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Chronic lymphoblastic leukemia (CLL) is a subtype of B-cell lymphoma, mainly occurring in middle-aged and elderly people, clinical progress is relatively slow, and heterogeneous, the incidence of CLL in China is increasing
year by year.
In recent years, with the continuous emergence of new drugs such as BTK inhibitors, BCL-2 inhibitors, and anti-CD20 monoclonal antibodies, the treatment and prognosis of CLL have undergone tremendous changes
.
To this end, the China Working Group on Chronic Lymphoblastic Leukemia has guided the "Light of Life" project, which aims to assist doctors in the whole process of managing CLL patients and improving their prognosis and long-term survival
.
Professor Li Jianyong of Jiangsu Provincial People's Hospital, Professor Qiu Lugui of Hematology Hospital of Chinese Academy of Medical Sciences, and Professor Ji Chunyan of Qilu Hospital of Shandong University were invited to share the treatment mode and long-term management exploration of CLL treatment and long-term management, in order to provide help
to colleagues in hematology.
01 Yimaitong: The China Working Group on Chronic Lymphoblastic Leukemia guided the "Light of Life" project for CLL patients, could you briefly introduce the project, which patients can join the project, and the significance of the project?
Professor Li Jianyong
The "Light of Life" project, whose full name is "Light of Life Chronic Lymphocytic Leukemia Patients Fine Management Project", is a project guided by the China Chronic Lymphocytic Leukemia Working Group and jointly participated by clinicians, patients and patients' families, health managers and volunteers.
Through professional and refined CLL medical history records and long-term management/follow-up service platforms, patients can record their past disease course, establish CLL patient files, assist doctors in patient education and patient self-health assessment, and complete the closed loop
of patient management.
using the "Light of Life" project.
The Light of Life project is of great importance
to both patients and doctors.
On the one hand, for patients, in line with the long-term management needs of CLL, patients can be managed
from before, during and after treatment 。 The emergence of BTK inhibitors makes CLL patients survive further, even close to the life level of non-CLL patients, becoming a chronic disease like hypertension, diabetes long-term treatment, for chronic diseases, treatment and long-term standardized management is equally important, all patients should be lifelong observation and follow-up, regular follow-up can help patients manage adverse reactions, standardize medication, improve patient compliance, etc.
, thereby improving the quality of life of
patients 。 On the other hand, a database of CLL/SLL patients is established to effectively feedback real-world data, and the main project doctors of each project hospital can use the information entered by the hospital to carry out research
.
02Yimaitong: With the emergence and application of BTK inhibitors, the survival of CLL patients has been extended and the treatment mode has changed, please talk about the exploration of the "Chinese plan" for the limited treatment of CLL
treatment.
Professor Qiu Lugui
At present, the first recommended treatment of CLL in domestic and foreign guidelines is mainly the treatment
of small molecule targeted drugs BTK inhibitors.
However, the monotherapy of small molecule targeted drugs such as BTK inhibitors requires lifelong medication, and the age of onset of CLL patients in China is relatively young, and lifelong drug patients are deficient
in economic and compliance management.
In view of this, limited-cycle treatment and intermittent treatment, or intermittent "cure", are now proposed, that is, patients do not need to take drugs for a period of time, like normal people, so that young patients who need to stop taking drugs can obtain longer, higher-quality survival
.
If the patient has not achieved deep remission before stopping the drug, abrupt discontinuation may lead to disease progression, at which point we may need to bridge immunochemotherapy to avoid the rebound or progression of the disease after the BTK inhibitor is stopped, that is, the concept of
"brakes".
For elderly patients, such as patients over 70 years old, they may not be able to tolerate immunochemotherapy, and the treatment does not pursue limited cycle treatment, but attaches importance to the whole process management of patients to improve the quality of life of
patients.
It can be seen that the clinical treatment strategies for different patients are different, and future treatment tends to be individualized according to the different conditions of patients
.
In addition, our center has done a "hamburger" program before, that is, alternating the use of immunochemotherapy and BTK inhibitors, to achieve deep remission and then stop the drug, the overall effect is very good, now 50 patients have been enrolled, the effective rate is 100%, and the complete response rate is more than 60%.
On this basis, we further explore orelabrutinib plus BR (bendamustine + rituximab) or FCR (fludarabine + cyclophosphamide + rituximab) limited-cycle regimens
.
At present, the study has been launched in dozens of centers across the country, through real-world prospective research to explore a limited-cycle combination treatment plan
that is more suitable for young CLL patients in China.
Professor Li Jianyong
The limited period combination therapy of new drugs not only overcomes the shortcomings of immunochemotherapy therapy, but also overcomes the shortcomings of single-agent long-term treatment of BTK inhibitors, so the limited treatment status of new drugs based on BTK inhibitors has gradually improved and become a research hotspot
.
At present, one of the more explored is the treatment mode of "BTK inhibitor + BCL-2 inhibitor ± anti-CD20 monoclonal antibody", which is relatively less toxic, has a faster effect, and has a deeper degree of remission than BTK inhibitor monotherapy, achieving complete remission, and more patients with minimal residual disease (MRD) negative, and a considerable number of patients can achieve drug withdrawal
。 After stopping the drug, the risk of drug resistance can be reduced, the cost of treatment can be reduced, and the quality of life of patients can be improved, especially for elderly patients who take more drugs, avoid drug interactions, etc.
, in addition, patients who relapse/progress after stopping the drug are still effective
in using BTK inhibitors again.
In addition, the combination of old drugs and new drugs, such as BTK inhibitors combined with FCR regimen or FCG (fludarabine + cyclophosphamide + obinutuzumab) regimen, our center is now conducting orelabrutinib combined with FCG regimen first-line treatment of CLL/SLL research, which is a very anticipated and suitable for
China's national conditions.
