Leading the future, targeting the style, and looking at the development trend of AML diagnosis and treatment from clinical practice and cutting-edge progress

In the past five years, acute myeloid leukemia (AML) has made many progress

Professor Wei Hui

Professor Zhang Yu

Professor Wei Hui

Professor Chen Suning

Clinically, a number of factors
should be considered in the prognosis assessment of patients with AML for the first time.

When conducting a physiological assessment, factors such as the patient's age, physical status, comorbidities, past history, treatment-related medical history, and family history should be considered.
When evaluating AML cells, leukemia cell morphology, immunology, genetics, molecular biology and other characteristics should be comprehensively analyzed
.

Doctors should pay special attention to the correct interpretation of the assessment report, and factors such as the state of the patient's assessment, the matching degree of the test items, the composition of the sample sent for testing, the interpretation of the test site, the relevance of the disease, and the clinical significance should be taken into account
.

The treatment process should be dynamically adjusted for prognosis assessment, and bone marrow examination, immunophenotyping testing, molecular biology testing, etc.
at fixed time points can help clinicians accurately judge the patient's response to the treatment plan, and then determine whether the patient needs to adjust the treatment mode
.

Professor Wei Hui

What are the current important international research results in the clinical treatment of high-risk AML patients? What is the status of targeted therapy and transplant therapy?

Professor Chen Suning

Under the traditional treatment model based on intensive therapy, the survival prognosis of AML patients in the high-risk group was not ideal
compared with that of patients in the medium and low-risk groups.

Adult high-risk AML patients receiving standard strong induction chemotherapy had a complete response (CR) rate of only 43%, and the 2-year or 5-year survival (OS) rate was significantly lower than that in the intermediate and low-risk groups
.

In recent years, the emergence of new targeted drugs such as Venequera is gradually changing the "face"
of the AML field.

Recent studies published by Chinese scholars have confirmed that the compound CR rate of 75%
of patients with high-risk AML who are newly diagnosed with venequera combined with 7+3 regimens is confirmed.

Our center uses rapid genome sequencing combined with other detection methods to screen high-risk AML patients within 3 days, and carries out venequera combined with dicetabine induction therapy, with a combined CR rate of 77% in 1 course and more than 90% in 2 courses, and 75% of patients complete hematopoietic stem cell transplantation, with an estimated 12-month OS rate of about 91%.

In the future, the combination of targeted mutations with pan-targeted drugs and traditional chemotherapy may have a positive effect on the treatment of high-risk AML patients in future clinics; In addition, hematopoietic stem cell transplantation is still an important cure for such patients, and attention should be paid to preventing recurrence after transplantation in the process of
practice.

Coexistence, relying on data to guide the application and innovation of the Venequera norm, Professor Chen Suning

As everyone's experience and confidence in using the BCL-2 inhibitor Venecora continues to increase, many clinicians are also exploring a variety of drugs, including different drug combinations or different doses and courses
of Venecora.

How do you see adherence to standardized treatment and encouraging research exploration?

Professor Zhang Yu

Doctors should adhere to the concept of exploring in the norms and innovating in practice for clinical diagnosis and treatment, and "speak" with clinical data
.

Adjusting the dosage or course of medication according to the guideline recommendations, medication instructions, and corresponding indications is the basis for the standardization of clinical diagnosis and treatment, and the clinical drug experience
should be continuously summarized based on this.

Real-world studies in our center have shown that the remission rate and MRD negative rate of elderly unfit AML patients who undergo venekela combined with demethylation induction therapy with full dose and foot treatment course are significantly higher than those of non-full doses or courses; And this protocol has better efficacy
in patients with mutations in the NPM1 and IDH1/2 genes.

However, adverse events such as cytopenia may also occur during treatment, and attention should be paid to proper management in accordance with the recommendations for dose adjustment of Venequera
.
Clinical trials must comply with the principles and ethics of clinical study design while exploring multi-drug innovative joint solutions with small samples and small cohorts
.

Our center explored the HVA regimen of adding high spinel to the venacora plus azacytidine regimen in the treatment of patients with relapsed refractory AML, and the response rate of primary refractory AML patients after chemotherapy reached 70%; For patients with initial FLT3-ITD mutation AML, the feasibility of adding sorafenib to the venequera joint protocol is being explored; For the NPM1 mutation subtype, post-remission treatment strategies driven by molecular MRD are also being explored
.

In the process of diversification exploration, our center focuses on enabling AML patients to achieve unfit into fit and then undergo hematopoietic stem cell transplantation in a conditional manner, thereby improving overall survival
.

In conclusion, emphasis should be placed on translating the need for discoveries in the clinical drug process into clinical research goals, and further feedback on research output data to guide clinical practice
.

Professor Wei Hui

From the perspective of patient management of standardized treatment, outpatient follow-up is required after the hospitalization of newly treated AML patients is relieved, and under the normalization of the epidemic situation, how to do a good job of patient follow-up management (especially for patients who visit other places), what experience and thinking do you have?

Professor Zhang Yu

The team of clinical specialists should establish the concept of continuous treatment of AML, especially for venequera in combination with demethylated drug therapy, and strengthen confidence in the use of this combination regimen
.

At the same time, the concept of continuous assessment and follow-up of AML MRD should be established to further improve patient compliance
with treatment.

