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Hosted by the Chinese Academy of Medical Sciences and Peking Union Medical College, and organized by the Hematology Hospital of the Chinese Academy of Medical Sciences and the National Clinical Research Center for Hematological Diseases On the 16th, it was held in an online format
.
With the theme of "Strengthening the Foundation, Emphasizing Clinical Practice, Promoting Transformation - Building a New Ecology of Hematology Innovation and Development", this conference invites top experts in the field of hematology at home and abroad to share the current status and trends of the field of hematology, and focus on the development of hematology in China.
In-depth discussion of the hot spots, difficulties and pain points
.
The meeting invited Professor Ken H.
Young (He Xuhua), Director of the Department of Hematology Diagnosis at Duke University Medical Center, to share the title of "Precise Diagnosis of Blood System Diseases - Current Situation, Development and Challenges"
.
01Precision Medicine and Precision Diagnosis Prof.
He Xuhua said that in the past few years, as an important field of medicine, hematology has made great progress in various researches, which has greatly improved the survival of patients.
A major boost to these advances comes from blood diseases accurate diagnosis and precise treatment
.
Precision therapy is an effective treatment scheme elucidated and developed on the basis of genetics and disease mechanisms
.
Precise diagnosis is the core part of precision medicine.
By determining the cellular origin of the disease and carrying out molecular stratification of the disease, it provides support for doctors in predicting the prognosis of the disease, selecting the treatment plan, and guiding the follow-up of the patient.
and follow-up process
.
Accurate diagnosis requires the full use of multiple detection methods, such as disease morphological detection, cytological detection, and next-generation gene sequencing, to help clinicians accurately classify diseases and explore the pathogenesis of diseases
.
In addition, precise diagnosis has also promoted the research and testing of new clinical drugs.
The advent of a series of new targeted drugs has greatly improved the prognosis of patients
.
Although precise diagnosis has been gradually promoted and applied in the diagnosis and treatment of blood diseases, there are still difficulties in the clinical application of precise diagnosis, which is mainly reflected in: for diseases with high heterogeneity, the detection of new markers cannot meet the needs of personalized treatment.
; For diseases with unclear cell phenotype and unclear cell origin, it is not yet possible to accurately identify and judge diseases,
etc.
These difficulties require that pathological detection be fully integrated with the clinical manifestations and imaging findings of patients, so that cutting-edge technologies can play a guiding role in the clinical treatment of patients
.
02Accurate diagnosis of blood diseases Through accurate diagnosis, the pathological process of diseases and targeted drugs are continuously explored in clinical practice, and the prognosis of patients with blood diseases is gradually improved
.
Professor He explained in detail the importance of accurate diagnosis for the diagnosis and treatment of blood diseases through leukemia, myeloproliferative diseases and lymphoma
.
Accurate diagnosis and classification can be used to guide the treatment of acute leukemia, greatly improving patient survival and prognosis
.
Clinically, acute myeloid leukemia is divided into nine categories according to genetic changes, with different genotype characteristics and prognostic manifestations (Figure 1), and patients with different disease types have different sensitivity to drugs during treatment.
Accurate diagnosis can provide clinicians with the basis for drug screening and treatment plans
.
Not only acute myeloid leukemia, but also other myeloid diseases, including myelodysplastic syndrome (MDS), myeloproliferative neoplasms (MPN) and other rare diseases, precision diagnosis and treatment can also help improve the survival and prognosis of these patients
.
Figure 1 Lymphoma, as a global malignant disease, has received extensive attention at home and abroad, especially lymphomas related to NK cells and T cells, which are difficult to treat, complex in diagnosis and classification, and poor in prognosis.
Accurate diagnosis and treatment of diseases is very important
.
In the diagnosis and treatment of T-cell lymphoma, precise diagnosis focuses on the detection of cell origin, cell phenotype and gene expression to predict patient efficacy
.
For example, using FISH probes to detect anaplastic large cell lymphoma (ALCL) gene expression, ALCL patients with TP63 mutations have a poorer prognosis, while DUSP22-mutated ALCL patients have a better prognosis (Figure 2)
.
