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From April 23rd to 24th, the 2021 Chinese Society of Clinical Oncology (CSCO) Guidelines Conference was successfully held.
At the meeting, Professor Gong Tiejun from the Harbin Institute of Hematology and Tumor gave a detailed and wonderful explanation on the update points of the "2021 CSCO Malignant Hematological Disease Diagnosis and Treatment Guide".
The update on leukemia (2021 CSCO guideline update | Leukemia update key points) and multiple myeloma (2021 CSCO guideline update | Multiple myeloma update key points) in the Department of Hematology of Yimaitong has been released in the previous content.
Let’s take a look.
Let’s update other content.
1.
Primary systemic amyloidosis 01 Evaluation before treatment Laboratory examination: increase: pituitary function; adrenal function (class 2) bone marrow examination: increase: DWI-MRI (class 3) imaging examination: increase: myocardial biopsy + Congo Red Staining; Kidney Biopsy + Congo Red Staining (Class 2); Mass Spectrometry Analysis of Needle Biopsy Tissue (Class 3) 02 Organ Remission and Progress Standard Increased Organ Function Progress Standard: Heart, Kidney, Liver, Peripheral Nerve.
03 Newly diagnosed treatment for patients who are suitable for transplantation: add: daratumomab + bortezomib + cyclophosphamide + dexamethasone (category 1A); delete: bortezomib + melphalan + dexamethasone, Laina Diamine + cyclophosphamide + dexamethasone, lenalidomide + dexamethasone, melphalan + dexamethasone.
For patients who are not suitable for transplantation: add: daratumomab + bortezomib + dexamethasone (category 1A); ixazomib + lenalidomide + dexamethasone (category 3); delete: lena Diamine + cyclophosphoryl gum + dexamethasone, lenalidomide + dexamethasone.
04 "Heart transplantation (Type 3) and kidney transplantation (Type 3)" are added for transplantation and consolidation treatment; "Allogeneic transplantation" is deleted.
05 Recurrence treatment increased "daratumomab + bortezomib + dexamethasone (category 1A), carfilzomib + dexamethasone (category 2), ixazomib + lenalidomide + dexamethasone (Class 2A), Bcl-2 inhibitor Venecla (Class 2A), Pomalidomide + Dexamethasone (Class 2)".
2.
Wahrenheit Macroglobulinemia (WM) 01 Assessment blood routine examination before treatment: add "manual"; immunological test ⑤: add "HIV"; genetic and genetic examination: add "6q-/MYB".
02 Added "Revised International WM Prognostic Scoring System (rIPSSWM)" for staging and prognosis, as shown in the figure below.
03 First-line treatment options: Add "Patients with symptomatic hyperviscosity and cryoglobulinemia, it is recommended to perform plasma exchange 2-3 times, followed by chemotherapy, and avoid direct application of rituximab (R ) Chemotherapy.
"Preferred program: modified to "①BR; ②Ibrutinib±R or Zebutinib single agent; ③RCD; ④VRd"; Other programs: add "Isazomib+Rituximab+Dexel Misson".
3.
Myelodysplastic Syndrome (MDS) 01 Pre-treatment Evaluation Laboratory Examination Level I Recommendation to increase "reticulocyte count", "thyroid stimulating hormone (TSH) lactate dehydrogenase (LDH), if clinically indicated, human immunodeficiency "Virus (HIV) testing" is adjusted from level III recommendation to level II recommendation to add "imaging examination": "T2* magnetic resonance imaging (MR1), heart and liver iron overload assessment" Bone marrow morphology examination specifications in Chinese and English names of each stain , Corrected CD41 to CD42b cytogenetic examination and added level III recommendation of "Chromosome Microarray (CMA)" molecular examination: "Considering human leukocyte surface antigen (HLA) matching for hematopoietic stem cell transplant candidates" is adjusted from level III recommendation to I Level recommendation 02 for the treatment of symptomatic thrombocytopenia or granulocytopenia: Level I experts recommend adding "clinical trials"; Level II experts recommend adding "Eltrombopag, Romipristin"; Level III experts recommend adding "Clinical trials; options Appropriate patients for allo-HST".
Rotexip: Recommended usage: 1.
0mg/kg, once every 3 weeks, subcutaneous injection. "Small-molecule targeted drugs: Some new data show the efficacy of Venecla and IDH1/2 inhibitors on high-risk MDS patients with HMA refractory diseases, and the optimal dose and course of treatment are still being optimized.
" Fourth, authenticity Cytocytosis 01 Evaluation of pretreatment laboratory examinations added "lipid, uric acid" and "hepatitis B, hepatitis C, HIV, cytomegalovirus, etc.
"; added "cytogenetics, G-band or R-band chromosome karyotype analysis, suspected chronic granuloma FISH can be added for cell leukemia”; “Consider human leukocyte surface antigen (HLA) matching for hematopoietic stem cell transplant candidates”; add “ASXL1, TET2, DNMT3a, SRSF2, U2AF1, EZH2, IDH1/2, SF3B1, Non-driver gene testing such as TP53 and CBL has been moved to level II recommendation.
