of Tongji Medical College of Huazhong University of Science and Technology were invited as executive chairmen, and well-known experts in the field were invited to serve as chairs, speakers and discussants.
The application and development
of autologous hematopoietic stem cell transplantation (ASCT) in lymphoma were jointly discussed.
This article has compiled the key contents of the conference for the readers
.

Opening remarks

At the beginning of the meeting, Professor Zhang Yicheng, Executive Chairman of the Conference, presided over the opening ceremony and extended a warm welcome and heartfelt thanks
to all participants.
Subsequently, Professor Ma Jun, chairman of the conference, said in his opening speech that although a variety of drugs and therapies such as targeted therapy and immunotherapy continue to emerge, ASCT is still an important consolidation and rescue treatment for
lymphoma.
In order to narrow this gap, we need to continuously exchange and learn from our clinicians, hoping that through this tour can improve the understanding of ASCT among clinicians in China and the number and level of ASCT application in China, so that more lymphoma patients can benefit and achieve longer survival and higher clinical cure rate
.
Finally, I wish this meeting a complete success!

Professor Zhang Yicheng served as the officiator of the opening ceremony

Professor Ma Jun delivered an opening speech

Academic session

After the opening ceremony, the academic session was full of dry goods!

Current status of ASCT treatment of lymphoma and northern swelling

The first session was chaired by Professor Zhang Yicheng
.

Professor Zhang Yicheng served as the moderator of the first session

Professor Zhu Jun shared the current situation of ASCT treatment of lymphoma and the experience of
Beiwei.
Firstly, the development of hematopoietic stem cell transplantation (HSCT) in China from 2008 to 2019 and ASCT in various provinces and cities in China in 2021 was reviewed, and the relevant research and experience of lymphoma treatment in Peking University Cancer Hospital in recent years were shared, indicating that the number of ASCT cases in China has increased in recent years, but regional differences are still significant
.
The diagnosis and treatment of lymphoma has entered a new era, and it is still necessary to follow the CSCO lymphoma diagnosis and treatment guidelines, and try and work
under the guidelines.
Although there are many options such as new regimens and new drugs, it is also extremely important
to choose ASCT treatment at the right time for the right patient.
It is hoped that the majority of colleagues will pay more attention to and choose ASCT, and work together under the guidance of the guidelines to make China's ASCT move to a new level in terms of quantity and proportion, in addition, it is necessary to improve the efficacy and pretreatment plan of rescue treatment as much as possible, and reduce the recurrence
after ASCT.

Professor Zhu Jun gave a wonderful report

In the discussion session, the panelists Cui Guohui of Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Professor Huang Zhiping of Jingzhou Central Hospital and Professor Meng Fankai of Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology conducted in-depth discussions on "standardized diagnosis and treatment of lymphoma", "ASCT timing", "ASCT maintenance therapy" and "secondary transplantation", etc
.
, with a strong academic atmosphere.

Hematopoietic stem cell transplantation for peripheral T-cell lymphoma

The second session was chaired by Professor Wang Xiaopei of Peking University Cancer Hospital
.

Professor Wang Xiaopei served as the moderator of the second session

Professor Zou Dehui from the Hospital of Hematology, Chinese Academy of Medical Sciences introduced the diagnosis and treatment status and progress
of hematopoietic stem cell transplantation in the treatment of peripheral T-cell lymphoma (PTCL).
PTCL is a rare and highly heterogeneous disease, which is classified by the 2016 WHO classification into up to 29 different disease subtypes
.
Different PTCL subtypes have different clinical features, genetic changes and immune characteristics, which are more likely to be misdiagnosed and missed
.
There is currently no standard treatment for PTCL, although some PTCL subtypes can be treated based on CHOP regimen, but some PTCL subtypes are not recommended for CHOP-based treatment, and some PTCL subtypes are relatively rare, and treatment-related data are lacking, so the current efficacy is not good
.
For patients with PTCL who are sensitive to first-line or salvage therapy, ASCT treatment is more beneficial; For patients with more aggressive subtypes and relapsed refractories, ASCT improves survival in some patients
.

Professor Zou Dehui gave a wonderful speech

In the discussion session, Professor Zhou Fuling of Zhongnan Hospital of Wuhan University, Professor Wang Huafang of Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, and Professor Cao Yang of Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology participated in the discussion, and had wonderful exchanges on topics such as "Treatment of ALK-positive anaplastic large cell lymphoma", "Whether patients with relapsed and refractory can be treated with ASCT combination regimen", "Which patients need active consolidation therapy" and "Pretreatment regimen for different types of PTCL"
。

Treatment strategies for relapsed and refractory DLBCL: ASCT or CAR-T?

The third session was chaired by Professor Xia Linghui
.

Professor Xia Linghui served as the moderator of the third session

Professor Zhang Yicheng analyzed the treatment strategy
of relapsed and refractory diffuse large B-cell lymphoma (R/R DLBCL).
High-dose chemotherapy (HDC)/ASCT is the standard of care for R/R DLCCL, but patients who benefit from transplantation are limited, and those who do not enter transplantation or who relapse after transplantation have a poor
prognosis.
For patients with FIT/transplant candidates, ASCT is performed as usual if salvage therapy achieves a complete response (CR)/partial response (PR) (including PET positive); Patients with relapse after transplantation undergo CAR-T cell therapy or allogeneic transplantation
.
Consider CAR-T cell therapy in patients with refractory DLBCL or early recurrence/genetic risk/salvage therapy
who are not candidates for HDC/transplantation.
Sequential CAR-T transplantation overcomes the limitations of simple autologous transplantation, such as salvage therapy does not reach CR/PR, special types, patients with high-risk genetic characteristics, etc.
, which are better than CAR-T
alone.
If the physical status is good, stem cells can be mobilized, and ASCT sequential CAR-T
is performed for patients who cannot reach PR or above.
CAR-T cell therapy is superior to ASCT as a second-line treatment for R/R DLLBCL, so CAR-T application may be advanced
.