The treatment of B-cell lymphoma also requires the help of accurate diagnosis, especially high-grade B-cell lymphoma (HGBL)
.
A major feature of HGBL is the strong heterogeneity of the disease.
Different subtypes have different morphological and molecular characteristics.
In clinical practice, next-generation sequencing or single-cell sequencing can be used to achieve accurate judgment
.
At present, HGBL's next-generation sequencing detection gene panel is continuously expanding, laying a good foundation for the realization of all-round genetic analysis and providing a basis for doctors to accurately classify diseases at the molecular level
.
Figure 2 Accurate diagnosis can run through the entire process of diagnosis, treatment, and follow-up of patients.
For example, the detection of minimal residual disease (MRD) can be used to evaluate the efficacy of patients
.
A study on the survival data of nearly 10,000 AML patients demonstrated that the overall survival (OS) and disease-free survival (DFS) of MRD-positive patients were significantly lower than those of MRD-negative patients (Figure 3)
.
Detection of MRD during patient follow-up can provide guidance for clinical treatment and disease management
.
Figure 3 Although most patients with blood diseases can be cured through precise diagnosis and treatment, some patients will relapse
.
No matter which disease patients experience recurrence, the same comprehensive and accurate analysis as conventional diagnosis is required, and comparison with the original diagnosis is required to evaluate the patient's treatment response and find the cause of recurrence
.
In addition, in addition to patient groups, accurate diagnosis can also be extended to healthy or sub-healthy groups, and through disease screening, early diagnosis and early treatment of diseases can be achieved
.
03Systematic consideration of precise diagnosis Accurate diagnosis is of great significance for the treatment of hematological tumors, so how to effectively use precise diagnosis to guide disease treatment in clinical practice? Prof.
He Xuhua shared 5 precautions: some tumors have similar morphological characteristics, such as diffuse large B-cell lymphoma (DLBCL) and HGBL, which require a combination of genotype and molecular mechanisms; some tumors have similar clinical manifestations, such as patients with A lump in the neck or abdomen is present, but it may not be the same disease and requires a full and adequate clinical evaluation; there is heterogeneity in the tumor, even if the same disease is diagnosed, but due to different cellular origins and different gene expression, the patient Different prognosis requires consideration of different treatment options; treatment needs to fully consider the tumor microenvironment, because in the blood, bone marrow or lymphatic microenvironment, there are not only tumor cells, but also many immune cells involved in the occurrence and development of the disease; disease treatment is a step-by-step process From initial diagnosis to relapse and refractory treatment, drug resistance and genetic changes may occur.
Therefore, close follow-up of patients is required, and new generation of drugs or new treatment regimens should be adopted in time for patients with drug resistance
.
In addition, Professor He Xuhua also emphasized that precision diagnosis and treatment should be reflected in precision medicine and precision oncology management, and run through the entire treatment and follow-up process of patients
.
Doctors need to formulate treatment plans for patients based on the results of various examinations, and have a certain grasp of the prognosis of patients
.
If the patient does not achieve the expected curative effect, the doctor needs to re-evaluate the patient and constantly explore new and more precise treatment options
.
This also means that the management of precise diagnosis requires a standardized process, namely sample collection, laboratory testing, and big data analysis, and quality control needs to be ensured, including the doctors and researchers involved in the entire process, which also requires high-quality monitoring
.
In the future, the application of tumor microenvironment detection in precise diagnosis needs further research, because microenvironmental factors may be an important mechanism for the emergence of drug resistance in patients.
Whether new treatment methods can be proposed also requires pharmacokinetics, pharmacokinetics, Research on tumor metabolism and many other aspects
.
Accurate diagnosis relies on doctors and researchers' full understanding of disease diagnosis and treatment guidelines and WHO disease classification standards, as well as accurate judgments of diseases
.
Doctors need to make full use of molecular and genetic detection methods to fully and completely grasp the mechanism of disease occurrence and development, judge patients' prognosis and treatment response through accurate diagnosis, and conduct effective follow-up and follow-up of patients
.
