The 8th National Conference on Blood Tumors, the latest treatment strategy for multiple myeloma in China, see Professor Qiu You give you a clear article

The 8th National Blood Tumor Congress was successfully concluded from October 16th to October 18th, 2020, and experts from all over the country gathered to form an academic feast of white family competition.
Qiu, of the Hospital of Hematology of the Chinese Academy of Medical Sciences, presented a wonderful report entitled "The Status and Prospects of Research on Multiple Myeloma in China".
meeting, the Blood Channel of the medical profession invited Professor Qiu to have an in-depth dialogue to review and share the highlights of the report.
The level of diagnosis and treatment of multiple myeloma in China is uneven, there is an urgent need to improve the incidence of multiple myeloma in China or there is an increasing trend, the prognosis needs to be improved at present, China's multiple myeloma (MM) lacks a systematic epidemiological investigation, so it is not yet possible to know the exact incidence.
But according to the 2016 National Cancer Center released china's tumor registration data, the incidence of MM in China is 1.6 per 100,000, the actual situation may be higher than this data, for two reasons: (1) domestic hematologists have MM incidence gradually increased experience, and may even exceed the incidence of acute leukemia population.
(2) With the gradual increase of MM patient survival, the cumulative number of patients is also increasing.
compared with developed countries in Europe and the United States, China MM patients early diagnosis rate is low, although some units in China will carry out annual routine physical examination, but usually do not do MM screening-related M protein testing.
Plus, MM's clinical manifestations are non-specific, such as bone pain and proteinuria or renal insanity, resulting in these patients may be the first department of orthopaedics, nephrology and other departments, prone to misdiagnosis and omission, delay the disease.
However, with the increase of MM's incidence and multidisciplinary education in recent years, clinicians' awareness and attention to the disease have gradually increased, and the proportion of MM's early diagnosis and treatment is increasing, and the proportion of missed and misdiagnosis is decreasing.
, compared with western developed countries, because China MM patients are diagnosed later, so the clinical stage of patients later, tumor load is greater.
whether it is economic, social or medical development, China has the problem of unethic development, so in some areas MM patients survival prognostic is not ideal.
patient prognosis differences are large in china, large triple-A hospitals have blood disease diagnosis and treatment centers, generally distributed in developed cities, these centers MM patients' survival time has been significantly improved.
For example, in the hematology hospital of the Chinese Academy of Medical Sciences, the median non-progression survival period (PFS) of MM patients in the past 20 years has been increased from 13 months in the past 1990-2000 to more than 3 years after the application of three consecutive queue research programs, and the median total survival period has been increased from 27 months to nearly 6 years (more than 70 months), and the patient's prognosis is close to that of western developed countries.
However, due to the late diagnosis time, limited economic capacity, lack of standardized treatment and education publicity, so the national MM patients OS is not good, estimated to be only about 3-4 years.
MM diagnosis and treatment of the two core: individual formulation of the program, pay attention to the overall treatment mm treatment development history has a long history, since the phenylalanine nitrogen mustard (mafaran) market in the last century, MM patients mainly to MP program (phenylalanine nitrogen mustard plus strong pine) treatment- mainly, followed by the emergence of a solution based on the dexamysong such as VAD (boronazome, amycin and dexamycin) and self-made hematopoietic stem cell transplantation and other intensive treatment methods.
After 2000, the new drug new program generation, China has been approved for the market of new drugs in addition to traditional cyclocyclic, alkane and other cytotoxic drugs, there is the first generation of protease inhibitors boron tazome, oral isazomi, immunomodulants such as salidamide, lanadamine and CD38 monoantitor utero- and so on. in recent years, the treatment plan of
individualized patients is also based on these new drugs, such as first-line standard treatment plan for immunomodulants, protease inhibitors or alkyl inhibitors or cyclic drugs and glucoticoids, and can flexibly develop different combinations of treatment options: (1) according to the patient's age, physical condition assessment, treatment strategy will be different, individually choose whether to use standard dose of three drugs treatment, reduction of three drugs treatment or dual treatment.
