New guidelines, new journey: China's AML diagnosis and treatment guidelines will be released in 2021!

In the early morning of October 10, 2021, the autumn is high and the air is refreshing.
In the beautiful and prosperous Hefei, the China Acute Myeloid Leukemia (AML) Guidelines Release Conference was grandly held
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Witnessed by many experts, scholars and clinicians in the field of hematology, Professor Wang Jianxiang from the Hematology Hospital of the Chinese Academy of Medical Sciences, Professor Jin Jie from the First Affiliated Hospital of Zhejiang University School of Medicine, Professor Xiao Zhijian from the Hematology Hospital of the Chinese Academy of Medical Sciences and Affiliated to the University of Science and Technology of China Professor Sun Zimin of the First Hospital jointly pressed the start column to light up the lamp of hope and released the 2021 China AML diagnosis and treatment guidelines
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During the meeting, the four experts shared with you the updated points of the new version of the guidelines, new drug application recommendations, clinical diagnosis and treatment experience, and future prospects for the field of blood diseases
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The new version of the guidelines follows the trend and helps the development of AML diagnosis and treatment as an important reference for clinicians' work, and the update of the guidelines often attracts attention
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Professor Wang Jianxiang said that every year or every period of time, certain research advances in various disease fields will be made at home and abroad.
These clinical research advances not only bring new cognition and changes to everyone, but also promote the update of the guidelines
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The 2021 China AML diagnosis and treatment guidelines are adjusted based on relevant research progress at home and abroad and combined with the actual situation in China to meet the development needs of the new changing situation and the needs of the development of AML diagnosis and treatment
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The new version of the guidelines has been adjusted or changed in many aspects, mainly due to the following points: First, refine the diagnostic classification, and clearly define the classification of good prognosis, poor and moderate prognosis
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This depends on the rapid development of diagnosis and treatment technology, especially the wide application of second-generation sequencing technology
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Second, adjust treatment strategies, including treatment changes for patients with newly treated and relapsed and refractory AML
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Professor Wang Jianxiang pointed out that the progress made in clinical research has brought us many new drugs and changed the outcome of patients' treatment
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Many of these new drugs, including BCL-2 inhibitors, FLT3 inhibitors, and IDH inhibitors, are included in the new version of the guidelines.
New drugs have appeared in both the first-line treatment and the treatment of relapsed and refractory AML, which reflects the medical perspective.
Progress
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Professor Sun Zimin added that for patients with relapsed and refractory AML, the new version of the guidelines emphasizes re-doing chromosomal and molecular genetic examinations to determine whether certain special abnormal chromosomes and mutated genes are present or newly appearing, and to provide help for the selection of retreatment options
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In addition, the new version of the guidelines also specifically emphasizes that AML patients with primary drug resistance or early relapse but not remission after two induction treatments can undergo hematopoietic stem cell transplantation as soon as possible
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This means that hematopoietic stem cell transplantation is a prerequisite, which can improve the tolerance of patients and also improve the efficacy of transplantation, because the patient's general condition is still very good at this time
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The changes in these details have brought huge changes to the clinical diagnosis and treatment of AML
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Professor Wang Jianxiang said that in the past, there was a lack of effective treatment for elderly and weakly physique newly diagnosed patients
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The emergence of new drugs such as the BCL-2 inhibitor Venecla significantly improved the prognosis of these patients, especially in combination with low-intensity chemotherapy, combined epigenetic therapy or combined targeted therapy
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Moreover, these new targeted drugs also bring more options to patients who are relapsed and refractory, and solve many treatment problems
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In addition, with the development of medical technology and continuous improvement of treatment strategies, the new version of the guidelines also put forward higher requirements for disease detection and patient management
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Professor Wang Jianxiang said that with new drugs and treatment strategies, how to make good use of these new drugs and manage patients throughout the process is a question that clinicians need to think about
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The new version of the guidelines has many updates in terms of diagnosis, treatment, or patient management.