Researchers need to closely combine research with clinical needs, explore unresolved clinical problems, and continuously advance the field of hematology
.
Summary Accurate diagnosis is the core of precision medicine, which can run through the whole process of patient's disease diagnosis and treatment
.
The rapid development of precise diagnosis helps the clinic to continuously explore the pathological process of the disease and discover potential therapeutic targets, which greatly improves the survival and prognosis of patients with hematological tumors, and at the same time strongly promotes the high-quality development of hematology research
.
Finally, Professor He Xuhua said that the purpose of precision medicine is to emphasize personalized treatment, help patients overcome diseases, improve patients' quality of life, and improve patient survival
.
Professor He Xuhua, Director of the Department of Hematology Diagnosis, Duke University Medical Center, USA, Chief Expert of Hematology and Tumor Diagnosis, Duke University Oncology Center, USA, World-renowned Hematology Disease Diagnosis Expert, International Primary Diffuse Large B-Cell Lymphoma, Primary Central Nervous System Lymphoma, Primary Testicular lymphoma and North American EBV-positive lymphoma, the leader of the North American NK/T cell lymphoma multi-center collaborative group project serves as the American Cancer Research Fund, the American Society of Leukemia and Lymphoma, the German Society of Oncology, the British Society of Oncology, the Swiss Society of Oncology, The review experts of the Australian Society of Oncology and the Canadian Society of Oncology Research Fund acted as reviewers for 25 of the world's top blood journals, including NEJM, CELL, JCO, BLOOD, Leukemia, etc.
Published 302 medical papers, hosted and participated in the editing of many blood disease diagnosis.
Recipient of several NIH/NCI National Science Foundation projects for academic works, various awards from the Cancer Center, Research Award of the Anti-Tumor Moon Shot Program, SPORE Project Development Fund Award for Lymphoma and Myeloma, Cancer Research Fund Award, Cooperation with Sister Hospitals Foundation Award, University of Texas MD Anderson and University of Wisconsin Lymphoma Research Award, Paul Carbone Oncology Center Lymphoma and Myeloma Award, American Lymphoma Research Foundation Award, Gunderson Medical Foundation Award, Hagemeister Lymphoma Award, etc.
" Read the original", we make progress together
.
With the theme of "Strengthening the Foundation, Emphasizing Clinical Practice, Promoting Transformation - Building a New Ecology of Hematology Innovation and Development", this conference invites top experts in the field of hematology at home and abroad to share the current status and trends of the field of hematology, and focus on the development of hematology in China.
In-depth discussion of the hot spots, difficulties and pain points
.
The meeting invited Professor Ken H.
Young (He Xuhua), Director of the Department of Hematology Diagnosis at Duke University Medical Center, to share the title of "Precise Diagnosis of Blood System Diseases - Current Situation, Development and Challenges"
.
01Precision Medicine and Precision Diagnosis Prof.
He Xuhua said that in the past few years, as an important field of medicine, hematology has made great progress in various researches, which has greatly improved the survival of patients.
A major boost to these advances comes from blood diseases accurate diagnosis and precise treatment
.
Precision therapy is an effective treatment scheme elucidated and developed on the basis of genetics and disease mechanisms
.
Precise diagnosis is the core part of precision medicine.
By determining the cellular origin of the disease and carrying out molecular stratification of the disease, it provides support for doctors in predicting the prognosis of the disease, selecting the treatment plan, and guiding the follow-up of the patient.
and follow-up process
.
Accurate diagnosis requires the full use of multiple detection methods, such as disease morphological detection, cytological detection, and next-generation gene sequencing, to help clinicians accurately classify diseases and explore the pathogenesis of diseases
.
In addition, precise diagnosis has also promoted the research and testing of new clinical drugs.
The advent of a series of new targeted drugs has greatly improved the prognosis of patients
.
Although precise diagnosis has been gradually promoted and applied in the diagnosis and treatment of blood diseases, there are still difficulties in the clinical application of precise diagnosis, which is mainly reflected in: for diseases with high heterogeneity, the detection of new markers cannot meet the needs of personalized treatment.