Professor Zhang Yicheng gave a wonderful speech

In the discussion session, Professor Jiang Daozi of Wuhan University People's Hospital, Professor Wan Chucheng of Shiyan Taihe Hospital and Professor Fang Jun of Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology had heated discussions
on "ASCT or CAR-T treatment recommended for high-risk patients", "benefits of secondary transplantation", "issues to be paid attention to when conducting CAR-T treatment in clinical practice" and "The difference between ASCT as bridging therapy for CAR-T therapy and ASCT alone".

The status of ASCT in MM treatment in the era of new drugs

The fourth session was chaired by Professor Xiao Yi of Tongji Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology
.

Professor Xiao Yi served as the host of the fourth session

Professor Li Chunrui from Tongji Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology elaborated on the status of ASCT in the treatment of
MM in the era of new drugs.
The number of autologous transplants in China is increasing, but the proportion of MM patients in China who receive autologous transplantation is still low
compared with Europe and the United States.
Foreign authoritative guidelines recommend melphalan 200mg/^m2 as the standard pretreatment regimen
for ASCT in MM patients.
The safety profile of high-dose melphalan without propylene glycol (PGF) for ASCT management in MM patients is encouraging, and the CR rate and MRD negative rate are encouraging
.
Patients with MM who undergo ASCT as consolidation therapy, 1 or 2 days of high-dose melphalan (HDM) infusion has similar efficacy, 1-day HDM infusion has lower toxicity, HDM infusion is recommended to be completed within one day, and patients benefit from
high CD34+ cell count.
Lenalidomide, bortezomib, and dexamethasone (RVd) combined with ASCT further improved prognosis
.
19% of MM patients have a chance to achieve 10-year progression-free survival, and PFS and OS improve
after tandem ASCT.
Tandem ASCT is more advantageous
than single-shot ASCT, myeloablative allo-SCT.
In the era of new drugs, the status of HDT/ASCT cannot be replaced, and many guidelines at home and abroad still recommend ASCT as a first-line option
for MM treatment.

Professor Li Chunrui gave a wonderful speech

In the discussion session, Professor Guo Jingming of Yichang Central People's Hospital and Professor Wang Hongxiang of Wuhan Central Hospital had a heated discussion
on "Bridge CAR-T therapy after ASCT or secondary transplantation" and "follow-up treatment plan for ASCT in high-risk patients who do not achieve CR after treatment".

Chinese expert consensus on autologous hematopoietic stem cell mobilization and collection of lymphoma

The fifth session was chaired by Professor Sun Chunyan of Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology
.

Professor Sun Chunyan served as the moderator of the fifth session

Professor Yuan Guolin from Xiangyang Central Hospital shared the consensus
of Chinese experts on the mobilization and collection of lymphoma autologous hematopoietic stem cells.
Lymphoma itself is a risk factor for poor mobilization, and traditional mobilization failure is more common, resulting in delayed treatment and increased treatment costs, and Proxaf solves the above unmet clinical needs
.
Identifying high-risk factors for mobilization failure before mobilization, and selecting mobilization schemes according to risk stratification can help reduce the mobilization failure rate, and a number of evidence confirm that G-CSF+ Proxaf can still achieve a high mobilization success rate
for patients at high risk of mobilization failure.
The first mobilization recommended steady-state mobilization with G-CSF alone is suitable for patients with low risk of mobilization failure, the first hematopoietic stem cell mobilization G-CSF plus Proxafol regimen is suitable for all lymphoma patients, and the use of G-CSF plus Proxaf in patients with high-risk factors with poor mobilization can effectively avoid remobilization
.
Cytokines alone are not recommended for remobilization, and chemotherapy plus cytokines may be considered as a remobilization regimen
in patients who fail mobilization using cytokines alone for the first time.
Remobilization regimens for patients with lymphoma are recommended to include Proxaf.

Professor Yuan Guolin gave a wonderful speech

In the discussion session, Professor Wang Haiyan of Yichang Central People's Hospital, Professor Kui Jia of Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Professor Qin Jun of Shiyan People's Hospital and Professor Shi Wei of Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology discussed "how to choose between steady-state mobilization, chemotherapy combined with cytokines and cytokines alone", "strategies for remobilization after failure of Prosafou", "whether MRD detection is required for routine collection" and "acquisition time under steady-state mobilization"
。

Summary of the meeting

At the end of the meeting, Professor Ma Jun summarized the conference
.
Professor Ma Jun said: The conference was a complete success! The conference included ASCT and ASCT combination regimen for the treatment of PTCL, R/R DLCCL and MM, among which the ASCT combined CAR-T treatment initiated by researchers from Tongji Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology greatly prolongs the long-term survival of patients compared with CAR-T therapy alone, and has been affirmed
by Professor Carl June, founder of CAR-T cell therapy.
It is hoped that Tongji Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology can lead our clinicians to conduct multi-center research in this direction and walk out of the road
with Chinese characteristics.
Thanks to the enthusiastic sharing of 5 professors and the enthusiastic discussion of 15 professors, I look forward to exploring more and better ASCT schemes in the future to enable more patients with hematological tumors to survive
longer.

Professor Ma Jun made a summary of the meeting