02 Treatment of second-line treatment: "Hydroxyurea and interferon can be interchangeable" should be added for level I, and "clinical trials" should be added for level II.
5.
Essential thrombocythemia 01 Before treatment, the laboratory examinations for the evaluation of "lipid, uric acid" and "hepatitis B, hepatitis C, HIV, cytomegalovirus, etc.
" were added; the "G-band or R-band chromosome karyotype in cytogenetics" was changed "Analysis"; add "Consider human leukocyte surface antigen (HLA) matching for hematopoietic stem cell transplant candidates" 02 Second-line treatment level I recommendation deletes "Rucotinib can be used as second-line first-line treatment" and "can be used as second-line first-line treatment", Level II recommends adding "clinical trials".
6.
The first-line stratified treatment of primary myelofibrosis: add "portal hypertension, rucotinib, transjugular intrahepatic portosystemic shunt (TIPS)"; in high-risk/extremely high-risk treatment, add "luco Tinib can be used as a bridging treatment before transplantation, symptomatic treatment is the same as that of the low- and middle-risk group", and "the spleen can be cut as appropriate before transplantation"; in supportive treatment, "thalidomide/lenalidomide, danazol/stanazol Contrazol, low-dose prednisone, erythropoietin" was changed to level I recommendation, "red blood cell or platelet transfusion" was deleted, and "clinical trial" was added to level II recommendation. 7.
CD19 CAR-T treatment of B-cell malignancies 01 Indications are added "Refractory and relapsed mantle cell lymphoma"; "Relapsed and refractory high-grade large B-cell lymphoma" is added; "Relapsed and refractory for failed BTK inhibitor therapy" is added Chronic lymphocytic leukemia/small B-cell lymphoma", because the FDA has not approved CAR-T for chronic lymphocytic leukemia, it is currently only applicable to clinical trials.
02 Evaluation before treatment increased: cytokines, ferritin.
Baseline cytokine levels help determine the severity of cytokine release syndrome (CRS) and hemophagocytic syndrome.
03 CRS classification and treatment note added: pay attention to the treatment of CRS combined with macrophage activation syndrome/hemophagocytic syndrome.
Note added: For CRS that is difficult to control with hormones and tocilizumab, consider anti-IL-6 monoclonal antibody Siltuximab, IL-1 receptor antagonist anakinra or chemotherapy, such as cyclophosphamide.
04 Central nervous system toxicity classification and treatment note added: pay attention to the identification of neurotoxicity caused by fludarabine.
Poke "read the original text" and we will make progress together
At the meeting, Professor Gong Tiejun from the Harbin Institute of Hematology and Tumor gave a detailed and wonderful explanation on the update points of the "2021 CSCO Malignant Hematological Disease Diagnosis and Treatment Guide".
The update on leukemia (2021 CSCO guideline update | Leukemia update key points) and multiple myeloma (2021 CSCO guideline update | Multiple myeloma update key points) in the Department of Hematology of Yimaitong has been released in the previous content.
Let’s take a look.
Let’s update other content.
1.
Primary systemic amyloidosis 01 Evaluation before treatment Laboratory examination: increase: pituitary function; adrenal function (class 2) bone marrow examination: increase: DWI-MRI (class 3) imaging examination: increase: myocardial biopsy + Congo Red Staining; Kidney Biopsy + Congo Red Staining (Class 2); Mass Spectrometry Analysis of Needle Biopsy Tissue (Class 3) 02 Organ Remission and Progress Standard Increased Organ Function Progress Standard: Heart, Kidney, Liver, Peripheral Nerve.
03 Newly diagnosed treatment for patients who are suitable for transplantation: add: daratumomab + bortezomib + cyclophosphamide + dexamethasone (category 1A); delete: bortezomib + melphalan + dexamethasone, Laina Diamine + cyclophosphamide + dexamethasone, lenalidomide + dexamethasone, melphalan + dexamethasone.
For patients who are not suitable for transplantation: add: daratumomab + bortezomib + dexamethasone (category 1A); ixazomib + lenalidomide + dexamethasone (category 3); delete: lena Diamine + cyclophosphoryl gum + dexamethasone, lenalidomide + dexamethasone.
04 "Heart transplantation (Type 3) and kidney transplantation (Type 3)" are added for transplantation and consolidation treatment; "Allogeneic transplantation" is deleted.
05 Recurrence treatment increased "daratumomab + bortezomib + dexamethasone (category 1A), carfilzomib + dexamethasone (category 2), ixazomib + lenalidomide + dexamethasone (Class 2A), Bcl-2 inhibitor Venecla (Class 2A), Pomalidomide + Dexamethasone (Class 2)".
2.
Wahrenheit Macroglobulinemia (WM) 01 Assessment blood routine examination before treatment: add "manual"; immunological test ⑤: add "HIV"; genetic and genetic examination: add "6q-/MYB".
02 Added "Revised International WM Prognostic Scoring System (rIPSSWM)" for staging and prognosis, as shown in the figure below.