; For diseases with unclear cell phenotype and unclear cell origin, it is not yet possible to accurately identify and judge diseases,
etc.
These difficulties require that pathological detection be fully integrated with the clinical manifestations and imaging findings of patients, so that cutting-edge technologies can play a guiding role in the clinical treatment of patients
.
02Accurate diagnosis of blood diseases Through accurate diagnosis, the pathological process of diseases and targeted drugs are continuously explored in clinical practice, and the prognosis of patients with blood diseases is gradually improved
.
Professor He explained in detail the importance of accurate diagnosis for the diagnosis and treatment of blood diseases through leukemia, myeloproliferative diseases and lymphoma
.
Accurate diagnosis and classification can be used to guide the treatment of acute leukemia, greatly improving patient survival and prognosis
.
Clinically, acute myeloid leukemia is divided into nine categories according to genetic changes, with different genotype characteristics and prognostic manifestations (Figure 1), and patients with different disease types have different sensitivity to drugs during treatment.
Accurate diagnosis can provide clinicians with the basis for drug screening and treatment plans
.
Not only acute myeloid leukemia, but also other myeloid diseases, including myelodysplastic syndrome (MDS), myeloproliferative neoplasms (MPN) and other rare diseases, precision diagnosis and treatment can also help improve the survival and prognosis of these patients
.
Figure 1 Lymphoma, as a global malignant disease, has received extensive attention at home and abroad, especially lymphomas related to NK cells and T cells, which are difficult to treat, complex in diagnosis and classification, and poor in prognosis.
Accurate diagnosis and treatment of diseases is very important
.
In the diagnosis and treatment of T-cell lymphoma, precise diagnosis focuses on the detection of cell origin, cell phenotype and gene expression to predict patient efficacy
.
For example, using FISH probes to detect anaplastic large cell lymphoma (ALCL) gene expression, ALCL patients with TP63 mutations have a poorer prognosis, while DUSP22-mutated ALCL patients have a better prognosis (Figure 2)
.
The treatment of B-cell lymphoma also requires the help of accurate diagnosis, especially high-grade B-cell lymphoma (HGBL)
.
A major feature of HGBL is the strong heterogeneity of the disease.
Different subtypes have different morphological and molecular characteristics.
In clinical practice, next-generation sequencing or single-cell sequencing can be used to achieve accurate judgment
.
At present, HGBL's next-generation sequencing detection gene panel is continuously expanding, laying a good foundation for the realization of all-round genetic analysis and providing a basis for doctors to accurately classify diseases at the molecular level
.
Figure 2 Accurate diagnosis can run through the entire process of diagnosis, treatment, and follow-up of patients.
For example, the detection of minimal residual disease (MRD) can be used to evaluate the efficacy of patients
.
A study on the survival data of nearly 10,000 AML patients demonstrated that the overall survival (OS) and disease-free survival (DFS) of MRD-positive patients were significantly lower than those of MRD-negative patients (Figure 3)
.
Detection of MRD during patient follow-up can provide guidance for clinical treatment and disease management
.
Figure 3 Although most patients with blood diseases can be cured through precise diagnosis and treatment, some patients will relapse
.
No matter which disease patients experience recurrence, the same comprehensive and accurate analysis as conventional diagnosis is required, and comparison with the original diagnosis is required to evaluate the patient's treatment response and find the cause of recurrence
.
In addition, in addition to patient groups, accurate diagnosis can also be extended to healthy or sub-healthy groups, and through disease screening, early diagnosis and early treatment of diseases can be achieved
.
03Systematic consideration of precise diagnosis Accurate diagnosis is of great significance for the treatment of hematological tumors, so how to effectively use precise diagnosis to guide disease treatment in clinical practice? Prof.
He Xuhua shared 5 precautions: some tumors have similar morphological characteristics, such as diffuse large B-cell lymphoma (DLBCL) and HGBL, which require a combination of genotype and molecular mechanisms; some tumors have similar clinical manifestations, such as patients with A lump in the neck or abdomen is present, but it may not be the same disease and requires a full and adequate clinical evaluation; there is heterogeneity in the tumor, even if the same disease is diagnosed, but due to different cellular origins and different gene expression, the patient Different prognosis requires consideration of different treatment options; treatment needs to fully consider the tumor microenvironment, because in the blood, bone marrow or lymphatic microenvironment, there are not only tumor cells, but also many immune cells involved in the occurrence and development of the disease; disease treatment is a step-by-step process From initial diagnosis to relapse and refractory treatment, drug resistance and genetic changes may occur.