(2) For high-risk MM patients, we will be based on three drugs and other drugs, such as our team of 04 programs using VRD (boronitazome combined with amines and dexamisund) combined X drugs, X drugs to select CD38 monoantigens, alkanes or cyclic drugs according to the patient's situation.
(3) According to whether the patient intends to receive hematopoietic stem cell transplantation to develop the corresponding program: for patients who intend to receive the transplant, intensive treatment after induction, after consolidation treatment and transplantation need to receive maintenance treatment;
importance to the whole management mm diagnosis and treatment should pay attention to the overall treatment, including anti-cancer full support treatment, such as MM osteopathy, kidney disease, anemia, neuritis support treatment.
addition, MM patients are difficult to cure, so we should pay attention to the rescue treatment after recurrence.
in short, MM's treatment strategy is to achieve deep relief through holistic treatment, control the disease through continuous treatment, effectively resolve treatment after recurrence progression, and maximize patient survival.
Iterative drugs, new target drugs are emerging, domestic MM patients will usher in more treatment options domestic scholars on MM new drugs to carry out a lot of research work, the next year in China will be listed in the following drugs: (1) Beijing Shadong independently developed a class of new drugs recombinant variants of human tumor necrosis factor apoptosis induced ligand (CPT), this drug after 16 years of development history, will be listed at the end of this year or next year.
(2) third-generation immunomodulant Pomadamine.
(3) XPO1 inhibitor, which has a new mechanism of action, will be available in 1-2 years.
(4) can partially overcome the third-generation protease inhibitor kafezome, which is resistant to boronitzomi or Isazzomi.
In addition to the above four drugs, there are many promising new drugs expected to be approved for market in the next 2-3 years, including CD38 monoantigen TJ202, carfezomethor, target B-cell mature antigen (BCMA) antibody association drug (ADC) belantamab mafodotin, BCMA and CD3 dual target antibodies.
, we can see that China MM new drugs will be more and more, gradually approaching Europe and the United States, the approval of these new drugs will provide more treatment options for domestic MM patients, thereby prolonging the survival of patients.
china's scientific research capacity has improved rapidly, MM treatment development prospects can be available for nearly 20 years, scholars have published more than 7000 MM-related Chinese papers.
SCI article on the pubmed website, Chinese scholars publish MM-related papers accounting for about 10% of the total international total.
is gratifying to note that the quality of papers published by Chinese teams in foreign journals is increasing, with more than 20 articles published in prominent journals such as Blod, Leukemia and Clinical Cancer Research as of September 2020, including 2 in Blood.
, transformational research or clinical research, China's MM field has made great progress.
MM has the characteristics of high instability of chromosomal genome, so patients with relapsed/refractic MM often have at least dozens of genetic abnormalities, and some genes such as P53 deficiency/mutation or MYC gene amplification/hetero-position can cause MM to change from inert to invasive, which is the cause of difficulty and drug resistance.
external causes, MM is closely related to the bone marrow immunosuppression micro-environment.
Therefore, future research will also be carried out from the above two pathogenesis, the current research on tumor cells is relatively in-depth, but the micro-environment research is just beginning, how to link the two in the future exploration is also very critical, at present our team is carrying out relevant systematic research, hope that the results of the study can bring new light to MM patients.
Expert Profile Professor Qiu Liugui: Second-level Professor/Director physician, Doctoral Mentor, Hematology Hospital, Chinese Academy of Medical Sciences, Director of the Lymphoma Center, Director of the Umbilical Cord Hematopoietic Stem Cell Bank of Tianjin City, Member of the Expert Committee of the International Myeloma Working Group, Chairman of the Hematoma 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 Professional Committee of the Association of Integrated Physicians Vice Chairman of the Hematology Professional Committee of the Chinese Medical Education Association, Chairman of the Hematology Professional Committee of the Tianjin Anti-Cancer Association, Standing Committee of the Professional Committee of the Chinese Anti-Cancer Association for Lymphoma, Standing Committee of the Precision Medicine Branch of the Chinese Pharmaceutical Biotechnology Association, Editors of Six Core Journals, including Blood Advances and The Chinese Journal of Hematology, published more than 400 papers and more than 120 SCI papers.
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