These updates are reflected in the details of the text, and clinicians may need to understand carefully
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Under the norms, continue to learn, explore and practice, and improve the level of diagnosis and treatment.
On the practical application of innovative drugs, Professor Jin Jie shared his experience
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The new version of the guidelines has clarified the most basic and standardized usage of new drugs
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For example, patients with unfit and newly diagnosed AML, as well as patients with relapsed and refractory AML can be treated with BCL-2 inhibitor Venecla, or combined with demethylation drugs, or combined with low-dose cytarabine, how to use it and how to increase the dose , The instructions are given in the guide
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But Professor Jin Jie said that this is far from enough, because we will encounter various situations in actual clinical practice.
For example, patients with fungal infections should be treated with antifungal drugs.
At this time, the dose of Vinekal Need to adjust; or encounter a blood cell reduction situation, how to deal with at this time, the guide did not introduce such detailed due to space limitations
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However, many conferences, lectures, and self-media platforms have explained the use of these new drugs, including the 16th National Leukemia and Lymphoma Academic Conference
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 Regarding how to base on the guidelines and explore the actual clinical diagnosis and treatment, Professor Sun Zimin also said that after the diagnosis of relapsed and refractory AML patients is clear, clinicians can choose one for the patient based on the patient’s clinical manifestations, physical fitness assessment, and combined with the patient’s relapse time.
Suitable programs, such as single-drug therapy with new drugs or combined therapy with other drugs
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In addition, the results of in vitro drug susceptibility tests can also be used to make comprehensive judgments, to provide patients with solutions that clinicians think may be effective, and to monitor them closely during treatment
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 Professor Jin Jie said that young doctors should continue to learn, observe, and think carefully while following the guidelines and norms of treatment.
When encountering problems, they should not only consult the literature, but also consult experienced experts, constantly sum up their clinical experience, and use new drugs well.
, Improve the level of diagnosis and treatment
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Pioneering and innovative to realize the progress from the international "following" to "parallel running" Professor Wang Jianxiang said that the new version of the guideline plays a standard role in the clinical diagnosis and treatment of AML, but outside the guideline, hematologists have a very open mind and will continue to do so.
A lot of exploration and innovation
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For example, a new drug has just been marketed and approved for the treatment of a very narrow indication, but its scope of application is far more than these
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Because the drug targets a certain target to play a role, giving clinicians Cognition is a treatment principle, and using this principle can open up more “territories
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”
For example, the BCL-2 inhibitor Venecla is currently approved for the treatment of elderly patients or newly diagnosed patients who cannot tolerate strong induction chemotherapy.
The scope of treatment is relatively limited, but based on the principle of this drug, many hematologists have actually carried out a lot of exploration, using this drug to treat relapsed, refractory and various other patients, and indeed feel that this new drug can give more patients Bring benefits
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Professor Wang Jianxiang concluded, “For a new drug, we must conduct more extensive research based on the understanding of the scientific principles of medicine, expand new treatment ideas and treatment fields, and solve more patients’ problems.
Rather than the patients briefly introduced in the guide
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This is the tremendous change brought to us by new drugs and new research, a conceptual change
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"Professor Jin Jie also said that in addition to basic and standardized treatment according to the guidelines, young doctors must also understand the mechanism of action behind new AML drugs and expand more applications
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For example, Venecla and intensive chemotherapy have been combined internationally.
Treatment of young patients has significantly improved the remission rate
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Young doctors can also do similar thinking in this regard, but after the proposal, they should discuss with their seniors or experienced doctors whether they can try in relapsed and refractory patients or initiate some clinical trials to try
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"Our country is now in a new era of innovation, so innovation should be a direction to implement the future
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" Professor Xiao Zhijian pointed out
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In recent years, Chinese hematologists have been in line with international standards in terms of clinical trials initiated by researchers, and have published many Chinese clinical research results in top international journals such as blood
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Innovation is the main theme of China, and with the country’s progress and strength, high-tech innovation and high-tech start-up pharmaceutical companies have sprung up like mushrooms
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Professor Xiao Zhijian said, “In China, molecularly targeted drugs, some new formulations of old drugs, are currently in parallel with the international market, and I think they may be “leading” in the future
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For example, in the CAR-T field, our country Has played a leading role in the international arena
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With the continuous improvement of China's medical level and the continuous enhancement of the innovative consciousness of scholars in the field of blood diseases, I firmly believe that in the next edition of the AML diagnosis and treatment guidelines, there will be more evidence from China.