Therefore, close follow-up of patients is required, and new generation of drugs or new treatment regimens should be adopted in time for patients with drug resistance
.
In addition, Professor He Xuhua also emphasized that precision diagnosis and treatment should be reflected in precision medicine and precision oncology management, and run through the entire treatment and follow-up process of patients
.
Doctors need to formulate treatment plans for patients based on the results of various examinations, and have a certain grasp of the prognosis of patients
.
If the patient does not achieve the expected curative effect, the doctor needs to re-evaluate the patient and constantly explore new and more precise treatment options
.
This also means that the management of precise diagnosis requires a standardized process, namely sample collection, laboratory testing, and big data analysis, and quality control needs to be ensured, including the doctors and researchers involved in the entire process, which also requires high-quality monitoring
.
In the future, the application of tumor microenvironment detection in precise diagnosis needs further research, because microenvironmental factors may be an important mechanism for the emergence of drug resistance in patients.
Whether new treatment methods can be proposed also requires pharmacokinetics, pharmacokinetics, Research on tumor metabolism and many other aspects
.
Accurate diagnosis relies on doctors and researchers' full understanding of disease diagnosis and treatment guidelines and WHO disease classification standards, as well as accurate judgments of diseases
.
Doctors need to make full use of molecular and genetic detection methods to fully and completely grasp the mechanism of disease occurrence and development, judge patients' prognosis and treatment response through accurate diagnosis, and conduct effective follow-up and follow-up of patients
.
Researchers need to closely combine research with clinical needs, explore unresolved clinical problems, and continuously advance the field of hematology
.
Summary Accurate diagnosis is the core of precision medicine, which can run through the whole process of patient's disease diagnosis and treatment
.
The rapid development of precise diagnosis helps the clinic to continuously explore the pathological process of the disease and discover potential therapeutic targets, which greatly improves the survival and prognosis of patients with hematological tumors, and at the same time strongly promotes the high-quality development of hematology research
.
Finally, Professor He Xuhua said that the purpose of precision medicine is to emphasize personalized treatment, help patients overcome diseases, improve patients' quality of life, and improve patient survival
.
Professor He Xuhua, Director of the Department of Hematology Diagnosis, Duke University Medical Center, USA, Chief Expert of Hematology and Tumor Diagnosis, Duke University Oncology Center, USA, World-renowned Hematology Disease Diagnosis Expert, International Primary Diffuse Large B-Cell Lymphoma, Primary Central Nervous System Lymphoma, Primary Testicular lymphoma and North American EBV-positive lymphoma, the leader of the North American NK/T cell lymphoma multi-center collaborative group project serves as the American Cancer Research Fund, the American Society of Leukemia and Lymphoma, the German Society of Oncology, the British Society of Oncology, the Swiss Society of Oncology, The review experts of the Australian Society of Oncology and the Canadian Society of Oncology Research Fund acted as reviewers for 25 of the world's top blood journals, including NEJM, CELL, JCO, BLOOD, Leukemia, etc.
Published 302 medical papers, hosted and participated in the editing of many blood disease diagnosis.
Recipient of several NIH/NCI National Science Foundation projects for academic works, various awards from the Cancer Center, Research Award of the Anti-Tumor Moon Shot Program, SPORE Project Development Fund Award for Lymphoma and Myeloma, Cancer Research Fund Award, Cooperation with Sister Hospitals Foundation Award, University of Texas MD Anderson and University of Wisconsin Lymphoma Research Award, Paul Carbone Oncology Center Lymphoma and Myeloma Award, American Lymphoma Research Foundation Award, Gunderson Medical Foundation Award, Hagemeister Lymphoma Award, etc.
" Read the original", we make progress together