03 First-line treatment options: Add "Patients with symptomatic hyperviscosity and cryoglobulinemia, it is recommended to perform plasma exchange 2-3 times, followed by chemotherapy, and avoid direct application of rituximab (R ) Chemotherapy.
"Preferred program: modified to "①BR; ②Ibrutinib±R or Zebutinib single agent; ③RCD; ④VRd"; Other programs: add "Isazomib+Rituximab+Dexel Misson".
3.
Myelodysplastic Syndrome (MDS) 01 Pre-treatment Evaluation Laboratory Examination Level I Recommendation to increase "reticulocyte count", "thyroid stimulating hormone (TSH) lactate dehydrogenase (LDH), if clinically indicated, human immunodeficiency "Virus (HIV) testing" is adjusted from level III recommendation to level II recommendation to add "imaging examination": "T2* magnetic resonance imaging (MR1), heart and liver iron overload assessment" Bone marrow morphology examination specifications in Chinese and English names of each stain , Corrected CD41 to CD42b cytogenetic examination and added level III recommendation of "Chromosome Microarray (CMA)" molecular examination: "Considering human leukocyte surface antigen (HLA) matching for hematopoietic stem cell transplant candidates" is adjusted from level III recommendation to I Level recommendation 02 for the treatment of symptomatic thrombocytopenia or granulocytopenia: Level I experts recommend adding "clinical trials"; Level II experts recommend adding "Eltrombopag, Romipristin"; Level III experts recommend adding "Clinical trials; options Appropriate patients for allo-HST".
Rotexip: Recommended usage: 1.
0mg/kg, once every 3 weeks, subcutaneous injection. "Small-molecule targeted drugs: Some new data show the efficacy of Venecla and IDH1/2 inhibitors on high-risk MDS patients with HMA refractory diseases, and the optimal dose and course of treatment are still being optimized.
" Fourth, authenticity Cytocytosis 01 Evaluation of pretreatment laboratory examinations added "lipid, uric acid" and "hepatitis B, hepatitis C, HIV, cytomegalovirus, etc.
"; added "cytogenetics, G-band or R-band chromosome karyotype analysis, suspected chronic granuloma FISH can be added for cell leukemia”; “Consider human leukocyte surface antigen (HLA) matching for hematopoietic stem cell transplant candidates”; add “ASXL1, TET2, DNMT3a, SRSF2, U2AF1, EZH2, IDH1/2, SF3B1, Non-driver gene testing such as TP53 and CBL has been moved to level II recommendation.
02 Treatment of second-line treatment: "Hydroxyurea and interferon can be interchangeable" should be added for level I, and "clinical trials" should be added for level II.
5.
Essential thrombocythemia 01 Before treatment, the laboratory examinations for the evaluation of "lipid, uric acid" and "hepatitis B, hepatitis C, HIV, cytomegalovirus, etc.
" were added; the "G-band or R-band chromosome karyotype in cytogenetics" was changed "Analysis"; add "Consider human leukocyte surface antigen (HLA) matching for hematopoietic stem cell transplant candidates" 02 Second-line treatment level I recommendation deletes "Rucotinib can be used as second-line first-line treatment" and "can be used as second-line first-line treatment", Level II recommends adding "clinical trials".
6.
The first-line stratified treatment of primary myelofibrosis: add "portal hypertension, rucotinib, transjugular intrahepatic portosystemic shunt (TIPS)"; in high-risk/extremely high-risk treatment, add "luco Tinib can be used as a bridging treatment before transplantation, symptomatic treatment is the same as that of the low- and middle-risk group", and "the spleen can be cut as appropriate before transplantation"; in supportive treatment, "thalidomide/lenalidomide, danazol/stanazol Contrazol, low-dose prednisone, erythropoietin" was changed to level I recommendation, "red blood cell or platelet transfusion" was deleted, and "clinical trial" was added to level II recommendation. 7.
CD19 CAR-T treatment of B-cell malignancies 01 Indications are added "Refractory and relapsed mantle cell lymphoma"; "Relapsed and refractory high-grade large B-cell lymphoma" is added; "Relapsed and refractory for failed BTK inhibitor therapy" is added Chronic lymphocytic leukemia/small B-cell lymphoma", because the FDA has not approved CAR-T for chronic lymphocytic leukemia, it is currently only applicable to clinical trials.
02 Evaluation before treatment increased: cytokines, ferritin.
Baseline cytokine levels help determine the severity of cytokine release syndrome (CRS) and hemophagocytic syndrome.
03 CRS classification and treatment note added: pay attention to the treatment of CRS combined with macrophage activation syndrome/hemophagocytic syndrome.
Note added: For CRS that is difficult to control with hormones and tocilizumab, consider anti-IL-6 monoclonal antibody Siltuximab, IL-1 receptor antagonist anakinra or chemotherapy, such as cyclophosphamide.
04 Central nervous system toxicity classification and treatment note added: pay attention to the identification of neurotoxicity caused by fludarabine.
Poke "read the original text" and we will make progress together
