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    Home > Active Ingredient News > Antitumor Therapy > Professor Zhang Xiaohui: In ALL, is the immunotherapy era an opportunity or a challenge for allo-HSCT?

    Professor Zhang Xiaohui: In ALL, is the immunotherapy era an opportunity or a challenge for allo-HSCT?

    • Last Update: 2021-04-23
    • Source: Internet
    • Author: User
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    Lymphocytic disease is currently one of the most vigorous fields in hematology at home and abroad.
    In recent years, remarkable achievements have been made in the pathogenesis of the disease to targeted and immunotherapy.

    In order to promote domestic and international peer exchanges, the First National Lymphocytic Disease Academic Conference of the Chinese Medical Association and the 2021 International Lymphoma Update Symposium will be held in Chengdu, Sichuan Province from April 16-18, 2021.

    At this meeting, Professor Zhang Xiaohui from Peking University People’s Hospital replaced Professor Huang Xiaojun in a keynote report on "The Role of Allogeneic Hematopoietic Stem Cell Transplantation (allo-HSCT) in Acute Lymphoblastic Leukemia (ALL) in the Era of Immunotherapy".
    The content is organized as follows.

    The role of Allo-HSCT in ALL Hematopoietic stem cell transplantation is an effective means to cure hematological malignancies, but the current application of hematopoietic stem cell transplantation in different hematological diseases is different.
    Patients with acute myeloid leukemia (AML) receive hematopoietic stem cells The number of transplants is relatively large.

    Statistics from the International Center for Blood and Bone Marrow Transplantation Research (CIBMTR) show that although the number of transplants carried out globally has decreased due to the impact of the epidemic in 2020, the number of transplants carried out globally has shown an overall upward trend in recent years.

    In recent years, the number of hematopoietic stem cell transplantation centers and the number of transplant cases in my country has also been increasing.

     Professor Zhang Xiaohui first analyzed the types of hematopoietic stem cell transplantation carried out in China.

    A total of 13,415 hematopoietic stem cell transplants were carried out in China in 2020, of which 10042 were allo-HSCT, and most of them were haploidentical allo-HSCT (6187 cases).

    Professor Zhang Xiaohui said that although the number of allo-HSCTs carried out by Chinese compatriots is relatively small (2110 cases), the creation of the world’s first non-T haplotype-compatible transplantation system, the “Beijing Plan”, is for patients with blood diseases who need to undergo transplantation.
    More choices of donors are coming.

    The long-term survival rate of leukemia patients (including AML, ALL, and chronic myeloid leukemia [CML]) who received this transplant protocol exceeds 40%.

    At the same time, Professor Zhang Xiaohui said that the creation of the "Beijing Plan" has promoted the formation of a new concept in the field of hematopoietic stem cell transplantation.

     Later, Professor Zhang Xiaohui introduced the application of allo-HSCT in ALL.

    He said that many studies have confirmed that allo-HSCT is better than traditional chemotherapy in ALL.

    The multi-center randomized controlled LALA-87 study showed that the efficacy of allo-HST in high-risk ALL patients receiving sibling allo-HST is better than chemotherapy, the 5-year leukemia-free survival rate (LFS, 39% vs 14%) and the 5-year overall survival rate (OS, 44% vs 20%) higher.

    The ECOG2993 study showed that the efficacy of allo-HSCT in Philadelphia chromosome-positive (PH+) ALL patients receiving sibling or unrelated donor allo-HSCT is also better than chemotherapy, and the 5-year OS rate is higher (sibling completely identical: 44%, unrelated donor all Consistency: 35% vs chemotherapy: 14%).

    For standard-risk PH-ALL patients, another multi-center prospective study showed that haplotype allo-HSCT is more effective than chemotherapy in this part of patients, with first complete remission (CR) time, cumulative recurrence rate (CIR), LFS , OS are better.

     For PH+ ALL patients, allo-HSCT also showed better efficacy than TKI inhibitors.

