Medical interview with Professor Wang Xin: Multi-means and multidisciplinary tumor reduction and lodging cancer, standardize the diagnosis and treatment of diffuse large B-cell lymphoma lymphoma

Lymphoma is a malignancy of lymphoid tissue origin that occurs mainly in secondary lymphoid organs or extranodal

01

Figure 1 Lymphoma type

02

In recent years, the study of molecular typing has made DBBCL enter the era of targeted therapy, and molecular diagnostic guidance for molecular targeted therapy of DBCL has become a future trend

Due to the high heterogeneity and invasiveness of DBBLLs, re-biopsies are required in refractory or relapsed DLBCL patients to avoid changes in pathological types, and comprehensive immunohistochemical examination and second-generation sequencing are recommended according to the patient's own situation, and a combination regimen such as R-CHOP+X is used to improve patient survival benefits

Figure 2 DLBCL4 genotypes were divided in 2018

03

During the clinical treatment of DLBCL, patients may have hematologic or non-hematologic related adverse reactions, and may affect the time of the second treatment and the dose
of the treatment drug.

Patients should be thoroughly screened prior to treatment to avoid adverse reactions
.

Hematologic related adverse reactions are mainly serious complications such as fever or lung infection caused by neutropenia, and the routine operation is to add long-acting granulocyte-stimulating factor to patients within 24-48 hours after chemotherapy, and neo-Ruibai ^® (polyethylene glycolated recombinant human granulocyte stimulating factor) (PEG-rhG-CSF)
is commonly used in clinical practice.

Patients who refuse treatment with New Ruibai ^® due to high economic burden need to undergo routine blood monitoring at least two to three times within one week of discharge, and if the neutrophil level is too low, they need to go to the local hospital for follow-up treatment
as soon as possible.

Non-hematologically related adverse reactions mainly include cardiac, liver and kidney function impairment, infusion reactions, infections, etc
.

Preparations should be made before treatment of DLBCL to avoid infusion reactions; For patients with hepatitis B, the replication status of hepatitis B virus should be confirmed before treatment, and if the virus replication is high, antiviral drugs should be taken to reduce viral replication, and then rituximab therapy should be performed; Since patients are susceptible to infection due to decreased immunity during immunotherapy, clinical response
is needed.

Minor infections such as gastroenteritis are easier to control, while serious infections such as the lungs are more difficult
.

Identification is required for drug-induced infection or lung infection, and the type of infection is bacterial, viral, or fungal for aggressive symptomatic prevention and treatment
.

For patients with lung infection, antibacterial, viral or fungal prevention is required after chemotherapy, and once the infection occurs, blood monitoring and lung CT monitoring are required for patients, and the current fibroidoscopy and alveolar lavage fluid have achieved better clinical results in the current auxiliary diagnosis and treatment; For some patients with cardiac toxicity and side effects caused by drugs such as doxorubicin, ecG and cardiac ultrasound should be performed as soon as possible
.

04

Professor Wang Xin concluded

In the treatment of lymphoma, it is necessary to adhere to the basic route of standardized diagnosis and treatment, but also to actively explore and innovate, especially whether the CAR-T treatment that is currently in the third line can be upgraded to the second line and autologous hematopoietic stem cell transplantation in the future to bring more benefits to patients, which is worth exploring
in depth.

In the future, it is expected that the progress of science and technology and the in-depth study of molecular typing will promote the development of clinical diagnosis and treatment and bring greater prosperity
to patients.

Expert Profiles

Professor Wang Xin

Shandong Provincial Hospital

Director of the Department of Hematology, Doctoral Supervisor

Dean of Clinical Medical College of Shandong University

Distinguished Professor of the Taishan Scholars Climbing Program

Outstanding contribution of the Ministry of Health to young and middle-aged experts

Specially appointed expert of the State Council with special allowances

Standing Committee Member of Hematology Branch of Chinese Medical Doctor Association

Member of the Hematology Branch of the Chinese Medical Association

Vice Chairman of The Hematology-Oncology Translational Medicine Branch of the Chinese Anti-Cancer Association

Chairman of the Blood Branch of Shandong Medical Doctor Association

Chairman of the Diagnostic Branch of Shandong Medical Association

Vice Chairman of the Hematology Branch of Shandong Medical Association

Member of ash, American Blood Society

References: (Swipe to view)

1.
Zhang Guibing, He Zhengfei, Shang Wenzhong, etc.
Effects of triethanolamine on cellular biocharacterism of diffuse large B-cell lymphoma.
Chinese Journal of General Medicine,2022,20(05):785-788.

2.
Shi Chunxia,Yang Yuan,Huang Yunhong.
Research progress on common pathogenic signaling pathways and targeted drugs for diffuse large B-cell lymphoma.
Modern Medicine and Clinical Medicine,2022,37(07):1666-1675.

3.
Li Xiaoqiu,Li Gandi,Gao Zifen,et al.
Distribution of lymphoma subtypes in China: An analysis of 10,002 multicentric cases in China.
Diagnostics-Theory & Practice,2012,11(02):111-115.
]

4.
Wen Tingyu,Liu Peng,Shi Yuankai.
Exploration and prospect of chemotherapy options for first-line treatment of diffuse large B-cell lymphoma.
Chinese Journal of Chronic Disease Prevention and Control,2021,29(08):619-622.

5.
Ren YR, Jin YD, Zhang ZH, et al.
Rituximab treatment strategy for patients with diffuse large B-cell lymphoma after first-line therapy: a systematic review and meta-analysis.
Chin Med J (Engl).
2015 Feb 5; 128(3):378-83.

6.
Xu Wei,Liang Jinhua.
Advances in the treatment of new genotyping and molecular targeting for diffuse large B-cell lymphoma.
Journal of Clinical Hematology,2020,33(09):594-598.

7.
 Zhang M, Xu P, Wang L, et al.
Genetic subtype guided rituximab-based immunochemotherapy improves outcome in newly diagnosed diffuse large B-cell lymphoma: first report of a randomized phase 2 study .
Hematological Oncology, 2021, 39.

8.
Younes A, Sehn LH, Johnson P, et al.
Randomized Phase III Trial of Ibrutinib and Rituximab Plus Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone in Non-Germinal Center B-Cell Diffuse Large B-Cell Lymphoma.
J Clin Oncol.
2019 May 20; 37(15):1285-1295.

9.
Lenz G, Hawkes E, Verhoef G, et al.
Single-agent activity of phosphatidylinositol 3-kinase inhibition with copanlisib in patients with molecularly defined relapsed or refractory diffuse large B-cell lymphoma.
Leukemia.
2020 Aug; 34(8):2184-2197.

10.
Zelenetz AD, Salles G, Mason KD, et al.
Venetoclax plus R- or G-CHOP in non-Hodgkin lymphoma: results from the CAVALLI phase 1b trial.
Blood.
2019 May 2; 133(18):1964-1976.

11.
Castellino A, Chiappella A, LaPlant BR, et al.
Lenalidomide plus R-CHOP21 in newly diagnosed diffuse large B-cell lymphoma (DLBCL): long-term follow-up results from a combined analysis from two phase 2 trials.
Blood Cancer J.
2018 Nov 8; 8(11):108.

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