03 Yimaitong: The development of CLL discipline is inseparable from the promotion of the society, the Chinese Anti-Cancer Association (CACA) Hematology and Oncology Professional Committee has done a lot of work in improving the level of doctors' CLL diagnosis and treatment, patient education and management, etc.
, please talk about the future exploration direction of CLL from the patient and clinical level, and the main work of the society in the field of CLL in the future?
Professor Chunyan Ji
At present, the main treatment goal of CLL in clinical practice is to stop disease progression, prolong patient survival, and improve the quality of
life.
In the future, we will continue to promote the standardized diagnosis and treatment of CLL, including standardized diagnosis, prognosis stratification, individualized treatment, and efficacy monitoring and follow-up, so as to achieve standardized management throughout the process, better apply existing innovative drugs, and enable patients to achieve deeper remission and longer survival
.
Now the limited period combination therapy CLL is a hot spot in domestic and foreign research, this model can not only reduce the side effects of drugs, but also reduce the economic burden of patients, more in line with China's national conditions and patient needs, but there are still some unmet clinical needs, such as MRD detection methods are not standardized, the discontinuation standards of each clinical trial are different, the timing of drug discontinuation has not reached consensus, and the short-term economic pressure of patients with multi-drug combination therapy is high.
In addition, there is a lack of long-term follow-up data for
MRD-driven limited treatment courses.
Based on this, we will continue to promote the exploration of the limited cycle treatment course of CL, including BTK inhibitor combined with immunochemotherapy, BTK inhibitor + BCL-2 inhibitor, BTK inhibitor + BCL-2 inhibitor + anti-CD20 monoclonal antibody, etc.
, to explore the most favorable treatment plan
for patients.
The European Research Center for Chronic Lymphocytic Leukemia (ERIC) has formulated and updated the recommended recommendations for CLL flow cytometry MRD detection, but the instruments and reagents of major domestic centers are different, and the detection level is also uneven, and it is urgent to meet China's national conditions MRD testing guidelines or consensus, and we will promote the standardization and standardized application
of MRD in CLL diagnosis and treatment in China in the future.
In addition, in order to enable patients and their families to have a more comprehensive understanding of the diagnosis, treatment and self-care knowledge of CLL, we will continue to promote the popularization of patients' medical education in the future, so that patients can better cooperate with doctors to carry out standardized treatment, grasp the timing of drug treatment, and then improve the quality of life of patients and achieve long-term survival
.
Professor Li Jianyong
Jiangsu Provincial People's Hospital, Pukou Slow Shower Center
Director of the Department of Hematology, First Affiliated Hospital of Nanjing Medical University, doctoral supervisor, postdoctoral co-supervisor, Class A distinguished professor
Member of the Standing Committee of the Hematology Branch of the Chinese Medical Association, Head of the Lymphocytic Disease Group
Chairman of the Fourth Hematology and Oncology Professional Committee of the Chinese Anti-Cancer Association
Vice Chairman of the Lymphoma Quality Control Expert Committee of the National Cancer Quality Control Center
Leader of the Chinese Working Group on Chronic Lymphocytic Leukemia
Vice Chair of the CSCO Lymphoma Expert Committee
Deputy head of the Lymphoma Group of the Oncology Branch of the Chinese Medical Association
Chairman of the Hematology Branch of Jiangsu Geriatrics Association
President-elect of Hematologist Branch of Jiangsu Medical Association
Former Chairman of Hematology Branch of Jiangsu Medical Association
Chairman of the Hematology Branch of Nanjing Medical Association
Vice Chairman of China Hematology Specialist Alliance
Vice Chairman of Hematology Institution Branch of Chinese Hospital Association
Prof.
Lugui Qiu
Hematology Hospital, Chinese Academy of Medical Sciences (Institute of Hematology, Chinese Academy of Medical Sciences)
Chief physician and doctoral supervisor of lymphoma diagnosis and treatment center
Director of Tianjin Cord Blood Hematopoietic Stem Cell Bank
Experts who enjoy special government allowances from the State Council
Member of the Membership Committee of the International Myeloma Society
Member of the Expert Committee of the International Myeloma Working Group
Editorial Board Member of Blood Advances
Chairman of the Hematology and Oncology Professional Committee of the Chinese Anti-Cancer Association
Vice Chairman of the Lymphoma Research Alliance of the Chinese Society of Clinical Oncology
Vice Chairman of the Hematology Committee of the Association of Integrative Physicians
Vice Chairman of the Hematology Professional Committee of China Medical Education Association
Chairman of Hematology and Oncology Professional Committee of Tianjin Anti-Cancer Association
Member of the editorial board of 6 core journals including Chinese Journal of Hematology
He has completed more than 20 fund projects such as key projects of the National Science and Technology Support Plan and national key natural projects
He has published nearly 500 papers, including more than 140 SCI papers
Professor Chunyan Ji
Distinguished Professor of Shandong University Teaching Teacher and Outstanding Talent System
Vice Dean of Qilu School of Medicine, Shandong University
Vice President of Qilu Hospital of Shandong University and Director of Cancer Center
Director of the Joint Laboratory of Intelligent Diagnosis and Treatment of Hematology Diseases of Shandong University
Tarzan Scholar Climbing Program Specialist
Young and middle-aged experts with outstanding contributions to national health and family planning
Enjoy the special government allowance of the State Council
Outstanding subject leader of health system in Shandong Province
He is the chairman-elect of the Hematology and Oncology Professional Committee of the Chinese Anti-Cancer Association
He is the chairman-elect of the Hematology and Oncology Branch of Shandong Anti-Cancer Association
Member of Hematology Branch of Chinese Medical Association
Chairman of Hematology Branch of Shandong Medical Association
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