    The GRAAPH-2003 study showed that the curative effect of PH+ ALL patients receiving sibling allo-HSCT is better than that of single-agent maintenance therapy with TKI inhibitors, and the 4-year OS rate is better (76% vs 33%).

    Haplotype allo-HSCT is also a better treatment option in children with PH+ ALL, with a 5-year event-free survival (EFS) rate of 61.
    0% and a 5-year OS rate of 70.
    0%.

     Professor Zhang Xiaohui then introduced the comparative study of the efficacy of different types of allo-HSCT in ALL.

    A study showed that haplotype allo-HSCT is more effective than sibling allo-HSCT in PH+ ALL patients, and haplotype allo-HSCT has a lower recurrence rate after treatment (19.
    1% vs 44.
    8%).

    The ECOG2993 study showed that the efficacy of sibling allo-HSCT in standard-risk PH-ALL patients is better than autologous hematopoietic stem cell transplantation and traditional chemotherapy, and the 5-year OS rate is better (62% vs 52%).

    CAR-T cell therapy brings opportunities for allo-HSCT.
    China's hematopoietic stem cell transplantation guidelines were released in 2018.
    For patients with relapsed and refractory ALL, the guidelines recommend allo-HSCT.

    However, the efficacy of allo-HSCT in relapsed and refractory ALL may decrease with the increase in the number of relapses.
    Related studies have shown: for the first CR (CR1), the second CR (CR2), the second or higher CR or never CR For the relapsed and refractory ALL patients, the 5-year LFS after allo-HSCT treatment was 68.
    9%, 56.
    6%, and 22.
    2%, respectively.

    Professor Zhang Xiaohui said that for patients with relapsed and refractory ALL, the treatment strategy around allo-HSCT still needs to be adjusted.

     Chimeric antigen receptor (CAR-) T cell immunotherapy has shown good therapeutic prospects in hematological diseases in recent years.
    At present, the number of CAR-T cell therapy-related clinical trials is rapidly increasing worldwide.

    For relapsed and refractory B-cell ALL (B-ALL), a number of domestic studies have shown that the application of CAR-T cell therapy improves the remission rate of these patients, and the CR after CAR-T cell therapy can make Bridging transplantation for relapsed and refractory B-ALL patients who have lost the chance of transplantation.

    Professor Zhang Xiaohui said that the emergence of CAR-T cell therapy has broadened the transplant indications for relapsed and refractory ALL, and brought better clinical effects for patients with relapsed and refractory ALL.

    The challenge of CAR-T cell therapy to the ALL treatment model Professor Zhang Xiaohui said that the treatment model of ALL may change in the CAR-T era.

    Under the current ALL treatment model, there are relatively few treatment options for patients who have not reached CR after induction chemotherapy.

    A study carried out in China showed that for patients with B-ALL who are initially treated for standard-risk, CAR-T induction therapy can also bring CR.

    Looking forward to the development of related research in the future to determine the status of CAR-T cell therapy in ALL, update the treatment model of ALL, and bring benefits to ALL patients.

    Summary Professor Zhang Xiaohui concluded: Allo-HSCT is currently the most effective treatment for ALL.
    CAR-T cell therapy brings more opportunities for allo-HSCT to ALL patients and also challenges the current treatment model for ALL.

    Professor Zhang Xiaohui Chief Physician, Professor, and Doctoral Supervisor, Deputy Director, Institute of Hematology, Peking University People's Hospital, Deputy Director, Committee of Hematology Branch, Chinese Medical Association, Deputy Director, Committee of Hematology and Immunity Branch, Chinese Society of Immunology, Deputy Director, China Anti-Leukemia Alliance, Deputy Director, Chinese Medicine Vice Chairman of the Hemostasis and Thrombosis Branch of the Education Society, the leader of the Hematopoietic Stem Cell Transplantation Application Group of the Hematology Branch of the Chinese Medical Association stamps "read the original text", and we make progress together
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