Hematology scholars’ own research results
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"Summary In this press conference and expert interviews, the participating experts, scholars and clinicians all have a deeper understanding and recognition of the significance of the 2021 China AML Guidelines
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Every point of academic lean and every detail change in the AML guideline embodies the wisdom and strength of many domestic experts in the field of hematology, and also brings more hope for treatment and rebirth to patients
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If the struggle between humans and AML is likened to a battle, the AML guidelines are equivalent to the strategic deployment, tactical methods, and combat plans used in the war.
With such a diagnosis and treatment standard, every battle will be fought accurately and steadily.
, And also played well
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Under such guidance, clinicians must continue to study in depth, summarize clinical experience, and innovate.
Only in this way can they win the battle against AML
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Professor Wang Jianxiang, Chief Physician, Professor, and Doctoral Supervisor, Deputy Director, Hematology Hospital (Institute of Hematology), Chinese Academy of Medical Sciences, Director of Leukemia Diagnosis and Treatment Center; Vice President of the Hematologists Branch of the Association of Physicians, Vice Chairman of the Experimental Hematology Branch of the Chinese Society of Pathophysiology, Professor Jin Jie, Member of the American Society of Hematology, Chief Physician and Professor, Director of the Department of Hematology, the First Affiliated Hospital of Zhejiang University School of Medicine, Director of the Lymphoma Center Zhejiang Director of the Provincial Key Laboratory of Hematology Oncology (Diagnosis and Treatment) Director of the Department of Hematology, Zhejiang University School of Medicine, National Clinical Key Discipline of the Ministry of Health-Leader of the Department of Hematology, Zhejiang Medical First Hospital, Zhejiang Key Innovation Team-Leukemia Basic and Clinical Research Innovation Team Leader The 7th and 9th Standing Committee of the Hematology Branch of the Chinese Medical Association Chairman of the Hematology Committee of the Chinese Women's Physician Association Chairman of the Hematology Transformation Committee of the Chinese Anti-Cancer Association Deputy Committee of the Chinese Society of Clinical Oncology (CSCO) Anti-leukemia Committee Chairman, Standing Member of the Anti-Lymphoma Special Committee, Professor Xiao Zhijian, Chairman of the Hematology Branch of the Zhejiang Medical Association, Chief Physician, Professor, and Doctoral Supervisor, Associate Director of the Chinese Academy of Medical Sciences Hematology Hospital (Institute of Hematology), Chinese Academy of Medical Sciences Blood Director of the Center for MDS Diagnosis and Treatment Center of the Hospital, Deputy Director of the Hematology Branch of the Chinese Medical Association.
His main research direction is myeloid tumors, especially the pathogenesis of myelodysplastic syndromes and myeloproliferative tumors.
“Ten Thousand Talents Project”, “Young and Middle-aged Experts with Outstanding Contributions” from the former Ministry of Health, “Government Special Experts” and “National Outstanding Scientific and Technological Workers” by the State Council.
Associate editor of Hematology Journal and Leukemia Lymphoma, Editor of Blood Review, Gene, Chromosomes and Cancer, etc.
Professor Sun Zimin Chief Physician, Professor, and Doctoral Supervisor First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital) Department of Hematology Anhui Province Academic Technology Leader Anhui Province 115 Industrial Innovation Team "Hematopoietic Stem Cell Transplantation" Leader Anhui Province Clinical Key Discipline Discipline Leader Anhui Provincial Hospital Hematopoietic Stem Cell Transplant Chief Expert RECOMMEND Recommended Reading 1.
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