It is also very important to strengthen patient education, and consideration can be given to using forms such as patient churches to improve the awareness of patients and their families about the disease, and to integrate and unify the differences in
the expectations of doctors, patients and family members for disease treatment.

The establishment of an Internet platform can help achieve these goals
.

After standardized training, our center relies on the Internet hospital platform of Southern Hospital to help some patients achieve home consultation and online Q&A
.

Looking ahead, experts call for deepening the understanding of AML diseases and exploring innovative treatment options Professor
Zhang Yu needs to further refine and deepen the classification of AML molecular diagnosis, or try to achieve rapid diagnosis of some key molecular mutations
.

At the same time, the establishment of AML-related MRD guidelines is crucial, and major domestic centers jointly conduct prospective cohort studies to explore evidence-based evidence
for MRD to guide clinical practice.

In addition, exploring the application of targeted drugs in different dimensions such as induction, post-remission, bridging transplantation, pretreatment, maintenance therapy, rescue therapy, etc.
is very critical
to improving the whole diagnosis and treatment of AML.

Establishing the concept of dynamic prognosis stratification and exploring MRD as an alternative endpoint are also important areas that need to be further explored in the
future.

Professor Wei Hui

How to integrate targeted drugs with chemotherapy and hematopoietic stem cell transplantation more effectively will be a hot topic in the field of AML, and further exploring the same feasible chemotherapy-free regimens as some hematological tumor areas, so as to truly achieve the goal of low-toxicity and high efficiency treatment, should also be the focus of
AML's future attention.

Professor Chen Suning

Small molecule targeted drugs in the AML field have made rapid progress, but the development of immune targeted drugs is lagging behind, and more breakthroughs
are expected in the future.

In addition, clinics should strive to adapt, understand, apply, and digest the new stratification system to promote the development of
diagnosis and treatment.

It is also an important exploration direction
to break through the many limitations of hematopoietic stem cell transplantation and solve the problem of high recurrence rate after transplantation.

Finally, from a longitudinal perspective, AML may belong to the terminal stage of the development of multiple myeloid tumors, and it is particularly critical to achieve early clinical recognition; From a horizontal point of view, AML may also coexist with different cell lines and different stages of blood tumors, and it is expected that in the future, morphology, cytogenetics, molecular biology, etc.
can be organically combined to understand such phenomena
in a deeper way.

summary

Professor Chen Suning

In recent years, with the clinical application of targeted drugs such as BCL-2 inhibitors Venequera, FLT3 inhibitors, IDH inhibitors, etc.
, the AML treatment pattern is gradually changing, and the impact of targeted drugs may be more far-reaching
.

There is still a long way to go
to organically combine new targeted drugs, diagnosis and treatment concepts, clinical guidelines and clinical practices and promote diagnosis and treatment norms.

It is expected that in the future, China's hematologists, especially young and middle-aged hematologists, will actively accumulate clinical experience, seek clinical evidence, and contribute to
the international hematology field.

Professor Chen Suing

• Professor and Chief Physician of the First Affiliated Hospital of Soochow University

• Deputy Director of Jiangsu Institute of Blood Research

• Member of the Hematology Branch of the Chinese Medical Association

• Member of the Standing Committee of the Experimental Hematology Branch of the Chinese Society of Pathophysiology

• Hematology Branch of Jiangsu Medical Association is the chairman-elect

Professor Zhang Yu

• Deputy Chief Physician of the Department of Hematology, Southern Hospital, Southern Medical University

• Director of the Subspecialty of Acute Myeloid Leukemia, Department of Hematology, Southern Hospital, Southern Medical University

• Member of the Clinical Research Professional Committee of the Clinical Medical Center of Nanfang Hospital of Southern Medical University

• Member of the 11th Leukemia Lymphoma Group of the Hematology Branch of the Chinese Medical Association

• Hematology Committee member of the Cross-Strait Medical and Health Exchange Association

• Standing Committee Member of Hematology and Tumor Professional Committee of Guangdong Preventive Medicine Association

• Standing committee member of the Expert Committee of Hematology of Guangdong Pharmaceutical Association

• Member of the Fifth Committee of the Hematology and Tumor Professional Committee of Guangdong Anti-Cancer Association

• Member of the 5th Committee of the Internal Medicine Branch of Guangdong Medical Association

• Member of the Leukemia Group of the Ninth Committee of the Hematology Branch of guangdong Medical Association

• Vice Chairman of the Review Group of the Second Regional Ethics Committee of the Guangdong Pharmaceutical Association

• Blood Chinese Edition Youth Editorial Board

Professor Wei Hui

• Chief Physician and Doctoral Supervisor of Leukemia Diagnosis and Treatment Center, Hematology Hospital, Institute of Hematology, Chinese Academy of Medical Sciences

• Deputy Director of the National Clinical Research Center for Diseases of the Blood System

• He is a member of the Hematology Branch of the Chinese Medical Association and the deputy leader of the Leukemia Lymphoma Group

• Associate Editor of Hematological Oncology (IF:5.
  271)

• He graduated from China Medical University in 2000 with a master's degree

• He graduated from Peking Union Medical College in 2006 with a ph.
  D.
  degree

• From 2010 to 2013, he worked as a postdoctoral fellow at the National Institutes of Health

• His research interests include basic and clinical research on leukemia

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